A Person-Centered Hepatitis B Approach Using the COM-B Model to Understand Barriers and Facilitators of Hepatitis B Testing, Management and Treatment

Abstract

Over 250 million individuals live with chronic hepatitis B worldwide. More work is needed to address care gaps associated with chronic hepatitis B. Behavioural theories can assist in understanding gaps and aid in the development of effective interventions to reach elimination goals. Using the COM-B model, a sample of HBV-related direct messages from social media platforms from 2021 to 2023 was collected from individuals directly impacted by hepatitis B. Qualitative analysis was employed for social media messages using a guided codebook and the COM-B model. A sample of 168 unique data points were analysed using thematic analysis. The themes that emerged corresponded to five COM-B subcomponents and represented barriers relating to psychological capability, physical opportunity, social opportunity, reflective motivation and automatic motivation. Within each of the five subcomponents were subthemes, such as limited knowledge; challenges accessing diagnostics, expert care, clinical trials, and treatment; as well as the social and cultural impacts of stigma, discrimination and quality of life. Future hepatitis B interventions should focus on addressing identified gaps and consider behavioural interventions as methods to address identified barriers. While this study further validated previously identified barriers, it also newly identified motivation among those with hepatitis B to seek out information related to care, management and prolonging life.