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Hepatitis B in Moroccan-Dutch: a qualitative study into determinants of screening participation.

ABSTRACT: Background:Chronic hepatitis B (HBV) leads to an increased risk for liver cirrhosis and liver cancer. In the Netherlands, chronic HBV prevalence in the general population is 0.20%, but 3.77% in first generation immigrants. Our aim was to identify determinants associated with the intention to participate in HBV testing among first generation Moroccan immigrants, one of the two largest immigrant groups targeted for screening. Methods:Semi-structured interviews were held with first (n = 9) and second generation (n = 10) Moroccan-Dutch immigrants, since second generation immigrants frequently act as their parents' brokers in healthcare. Results:Most participants had little knowledge about hepatitis B, but had a positive attitude towards screening. Facilitators for screening intention were perceived susceptibility to and severity of disease, positive attitude regarding prevention, wishing to know their hepatitis B status and to prevent potential hepatitis B transmission to others. Additional cultural facilitators included fear (of developing cancer), and existing high health care utilization; a religious facilitator was the responsibility for one's own health and that of others. Barriers included lack of awareness and knowledge, practical issues, not having symptoms, negative attitude regarding prevention, fear about the test result and low-risk perception. A cultural barrier was shame and stigma, and a religious barrier was fatalism. Conclusion:We identified important facilitators and barriers, which we found, can be interpreted differently. Specific and accurate information should be provided, accompanied by strategies to address shame and stigma, in which Islamic religious leaders could play a role in bringing information across.

SUBMITTER: Hamdiui N

PROVIDER: S-EPMC6148971 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:In November 2016, the Dutch Health Council recommended hepatitis B (HBV) screening for first-generation immigrants from HBV endemic countries. However, these communities show relatively low attendance rates for screening programmes, and our knowledge on their participation behaviour is limited. We identified determinants associated with the intention to request an HBV screening test in first-generation Moroccan-Dutch immigrants. We also investigated the influence of non-refundable costs for HBV screening on their intention.Offline and online questionnaires were distributed among first- and second/third-generation Moroccan-Dutch immigrants using respondent-driven sampling. Random forest analyses were conducted to determine which determinants had the greatest impact on (1) the intention to request an HBV screening test on one's own initiative, and (2) the intention to participate in non-refundable HBV screening at €70,-.Of the 379 Moroccan-Dutch respondents, 49.3% intended to request a test on their own initiative, and 44.1% were willing to attend non-refundable screening for €70,-. Clarity regarding infection status, not having symptoms, fatalism, perceived self-efficacy, and perceived risk of having HBV were the strongest predictors to request a test. Shame and stigma, fatalism, perceived burden of screening participation, and social influence of Islamic religious leaders had the greatest predictive value for not intending to participate in screening at €70,- non-refundable costs. Perceived severity and possible health benefit were facilitators for this intention measure. These predictions were satisfyingly accurate, as the random forest method retrieved area under the curve scores of 0.72 for intention to request a test and 0.67 for intention to participate in screening at €70,- non-refundable costs.By the use of respondent-driven sampling, we succeeded in studying screening behaviour among a hard-to-reach minority population. Despite the limitations associated with correlated data and the sampling method, we recommend to (1) incorporate clarity regarding HBV status, (2) stress the risk of an asymptomatic infection, (3) emphasise mother-to-child transmission as the main transmission route, and (4) team up with Islamic religious leaders to help decrease elements of fatalism, shame, and stigma to enhance screening uptake of Moroccan immigrants in the Netherlands.

Project description:BackgroundEating behaviour of older adults is influenced by a complex interaction of determinants. Understanding the determinants of a specific target group is important when developing targeted health-promoting strategies. The aim of this study was to explore interpersonal determinants of eating behaviours in older adults living independently in a specific neighbourhood in the Netherlands.MethodsIn the neighbourhood of interest, populated by relatively many older adults, fifteen semi-structured interviews were conducted with independently living older adults (aged 76.9 ± 6.4y). Interviews were complemented with observations among the target group: three occasions of grocery shopping and three collective eating occasions in the neighbourhood. A thematic approach was used to analyse the qualitative data.ResultsWhen we asked the older adults unprompted why they eat what they eat, the influence of interpersonal determinants did not appear directly; respondents rather mentioned individual (e.g. habits) and environmental factors (e.g. food accessibility). Key findings regarding interpersonal factors were: 1) Behaviours are shaped by someone's context; 2) Living alone influences (determinants of) eating behaviour via multiple ways; 3) There is a salient norm that people do not interfere with others' eating behaviour; 4) Older adults make limited use of social support (both formal and informal) for grocery shopping and cooking, except for organised eating activities in the neighbourhood. In this particular neighbourhood, many facilities (e.g. shops at walking distance) are present, and events (e.g. dinners) are organised with and for the target group, which likely impact (determinants of) their behaviours.ConclusionsThe study showed that older adults do not directly think of interpersonal factors influencing their eating behaviour, but rather of individual or environmental factors. However, multiple interpersonal factors did appear in the interviews and observations. Moreover, neighbourhood-specific factors seem to play a role, which underlines the need to understand the specific (social) setting when developing and implementing intervention programmes. Insights from this study can assist in developing health-promoting strategies for older adults, taking into account the context of the specific neighbourhood.

Project description:BACKGROUND:Older Moroccan-Dutch migrant women exhibit high rates of diabetes, hypertension, overweight and obesity which is further compounded by their high risk of multi-morbidity. Healthcare professionals' efforts to encourage this group to adopt a healthier lifestyle have little success. We ask ourselves whether the concepts used in health education and promotion relate to these women's experiences and beliefs. Today's pluralistic Dutch society requires a more differentiated and applied approach, not in an essentialist way but in awareness that translation of rather individualized concepts like health and lifestyle is not always adequate, as the meaning and interpretation of such concepts may differ and may be related to women's other (fundamental) perceptions. This can have practical consequences for health promotion and education. The aim of this explorative, qualitative research, conducted between April and September 2015 and taking an intersectional approach, was to explore older Moroccan-Dutch women's perceptions of health and lifestyle and to analyse these in a broader context, related to other fundamental forms of identity such as gender, culture and religion. METHODS:We recruited women with Moroccan backgrounds by approaching Moroccan women's organisations and using the snowballing method (chain-referral sampling). Seven 'natural' group discussions were held (amongst women who regularly meet each other, aged between 22 and 69?years), and twelve in-depth interviews and an observation day (with women from 40 to 66?years). The transcripts were then analysed using thematic content analysis. RESULTS:Five major themes were identified. Health was perceived of in the terms used in prevailing health promotion discourses in the Netherlands, but lifestyle was interpreted in a much broader sense than the current health promotion debate allows; it is not seen as an individual responsibility or as something an individual could control on their own, and the social benefits of health behaviours appear to outweigh the health benefits themselves. Lifestyle was located in three main social identities of the women: Moroccan, Muslim and mother. Finally, Ramadan played a huge and dominant role in the lifestyle experience of older Moroccan women and was central in this research. CONCLUSIONS:The finding that lifestyle is not seen as an individual responsibility but is located in social identities, can be applied to other settings that older migrant-Dutch women occupy. Further research will clarify this.

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Hepatitis B in Moroccan-Dutch: a qualitative study into determinants of screening participation.

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