Identifying determinants of viral hepatitis and liver cancer care in Michigan Asian American communities through multilevel engagement.

Background: In Michigan, Asian Americans are disproportionately infected with HBV and HCV. As many infections are first diagnosed when patients present with advanced liver disease or liver cancer, HBV and HCV screening, awareness, and early treatment are critical to improving outcomes.

Methods: Using a theory-informed approach, we administered a bi-level qualitative study to identify determinants of viral hepatitis and liver cancer care and treatment in Michigan Asian American communities. We conducted a focus group involving representatives from public health agencies, cancer coalitions, and Asian diaspora organizations across the state. We then completed 1:1 interviews with leaders from the communities. Groups and interviews were taped, transcribed, and used to identify common and distinct themes according to the National Institute of Minority Health and Health Disparities framework.

Results: According to community leaders, language barriers, costs, and a lack of viral hepatitis education appeared among the top shared screening barriers between the 3 communities. Conversely, common facilitators included pre-existing health programs, interpretation services, and community partnerships. Such sentiments were also echoed by the stakeholder focus group. However, the communities also raised distinct concerns about medical mistrust and positive health messaging.

Conclusions: This qualitative report marks the first phase of a bi-level mixed methods study in Asian American Michigan communities to understand determinants of viral hepatitis and liver cancer care and treatment. This work lays the foundation for a quantitative survey that will gather data from community members to inform the development of a future intervention.