Community Health Education at Student-Run Clinics for Hepatitis B Summary Oftentimes student-run clinics (SCRs) can be important healthcare safety nets for underserved populations, their efficacy for improving patient health knowledge has not been thoroughly explored (Ouyang, Yuan, Sheu, Lau, Chen, Lai, 2013). From September 2011 to April 2012, a study was done by assessing patients’ retention of hepatitis B virus (HBV) knowledge after receiving student-led education at two student-run HBV screening and vaccination clinics.
Patient education was provided by trained first and second-year medical, nursing, and pharmacy students, aided by a script and interpreters (Ouyang et al, 2013). Patient knowledge of HBV was evaluated at three points: before education, after the initial visit, and at one-month follow-up. Student-led education produced improved knowledge of HBV transmission, prevention, and management, which was retained 1 month after education for 52 patients tracked through time (Ouyang et al, 2013).
There was a statistically significant difference between the first and second tests and the first and third tests, but no difference between the second and third tests. In 2007, there were 111 documented SRCs, which cumulatively logged more than 36,000 annual patient visits. Recent studies have shown that SRCs can in fact provide effective preventive healthcare as well as other disease management services such as mental health care, diabetes care, and smoking cessation counseling (Ouyang et al, 2013).
Students volunteering in SRCs may also serve an important role in educating patients on public health issues, such as preventive practices. According to the Ouyan et al’s article “Community Health”, there has yet to be widespread adoption and utilization of these educational methods, and studies have demonstrated conflicting results on whether these interventions improve patients’ health knowledge for significant periods of time. At the University of California, San Francisco (UCSF), health professional students conduct two monthly SRCs targeting HBV infection.
At these clinics, student volunteers educate, screen, and vaccinate patients for HBV (Ouyang et al, 2013). Given the strong association between higher HBV knowledge and increased preventive practices, improving patient understanding of this disease is particularly important. Previous studies have shown that patients with higher HBV knowledge are several times more likely to be screened and vaccinated as well as have their children screened and vaccinated (Ouyang et al, 2013).
Improving patient knowledge and preventive practices for this disease is of particular concern for the Asian Pacific Islander (API) community in the United States, where HBV disproportionately affects 1 in 10 individuals from this group. A prospective non-randomized study was performed to assess changes in patient understanding of HBV transmission and management before and after student-led patient education sessions at UCSF’s HBV SRCs (Ouyang et al, 2013).
Patient knowledge was assessed by the administration of a knowledge survey before structured education, after structured education at the end of the screening visit, and at one-month follow-up. This study was organized by students of UCSF’s San Francisco Hepatitis B Collaborative, which is a health professional student-run volunteer organization, and was conducted at two monthly SRCs affiliated with UCSF and the San Francisco Department of Public Health.
All new patients who presented to the two clinics in the area between September 2011 and April 2012 were invited to take the survey (Ouyang et al, 2013). First- and second-year medical, nursing, and pharmacy students who elected to volunteer at the HBV SRCs were required to complete a multi-session 10-hour elective course offered in the Fall, which covered HBV epidemiology, transmission, prevention, management, and social impact. The elective also included 2 hours of instruction on cross-cultural communication and working with interpreters (Ouyang et al, 2013).
Students who completed the HBV elective were then eligible to volunteer at the HBV SRCs, where their roles included providing patient education, performing phlebotomy, and administering vaccinations. Students learned how to open and close the patient encounter, specifically, students were taught to elicit the patient’s overall understanding of HBV using open-ended questions and to close by asking the patient if he or she desired any further clarifications (Ouyang et al, 2013). Patient knowledge of HBV was evaluated with a 16-question true/false survey.
The survey was adapted from a previously validated tool for assessing hepatitis C knowledge and covered three main knowledge domains: positive transmission risk factors for HBV, non-positive transmission risk factors for HBV, and HBV vaccination and management (Ouyang et al, 2013). Surveys were scored on a scale of 0–16. Each question was worth one point. The survey was administered twice during the first visit, once prior to education and again at the end of the clinic visit after education and phlebotomy. The third survey was administered during follow-up 1 month later, before patients received their screening results.
The first survey had additional optional questions that solicited information on the patient’s age, gender, primary language, income, education, and how long they had resided in the United States (Ouyang et al, 2013). This demographic information was correlated with survey performance for analysis of predictors of performance and retention. Multivariate analysis was used to assess the relationship between survey performance and patient age, education, socioeconomic status, primary language, gender and time in the United States (Ouyang et al, 2013).
One hundred and twelve patients filled out the first survey (81 %), 107 patients filled out the second survey, and 92 patients filled out the third survey. Patients, on average, scored 10 and 11 % higher on the second and third tests, respectively, when compared to the first test (Ouyang et al, 2013). At baseline, patients correctly answered more questions about positive risk factors for transmission (68 % correct) and knew relatively less about non-positive risk factors and HBV management (49 and 51 % correct).
Patients exhibited similar gains of knowledge in each domain (Ouyang et al, 2013). There was an absolute improvement for each domain. Opinion This specific peer-reviewed article is dealing with community health education in SRCs. Although little is known about the impact of SRC education on patients’ understanding of preventive behaviors, given the growth of SRCs in recent years, SRCs may present a particularly valuable venue for patient education at the community level.
The multi-variable analyses demonstrated that retention was correlated with patient educational background but independent of patient age, gender, income, primary language, and number of years lived in the United States. The study suggests that trained health professional students can effectively convey health knowledge that is retained by patients for at least 1 month. I believe these results warrant consideration of student-led educational sessions at SRCs as a promising community health education model. Strengths/Weaknesses There are multiple strengths exhibited within this article. The main strength is the focus on the SRCs.
In this study in the article they found that disease-specific education led by trained health professional students at SRCs improved patients’ immediate understanding of the transmission, prevention, and management of HBV infection, with more highly educated patients demonstrating larger knowledge gains (Ouyang et al, 2013). A weakness in the study was their inability to specifically correlate improvements in HBV knowledge with changes in behavior after SRC education (Ouyang et al, 2013). That is a relationship that would be an important topic for further future research in this area. Conclusion
The findings suggest that targeted, disease-specific preventive education at SRCs can be effective across a broad spectrum of patients in improving several areas of a patient’s health knowledge (Ouyang et al, 2013). These knowledge improvements can be retained for periods as long as a month or more, which although not proven, may lead to preventive behaviors (Ouyang et al). Given the prevalence of SRCs nationwide and their prominent role in preventative care, the model for training students to provide structured, disease-specific patient education at student-run clinics may be an effective method for providing community health education.