Results Summary

What was the research about?

Infection with hepatitis B and C viruses increases the risk of liver disease and liver cancer. Treatment can slow hepatitis B and cure hepatitis C. But many people don’t know they have the viruses. Asian Americans have a high risk for both viruses and get liver cancer three times as often as white people.

In this study, the research team compared two ways to increase screening for these viruses among Asian Americans. The first was to give doctors a list of patients who need screening. All doctors in the study got this list. The second was to give patients a mobile app that teaches them about hepatitis and prepares them to ask their doctors about screening. In this study, half the patients used the hepatitis app while waiting for their doctors’ visit. The other patients used an app with general health information.

What were the results?

Compared with patients who used the general health app, those who used the hepatitis app were more likely to

  • Report talking to their doctors about hepatitis B and C.
  • Say their doctors recommended getting tested.
  • Get a test for hepatitis B or C.

Doctors were more likely to order tests for hepatitis B or C for patients who used the hepatitis app than for those who used the general health app.

Using the hepatitis app didn’t change how much people knew about the viruses or whether they said they were aware of hepatitis.

Who was in the study?

The study included 189 primary care doctors and 452 patients. All patients were Asian American, and 80 percent were born outside the United States. The average age of patients was 57, and 64 percent were women.

What did the research team do?

The research team developed an app that would teach patients about hepatitis B and C and ask patients about their risk for the viruses. The app included printed information that patients could take to their doctors. Patients could view the app in English, Cantonese, Mandarin, and Vietnamese.

All doctors in the study got a list of patients who hadn’t had hepatitis B tests. The research team then assigned doctors to one of the two groups by chance. Patients of doctors in the first group got the hepatitis app on a tablet when they came for a clinic visit. Patients in the other group got the general health app. The team followed up with patients directly after their appointments to find out if they had talked to their doctors about hepatitis testing and if their doctors had recommended or ordered testing. Three months later, the research team asked whether the patients had a referral for testing or were tested. The team also surveyed patients about their knowledge of hepatitis.

Local hepatitis organizations, Asian health groups, patients, clinic staff, and doctors helped plan the research and develop the hepatitis app.

What were the limits of the study?

Patients in this study said that even before using the app, they felt comfortable asking their doctors about hepatitis. Results might differ for people who don’t feel that way. The study took place in one city with a large Asian American population. Results may differ in other parts of the country. Doctors in this study see an average of 17 patients per week. Results may differ for doctors who see more patients.

Future research could focus on testing similar apps for other health problems and different patient populations.

How can people use the results?

Doctors’ offices can consider using a mobile app like the one in this study to increase screening for hepatitis among Asian American patients.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers asked for clarification about the researchers’ use of the term, Asian populations, because it lacked specificity. The researchers responded that this was a common criticism of intervention studies, which sometimes included a so-called Asian subgroup without taking into account the cultural, geographical, and linguistic differences within this designation. The researchers stated that their intervention was applicable to the 66 percent of Asian Americans who were fluent in English, as well as the 12 percent who were not English proficient but were fluent in Chinese or Vietnamese. The researchers expanded their description of patient eligibility, results, and limitations to address the intervention’s applicability to Asian American populations.
  • The reviewers expressed concern that the lack of an upper age limit meant patients in their 80s and 90s received inappropriate screening for hepatitis and that inclusion of these patients could bias the sample. The researchers explained that they lacked an upper age limit based on stakeholder recommendations. The researchers also noted that the app they developed was more user-friendly because of the wider user base they needed to accommodate.

Conflict of Interest Disclosures

Project Information

Tung Nguyen, MD
University of California, San Francisco
$2,201,794 *
10.25302/02.2020.AD.12114615
A Patient-Centered Intervention to Increase Screening of Hepatitis B and C Among Asian-Americans

Key Dates

May 2013
December 2018
2013
2018

Study Registration Information

Final Research Report

View this project's final research report.

Journal Articles

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Last updated: November 30, 2022