title: Health literacy in patients with chronic hepatitis B attending a tertiary hospital in Melbourne: a questionnaire based survey.
abstract: BACKGROUND
  Current estimates suggest over 218,000 individuals in Australia are chronically infected with hepatitis B virus. The majority of these people are migrants and refugees born in hepatitis B endemic countries, where attitudes towards health, levels of education, and English proficiency can be a barrier to accessing the Australian health care system, and best managing chronic hepatitis B. This study aimed to assess the knowledge of transmission and consequences of chronic hepatitis B among these patients.
  
  
  METHODS
  A prospective study was conducted between May and August 2012. Patients with chronic hepatitis B were recruited from three Royal Melbourne Hospital outpatient clinics. Two questionnaires were administered. Questionnaire 1, completed during observation of a prospective participants' consultation, documented information given to the patient by their clinician. After the consultation, Questionnaire 2 was administered to assess patient demographics, and overall knowledge of the effect, transmission and treatment of hepatitis B.
  
  
  RESULTS
  55 participants were recruited. 93% of them were born overseas, 17% used an interpreter, and the average time since diagnosis was 9.7 years.Results from Questionnaire 1 showed that the clinician rarely discussed many concepts. Questionnaire 2 exposed considerable gaps in hepatitis B knowledge. Few participants reported a risk of cirrhosis (11%) or liver cancer (18%). There was a high awareness of transmission routes, with 89% correctly identifying sexual transmission, 93% infected blood, and 85% perinatal transmission. However, 25% of participants believed hepatitis B could be spread by sharing food, and over 50% by kissing and via mosquitoes. A knowledge score out of 12 was assessed for each participant. The average score was 7.5. Multivariate analysis found higher knowledge scores among those with a family member also diagnosed with chronic hepatitis B and those routinely seeing the same clinician (p = 0.009 and p = 0.002, respectively).
  
  
  CONCLUSIONS
  This is the largest Australian study assessing knowledge and understanding of the effect, transmission, and treatment of hepatitis B among chronically infected individuals. The findings highlight the knowledge gaps and misconceptions held by these patients, and the need to expand education and support initiatives.
authors.forename: Tanya F M
authors.initials: TF
authors.lastname: Dahl
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Cowie
authors.forename: Beverley-Ann
authors.initials: BA
authors.lastname: Biggs
authors.forename: Karin
authors.initials: K
authors.lastname: Leder
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: MacLachlan
authors.affiliation: Victorian Infectious Disease Service (VIDS), Royal Melbourne Hospital, Grattan St, Parkville, 3050 Victoria, Australia. caroline.marshall@mh.org.au.
authors.forename: Caroline
authors.initials: C
authors.lastname: Marshall
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D005260:Female; D057220:Health Literacy; D019694:Hepatitis B, Chronic / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers