Hepatitis B screening among immigrants: How to successfully reach the Moroccan community

Immigrants show relatively low participation rates in screening programs due to lack of awareness and knowledge. To promote screening for chronic hepatitis B, Dutch Municipal Public Health Services need evidence on how to reach and inform immigrants. Our aims were to describe the performance of respondent-driven sampling (RDS) to reach Moroccan-Dutch, and to estimate their awareness, knowledge, and information needs on hepatitis B and its screening. With this in mind, invitation and information strategies that suit Moroccan-Dutch the best can be developed adequately. Between February and November 2019, first- and second-generation Moroccan-Dutch were asked, using RDS, to complete paper-based questionnaires and forward them to peers. Population estimates were calculated. We invited 21 persons ("seeds") of whom 10 were successful in peer-recruitment. We reached 14 waves and 295 Moroccan immigrants. Of all respondents, 63.7% were willing to peer-recruit, of whom 40.7% succeeded. However, support from the researchers was often needed. Of the total population of Moroccans in the Netherlands, 76.6% [95% CI 67.7 - 85.5] had ever heard of hepatitis B and 23.1% [95% CI 14.2 - 31.9] of its screening. About half (48.2% [95% CI 42.3 - 54.1]) had sufficient knowledge and 39.4% [95% CI 30.4 - 48.4] had an information need. In conclusion, although extra time and effort from the researchers were required, RDS offers a promising method for Municipal Public Health Services to reach otherwise hard-to-reach Moroccan immigrants. Knowledge on hepatitis B and its screening is limited, and there is an information need. Future information materials should focus on the asymptomatic nature of the disease, as it could potentially increase immigrants' future screening participation rates.