Facilitators and barriers to accessing hepatitis B care in the postpartum period among foreign-born New Yorkers: a qualitative analysis of case notes.

BACKGROUND: Approximately 241,000 people are living with hepatitis B in New York City. Among those living with hepatitis B, pregnant people are particularly at risk for elevated viral load due to changes in immune response and require prompt linkage to health care. The New York City Department of Health and Mental Hygiene's Viral Hepatitis Program implemented a telephone-based patient navigation intervention for people living with hepatitis B in the postpartum period to connect them with hepatitis B care. METHODS: During the intervention, patient navigators called participants to inquire about their past experience with receiving care, available supports, and barriers to care, and worked with them to develop a plan with participants for linkage to hepatitis B care. The information collected during initial assessments and follow-up interactions were recorded as case notes. In this qualitative study, researchers conducted a thematic analysis of 102 sets of case notes to examine facilitators and barriers to accessing hepatitis B care among the intervention participants, all of whom were foreign-born and interested in receiving hepatitis B patient navigation services. RESULTS: The qualitative analysis illustrated the various ways in which patient navigators supported access to hepatitis B care. Findings suggest that receiving care through a preferred provider was a central factor in accessing care, even in the presence of significant barriers such as loss of health insurance and lack of childcare during appointments. Expectations among family members about hepatitis B screening, vaccination and routine clinical follow up were also identified as a facilitator that contributed to participants' own care. CONCLUSIONS: This study suggests that while there are numerous barriers at the personal and systemic levels, this patient navigation intervention along with the identified facilitators supported people in accessing hepatitis B care. Other patient navigation initiatives can incorporate the lessons from this analysis to support people in connecting to a preferred provider.

Religion and unforgivable offenses.

The value of forgiveness is emphasized in many religions, but little is known about how members of distinct religious cultures differ in their views of forgiveness. We hypothesized and found that Jews would agree more than Protestants that certain offenses are unforgivable and that religious commitment would be more negatively correlated with belief in unforgivable offenses among Protestants than among Jews (Studies 1 and 2). Dispositional forgiveness tendencies did not explain these effects (Studies 1 and 2). In Study 3, Jews were more inclined than Protestants to endorse theologically derived reasons for unforgivable offenses (i.e., some offenses are too severe to forgive, only victims have the right to forgive, and forgiveness requires repentance by the perpetrator). Differential endorsement of these reasons for nonforgiveness fully mediated Jew-Protestant differences in forgiveness of a plagiarism offense and a Holocaust offense.