Determinants of uptake of hepatitis B testing and healthcare access by migrant Chinese in the England: a qualitative study

Abstract

BackgroundGlobal migration from hepatitis B endemic countries poses a significant public health challenge in receiving low-prevalence countries. In the UK, Chinese migrants are a high risk group for hepatitis B. However, they are an underserved population that infrequently accesses healthcare. This study sought to increase understanding of the determinants of hepatitis B testing and healthcare access among migrants of Chinese ethnicity living in England.MethodsWe sought to obtain and integrate insights from different key stakeholders in the system. We conducted six focus group discussions and 20 in-depth interviews with community members and patients identifying themselves as ‘Chinese’, and interviewed 21 clinicians and nine health service commissioners. Data were thematically analysed and findings were corroborated through two validation workshops.ResultsThree thematic categories emerged: knowledge and awareness, visibility of the disease, and health service issues. Low disease knowledge and awareness levels among community members contributed to erroneous personal risk perception and suboptimal engagement with services. Limited clinician knowledge led to missed opportunities to test and inaccurate assessments of infection risks in Chinese patients. There was little social discourse and considerable stigma linked to the disease among some sub-sections of the Chinese population. A lack of visibility of the issue and the population within the health system meant that these health needs were not prioritised by clinicians or commissioners. Service accessibility was also affected by the lack of language support. Greater use of community outreach, consultation aids, ‘cultural competency’ training, and locally adapted testing protocols may help.ConclusionsHepatitis B among migrants of Chinese ethnicity in England can be characterised as an invisible disease in an invisible population. Multi-modal solutions are needed to tackle barriers within this population and the health system.Electronic supplementary materialThe online version of this article (10.1186/s12889-017-4796-4) contains supplementary material, which is available to authorized users.

Environmental factors affecting self‐management of chronic hepatitis B from the patients’ perspective

“…Instead, results emphasised that work- Furthermore, if patients perceive that the health care provided is not helpful to them, they are more likely to neglect opportunities to link with the self-management programme of hepatitis B. Limits to the provision of health care include lack of a subsidised healthcare system (Lee et al, 2017(Lee et al, , 2014Stanford et al, 2016), use of language that patients do not understand (Davies, Bukulatjpi, Sharma, Davis, & Johnston, 2014) and use of unsuitable media platforms for information propagation (Nguyen-Truong, Lee-Lin, & Gedaly-Duff, 2013;Zhu, Gao, Jiang, Ding, & Sun, 2015). In this study, findings indicated that the policies of chronic hepatitis B prevention largely focused on school-age students and inpatients, and that regular health check-ups for adults or labourers did not include these screenings or information.…”

“…Studies of patients with liver disease worldwide have suggested that patients' explanations of symptoms (such as fatigue and tiredness) may be influenced by folk health beliefs, which affect the health behaviours and management of the disease, including adopting new lifestyles or alternative/traditional treatments (Brener et al, 2016 (Fang & Stewart, 2018), remedial or healing herbs (Fang & Stewart, 2018;Giles-Vernick et al, 2016). In the patients' experience, these treatments are often used as alternative treatments instead of usual medical treatment (Fang & Stewart, 2018;Lee et al, 2017;Owiti et al, 2015). To date, conventional medical treatments for chronic hepatitis B include active adherence to antiviral medications and follow-up enhanced by developing a self-management programme (Kong et al, 2018).…”

“…Recent studies revealed an individual's awareness and management of diseases are affected by family habits with regard to seeking treatment consultation, availability of healthcare resources, access to subsidised health care and traditional treatment culture. Additionally, these studies emphasised that, in the patients' opinion, personal factors cannot overcome illnesses attributed to environmental factors, such as the lack of sports facilities in the working environment (Bhandari & Kim, ), health care providers' attitudes (Lee et al, ), linguistic barriers (Lee et al, ; Stanford, Biba, Khubchandani, Webb, & Rathore, ) and the lack of a supportive care environment for different cultures (Jangland, Teodorsson, Molander, & Muntlin, ).…”

“…Traditional treatments are often related to cultural beliefs, including spiritual healing (Fang & Stewart, ), remedial or healing herbs (Fang & Stewart, ; Giles‐Vernick et al, ). In the patients' experience, these treatments are often used as alternative treatments instead of usual medical treatment (Fang & Stewart, ; Lee et al, ; Owiti et al, ). To date, conventional medical treatments for chronic hepatitis B include active adherence to antiviral medications and follow‐up enhanced by developing a self‐management programme (Kong et al, ).…”

“…Additionally, these studies emphasised that, in the patients' opinion, personal factors cannot overcome illnesses attributed to environmental factors, such as the lack of sports facilities in the working environment (Bhandari & Kim, 2016), health care providers' attitudes (Lee et al, 2017), linguistic barriers (Lee et al, 2017;Stanford, Biba, Khubchandani, Webb, & Rathore, 2016) and the lack of a supportive care environment for different cultures (Jangland, Teodorsson, Molander, & Muntlin, 2018).…”