“Heparjoc-Actúa”: educational tool created through a process of participatory action research with vulnerable immigrant groups to improve accessibility to diagnosis of hepatitis B
e202007078
Keywords:
Infectious diseases, Hepatitis B, Community health, Community Health Agents, Health education, Participatory Action Research, ImmigrationAbstract
Background: The World Health Organization estimates that 257 million people suffer from chronic infection by the hepatitis B (HB) virus. It is common for diagnosis to be delayed or never given at all. In Spain, immigrants that come from endemic areas present a prevalence of infection of around 8%. In the year 2015, this study was begun with the aiml of improving accessibility to hepatitis B diagnoses in immigrant communities.
Methods: A descriptive qualitative study was carried out, based on participatory action research (IAP). It was divided into two cycles: in the first cycle, after forming a motor group (GIAP), a participatory community assessment (DCP) was performed with the population, through a descriptive-interpretative qualitative study (ECDI) with 3 focal groups (n=17). A narrative analysis was then performed of thematic content. In the second cycle, two collaborative workshops (coworking) were held to create an educational tool (HEPARJOC) and to co-create an action plan (PDA). As a pilot test, the PDA was put into practice through eight workshops (n=56). A knowledge questionnaire was used to compare the median number of correct responses before and after the workshop, using the t of Student for paired data.
Results: A GIAP was formed with 8 members of different sectors and community spaces. In the DCP it was observed that there was a lack of knowledge about different aspects of hepatitis B. Visual, interactive materials were proposed as educational tools, and “HEPARJOC” was created as the final product. In the pilot test of the PDA, the median of correct responses to the knowledge questionnaire about HB was 7.7 (DE=3) before the workshop, and 10.6 (DE=0.2) afterward. The improvement of the median was 2.9 points (IC 95% 2.2-3.6), which is statistically significant (p<0.001). 30 people sought screening (53.6% of participants), and 23 of those people were screened (41% of participants).
Conclusions: “HEPARJOC-ACTUA” is a strategy that could contribute to transforming knowledge and improving accessibility to hepatitis B diagnosis in immigrant communities. Key words: Infectious diseases, hepatitis B, community health, community health agents, health education, participatory action research, immigration.
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References
Organización Mundial de la Salud. Hepatitis B. Datos y cifras. [Internet]. 18-Julio-2018. 2018 [cited 2018 Aug 7]. Available from: http://www.who.int/es/news-room/fact-sheets/detail/hepatitis-b.
Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet [Internet]. 2015 Oct 17 [cited 2018 Aug 7];386(10003):1546–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26231459.
Sharma S, Carballo M, Feld JJ, Janssen HLA. Immigration and viral hepatitis. J Hepatol [Internet]. 2015 Aug 1 [cited 2018 Aug 7];63(2):515–22. Available from: https://www.sciencedirect.com/science/article/pii/S0168827815003207#b0190.
Subdirección de Promoción de la Salud y Prevención. Dirección General de Atención Primaria. Documentos Técnicos de Salud Pública. IV Encuesta de serovigilancia de la Comunidad de Madrid. [Internet]. 2015 [cited 2018 Aug 7]. Available from: http://www.madrid.org/cs/Satellite?blobcol=urldata&blobheader=application%2Fpdf&blobheadername1=Content-disposition&blobheadername2=cadena&blobheadervalue1=filename%3DIVSEROVI_Documento+técnico_revisión+final+22_05_2015.pdf&blobheadervalue2=lang.
Coppola N, Alessio L, Gualdieri L, Pisaturo M, Sagnelli C, Minichini C et al. Hepatitis B virus infection in undocumented immigrants and refugees in Southern Italy: demographic, virological, and clinical features. Infect Dis poverty [Internet]. 2017 Feb 9 [cited 2018 Aug 7];6(1):33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28179020.
European Centre for Disease Prevention and Control. Epidemiological assessment of hepatitis B and C among migrants in the EU/EEA. Stockholm: ECDC; 2016 [Internet]. [cited 2018 Aug 7]. Available from: www.ecdc.europa.eu.
Calderón Sandubete E, Yang Lai R, de la Luz Calero Bernal M, Teresa Martínez Rísquez M, Calderón Baturone M, de la Horra Padilla C et al. Hepatitis Crónicas virales B y C en población inmigrante en España. Revisión Bibliográfica. [cited 2018 Aug 7]; Available from: http://dx.doi.org/10.4321/S1135-57272014000600012.
Morbiditat per malalties de declaració obligatòria a Barcelona ciutat 2015. Estadístiques de Salut. Barcelona. Agència de Salut Pública de Barcelona. 2015. [Internet]. [cited 2018 Aug 7]. Available from: https://www.aspb.cat/wp-content/uploads/2017/11/Morbiditat_per_malalties_declaracio_obligatoria_Barcelona_2015.pdf.
EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. European Association for the Study of the Liver. [Internet]. [cited 2018 Aug 7]. Available from: https://asscat-hepatitis.org/wp-content/uploads/English-report.pdf.
Organización mundial de la Salud. Estrategia Mundial del sector de la Salud contra las Hepatitis Víricas 2016-2021 Hacia el fin de las hepatitis víricas [Internet]. 2016 [cited 2018 Aug 7]. Available from: http://apps.who.int/iris/bitstream/handle/10665/250578/WHO-HIV-2016.06-spa.pdf?sequence=1.
Manzardo C, Treviño B, Gómez i Prat J, Cabezos J, Monguí E, Clavería I et al. Communicable diseases in the immigrant population attended to in a tropical medicine unit: Epidemiological aspects and public health issues. Travel Med Infect Dis [Internet]. 2008 Jan [cited 2019 Jul 22];6(1–2):4–11. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1477893907001585.
Delcor NS, Maruri BT, Arandes AS, Guiu IC, Essadik HO, Soley ME et al. Infectious Diseases in Sub-Saharan Immigrants to Spain. Am J Trop Med Hyg [Internet]. 2016 [cited 2019 Jul 22];94(4):750. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824214/.
Zibrik L, Huang A, Wong V, Novak Lauscher H, Choo Q, Yoshida EM et al. Let’s Talk About B: Barriers to Hepatitis B Screening and Vaccination Among Asian and South Asian Immigrants in British Columbia. J Racial Ethn Heal Disparities [Internet]. 2018 Mar 19 [cited 2018 Aug 9];1–9. Available from: http://link.springer.com/10.1007/s40615-018-0483-0.
Sievert K, O’Neill P, Koh Y, Lee J-H, Dev A, Le S. Barriers to Accessing Testing and Treatment for Chronic Hepatitis B in Afghan, Rohingyan, and South Sudanese Populations in Australia. J Immigr Minor Heal [Internet]. 2018 Feb 24 [cited 2018 Aug 9];20(1):140–6. Available from: http://link.springer.com/10.1007/s10903-017-0546-z.
Bas-Sarmiento P, Fernández-Gutiérrez M, Albar-Marín MJ, García-Ramírez M. Percepción y experiencias en el acceso y el uso de los servicios sanitarios en población inmigrante. Gac Sanit [Internet]. 2015 Jul 1 [cited 2018 Aug 9];29(4):244–51. Available from: http://linkinghub.elsevier.com/retrieve/pii/S021391111500062X.
Singh P, Chokshi DA. Community Health Workers — A Local Solution to a Global Problem. N Engl J Med [Internet]. 2013 Sep 5 [cited 2018 Aug 7];369(10):894–6. Available from: http://www.nejm.org/doi/10.1056/NEJMp1305636.
Pasarín MI, Forcada C, Montaner I, De Peray JL, Gofin J. Salud comunitaria: una integración de las competencias de atención primaria y de salud pública. Informe SESPAS 2010. Gac Sanit [Internet]. 2010 Dec 1 [cited 2018 Aug 7];24:23–7. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0213911110001949.
Ospina JE, Orcau À, Millet J-P, Sánchez F, Casals M, Caylà JA. Community health workers improve contact tracing among immigrants with tuberculosis in Barcelona. BMC Public Health [Internet]. 2012 Dec 6 [cited 2018 Aug 7];12(1):158. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22394990.
Reason P, Bradbury H. The Sage Handbook of Action Research: Participative Inquiry and Practice. Sage, CA; 2008. 720 p.
Kemmis S. (1983). Action research, En T. Husen and T. Postleth-Waite (Eds.). International encyclopedia of education: research and studies. Oxford: Pergamon.
Universidad de los Andes (Bogotá CC de I y F en E. Voces y silencios, revista latinoamericana de educación. [Internet]. Vol. 3, Voces y Silencios, ISSN-e 2215-8421, Vol. 3, No. 1, 2012, págs. 102-115. Centro de Investigación y Formación en Educación. Universidad de los Andes, Bogotá, Colombia.; 2012 [cited 2019 Jul 22]. 102–115 p. Available from: https://dialnet.unirioja.es/servlet/articulo?codigo=4054232.
Essadek HO, Mendioroz J, Guiu IC, Barrabeig I, Clotet L, Álvarez P, Rodés A, Gómez i Prat J; Barcelona Health Region Tuberculosis Prevention and Control Programme Working Group. Community strategies to tackle tuberculosis according to the WHO region of origin of immigrant communities. Public Health Action. 2018 Sep 21;8(3):135-140.
Gómez i Prat J, Peremiquel-Trillas P, Claveria Guiu I, Choque E, Oliveira Souto I, Serre Delcor N, Sulleiro E, Espasa M, Pastoret C, de Los Santos JJ, Ouaarab H, Albajar Viñas P, Ascaso Terren C. A Community-Based Intervention for the Detection of Chagas Disease in Barcelona, Spain. J Community Health. 2019 Aug;44(4):704-711.
Berenguera A, Fernández de Sanmamed MJ, Pons M, Pujol E, Rodríguez D, Saura S. Escuchar, observar y comprender. Recuperando la narrativa en las Ciencias de la Salud. Aportaciones de la investigación cualitativa. Barcelona: Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP J. Gol), 2014.
Jevetta Stanford, Alma Biba, Jagdish Khubchandani, Fern Webb, Mobeen H Rathore. Community-engaged Strategies to Promote Hepatitis B Testing and Linkage to Care in Immigrants of Florida. J Epidemiol Glob Health. 2016 Dec;6(4):277-284.
Ortiz E, Scanlon B, Mullens A et al. Effectiveness of Interventions for Hepatitis B and C: A Systematic Review of Vaccination, Screening, Health Promotion and Linkage to Care Within Higher Income Countries. J Community Health 45, 201–218 (2020).
Rajamoorthy Y, Taib NM, Munusamy S et al. Knowledge and awareness of hepatitis B among households in Malaysia: a community-based cross-sectional survey. BMC Public Health. 2019;19(1):47. Published 2019 Jan 10. doi:10.1186/s12889-018-6375-8.
Taylor VM, Seng P, Acorda E, Sawn L, Li L. Hepatitis B knowledge and practices among Cambodian immigrants. J Cancer Educ. 2009;24(2):100-104.
Taylor VM, Jackson JC, Chan N, Kuniyuki A, Yasui Y. Hepatitis B knowledge and practices among Cambodian American women in Seattle, Washington. J Community Health. 2002;27(3):151-163.
Sociedad Española de Salud Pública y Administración Sanitaria. E, Peirò R. Gaceta sanitaria [Internet]. Vol. 18, Gaceta Sanitaria. Sociedad Española de Salud Pública y Administración Sanitaria; 2004 [cited 2019 Jul 22]. 158–167 p. Available from: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-91112004000400025.
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Copyright (c) 2020 Hakima Ouaarab Essadek, Blanca Borrás Bermejo, Johanna Caro Mendivelso, L. Laia Rodríguez Arjona, Apolonia Bisobe, Isabel Claveria Guiu, Grupo de trabajo HEPARJOC, Jordi Gómez i Prat
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