title: Adapting the Andersen model to a francophone West African immigrant population: hepatitis B screening and linkage to care in New York City.
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 identified 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 identified 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 modification of the model is proposed that is intended to inform examinations of other minority communities' access to health care.
authors.affiliation: Institute for Family Health, Harlem Residency in Family Medicine, 1824 Madison Ave, New York, NY, 10035, USA, dblanas@institute2000.org.
authors.forename: Demetri A
authors.initials: DA
authors.lastname: Blanas
authors.forename: Kim
authors.initials: K
authors.lastname: Nichols
authors.forename: Mulusew
authors.initials: M
authors.lastname: Bekele
authors.forename: Hari
authors.initials: H
authors.lastname: Shankar
authors.forename: Saba
authors.initials: S
authors.lastname: Bekele
authors.forename: Lina
authors.initials: L
authors.lastname: Jandorf
authors.forename: Saria
authors.initials: S
authors.lastname: Izzeldin
authors.forename: Daouda
authors.initials: D
authors.lastname: Ndiaye
authors.forename: Adama
authors.initials: A
authors.lastname: Traore
authors.forename: Motahar
authors.initials: M
authors.lastname: Bassam
authors.forename: Ponni V
authors.initials: PV
authors.lastname: Perumalswami
mesh_terms: D000328:Adult; D000354:Africa, Western / Q000208:ethnology; D044383:Black People; D054242:Emigrants and Immigrants; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006509:Hepatitis B / Q000175:diagnosis* / Q000208:ethnology; D006801:Humans; D020407:Internet; D007802:Language; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010465:Perception; D012944:Social Support; D012959:Socioeconomic Factors; D014175:Translating; D014481:United States; D001741:Black or African American