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. 2025 Aug 25:10.1007/s40615-025-02580-w.
doi: 10.1007/s40615-025-02580-w. Online ahead of print.

Exploring the Psychosocial Influences on Hepatitis B and Liver Cancer Disparities

Suzanne J Block  1 , Beatrice Zovich  2 , Fiona Borondy-Jenkins  2 , Thomas Chen  3 , Kate Moraras  2 , Bright Ansah  2 , Chari Cohen  2
Affiliations

Exploring the Psychosocial Influences on Hepatitis B and Liver Cancer Disparities

Suzanne J Block et al. J Racial Ethn Health Disparities. .

Abstract

Background: Diverse communities from Asia, the Pacific Islands, the Caribbean, and Africa are disproportionately impacted by chronic hepatitis B. Low screening rates and limited engagement with disease management contribute to higher rates of liver cancer. This qualitative study aimed to explore the psychosocial factors influencing health behaviors related to hepatitis B and liver cancer, to inform the development of a public health communication campaign tailored to highly impacted communities.

Methods: In collaboration with community partners, individuals identifying with each community were purposively selected to participate in this study. Fifteen focus groups, ranging in size from 7 to 12 participants, and two key informant interviews were conducted with individuals from Asian and Pacific Islander, Caribbean, and African communities in the United States (total n = 101). The Health Belief Model and Social Ecological Model guided initial codebook development, with inductive approaches capturing emergent themes identified during analysis.

Results: Participants described incomplete knowledge of hepatitis B transmission and its link to liver cancer within their communities. These influenced health beliefs and behaviors surrounding screening and care, shaping feelings of self-efficacy and uncertainty regarding prevention and management. Misperceptions about disease risk and management were reproduced within interpersonal relationships, with many describing stigma and social isolation. Family support and culturally embedded social norms were influential in healthcare decisions and seeking.

Conclusion: This study demonstrates the multi-level influences contributing to low rates of screening and care engagement across impacted communities, highlighting key differences and similarities. These findings reinforce the importance of culturally tailored education that reflects the diversity of communities affected by hepatitis B.

Keywords: Health disparities; Hepatitis B; Immigrant health; Liver cancer; Psychosocial factors.

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Conflict of interest statement

Declarations. Ethics Approval and Consent to Participate: This study received ethics approval through Heartland IRB before the initiation of this study (HIRB project No. 329–062421). All focus groups were conducted anonymously, and no identifying information was collected. Since all focus groups were conducted via Zoom and no written forms were completed or collected, the Hepatitis B Foundation collected verbal informed consent from all participants and verbal authorization to record the focus group and include the anonymous data in this study’s analysis. The procedure for collecting verbal informed consent was approved by Heartland IRB (HIRB project No. 329–062421). The voluntary nature of participating in and contributing to any portion of the discussion, and the ability of any participant to leave the focus group at any time, was made explicit at the beginning of each focus group. Consent for Publication: Not applicable. Conflict of interest: The Hepatitis B Foundation receives public health program and research grants from BMS, GSK, Gilead Sciences, Dynavax Technologies, Roche, Vir, and Precision Biosciences. Chari Cohen serves on a patient advocacy advisory committee for GSK and Gilead Sciences, with remuneration going directly to the Hepatitis B Foundation. Beatrice Zovich has received remuneration for serving on a hepatitis delta advisory committee for Gilead Sciences. The other authors declare they have no competing interests. Suzanne Block is supported by the training grant T32 CA009314 from the National Cancer Institute, National Institutes of Health. The content of this work is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.

Figures

Fig. 1
Fig. 1
The psychosocial influences of hepatitis B and liver cancer health behaviors
See this image and copyright information in PMC

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