Cluster-Randomized Trial to Increase Hepatitis B Testing among Koreans in Los Angeles

Cancer Epidemiol Biomarkers Prev. 2015 Sep;24(9):1341-9. doi: 10.1158/1055-9965.EPI-14-1396. Epub 2015 Jun 23.


Background: In the United States, Korean immigrants experience a disproportionately high burden of chronic hepatitis B (HBV) viral infection and associated liver cancer compared with the general population. However, despite clear clinical guidelines, HBV serologic testing among Koreans remains persistently suboptimal.

Methods: We conducted a cluster-randomized trial to evaluate a church-based small group intervention to improve HBV testing among Koreans in Los Angeles. Fifty-two Korean churches, stratified by size (small, medium, large) and location (Koreatown versus other), were randomized to intervention or control conditions. Intervention church participants attended a single-session small-group discussion on liver cancer and HBV testing, and control church participants attended a similar session on physical activity and nutrition. Outcome data consisted of self-reported HBV testing obtained via 6-month telephone follow-up interviews.

Results: We recruited 1,123 individuals, 18 to 64 years of age, across the 52 churches. Ninety-two percent of the sample attended the assigned intervention session and 86% completed the 6-month follow-up. Sample characteristics included were as follows: mean age 46 years, 65% female, 97% born in Korea, 69% completed some college, and 43% insured. In an intent-to-treat analysis, the intervention produced a statistically significant effect (OR = 4.9, P < 0.001), with 19% of intervention and 6% of control group participants reporting a HBV test.

Conclusion: Our intervention was successful in achieving a large and robust effect in a population at high risk of HBV infection and sequelae.

Impact: The intervention was fairly resource efficient and thus has high potential for replication in other high-risk Asian groups.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Female
  • Follow-Up Studies
  • Health Education*
  • Hepatitis B, Chronic / diagnosis*
  • Humans
  • Insurance, Health / statistics & numerical data
  • Intention to Treat Analysis
  • Los Angeles
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / ethnology*
  • Program Evaluation
  • Religion and Medicine*
  • Republic of Korea / ethnology
  • Serologic Tests / statistics & numerical data
  • Young Adult