Perspectives on the Impact of COVID-19 among Korean Americans with Chronic Hepatitis B: A Mixed Methods Exploration

Introduction: The COVID-19 pandemic heavily impacted Asian Americans in the United States, especially those also managing underlying health conditions. Methods: A sequential, convergent mixed methods approach was used to explore pandemic-related experiences among a cohort of Korean Americans living with chronic hepatitis B (CHB). During August 2021̶-January 2023, structured surveys were conducted in Korean and English with 365 Korean American adult patients at clinical sites in Los Angeles, California and Philadelphia, Pennsylvania. Surveys measured physical and mental health, sociodemographic and psychosocial characteristics, and pandemic-related hardships using a newly developed index that included seven types of hardship measures. In late 2023, a purposive sample of 30 of these patients also participated in an in-depth qualitative interview that captured personal perspectives on their COVID-19 experiences. Results: Participants experienced a moderate level of COVID-19 related stressors (mean index score of 8.47 out of a possible 21) with high rates of reduced day-to-day enjoyment, fears related to their health, anti-Asian hostility, and limited access to medical care. Concerns about access to medications, financial concerns, and separation from family and friends were less common. In multivariable models, older age, stronger Korean identity, and larger body mass index were associated with lower levels of COVID-19 related stressors. Greater financial hardships and higher levels of depressive symptoms, acculturative stress, and CHB-related stigma were associated with high disease burden. Qualitative interviews taken as the pandemic waned included reflections on a wide range of negative as well as beneficial experiences. Conclusion: Clinicians caring for Asian Americans living with serious chronic diseases such as CHB would do well to consider monitoring and addressing residual psychosocial consequences of the pandemic among their most vulnerable patients.