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J Community Health (2015) 40:175184 DOI 10.1007/s10900-014-9916-9
ORIGINAL PAPER
Adapting the Andersen Model to a Francophone West African Immigrant Population: Hepatitis B Screening and Linkageto Care in New York City
Demetri A. Blanas Kim Nichols Mulusew Bekele Hari Shankar
Saba Bekele Lina Jandorf Saria Izzeldin Daouda Ndiaye
Adama Traore Motahar Bassam Ponni V. Perumalswami
Published online: 8 July 2014 Springer Science+Business Media New York 2014
Abstract Hepatitis B virus (HBV) is highly endemic in West Africa and immigration from this region to the United States has greatly increased over the past quarter century. Using the Andersen Model as a conceptual framework, this study qualitatively examines francophone West African immigrants perceptions of factors affecting access to HBV screening and linkage-to-care in New York City. Four focus groups were conducted with 39 purposefully selected participants. The focus groups were conducted in French, audio-recorded, translated into English, transcribed, analyzed, and coded for major themes. Participants identied increasing knowledge of HBV and opportunities to access care in a culturally-sensitive manner that decreases fatalism and avoids generating stigma as priorities. They also emphasized the importance of engaging religious establishments and social networks and employing the Internet to disseminate HBV-relevant information. Cost and health insurance are identied as future challenges that will need to be addressed in a health care environment in which undocumented immigrants are ineligible for health insurance. The qualitative analysis in this study highlights the recursive and interdependent nature of the Andersen
Model, and a modication of the model is proposed that is intended to inform examinations of other minority communities access to health care.
Keywords Hepatitis B Immigration West Africa
Qualitative research
Background
Approximately two billion persons have been infected with the HBV, 360 million of whom are chronically infected, and 600,000 of whom die annually from HBV-associated deaths [43, 44]. Although a global epidemic, HBV disproportionately affects sub-Saharan Africa where the prevalence is[5 % [35]. Within sub-Saharan Africa, West
Africa appears to have the highest rates of chronic infection with a prevalence of [8 % [35] with those who have not beneted from recent widespread childhood HBV vacci-nation campaigns most at risk [19].
Over the past three decades, emigration from Africa to the United States (US) has grown signicantly with a
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