Recognition and management of HBV infection in a social context.

Chronic viral hepatitis B and C infection is three to five times more frequent than HIV in the USA, and chronically infected people are at risk for long-term sequelae including cirrhosis, liver decomposition, and hepatocellular carcinoma (Institute of Medicine, 2010). Socio-cultural factors are central to the way an individual constructs hepatitis B virus (HBV) infection, perceives it as serious health problem, and moves on to appropriate health behavior (Lee et al., J Canc Educ 25:337-342, 2010; Kim, J Health Care Poor Underserved 5:170-182, 2004; Lee et al., Asian Nurs Res 1:1-11, 2007; Wu et al, Asian Pac J Cancer Prev 8(1):127-234, 2007; Yang et al., J Korean Academy Nurs 40:662-675, 2010). The purpose of this study was to seek "real world" data about factors that influence the recognition and management of HBV infection in Korean Americans' socio-cultural contexts. The descriptive qualitative study used an interview informed by ethnography to collect data and was guided by the Network-Episode Model. (Pescosolido, Adv Med Sociol 2:161-184, 1991; Pescosolido, AJS 97:1096-1138, 1992; Pescosolido, Res Sociol Health Care 13A:171-197, 1996). The sample comprised 12 HBV patients and nine key informants. Six factors that influenced the management of HBV infection emerged from the interviews: recognition of disease within a social context, unrecognized disease in a hidden health system, the socio-cultural meaning of disease, lay construction of the cause of disease, misunderstandings and cultural learning styles, and personal and environmental barriers to health care. Each theme was associated with Korean American (KA) social contexts, participants' experiences, and the beliefs they held about the disease. The findings explored that the family network is "genetic code" for social networking among KAs and the network of patients was not geographically bound. Health management behaviors are mediated by an array of types and levels of social and personal networks, and this raises questions about current health education, management of HBV, and prevention of liver cancer.