Education and Counseling of Pregnant Patients with Chronic Hepatitis B: Perspectives from Obstetricians and Perinatal Nurses in Santa Clara County, California

  • Yang, Elizabeth J. (Asian Liver Center at Stanford University) ;
  • Cheung, Chrissy M. (Asian Liver Center at Stanford University) ;
  • So, Samuel K.S. (Asian Liver Center at Stanford University) ;
  • Chang, Ellen T. (Asian Liver Center at Stanford University) ;
  • Chao, Stephanie D. (Asian Liver Center at Stanford University)
  • Published : 2013.03.30


Background: This study aimed to better understand the barriers to perinatal hepatitis B prevention and to identify the reasons for poor hepatitis B knowledge and delivery of education to hepatitis B surface-antigen-positive pregnant women among healthcare providers in Santa Clara County, California. Materials and Methods: Qualitative interviews were conducted with 16 obstetricians and 17 perinatal nurses in Santa Clara County, California, which has one of the largest populations in the United States at high risk for perinatal hepatitis B transmission. Results: Most providers displayed a lack of self-efficacy attributed to insufficient hepatitis B training and education. They felt discouraged from counseling and educating their patients because of a lack of resources and discouraging patient attitudes such as stigma and apathy. Providers called for institutional changes from the government, hospitals, and nonprofit organizations to improve care for patients with chronic hepatitis B. Conclusions: Early and continuing provider training, increased public awareness, and development of comprehensive resources and new programs may contribute to reducing the barriers for health care professionals to provide counseling and education to pregnant patients with chronic hepatitis B infection.


Supported by : Centers for Disease Control and Prevention


  1. Asian and Pacific Islander Health Forum. Diverse communities, diverse experiences: the status of Asian Americans and Pacific Islanders in the U.S. Available at: Accessed on January 30, 2013.
  2. Center for Infectious Diseases, Division of Communicable Disease Control, Immunization Branch, and California Department of Public Health. Vaccine-preventable diseases and immunization coverage in California, 2001-2006. Richmond, CA: California Department of Public Health, 2008.
  3. Centers for Disease Control and Prevention (CDC). A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part 1: immunization of infants, children, and adolescents. MMWR, 54, 1-23.
  4. Chao SD, Cheung CM, Yang EJ, So SK, Chang ET (2012). Low levels of knowledge and preventive practices regarding vertical transmission among perinatal nurses. J Obstet Gynecol Neonatal Nurs, 41, 494-505.
  5. Euler GL, Copeland J, Williams WW (2003). Impact of four urban perinatal hepatitis B prevention programs on screening and vaccination of infants and household members. Am J Epidemiol, 157, 747-53.
  6. Glaser BG, Strauss AL (1967). The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine Publishing Company.
  7. Greenberg DP (1993). Pediatric experience with recombinant hepatitis B vaccines and relevant safety and immunogenicity studies. Pediatr Infect Dis J, 12, 438-45.
  8. Institute of Medicine. Hepatitis and liver cancer: a national strategy for prevention and control of hepatitis B and C. Washington, DC: The National Academies Press, 2010.
  9. Jacques-Carroll L (2005). Presentation: expected births to HBsAg-positive women. Washington, D.C.: Centers for Disease Control and Prevention, December 5.
  10. Jacques-Carroll L (2013). Essentials of perinatal hepatitis B prevention: a training series for coordinators and case managers 2008. Available at: Accessed on January 30, 2013.
  11. Lai CJ, Nguyen TT, Hwang J, (2007). Provider knowledge and practice regarding hepatitis B screening in Chinese-speaking patients. J Cancer Educ, 22, 37-41.
  12. Ma GX, Shive SE, Fang CY, et al (2007). Knowledge, attitudes, and behaviors of hepatitis B screening and vaccination and liver cancer risks among Vietnamese Americans. J Health Care Poor Underserved, 18, 62-73.
  13. Miles MB, Huberman AM (1994). An expanded sourcebook: qualitative data analysis. 2nd ed. Thousand Oaks: SAGE Publications.
  14. Navar AM, Halsey NA, Carter TC, Montgomery MP, Salmon DA (2007). Prenatal immunization education: the pediatric prenatal visit and routine obstetric care. Am J Prev Med, 33, 211-3.
  15. Nguyen GT, Bellamy SL (2006). Cancer information seeking preferences and experiences: disparities between Asian Americans and whites in the health information national trends survey (HINTS). J Health Commun, 11, 173-80.
  16. Patton MQ (1990). Qualitative evaluation methods (2nd edition). Newbury Park, CA: Sage.
  17. Shepard CW, Simard EP, Finelli L, Fiore AE, Bell BP (2006). Hepatitis B virus infection: epidemiology and vaccination. Epidemiol Rev, 28, 112-25.
  18. Taylor VM, Tu SP, Woodall E, et al (2006). Hepatitis B knowledge and practices among Chinese immigrants to the United States. Asian Pac J Cancer Prev, 7, 313-7.
  19. Tran T (2009). Understanding cultural barriers in hepatitis B virus infection. Cleve Clin J Med, 76, 10-3.
  20. United States Census Bureau. Facts for features: Asian/Pacific American Heritage Month: May 2010. Report CB10-FF.07. Washington, D.C.: U.S. Census Bureau, March 2, 2010.
  21. United States Department of Health & Human Services. Combating the silent epidemic of viral hepatitis: action plan for the prevention, care & treatment of viral hepatitis. Available at: Accessed on January 30, 2013.
  22. Victor JC, Brewster JM, Ferrence R, et al (2010). Tobaccorelated medical education and physician interventions with parents who smoke: survey of Canadian family physicians and pediatricians. Can Fam Physician, 56, 157-63.
  23. Wasley A, Kruszon-Moran D, Kuhnert W, et al (2010). The prevalence of hepatitis B virus infection in the United States in the era of vaccination. J Infect Dis, 202, 192-201.
  24. World Health Organization. Hepatitis B fact sheet no. 204. Available at: Accessed on January 30, 2013.
  25. Wu CA, Lin SY, So SK, Chang ET (2007). Hepatitis B and liver cancer knowledge and preventive practices among Asian Americans in the San Francisco Bay Area, California. Asian Pac J Cancer Prev, 8, 127-34
  26. Zickmund SL, Brown KE, Bielefeldt K (2007). A systematic review of provider knowledge of hepatitis C: is it enough for a complex disease? Dig Dis Sci, 52, 2550-6.

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