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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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Cama E, Brener L, Horwitz R, Broady TR, Khoi Vu HM, Jin D, Wu KOE, Treloar C. Factors associated with hepatitis B knowledge among people of Vietnamese ethnicity in Australia. PSYCHOL HEALTH MED 2024:1-12. [PMID: 38762748 DOI: 10.1080/13548506.2024.2350703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/28/2024] [Indexed: 05/20/2024]
Abstract
Despite high hepatitis B (HBV) prevalence among people of Vietnamese ethnicity in Australia and elsewhere, there is limited research on levels of HBV knowledge and factors associated with such knowledge. The aim of this study was to examine HBV knowledge and associated demographic and attitudinal factors among people of Vietnamese ethnicity in Australia. People of Vietnamese ethnicity (n = 966) were recruited through community events and social media groups to complete online surveys measuring HBV knowledge, attitudes towards HBV, levels of mistrust in Western medicine, and demographic characteristics. Findings of this study indicate that levels of knowledge are mixed, with gaps in knowledge related to transmission and treatment of the virus. Those with greater knowledge of HBV tended to be older, have higher levels of formal education, have been tested for HBV, and know someone living with HBV. Those with lower levels of knowledge tended to have more negative attitudes towards the virus and greater levels of mistrust in Western medicine. Given that health literacy is connected to effective communication from health providers, we suggest that there is a need for the development of health promotion and education resources targeted at people of Vietnamese ethnicity and translated into Vietnamese. We propose that such resources be developed in consultation with Vietnamese communities and health providers to ensure that they are culturally appropriate and sensitive to people of Vietnamese ethnicity living in Australia.
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Robyn Horwitz
- Centre for Social Research in Health, UNSW Sydney, Australia
| | | | | | - Defeng Jin
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - K O E Wu
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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Bryant J, Smith AKJ, Persson A, Valentine K, Drysdale K, Wallace J, Hamilton M, Newman CE. Logics of control and self-management in narratives of people living with HIV, hepatitis C and hepatitis B. CULTURE, HEALTH & SEXUALITY 2023; 25:1214-1229. [PMID: 36476229 DOI: 10.1080/13691058.2022.2149858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
In Australia, the response to HIV, hepatitis C and hepatitis B has largely been through the constructed category of 'blood borne viruses' which treats these viruses as an interconnected set of conditions with respect to their mode of transmission. In this paper, we explore how people understand their viral infection, and compare the logics underpinning these different understandings. In-depth interviews were conducted with 61 participants who were either living with a blood borne virus or were the family members of people living with them. Our analysis reveals that the viral infection was often described as 'just a condition that needs to be managed', albeit in potentially exhausting ways. This understanding hinged upon a biomedical logic in which viral invasion was seen as causing illness and in turn necessitating biomedical intervention. In contrast, some participants with hepatitis B presented their infection as a condition unintelligible through Western biomedical logics, defined instead by symptomology - in terms of 'liver disease', and/or 'liver inflammation'. This focus on symptomology calls into question the soundness of prevention and management responses to hepatitis B based in biomedical logics and reveals the extent to which living with a virus involves multiple, sometimes incompatible, cultural logics. The different logics underpinning HIV, hepatitis C and hepatitis B reveal shortcomings of framing these viruses together as a coherent single construct.
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Affiliation(s)
- Joanne Bryant
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Asha Persson
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Myra Hamilton
- University of Sydney Business School, Sydney, NSW, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
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Yussf N, Wallace J, Perrier M, Romero N, Cowie B, Allard N. Women with hepatitis B: how mothers with chronic hepatitis B understand and experience the prevention of mother-to-child transmission interventions in Victoria, Australia. Aust J Prim Health 2022; 28:514-521. [PMID: 36155134 DOI: 10.1071/py22014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mother-to-child transmission (MTCT) of hepatitis B can be prevented with targeted interventions; however, MTCT continues to occur in Australia and globally. This qualitative research investigated how mothers with chronic hepatitis B (CHB) understand and experience interventions for the prevention of MTCT of CHB (PMTCT-CHB) in Victoria, Australia. METHODS Semi-structured interviews were conducted with women with CHB. Participants were recruited through purposive and snowballing sampling. Interviews explored the women's experience of care for themselves and their infants aimed at PMTCT-CHB. Interviews were conducted over the phone with a qualified interpreter where required. The consolidated criteria for reporting qualitative research framework was used with data thematically analysed. This study was co-designed with mothers with CHB through a Community Advisory Group established for this research; coordinated and supported by LiverWELL and the researchers. RESULTS Sixteen women were interviewed. Although most women understood the purpose of hepatitis B vaccination, there were significant gaps in information and education provided to mothers regarding PMTCT-CHB. These gaps included understanding of the extent of protection of vaccination, breastfeeding with CHB, post-vaccination testing for infants and lack of clarity of the woman's own hepatitis B status. There was notable fear and worry associated with hepatitis B transmission, with emotional support for mothers identified as a major gap in service delivery. Additionally, some women experienced stigma and discrimination due to their hepatitis B and refugee status. CONCLUSIONS This study explored how mothers with CHB understand and experience interventions to prevent MTCT. Our findings reveal substantial gaps in delivery of information and care in the context of PMTCT-CHB in Victoria. Our findings can support development of evidence-based interventions and systems to improve healthcare for mothers with CHB and their infants, and thereby reduce possible CHB transmission and other negative outcomes, including stigma and discrimination.
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Affiliation(s)
- Nafisa Yussf
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute for Infection and Immunity, Melbourne, Vic. 3000, Australia; and Department of Infectious Diseases, University of Melbourne, Melbourne, Vic. 3000, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne, Vic. 3004, Australia
| | | | - Nicole Romero
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute for Infection and Immunity, Melbourne, Vic. 3000, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute for Infection and Immunity, Melbourne, Vic. 3000, Australia; and Department of Infectious Diseases, University of Melbourne, Melbourne, Vic. 3000, Australia; and Royal Melbourne Hospital, Melbourne, Vic. 3000, Australia
| | - Nicole Allard
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute for Infection and Immunity, Melbourne, Vic. 3000, Australia; and Department of Infectious Diseases, University of Melbourne, Melbourne, Vic. 3000, Australia
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Wallace J, Richmond J, Howell J, Hajarizadeh B, Power J, Treloar C, Revill PA, Cowie B, Wang S, Stoové M, Pedrana A, Hellard M. Exploring the Public Health and Social Implications of Future Curative Hepatitis B Interventions. Viruses 2022; 14:v14112542. [PMID: 36423153 PMCID: PMC9693003 DOI: 10.3390/v14112542] [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] [Received: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Hepatitis B is a significant global health issue where the 296 million people estimated to live with the infection risk liver disease or cancer without clinical intervention. The World Health Organization has committed to eliminating viral hepatitis as a public health threat by 2030, with future curative hepatitis B interventions potentially revolutionizing public health responses to hepatitis B, and being essential for viral hepatitis elimination. Understanding the social and public health implications of any cure is imperative for its successful implementation. This exploratory research, using semi-structured qualitative interviews with a broad range of professional stakeholders identifies the public health elements needed to ensure that a hepatitis B cure can be accessed by all people with hepatitis B. Issues highlighted by the experience of hepatitis C cure access include preparatory work to reorientate policy settings, develop resourcing options, and the appropriateness of health service delivery models. While the form and complexity of curative hepatitis B interventions are to be determined, addressing current disparities in cascade of care figures is imperative with implementation models needing to respond to the cultural contexts, social implications, and health needs of people with hepatitis B, with cure endpoints and discourse being contested.
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Affiliation(s)
- Jack Wallace
- Burnet Institute, Melbourne, VIC 3004, Australia
- Australian Research Centre in Sex, Health and Society, Latrobe University, Bundoora, VIC 3083, Australia
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
- Correspondence: ; Tel.: +61-432850708
| | | | - Jessica Howell
- Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | | | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, Latrobe University, Bundoora, VIC 3083, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
| | - Peter A. Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
| | - Su Wang
- Center for Asian Health, Saint Barnabas Medical Center, RWJBarnabas-Rutgers Medical Group, Florham Park, NJ 07039, USA
| | - Mark Stoové
- Burnet Institute, Melbourne, VIC 3004, Australia
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, VIC 3004, Australia
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Wallace J, Xiao Y, Howell J, Thompson A, Allard N, Adamson E, Richmond J, Hajarizadeh B, Eagle M, Doyle J, Hellard M. Understanding how to live with hepatitis B: a qualitative investigation of peer advice for Chinese people living with hepatitis B in Australia. BMC Public Health 2022; 22:536. [PMID: 35303855 PMCID: PMC8932317 DOI: 10.1186/s12889-022-12907-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatitis B is a chronic viral infection, a leading cause of primary liver cancer and identified as a major public health priority by the World Health Organization. Despite a high proportion of people in Australia who have been diagnosed with hepatitis B, significant gaps remain in health care access and in accurate knowledge about hepatitis B. Most people with hepatitis B in Australia were born in China, where the infection has an intergenerational impact with significant social implications resulting from the infection. Understanding how people of Chinese ethnicity with hepatitis B understand and respond to hepatitis B is imperative for reducing morbidity, mortality, and the personal and social impact of the infection. METHODS Qualitative semi-structured interviews with people with hepatitis B of Chinese ethnicity recruited through a specialist service identified the advice people with hepatitis B thought was important enough to inform the experience of people newly diagnosed with hepatitis B. A thematic analysis of the data privileged the lived experience of participants and their personal, rather than clinical, explanations of the virus. RESULTS Hepatitis B infection had psychological and physical consequences that were informed by cultural norms, and to which people had responded to with significant behavioural change. Despite this cohort being engaged with specialist clinical services with access to the most recent, comprehensive, and expert information, much of the advice people with hepatitis B identified as important for living with hepatitis B was not based on biomedical understandings. Key suggestions from people with hepatitis B were to form sustainable clinical relationships, develop emotional resilience, make dietary changes, regulate energy, and issues related to disclosure. CONCLUSIONS The study highlights conflicts between biomedical and public health explanations and the lived experience of hepatitis B among people of Chinese ethnicity in Australia. Beliefs about hepatitis B are embedded within cultural understandings of health that can conflict with bio-medical explanations of the infection. Acknowledging these perspectives provides for insightful communication between health services and their clients, and the development of nuanced models of care informed by the experience of people with hepatitis B.
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Affiliation(s)
- Jack Wallace
- Burnet Institute, Melbourne, VIC, 3004, Australia. .,La Trobe University, Bundoora, VIC, 3086, Australia. .,Centre for Social Research in Health, University of New South Wales Sydney, Kensington, NSW, 2052, Australia.
| | - Yinzong Xiao
- Burnet Institute, Melbourne, VIC, 3004, Australia.,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, 3065, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jess Howell
- Burnet Institute, Melbourne, VIC, 3004, Australia.,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, 3065, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Alex Thompson
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, 3065, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia
| | - Nicole Allard
- World Health Organization Collaborating Centre for Viral Hepatitis, The Doherty Institute, Melbourne, VIC, 3004, Australia
| | | | - Jacqui Richmond
- Burnet Institute, Melbourne, VIC, 3004, Australia.,La Trobe University, Bundoora, VIC, 3086, Australia
| | - Behzad Hajarizadeh
- Kirby Institute, University of New South Wales Sydney, Kensington, NSW, 2052, Australia
| | | | - Joseph Doyle
- Burnet Institute, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, 3004, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, 3004, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, 3004, Australia
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Le Gautier R, Wallace J, Richmond JA, Pitts M. The personal and social impact of chronic hepatitis B: A qualitative study of Vietnamese and Chinese participants in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1420-1428. [PMID: 33064908 DOI: 10.1111/hsc.13197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 08/09/2020] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Abstract
This study explores the lived experiences of chronic hepatitis B (CHB) among Vietnamese and Chinese-born people living in Melbourne, Australia. The aims of this study were to investigate the personal and social implications of CHB, and the extent to which these implications, including experiences of stigma and marginalisation, affect individuals' overall quality of life. This study is based on individual semi-structured interviews with 37 Vietnamese and Chinese people with CHB in Australia (n = 22 and n = 15 respectively). The interviews were conducted between February 2015 and November 2016. Electronically recorded interviews of up to 1.5 hr were conducted, translated where necessary and transcribed verbatim. Transcripts were coded using NVivo, with coding themes guided by the principles of thematic analysis. Fundamental to most participants' accounts was the experience of living in constant fear of stigma and marginalisation, which participants unanimously attributed to prevailing misconceptions about hepatitis B-related transmission routes and disease outcomes. The accompanying experiences of social isolation-whether imposed upon themselves or by others-brought on additional feelings of shame and emotional pain, which had a profound impact on participants' overall quality of life. By exploring participants' lived experiences of hepatitis B, it became clear that concerns about the clinical implications related to hepatitis B as a biomedical infection make up only a small part of their experiences. Of particular significance were personal and social concerns around transmission, disclosure as well as the impact of stigma and marginalisation on participants and their families. Adopting a comprehensive multi-pronged response to tackle the multitude of complexities surrounding this infection among key affected communities will be more effective than just recognising the physical experience of the infection.
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Affiliation(s)
- Roslyn Le Gautier
- Palliative Nexus, Department of Medicine, University of Melbourne, Fitzroy, VIC, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne VIC, Australia
- Australian Research Centre in Sex, Health & Society, La Trobe University, Bundoora, VIC, Australia
| | - Jacqueline A Richmond
- Burnet Institute, Melbourne VIC, Australia
- Australian Research Centre in Sex, Health & Society, La Trobe University, Bundoora, VIC, Australia
| | - Marian Pitts
- Australian Research Centre in Sex, Health & Society, La Trobe University, Bundoora, VIC, Australia
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Brener L, Cama E, Broady T, Hopwood M, Treloar C. Comparing Australian health worker and student attitudes and concerns about providing care to people living with hepatitis B. Health Promot J Austr 2021; 33:282-288. [PMID: 33687771 DOI: 10.1002/hpja.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/04/2021] [Indexed: 01/02/2023] Open
Abstract
ISSUE ADDRESSED Hepatitis B (HBV) is a major public health issue with over 250 million people chronically infected worldwide. In Australia, prevalence is higher among migrant communities and these groups may be reticent to attend health care services due to concerns about experiencing stigma and discrimination. The way health workers perceive their clients, particularly those of migrant backgrounds, may influence the way they treat these clients and the quality of care provided. This study investigated and compared the attitudes and concerns health workers and health students have towards working with clients living with HBV. METHODS Health workers (n = 551) and students (n = 199) completed an online survey which investigated attitudes towards people living with HBV, comfort with providing care for these clients and concerns they have about working with them. RESULTS Health students expressed less comfort (U = 47 611, z = -2.73, P = .006) and reported more concerns about working with people with HBV than qualified health workers (U = 61611.50, z = 2.64, P = .008). Students' concerns were centred around their own ability to provide care rather than issues related to clients. There were no differences in overall attitudes towards people living with HBV between health workers and students. CONCLUSION To address concerns that health workers and students may have in working with people living with HBV, particularly those from migrant communities, and to ensure that health workers feel comfortable and confident, HBV workforce development should be included in undergraduate and postgraduate training programmes as well as in continuing professional education. SO WHAT?: This will assist the health workforce to develop competency in the treatment of people living with HBV, with the ultimate aim of providing best quality, non-judgemental care to all people living with HBV.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Elena Cama
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Tim Broady
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Max Hopwood
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
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