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Hep Talk: Patients as Co-Authors of Their Hepatitis Prevention Plan

The Migrant Clinicians Network (MCN), in partnership with CHEC has been awarded a five year grant from the Centers for Disease Control and Prevention. The goal of the grant, called Hep Talk, is productive communication, between primary care providers and patients who migrate for purposes of work, or family unification, about risk and prevention of Hepatitis A, B, and C.

Prevention of hepatitis is a complex task. Risk portraits for each person are unique, and include specific factors, such as inadequate housing and sanitation, often encountered by mobile populations. To elicit these portraits requires adept interviewing skills on the part of the clinician. Prevention strategies can include relatively straightforward approaches such as immunization of a child, but will also most likely include more emotionally charged and complex behavior change considerations around personal and family hygiene, sex, and illegal drug use.

Hep Talk posits that patients will engage in discussions of emotionally charged issues surrounding Hepatitis A, B, or C risk and prevention if the clinic environment includes the following: access to language-appropriate information on hepatitis, consistent with the CDC Guidelines; the occasion to discuss emotionally-charged personal health topics; and clinicians able to anticipate, recognize, encourage, and participate in these discussions.

Protective behavior change in regards to hepatitis infection will result from a productive discussion of hepatitis risk factors, including those with high emotional valences, and prevention mechanisms that are culturally and practically feasible for the patient. Patients will sustain these discussions of emotionally charged risk and prevention issues if the clinic environment includes clinicians who have the skills to be receptive to the patient cues and conversation AND to follow up appropriately. The clinician must engage the patient in determining what strategies are most important and most possible in that personÕs life. The prevention plan that is "co-authored" by the patient will be most likely to be adopted.

To increase the potential for this kind of clinic environment, Hep Talk will develop a clinic site assessment for federally-funded Migrant and Community Health Centers and local health departments in order to provide appropriate information and multiple opportunities for hepatitis risk and prevention discussion. It will develop a Standardized Patient Training (SPT) and self-training materials for MHC clinicians. Hep Talk will evaluate the use of site assessment + standardized patient training, and the use of site self-assessment + self-training. At the end of the project, Hep Talk will disseminate the results of the project and the training tools developed.