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Holt B, Mendoza J, Nguyen H, Doan D, Nguyen VH, Cabauatan DJ, Duy LD, Fernandez M, Gaspar M, Hamoy G, Manlutac JMD, Mehtsun S, Mercado TB, Neo BL, Le BN, Nguyen H, Nguyen HT, Nguyen Y, Pham T, Pollack T, Rombaoa MC, Thai P, Thu TK, Truong PX, Vu D, Ong J, Duong D. Barriers and enablers to people-centred viral hepatitis care in Vietnam and the Philippines: Results of a patient journey mapping study. J Viral Hepat 2024; 31:391-403. [PMID: 38654623 DOI: 10.1111/jvh.13944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 02/09/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
In Vietnam and the Philippines, viral hepatitis is the leading cause of cirrhosis and liver cancer. This study aims to understand the barriers and enablers of people receiving care for hepatitis B and C to support both countries' efforts to eliminate viral hepatitis as a public health threat by 2030. Retrospective, semi-structured interviews were conducted with a purposive, quota-based sample of 63 people living with hepatitis B or C in one province of Vietnam and one region of the Philippines. A rapid deductive approach to thematic analysis produced key findings among the three phases of care: (1) pre-awareness and testing, (2) linkage and treatment initiation and (3) ongoing treatment and recovery. The research found that participants followed five typical journeys, from a variety of entry points. Barriers during the pre-awareness and testing phase included limited awareness about hepatitis and its management, stigma and psychological impacts. Enablers included being familiar with the health system and/or patients benefiting from social connections within the health systems. During the linkage and treatment initiation phase, barriers included difficult physical access, complex navigation and inadequate counselling. In this phase, family support emerged as a critical enabler. During the ongoing treatment and recovery phase, the cost of care and socially and culturally informed perceptions of the disease and medication use were both barriers and enablers. Exploring peoples' journeys with hepatitis B and C in Vietnam and the Philippines revealed many similarities despite the different cultural and health system contexts. Insights from this study may help generate a contextualized, people-centred evidence base to inform the design and improvement of primary care services for hepatitis in both research sites.
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Affiliation(s)
- Bethany Holt
- Program in Global Primary Care and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jhaki Mendoza
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Hoang Nguyen
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Duong Doan
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Vy H Nguyen
- Program in Global Primary Care and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Joy Cabauatan
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Lam Dam Duy
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Martin Fernandez
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Manu Gaspar
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Geohari Hamoy
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | | | - Sinit Mehtsun
- Global Patient Solutions, Gilead Science, Washington, DC, USA
- Global Patient Solutions, Gilead Science, Singapore, Singapore
| | - Timothy Bill Mercado
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Boon-Leong Neo
- Global Patient Solutions, Gilead Science, Washington, DC, USA
- Global Patient Solutions, Gilead Science, Singapore, Singapore
| | - Bao Ngoc Le
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Hoa Nguyen
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Huyen Thu Nguyen
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Yen Nguyen
- Action to the Community Development Institute, Hanoi, Vietnam
| | - Thuy Pham
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Todd Pollack
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mary Cris Rombaoa
- School of Health Sciences, University of the Philippines Manila, Tarlac, Philippines
| | - Pham Thai
- Department of Health, Thai Binh, Vietnam
| | - Tran Khanh Thu
- Department of Health, Thai Binh, Vietnam
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | | | - Dung Vu
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Janus Ong
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - David Duong
- Program in Global Primary Care and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Brener L, Vu HMK, Horwitz R, Cama E, Martin K, Rance J, Okeke S, Bryant J. 'People Like Us Would Have No Clue If the Information Is Online': Exploring Understanding and Sources of Hepatitis B Information Among Vietnamese Australians. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02055-4. [PMID: 38918320 DOI: 10.1007/s40615-024-02055-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024]
Abstract
Socio-cultural and behavioural factors are often not adequately considered in designing health promotion programs for culturally and linguistically diverse communities in Australia. Given that people of Vietnamese background are disproportionately impacted by hepatitis B, the aim of this research was to better understand these factors to inform hepatitis B health promotion messages for the Vietnamese community. Twenty participants (four living with hepatitis B) were interviewed by a Vietnamese-speaking researcher. The interview sessions explored beliefs about health, the body and liver; knowledge and attitudes about hepatitis B vaccines, testing, clinical management and stigma; and sources of health information and value given to information on social media. Participants had a range of understandings of health and hepatitis B which informed their responses to health education and intervention. Participants appeared to have limited knowledge and misconceptions about transmission, prevention, treatment, and management of hepatitis B. Stigma surrounding hepatitis B was apparent, with over half the participants reporting that they distanced themselves from people living with hepatitis B. Participants preferred online information resources for younger people and traditional media in the Vietnamese language for older people. By understanding what Vietnamese people know about hepatitis B and how they access health information, these findings can be used to inform health promotion campaigns using print, media, and radio to ensure wide reach. Knowledge of community specific information is key to reducing the burden of hepatitis B among culturally and linguistically diverse communities and ensuring they are able to access healthcare services for testing, monitoring, and care.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | | | - Robyn Horwitz
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kacey Martin
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Sylvester Okeke
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Wang T, Kong LN, Yao Y, Li L. Self-Efficacy, Coping Strategies and Quality of Life among Patients with Chronic Hepatitis B. West J Nurs Res 2023; 45:800-806. [PMID: 37377383 DOI: 10.1177/01939459231184714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
This study aimed to examine the relationships of self-efficacy, coping strategies, and quality of life (QoL) among patients with chronic hepatitis B and to explore whether coping strategies play a mediating role. In this cross-sectional study, 193 patients with chronic hepatitis B from two tertiary hospitals were recruited. Data were collected using a self-report questionnaire. The results indicated that physical and mental QoL were positively associated with self-efficacy and negatively associated with resignation coping. Moreover, resignation coping partially mediated the relationship between self-efficacy and physical and mental QoL. Our findings indicated that healthcare providers can enhance self-efficacy with an emphasis on reducing the use of resignation coping to better improve QoL among patients with chronic hepatitis B.
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Affiliation(s)
- Tian Wang
- Resident Physician, Department of Infectious Disease, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ling-Na Kong
- Associate Professor, School of Nursing, Chongqing Medical University, Chongqing, China
| | - Yu Yao
- Lecturer, School of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Lin Li
- Attending Physician, Department of Liver Disease, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
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Drysdale K, Persson A, Smith AKJ, Wallace J, Valentine K, Gray RM, Bryant J, Hamilton M, Newman CE. Professional perspectives on serodiscordant family service provision in the context of blood-borne viruses. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:145-160. [PMID: 35980804 DOI: 10.1080/14461242.2022.2110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/03/2022] [Indexed: 05/18/2023]
Abstract
In recognition of the broader relational aspects of viral infections, family support is considered important when someone is diagnosed with a blood-borne virus (BBV), such as HIV, hepatitis C (HCV) and hepatitis B (HBV). However, families' own support needs are often not a priority in service provision within the BBV sector. In this article, we draw on qualitative interviews with 20 key informants working in various professional capacities in health, social policy, care and advocacy sectors in Australia, and explore their experiences and perspectives on family inclusivity in their services. Overall, key informants acknowledged the diversity of what constitutes family, and consistently viewed family engagement as beneficial to both diagnosed individuals and the wider familial networks affected by a diagnosis. However, prioritising individual care in support services presented barriers to engaging families, which are further complicated by the role of stigma in shaping the social realities of living with a BBV. Increasing understanding in service provision settings that serodiscordance can be a family experience has the potential to widen this analytic lens to consider the support needs of families in their own right.
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Affiliation(s)
- Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Asha Persson
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Kylie Valentine
- Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Rebecca M Gray
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Myra Hamilton
- Centre of Excellence in Population Ageing Research, Work and Organisational Studies, University of Sydney, Sydney, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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de-Graft Aikins A, Sanuade O, Baatiema L, Adjaye-Gbewonyo K, Addo J, Agyemang C. How chronic conditions are understood, experienced and managed within African communities in Europe, North America and Australia: A synthesis of qualitative studies. PLoS One 2023; 18:e0277325. [PMID: 36791113 PMCID: PMC9931108 DOI: 10.1371/journal.pone.0277325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/24/2022] [Indexed: 02/16/2023] Open
Abstract
This review focuses on the lived experiences of chronic conditions among African communities in the Global North, focusing on established immigrant communities as well as recent immigrant, refugee, and asylum-seeking communities. We conducted a systematic and narrative synthesis of qualitative studies published from inception to 2022, following a search from nine databases-MEDLINE, EMBASE, PsycINFO, Web of Science, Social Science Citation Index, Academic Search Complete, CINAHL, SCOPUS and AMED. 39 articles reporting 32 qualitative studies were included in the synthesis. The studies were conducted in 10 countries (Australia, Canada, Denmark, France, Netherlands, Norway, Sweden, Switzerland, United Kingdom, and the United States) and focused on 748 participants from 27 African countries living with eight conditions: type 2 diabetes, hypertension, prostate cancer, sickle cell disease, chronic hepatitis, chronic pain, musculoskeletal orders and mental health conditions. The majority of participants believed chronic conditions to be lifelong, requiring complex interventions. Chronic illness impacted several domains of everyday life-physical, sexual, psycho-emotional, social, and economic. Participants managed their illness using biomedical management, traditional medical treatment and faith-based coping, in isolation or combination. In a number of studies, participants took 'therapeutic journeys'-which involved navigating illness action at home and abroad, with the support of transnational therapy networks. Multi-level barriers to healthcare were reported across the majority of studies: these included individual (changing food habits), social (stigma) and structural (healthcare disparities). We outline methodological and interpretive limitations, such as limited engagement with multi-ethnic and intergenerational differences. However, the studies provide an important insights on a much-ignored area that intersects healthcare for African communities in the Global North and medical pluralism on the continent; they also raise important conceptual, methodological and policy challenges for national health programmes on healthcare disparities.
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Affiliation(s)
- Ama de-Graft Aikins
- Institute of Advanced Studies, University College London, London, United Kingdom
- * E-mail:
| | - Olutobi Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kafui Adjaye-Gbewonyo
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom
| | - Juliet Addo
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Mitchell T, Nayagam JS, Dusheiko G, Agarwal K. Health inequalities in the management of chronic hepatitis B virus infection in patients from sub-Saharan Africa in high-income countries. JHEP REPORTS : INNOVATION IN HEPATOLOGY 2022; 5:100623. [PMID: 36636709 PMCID: PMC9829705 DOI: 10.1016/j.jhepr.2022.100623] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Chronic hepatitis B virus disproportionately affects migrant communities in high-income countries, reflecting increased migration from sub-Saharan Africa. Chronic hepatitis B virus is endemic in sub-Saharan Africa, yet the natural history of chronic infection experienced by patients remains incompletely understood, with evidence of variability across genotypes and regions within sub-Saharan Africa. Clinical guidelines recommending treatment thresholds are not specific to sub-Saharan African patients and are based on natural history studies from Western Pacific Asian countries. Access to standard of care treatment is available for sub-Saharan African people with chronic hepatitis B virus infection in high-income countries; however, the evidence base for these treatments was not established in this cohort and areas of uncertainty remain, particularly regarding HCC surveillance and treatment discontinuation. Participation in phase III clinical trials for chronic hepatitis B therapies is almost non-existent amongst sub-Saharan African patients, even when residing in high-income countries that participate in multicentre trials. Engagement with sub-Saharan African patients with chronic hepatitis B in high-income countries is challenging because of the stigma associated with the diagnosis, absence of routine screening systems and the complexities involved in navigating the healthcare system. Nonetheless, improved engagement is critical if we are to achieve global hepatitis B virus elimination.
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Affiliation(s)
- Tim Mitchell
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom,Gastroenterology and Hepatology Department, Royal Perth Hospital, Perth, Australia,Corresponding author. Address: Gastroenterology and Hepatology Department, Level 8 A Block, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia 6000, Australia; Tel.: +61 8 9224 2179.
| | - Jeremy S. Nayagam
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom,Department of Inflammation Biology, King’s College London, London, UK
| | - Geoffrey Dusheiko
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom,University College London Medical School, London, UK
| | - Kosh Agarwal
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom
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Lanyo TN, Ani-Amponsah M, Adjei CA. Challenges and ways of coping of parturient women with chronic hepatitis B in Ghana during COVID-19 pandemic: a qualitative inquiry. BMJ Open 2022; 12:e062557. [PMID: 36283752 PMCID: PMC9606735 DOI: 10.1136/bmjopen-2022-062557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the psychosocial concerns and ways of coping of pregnant women with chronic hepatitis B infection in Ghana. SETTING Participants were selected from public health facilities in the Tema Metropolis. DESIGN Exploratory descriptive qualitative design was employed. PARTICIPANTS Fourteen pregnant women were purposively selected to participate in face-to-face interviews. The data were analysed using the content analysis procedure. RESULTS The participants' psychosocial concerns and coping strategies were diverse. A significant number of the participants were concerned about the impact their hepatitis B seropositivity would have on their relationships, finances, and general well-being. Specifically, they feared that their social network, especially their spouses, would perceive them as having led a promiscuous lifestyle in the past to acquire hepatitis B infection. Also, fear of transmitting the infection to their infants and the effects of the infection on their infants later in life were identified as major concerns by nearly all participants. The participants further reported feelings of distress and diminished self-esteem. These psychosocial afflictions reported were attributed to lack of pre-test counselling during the antenatal care period. However, the participants coped using different strategies, including avoidance/denial, spirituality, and alternative treatment use. CONCLUSION To achieve optimal psychological and social well-being of pregnant women with chronic hepatitis B, it is important that their unique challenges are considered in their care and treatment cascade. Explicitly, protocols for supportive care addressing the specific needs of pregnant women with chronic hepatitis B should be implemented in the study setting.
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Affiliation(s)
| | - Mary Ani-Amponsah
- Department of Maternal and Child Health, University of Ghana School of Nursing, Accra, Ghana
| | - Charles Ampong Adjei
- Department of Public Health Nursing, University of Ghana School of Nursing, Accra, Ghana
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Hou L, Zhang Y, Tang S, Tang X. The loss and return of self: An interpretative phenomenological analysis of coping and recovery from chronic hepatitis B in China. Nurs Health Sci 2022; 24:625-633. [PMID: 35670524 DOI: 10.1111/nhs.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
Chronic hepatitis B (CHB) is a prevalent disease with various negative consequences. The lived experience of coping and recovery of a patient with Chronic hepatitis B was explored in this study. A semistructured interview was conducted with one participant who had been recovered from Chronic hepatitis B for 10 years. Data were analyzed using interpretative phenomenological analysis. Five superordinate themes emerged, including lingering in the shadow of death anxiety, diminished functioning of the self, adopting a highly disciplined lifestyle, receiving social support, and the return of the self with scars. The findings revealed that the disease is deeply associated with moral standing, which means the diagnosis of Chronic hepatitis B might imply a loss of moral face for Chinese people living with the condition. Our findings point to the need for increasing knowledge about chronic hepatitis B, decoupling the disease from a moral standpoint, and providing a supportive environment.
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Affiliation(s)
- Liqi Hou
- Department of Sociology, Peking University, Beijing, China
| | - Yansong Zhang
- School of Journalism, Fudan University, Shanghai, China.,Department of Media and Communication, City University of Hong Kong, Hong Kong SAR, China
| | - Suqin Tang
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Xinfeng Tang
- Department of Psychology, Renmin University of China, Beijing, China
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Khatri RB, Assefa Y. Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges. BMC Public Health 2022; 22:880. [PMID: 35505307 PMCID: PMC9063872 DOI: 10.1186/s12889-022-13256-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/19/2022] [Indexed: 12/14/2022] Open
Abstract
Background About half of first- or second-generation Australians are born overseas, and one-in-five speak English as their second language at home which often are referred to as Culturally and Linguistically Diverse (CALD) populations. These people have varied health needs and face several barriers in accessing health services. Nevertheless, there are limited studies that synthesised these challenges. This study aimed to explore issues and challenges in accessing health services among CALD populations in Australia. Methods We conducted a scoping review of the literature published from 1st January 1970 to 30th October 2021 in four databases: PubMed, Scopus, Embase, and the Web of Science. The search strategy was developed around CALD populations and the health services within the Australian context. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for selection and Arksey and O’Malley framework for analysis of relevant articles. A narrative synthesis of data was conducted using inductive thematic analysis approach. Identified issues and challenges were described using an adapted socioecological model. Results A total of 64 studies were included in the final review. Several challenges at various levels were identified to influence access to health services utilisation. Individual and family level challenges were related to interacting social and health conditions, poor health literacy, multimorbidity, diminishing healthy migrants’ effect. Community and organisational level challenges were acculturation leading to unhealthy food behaviours and lifestyles, language and communication problems, inadequate interpretation services, and poor cultural competency of providers. Finally, challenges at systems and policy levels included multiple structural disadvantages and vulnerabilities, inadequate health systems and services to address the needs of CALD populations. Conclusions People from CALD backgrounds have multiple interacting social factors and diseases, low access to health services, and face challenges in the multilevel health and social systems. Health systems and services need to focus on treating multimorbidity through culturally appropriate health interventions that can effectively prevent and control diseases. Existing health services can be strengthened by ensuring multilingual health resources and onsite interpreters. Addressing structural challenges needs a holistic policy intervention such as improving social determinants of health (e.g., improving living and working conditions and reducing socioeconomic disparities) of CALD populations, which requires a high level political commitment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13256-z.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, the University of Queensland, Brisbane, Australia.
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
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Mude WW, Fisher CM, Richmond J, Gautier RL, Wallace J. Social impacts of living with chronic hepatitis B in South Sudanese community in Australia. ETHNICITY & HEALTH 2022; 27:529-541. [PMID: 32568555 DOI: 10.1080/13557858.2020.1782849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
Introduction: Chronic hepatitis B presents significant issues to public health and clinical practices. The infection requires lifelong clinical management and is a leading risk factor for liver cancer and liver cirrhosis. Limited studies currently exist on the social impacts of living with chronic hepatitis B, especially for people from Sub-Saharan Africa. The current study explored the experiences of South Sudanese people living with chronic hepatitis B in Australia.Methods: A qualitative inquiry using face-to-face interviews with fifteen South Sudanese people with chronic hepatitis B in Australia explored the social impacts of living with chronic hepatitis B. The study purposively sampled participants who self-identified as South Sudanese with hepatitis B and over 18 years of age. Interviews were coded and analysed using thematic analysis.Results: The study identified three themes relating to the experiences of living with chronic hepatitis B, and were grouped into psychological, interpersonal and healthcare system levels. Psychological level experiences related to the uncertainty of living with chronic hepatitis B and liver cancer risk, where participants expressed persistent fear of disease progression and anxiety around death related to the disease. Interpersonal level experiences involved the disclosure of hepatitis B and its social impacts including stigma, social distancing and isolation. Healthcare system level experiences included receiving mixed messages about hepatitis B, challenges with regular testing and difficulty receiving hepatitis B treatment.Conclusion: The findings provide valuable insights into the social impacts of hepatitis B. It underlines the importance of integrated public health interventions at the community level to improve knowledge and awareness of hepatitis B which address stigma in the South Sudanese community in Australia.
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Affiliation(s)
- William W Mude
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Christopher M Fisher
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - Roslyn Le Gautier
- Palliative Medicine Research Group, The University of Melbourne & St Vincent's Hospital, Melbourne Australia
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Robotin MC, Wallace J, Gallego G, George J. Hepatitis B and Liver Cancer: Community Awareness, Knowledge and Beliefs of Middle Eastern Migrants in Sydney, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168534. [PMID: 34444285 PMCID: PMC8394558 DOI: 10.3390/ijerph18168534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
Chronic hepatitis B (CHB) is a significant global health challenge given an increasing morbidity and inadequate public health response, Migrant populations are primarily affected by CHB in industrialised countries, and while more than 7% of Australians with CHB were born in Africa or the Middle East, little is known of their awareness or knowledge of viral hepatitis and its impact. This qualitative study, using semi-structured interviews with Assyrian and Arabic community leaders and focus groups (FG) with 66 community members sought to identify hepatitis and liver cancer knowledge and awareness among local Arabic and Assyrian-speaking communities in Western Sydney. Interviews were thematically analysed, with findings framing the topics for the FGs which were analysed using a framework analysis. Themes identified across both methods included limited awareness or knowledge of viral hepatitis or liver cancer, stigma associated with both conditions, variable levels of health literacy and trust in medical practitioners, and fear that receiving “bad news” would deter people from seeking care. Preferred sources of health information were family doctors, family members, the internet and the ethnic media. The study gave valuable information for the design of an educational program and provided useful information for the planning of culturally appropriate hepatitis screening and treatment services for these communities.
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Affiliation(s)
- Monica C. Robotin
- School of Medicine, The University of Notre Dame, Sydney, NSW 2007, Australia;
| | - Jack Wallace
- Burnet Institute, Melbourne, VIC 3004, Australia;
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Bundoora, VIC 3086, Australia
| | - Gisselle Gallego
- Auburn Clinical School, School of Medicine, The University of Notre Dame, Sydney, NSW 2007, Australia
- Correspondence: ; Tel.: +61-2-8204-4237
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney, NSW 2145, Australia;
- Westmead Clinical School, The University of Sydney, Sydney, NSW 2006, Australia
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Sievert K, Liddle R, Tan A, Arachchi N, Valaydon Z, Allard N. Promoting hospital and primary care collaboration for timely and effective care for chronic hepatitis B in western Melbourne. AUST HEALTH REV 2021; 44:521-526. [PMID: 32718420 DOI: 10.1071/ah19135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 02/21/2020] [Indexed: 01/11/2023]
Abstract
Objective The aims of this study were to: (1) identify the characteristics of patients with chronic hepatitis B (CHB) who do not attend their hospital liver clinic appointments; and (2) raise awareness among general practitioners (GP) of alternative pathways to care for CHB in order to prevent long-term complications of CHB (liver cancer and cirrhosis). Methods This prospective study was conducted between May 2018 and January 2019 at one site of a tertiary referral hospital in western Melbourne. Patients with minimal liver complications who did not attend their first two initial appointments were included in the study, in addition to referring GPs of new CHB patients to the liver clinic who had minimal liver complications (characterised by minimal fibrosis (<7kPa)) and no liver comorbidities (including cirrhosis and/or hepatocellular carcinoma). GPs of patients who failed to attend the liver clinic as a new patient were sent an alternative discharge letter that included information on alternative pathways to care in the community for their patients. A follow-up survey to referring GPs was conducted afterwards for feedback. Demographic data was also collected for included patients. Results Thirty patients with non-complicated CHB were included in the study (median age 32.5 years). Patients were from 11 different countries and six regions. The mean wait time from referral to clinic date was 424 days (SD 218.9). Only four GPs responded to the letter, with non-responding GPs surveyed primarily not participating due to having over 1 year of no contact from the patient or hospital. Conclusion This study showed that there were long waiting lists for CHB referrals and alerting GPs to alternative pathways after patients failed to attend appointments was ineffective. There needs to be improved coordination between tertiary and primary services to provide timely and effective care for patients with CHB. What is known about this topic? There are 239000 Australians living with CHB: most recent estimates indicate that only 62% have been diagnosed, 15% are being monitored and 6% of those requiring treatment are receiving antiviral therapy. The complications of CHB (liver cancer and cirrhosis) can be averted by routine monitoring and timely commencement of highly effective oral antiviral therapy. In Australia, both GPs and specialists in gastroenterology and infectious diseases are involved in the management of CHB patients, but most prescribing occurs in specialist services. The current specialist-centred model of CHB care has been described as neither practical nor sustainable given the limited resources and capacity of specialist services, and the challenges for people with CHB to access public hospitals for routine care. What does this paper add? Non-attending patients were a primarily young population. The median wait time for a clinic appointment in this hospital setting was 424 days, with some patients waiting ≥800 days for an appointment. This extensive wait time for a largely asymptomatic condition may have affected attendance rates. Although this particular intervention to engage GPs in collaborative care had limited results, it is clear that management of CHB by GPs, transparency in wait lists and adequate resourcing of specialist services would help alleviate the referral burden on hospitals. What are the implications for practitioners? GPs should be aware that waiting lists for liver clinic appointments can be extensive in public hospital settings due to the high referral burden and limited resources of these services. Alternative pathways to care, such as GPs trained to prescribe Schedule 100 drugs, are an effective means of alleviating this burden while also ensuring CHB patients are seen in a timely manner and receive routine monitoring.
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Affiliation(s)
- Katherine Sievert
- Hepatitis Victoria, 5/200 Sydney Road, Brunswick, Vic. 3068, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Vic. 3004, Australia
| | - Rachel Liddle
- Department of Hepatology and Gastroenterology, Western Health, Gordon Street, Footscray, Vic. 3011, Australia. ; ;
| | - Annie Tan
- Department of Intensive Care Medicine, Austin Health, Melbourne, Vic. 3084, Australia.
| | - Niranjan Arachchi
- Department of Hepatology and Gastroenterology, Western Health, Gordon Street, Footscray, Vic. 3011, Australia. ; ;
| | - Zina Valaydon
- Department of Hepatology and Gastroenterology, Western Health, Gordon Street, Footscray, Vic. 3011, Australia. ; ;
| | - Nicole Allard
- WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Vic. 3000, Australia; and Corresponding author.
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