Determinants of hepatitis B screening behavior among Asian Americans: From the theory of planned behavior perspective and the evaluation of the intervention

Background: Asian Americans have been at greater risk of contracting hepatitis B virus (HBV) infection, and of subsequently developing cirrhosis or liver cancer. Having a HBV screening is a useful measure to know one's infection status; however, the screening rate remains low. Little is known about the determinants of HBV screening behavior among Asian Americans.;Purpose: The purpose of this dissertation is to expand our knowledge of the determinants of HBV screening behavior of Asian Americans by using the Theory of Planned Behavior (TPB) and by examining the effectiveness of a culturally and linguistically tailored HBV intervention program.;Methods: A comprehensive literature review of the TPB regarding cancer screening behaviors examined the most recent findings of TPB's application, model expansion, and emerging themes. The review helped shape research questions and provided background knowledge for the second paper. The second paper tested the utility of expanded TPB with descriptive norm and mediation effects of TPB constructs on hepatitis B screening by structural equation models. The third paper examined the effectiveness of a culturally and linguistically tailored HBV intervention program by comparing effects on screening rates and knowledge scores. The second and third papers used the data from the Maryland Asian American Liver Education Program (n = 877).;Main Findings: The literature review found that subjective norm was the strongest predictor for cancer screening uptake/intention in some studies. A growing number of studies include additional components, such as descriptive norm, to augment the utility of the TPB. The structural model analysis found that inclusion of descriptive norm significantly increased the utility of the TPB on hepatitis B screening. Subjective norm and descriptive norm were only significant predictors for the screening behavior. The culturally and linguistically HBV intervention significantly increased HBV screening rates and knowledge scores of HBV in the intervention groups' participants without the initial screening.;Significance: This dissertation research will contribute to our growing knowledge of the determinants of hepatitis B screening behavior among Asian Americans from the perspective of a theoretical as well as an empirical intervention. Future studies should examine differences of intervention effects and behavioral pathways for HBV screening by subgroups.