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. 2017 Sep 26;17(1):747.
doi: 10.1186/s12889-017-4796-4.

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

Andrew Chee Keng Lee  1 , Alicia Vedio  2 , Eva Zhi Hong Liu  3 , Jason Horsley  4 , Amrita Jesurasa  3 , Sarah Salway  3
Affiliations

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

Andrew Chee Keng Lee et al. BMC Public Health. .

Abstract

Background: Global 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.

Methods: We 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.

Results: Three 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.

Conclusions: Hepatitis 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.

Keywords: Chinese; Ethnicity; Healthcare access; Hepatitis B; Migrants.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval and consent was sought and received from the University of Sheffield Research Ethics Committee and the NHS National Research Ethics Committee (13/EM/0452). Written informed consent was obtained from all study participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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