Abstract
Objectives
According to recent census data, 1,216,600 Canadians are of Chinese descent, and over 80% of Chinese Canadians are foreign born. Approximately 10% of Chinese immigrants are chronic carriers of hepatitis B, compared with less than 0.5% of the general population. English as a second language (ESL) classes provide ready access for individuals with limited English proficiency who are not reached by English language health education materials and media campaigns. We conducted a group-randomized trial to evaluate the effectiveness of a hepatitis B ESL educational curriculum for Chinese immigrants.
Methods
Five community-based organizations that provide ESL education in the greater Vancouver area participated in the study. Forty-one ESL classes (which included 325 Chinese students) were randomly assigned to experimental or control status. A follow-up survey, conducted six months after randomization, assessed knowledge about hepatitis B. Generalized estimating equations were used to analyze the data.
Results
Follow-up surveys were completed by 298 (92%) of the students. At follow-up, experimental group students were significantly (p<0.05) more likely than control group students to know that immigrants have higher hepatitis B infection rates than people who were born in Canada; hepatitis B can be spread during childbirth, during sexual intercourse and by sharing razors; hepatitis B is not spread by sharing eating utensils; and hepatitis B infection can cause cirrhosis and liver cancer.
Conclusion
Our findings indicate that ESL curricula can have a positive impact on health knowledge among Chinese immigrants with limited English. Future research should evaluate the effectiveness of ESL curricula for other immigrant groups, as well as other health topics.
Key words: Chinese, health education, hepatitis B
Résumé
Objectif
Selon les données du dernier Recensement, 1 216 600 Canadiens sont d’ascendance chinoise, et plus de 80% des Sino- Canadiens sont nés à l’étranger. Environ 10% des immigrants chinois sont porteurs chroniques de l’hépatite B, contre moins de 0,5% dans la population générale. Les classes d’anglais, langue seconde (ALS) permettraient de joindre facilement les personnes qui maîtrisent mal l’anglais et que l’on n’atteint pas par les outils d’éducation sanitaire et les campagnes de publicité-médias en anglais. Nous avons mené un essai de groupe randomisé pour évaluer l’efficacité d’un programme d’ALS pour les immigrants chinois qui comportait un cours sur l’hépatite B.
Méthode
Cinq organismes communautaires qui enseignent l’ALS dans la région du Grand Vancouver ont participé à l’étude. Nous avons attribué au hasard à 41 classes d’ALS (incluant 325 étudiants chinois) le statut de groupe expérimental ou témoin. Un questionnaire de suivi administré six mois après l’étude randomisée a permis d’évaluer les connaissances des étudiants sur l’hépatite B. Les données ont été analysées à l’aide d’équations d’estimation généralisées.
Résultats
Le questionnaire de suivi a été rempli par 298 étudiants (92%). Lors du suivi, les étudiants du groupe expérimental étaient significativement (p<0,05) plus susceptibles que les étudiants du groupe témoin de savoir que les immigrants ont des taux d’infection par l’hépatite B supérieurs à ceux des personnes nées au Canada; que l’hépatite B peut se transmettre durant l’accouchement, durant les rapports sexuels et lorsqu’on partage un rasoir; que l’hépatite B ne se transmet pas par le partage d’ustensiles; et que l’infection par l’hépatite B peut causer la cirrhose et le cancer du foie.
Conclusion
Les programmes d’ALS peuvent avoir un impact positif sur les connaissances sanitaires des immigrants chinois qui maîtrisent mal l’anglais. Les études futures devraient évaluer l’efficacité des programmes d’ALS auprès d’autres groupes d’immigrants et pour d’autres thématiques de santé.
Mots clés: Chinois, éducation sanitaire, hépatite B
Footnotes
Acknowledgements: This publication was supported by grant R01-CA-113663 from the US National Cancer Institute. Dr. Bajdik is the recipient of a Scholar Award from the Michael Smith Foundation for Health Research. We thank the following community-based organizations for their assistance with this study: Burnaby Continuing Education, the Immigrant Services Society of British Columbia, MOSAIC, Richmond Continuing Education, and S.U.C.C.E.S.S.
References
- 1.Kandula N, Keresey M, Lurie N. Assuring the health of immigrants: What the leading health indicators tell us. Ann Rev Public Health. 2004;25:357–76. doi: 10.1146/annurev.publhealth.25.101802.123107. [DOI] [PubMed] [Google Scholar]
- 2.Statistics Canada. Chinese Canadian Population in BC: 2001–2006. Available at: www.chineseinvancouver.ca (Accessed April 16, 2009).
- 3.Statistics Canada. Canada’s major census metropolitan areas. In: Canada’s Ethnocultural Mosaic, 2006 Census. Available at: www.12,statcan.ca (Accessed April 16, 2009).
- 4.Bosch FX, Ribes J, Díaz M, Cleries R. Primary liver cancer: Worldwide incidence and trends. Gastroenterol. 2004;127(Suppl1):5–16. doi: 10.1053/j.gastro.2004.09.011. [DOI] [PubMed] [Google Scholar]
- 5.Custer B, Sullivan SD, Hazlet TK, Iloeie U, Veenstra DL, Kowdlev KV. Global epidemiology of hepatitis B virus. J Clin Gastroenterol. 2004;38(Suppl3):158–68. doi: 10.1097/00004836-200411003-00008. [DOI] [PubMed] [Google Scholar]
- 6.Lok A, McMahon B. Chronic hepatitis B. Hepatology. 2007;45:507–39. doi: 10.1002/hep.21513. [DOI] [PubMed] [Google Scholar]
- 7.Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR. 2008;57(RR8):1–20. [PubMed] [Google Scholar]
- 8.Chang ET, Sue E, Zola J, Lin SY, So SKS. 3 for Life: A model pilot program to prevent hepatitis B and liver cancer in Asian and Pacific Islander Americans. Am J Health Promot. 2009;23(3):176–81. doi: 10.4278/ajhp.071025115. [DOI] [PubMed] [Google Scholar]
- 9.Jenkins CNH, Buu C, Berger W, Son DT. Liver carcinoma prevention among Asian Pacific Islanders. Cancer. 2001;91(Suppl1):252–56. doi: 10.1002/1097-0142(20010101)91:1+<252::AID-CNCR14>3.0.CO;2-Y. [DOI] [PubMed] [Google Scholar]
- 10.Elder JP, Candelaria JI, Woodruff SI, Criqui MH, Talavera GA, Rupp JW. Results of language for health: Cardiovascular disease nutrition education for Latino English-as-a-second-language students. Health Educ Behav. 2000;27(1):50–63. doi: 10.1177/109019810002700106. [DOI] [PubMed] [Google Scholar]
- 11.Bennett IM, Kripalani S, Weiss BD, Coyne CA. Combining cancer control information with adult literacy education: Opportunities to reach adults with limited literacy skills. Cancer Control. 2003;10(5):81–83. doi: 10.1177/107327480301005s11. [DOI] [PubMed] [Google Scholar]
- 12.ELSA Net. English Services for Adults. Available at: www.elsanet.org (Accessed April 17, 2009).
- 13.Chinese Canadian National Council. 2006 Census Data on Chinese Canadian Community. Available at: https://doi.org/www.ccnc.ca (Accessed April 16, 2009).
- 14.Tu SP, Jackson C, Teh C, Lai A, Do H, Hsu L, et al. Translation challenges of cross-cultural research and program development. Asian Am Pac Isl J Health. 2003;10(1):58–66. [PubMed] [Google Scholar]
- 15.Taylor VM, Coronado G, Acorda E, Teh C, Tu SP, Yasui Y, et al. Development of an ESL curriculum to educate Chinese immigrants about hepatitis B. J Community Health. 2008;33(4):217–24. doi: 10.1007/s10900-008-9084-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Podnecky J, Grognet AG, Crandall J. Life Prints–ESL for Adults. New York, NY: New Readers Press; 2002. [Google Scholar]
- 17.Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42(1):121–30. doi: 10.2307/2531248. [DOI] [PubMed] [Google Scholar]
- 18.Rudd RE, Moeykens BA, Colton TC. Health and literacy: A review of medical and public health literature. 2009. [Google Scholar]
- 19.Institute of Medicine. Health Literacy. Washington, DC: National Academies Press; 2004. pp. 154–57. [Google Scholar]