Core Concepts for Hepatitis Education

Authors: Lisa K. Gilbert, PhD Kathy Ford, MSSW David Bergmire-Sweat, MPH

Funded by the Centers for Disease Control and Prevention (CDC), CA # U50/CCU418796 to

“Test, Disseminate and Evaluate Education Materials and Messages, and Training Programs Concerning Prevention

and Control of Viral Hepatitis”

Background

Few, if any, published studies have identified essential (core) concepts to include in hepatitis prevention educational materials (brochures, Web sites, etc.)

Few, if any, published studies have systematically analyzed the content of hepatitis prevention educational materials

Study Goals

To develop consensus core concepts To evaluate individual hepatitis prevention

educational materials based on inclusion of the identified core concepts

To assess the degree to which each core concept is covered across all relevant educational materials

Methods: Developing Core Concepts

ASHA-identified 79 hepatitis experts 26 were selected by the CDC for inclusion in

the Delphi Technique First round survey (n=11) elicited 197

concepts which were categorized and summarized

Second round survey (n=12) experts rank ordered concepts

Results: Core Concepts

Within the following six categories, concepts which:– ranked below the mean were excluded– ranked above the mean were included

Core concepts, by category:HAV HBV HCV

Patients 13 17 20

Providers 16 19 18

Methods: Evaluating Materials

Developed a data collection tool Collected hepatitis materials (n=405) Systematically scored each based on core

concept inclusion: Not mentioned = “0” Mentioned = “1” or Explained = “2”

Tallied total score for each material and computed percent out of total

Scoring Educational Materials

For example:– 13 core concepts for patients re: HAV– Each educational material scored based on

coverage of each of 13 concepts– Percent of core concept coverage calculated =

score/26 (score/total score possible) Range was 0 to 71% coverage

Hepatitis A materials

Patients:– 49 brochures & 2 Web sites

– Core concept coverage: 15% - 70%

Providers:– No materials specifically for

HAV!

Hepatitis B materials

Patients:– 132 brochures, 7 Web sites & 7

videos

– Core concept coverage: 3% - 71%

Providers:– 5 brochures & 1 Web site

– Core concept coverage: 11% - 45%

Hepatitis C materials

Patients:– 60 brochures & 59 Web sites

– Core concept coverage: 0 - 58%

Providers:– 3 brochures

– 5 Web sites

– Core concept coverage: 1% - 67%

Methods: Core Concept Coverage

For each core concept, the degree to which it was mentioned or explained was recorded

Frequencies revealed which were covered– For example, this HAV core concept for

patients: “Hepatitis A is highly contagious”:» was not mentioned in 33 (67%) of the materials

» was mentioned in 14 (29%) of the materials

» was explained in 2 (4%) of the materials

Patient Concepts Well Covered

Hepatitis A, B or C concepts mentioned or explained in half or more of the materials evaluated:– Transmission (70% - 100%)– Risk factors (50% - 76%)– Potential for chronic infection w/B or C (74% -

79%)

Patient Concepts Not Well Covered

Hepatitis A, B or C concepts mentioned or explained in less than half of the materials evaluated: :– How A, B and C differ (4% - 14%)– How they can become major health problems

(14% - 32%)

Patient Concepts Not Well Covered

Hepatitis A core concepts mentioned or explained in less than half of the materials evaluated: – Safety/efficacy of the HAV vaccine 47%– Testing information

26%– HAV is highly contagious

23%

Patient Concepts Not Well Covered

Hepatitis B core concepts mentioned or explained in less than half of the materials evaluated:– HBV prevention 46%– Testing information

36%– The vaccine prevents liver cancer 4%

Patient Concepts Not Well Covered

Hepatitis C core concepts mentioned or explained in less than half of the materials evaluated: – Preventing transmission 41-50%– Specific risks 30-50%– Follow-up healthcare

information 1-35%

Implications for Public Health Educators

Design, select and/or tailor educational materials to include these core concepts:– risk & transmission– signs/symptoms & testing– chronic infection– prevention (including vaccines)– type differences– referral options

Research Recommendations

Survey patients and providers to assess their core concept recommendations

Compile “comprehensive core concepts” recommendations from three samples (patients, providers and experts)

Re-score currently available materials

Acknowledgements

Cindy Weinbaum, MD - Project Officer Kelli Scanlon - Project Manager Delphi participants