Hepatitis B Vaccination Barriers Among Adults Aged 19 to 59 with Diagnosed Diabetes

Background Hepatitis B virus (HBV) infection is a serious health problem that is often overlooked among those diagnosed with diabetes mellitus, a disorder of glucose metabolism in the body linked to insulin production and effectiveness. People with diabetes (Type 1 and 2) are at an increased risk of contracting HBV, however, HBV vaccination rates among adults with diabetes are low. This study aimed to examine (1) the prevalence of hepatitis B among those diagnosed with diabetes; (2) the hepatitis B vaccination rates among those with diabetes; (3) the factors associated with hepatitis B vaccination status among adults with diabetes; and (4) the barriers individuals with diabetes have to receive hepatitis B vaccinations. Methods This study used an explanatory sequential mixed methods design. For the quantitative phase, National Health and Nutrition Examination Survey (NHANES) data from 2015–2018 were used to compare sociodemographic characteristics and health insurance coverage between adults with and without diabetes (Type 1 and 2). Chi-square analysis was used to test differences between adults with and without diabetes, associations between HBV vaccination status and sociodemographic variables, and associations between HBV vaccination status and HBV infection. Weighted logistic regression was employed to identify factors associated with being fully vaccinated. As for the qualitative phase, semi-structured interviews were used to describe the perspective of 11 Primary Care Physicians (PCPs) from the Penn State Health Medical Group to explore HBV vaccination perceptions among their patients with Type 1 and 2 diabetes. Thematic content analysis yielded descriptions of barriers and strategies that could potentially impact HBV vaccination among adults with diabetes. Results The quantitative results found an overall HBV infection rate of 1.1%. The HBV vaccination rate was 32.3% for those with diabetes vs. 43.6% for those without diabetes (P=0.01). After adjusting for sociodemographic factors, having diabetes was not associated with being fully vaccinated against HBV (P=0.583). Adults aged 45-59 years were less likely to be vaccinated against HBV (28.8%), while 65% of adults aged 19–29 were fully vaccinated. Age and educational level were also associated with HBV vaccination status (p<0.01). HBV vaccination status was associated with infection status for adults with diabetes (p=0.006) and those without diabetes (p=0.01). The qualitative result described four themes related to physician responses: (1) Physicians' perception of HBV risk and the CDC recommendation for adults with diabetes; (2) Understanding physicians’ perceived importance of HBV vaccination and recommendations for the HBV vaccine; (3) Perceived Barriers to HBV vaccination among adults with a focus on adults with diabetes; and (4) Physician recommended strategies to increase HBV vaccination among adults with diabetes. Conclusion The results of these studies highlight the importance of understanding and addressing the barriers adults with diabetes have to receiving the HBV vaccine. Barriers to receiving the HBV vaccine exist among adults with diabetes, and strategies to improve HBV vaccination are necessary. Awareness of the ACIP recommendation of HBV vaccination for adults with diabetes is needed to increase vaccination among this vulnerable population. The healthcare system and primary care practices should consider including HBV vaccination for adults with diabetes as part of their standard of care and implement organizational and structural changes within the practice to help physicians effectively promote HBV vaccination among adults with diabetes. These recommendations could serve as a basis to improve HBV vaccination and promote patient-centered care.

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Work Title Hepatitis B Vaccination Barriers Among Adults Aged 19 to 59 with Diagnosed Diabetes
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  1. Douwné Müller
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Work Type Dissertation
Publication Date 2022
Deposited December 09, 2022

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    • 2022
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    Work Title
    • HEPATITIS B VACCINATION BARRIERS AMONG ADULTS AGED 19 TO 59 WITH DIAGNOSED DIABETES
    • Hepatitis B Vaccination Barriers Among Adults Aged 19 to 59 with Diagnosed Diabetes
    Description
    • Background
    • Hepatitis B virus (HBV) infection is a serious health problem that is often overlooked among those diagnosed with diabetes mellitus, a disorder of glucose metabolism in the body linked to insulin production and effectiveness. People with diabetes (Type 1 and 2) are at an increased risk of contracting HBV, however, HBV vaccination rates among adults with diabetes are low. This study aimed to examine (1) the prevalence of hepatitis B among those diagnosed with diabetes; (2) the hepatitis B vaccination rates among those with diabetes; (3) the factors associated with hepatitis B vaccination status among adults with diabetes; and (4) the barriers individuals with diabetes have to receive hepatitis B vaccinations.
    • Background Hepatitis B virus (HBV) infection is a serious health problem that is often overlooked among those diagnosed with diabetes mellitus, a disorder of glucose metabolism in the body linked to insulin production and effectiveness. People with diabetes (Type 1 and 2) are at an increased risk of contracting HBV, however, HBV vaccination rates among adults with diabetes are low. This study aimed to examine (1) the prevalence of hepatitis B among those diagnosed with diabetes; (2) the hepatitis B vaccination rates among those with diabetes; (3) the factors associated with hepatitis B vaccination status among adults with diabetes; and (4) the barriers individuals with diabetes have to receive hepatitis B vaccinations.
    • Methods
    • This study used an explanatory sequential mixed methods design. For the quantitative phase, National Health and Nutrition Examination Survey (NHANES) data from 2015–2018 were used to compare sociodemographic characteristics and health insurance coverage between adults with and without diabetes (Type 1 and 2). Chi-square analysis was used to test differences between adults with and without diabetes, associations between HBV vaccination status and sociodemographic variables, and associations between HBV vaccination status and HBV infection. Weighted logistic regression was employed to identify factors associated with being fully vaccinated. As for the qualitative phase, semi-structured interviews were used to describe the perspective of 11 Primary Care Physicians (PCPs) from the Penn State Health Medical Group to explore HBV vaccination perceptions among their patients with Type 1 and 2 diabetes. Thematic content analysis yielded descriptions of barriers and strategies that could potentially impact HBV vaccination among adults with diabetes.
    • Results
    • The quantitative results found an overall HBV infection rate of 1.1%. The HBV vaccination rate was 32.3% for those with diabetes vs. 43.6% for those without diabetes (P=0.01). After adjusting for sociodemographic factors, having diabetes was not associated with being fully vaccinated against HBV (P=0.583). Adults aged 45-59 years were less likely to be vaccinated against HBV (28.8%), while 65% of adults aged 19–29 were fully vaccinated. Age and educational level were also associated with HBV vaccination status (p<0.01). HBV vaccination status was associated with infection status for adults with diabetes (p=0.006) and those without diabetes (p=0.01). The qualitative result described four themes related to physician responses: (1) Physicians' perception of HBV risk and the CDC recommendation for adults with diabetes; (2) Understanding physicians’ perceived importance of HBV vaccination and recommendations for the HBV vaccine; (3) Perceived Barriers to HBV vaccination among adults with a focus on adults with diabetes; and (4) Physician recommended strategies to increase HBV vaccination among adults with diabetes.
    • Conclusion
    • The results of these studies highlight the importance of understanding and addressing the barriers adults with diabetes have to receiving the HBV vaccine. Barriers to receiving the HBV vaccine exist among adults with diabetes, and strategies to improve HBV vaccination are necessary. Awareness of the ACIP recommendation of HBV vaccination for adults with diabetes is needed to increase vaccination among this vulnerable population. The healthcare system and primary care practices should consider including HBV vaccination for adults with diabetes as part of their standard of care and implement organizational and structural changes within the practice to help physicians effectively promote HBV vaccination among adults with diabetes. These recommendations could serve as a basis to improve HBV vaccination and promote patient-centered care.
  • Updated