Perceptions of Stigma Among Patients With Hepatitis B in Germany: Cross-Sectional Survey

Many studies find associations between hepatitis B and stigma, but studies from the Western European context are lacking. Based on available studies, we hypothesized that younger age, higher education, male gender, higher privacy needs, and non-German mother tongue were positively associated with perceived hepatitis B-related stigma.

This study aims to describe the prevalence of perceived social stigma among patients with hepatitis B in Germany and to assess what factors are associated with perceptions of hepatitis B-related stigma.

Applying the short version of the Berger stigma scale, we surveyed 195 patients with hepatitis B about their perceptions of hepatitis B-related stigma, privacy needs, and demographic variables through a paper-based questionnaire. Venue-based recruitment of adult patients diagnosed with acute or chronic hepatitis B was implemented at 3 clinical centers in Germany. Patients who could not read German were excluded from the study.

From the 195 valid questionnaires, 45.1% (88/195) of participants identified as female, 36.6% (71/195) had a high school diploma, and 56.9% (111/195) reported a mother tongue other than German. The mean (SD) stigma score throughout the sample was 5.52 (6.02; range 0-24) and the median was 3.50 (IQR=9.75). Regression analysis revealed that non-German mother tongue, individual data privacy needs, and participants' secrecy regarding their hepatitis B diagnosis independently predicted perceived hepatitis B-related stigma. More precisely, the higher the data privacy need and the more secret the hepatitis B diagnosis, the higher the perceived stigma, and perceived stigma was higher for patients with a non-German mother tongue. Age, gender, and education were no predictors of perceived stigma.

The surveyed patients with hepatitis B in Germany reported lower levels of hepatitis B-related stigma than found in other studies conducted in Asian countries. The association with non-German mother tongue indicates an important cultural and social component in the perception of stigma. Community-based interventions and the sensibilization of health care professionals might help overcome perceptions of stigma among hepatitis B-affected populations.