1. The Development, Distribution and Evaluation of a Hepatitis C Educational Videotape
Massachusetts Department of Public Health
Division of Epidemiology and Immunization
Church, Gilmore, Baxter, Pokela, Kludt, Goldstein, Matyas, DeMaria
San Antonio, January 2003

2. Background: Evolution of Educational Program in MA
Program started in 1999
Previous educational efforts:
Primary care providers
Nurses
General public
People at-risk for hepatitis C infection
Active injection drug users (IDU)

3. New Focus: Newly Diagnosed
Videotape: based on information from needs assessment activities
What information do people need after being diagnosed?
What is the best way to present that information?
What are tools that people living with hepatitis C need?

4. Development Focus groups Series of 5 groups in February, 2001
2 with English-speaking people in recovery
2 with Spanish-speaking people in recovery
1 with transfusion/transplant recipients

5. Results of Initial Focus Groups - 1
Good baseline knowledge among former/current IDUs
Poor understanding of screening tests
Good understanding of major transmission routes, more confusion with lower risk behaviors
Poor understanding of need for hepatitis A and B vaccine
Spanish speakers indicated a need for help in advocating for themselves in the health care setting

6. Results of Initial Focus Groups - 2
Concern over availability of non-biased, comprehensive information on hepatitis C
Concern over knowledge of health care providers on hepatitis C and recovery from drug addiction
People with a history of transfusion/transplantation had less information and fewer available resources
Spanish speaking participants also reported limited resources available in Spanish
Most people received the diagnosis through their primary care provider

7. Results of Initial Focus Groups - 3
Having access to an educational videotape at the time of diagnosis was viewed positively
Venues to view a video mentioned were: MD’s office, home, drug treatment facility, support groups
Requested supplementary materials with a focus on liver health and co-infection with HCV and HIV
Materials developed should be optimistic, delivered by a credible spokesperson and available in non-technical language

8. Next Steps in Development
Hepatitis C Advisory Committee Education and Awareness Working Group
Identify distribution mechanisms
Evaluate developed videotape to determine content of supplementary materials

9. Evaluation of Videotape
4 focus groups in April, 2002
2 with people at-risk but not diagnosed with hepatitis C:
1 with transfusion/transplant recipients (8 participants)
1 with former IDUs (9 participants)
2 with IDUs diagnosed with hepatitis C
1 in English, 1 in Spanish (9 participants each)

10. Methodology All participants screened to ensure they met criteria
Pre- and Post-tests used to determine video’s impact on participant knowledge
All focus groups were audiotaped
Participants provided with $ incentive

11. Percent of Correct Responses to HCV Knowledge test

12. High Knowledge  High Knowledge
Knowledge Item
Pre-test % correct
Post-test % correct
Transmitted via blood
100
Damages liver 97
Not airborne
Sexual transmission 91 89
IDU transmission 86
Blood transfusion transm.
Can be asymptomatic 83 94
Side effects of treatment 80

13. Low Knowledge  High Knowledge
Knowledge Item
Pre-test % correct
Post-test % correct
Interpretation of EIA 20 89
Positive EIA  cleared virus 17 80
Interferon is a treatment 31 54
Not transmitted via saliva 63
More than one genotype 57 83
No vaccine for hepatitis C
Can reduce risk of progression (liver health)

14. Low Knowledge  Low Knowledge
Knowledge Item
Pre-test % correct
Post-test % correct
What is a RIBA test 11
What is a PCR test 3 9
Can clear HCV w/out meds. 14 20
Combination treatment
What is an EIA 40
Possibility of false positives 46
Impact of alcohol use on liver 66 63

15. Questions not answered by the video
Is HCV fatal?
What is reinfection?
How often should a person be re-tested?
More detail wanted on:
Treatment options (including urgency, length of treatment and side effects)
Different available tests (including genotyping)
Insurance coverage
What resources are available

16. Additional Materials Suggested
List of questions to discuss with health care provider
Written summary of video
Handout with detailed information on testing
Public information campaign to reduce stigma and encourage at-risk people to get tested

17. Supplemental Booklet: Format
Covers all information in video and provides additional detail in some areas
Provides detail on liver health, testing, treatment, co-infection, and available resources
List of questions to discuss with a medical provider
Done as one document rather than several different handouts for ease of use
Created in conjunction with a brochure for people recently diagnosed with HIV (“Now that you Know”)

18. Distribution Mailing to primary care providers (business reply card)
MDPH funded programs (Hepatitis C Program, HIV/AIDS Bureau, Bureau of Substance Abuse Services)
Bulk packages to: hospitals, managed care organizations, community health centers, long-term care facilities, appropriate academic settings
Video/Booklet to GI and ID specialists, jails, local health departments, libraries, ICPs
In total, mailing will target ~6,000

19. What next?
Need for low-literacy materials on co-infection with HIV/Hepatitis C
Evaluate effectiveness of supplemental booklet
Additional education for general public
Future of programs in MA?