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Downs LO, Kabagambe K, Williams S, Waddilove E, Delphin M, Lumley SF, Ndungutse R, Kimono B, Newton R, Ko J, Martyn E, Carter J, Kemper A, Monteiro F, O'Regan S, Surey J, Sultan B, Story A, MacDonald D, Tu T, Seeley J, Dusheiko G, Maponga T, Andersson MI, Spearman CW, Tucker JD, Cohen C, Wang S, Adda D, Freeland C, Halford R, Jack K, Ghosh I, Elsharkawy AM, Matthews PC, Flanagan S. Peer support for people living with hepatitis B virus-A foundation for treatment expansion. J Viral Hepat 2024; 31:490-499. [PMID: 38798022 DOI: 10.1111/jvh.13952] [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: 10/30/2023] [Revised: 03/04/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024]
Abstract
Chronic hepatitis B infection (CHB) affects 300 million people worldwide and is being targeted by the United Nations 2030 Sustainable Development Goals (SDGs) and the World Health Organisation (WHO), working towards elimination of hepatitis B virus (HBV) as a public health threat. In this piece, we explore the evidence and potential impact of peer support to enhance and promote interventions for people living with CHB. Peer support workers (PSWs) are those with lived experience of an infection, condition or situation who work to provide support for others, aiming to improve education, prevention, treatment and other clinical interventions and to reduce the physical, psychological and social impacts of disease. Peer support has been shown to be a valuable tool for improving health outcomes for people living with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), but to date has not been widely available for communities affected by HBV. HBV disproportionately affects vulnerable and marginalised populations, who could benefit from PSWs to help them navigate complicated systems and provide advocacy, tackle stigma, improve education and representation, and optimise access to treatment and continuity of care. The scale up of peer support must provide structured and supportive career pathways for PSWs, account for social and cultural needs of different communities, adapt to differing healthcare systems and provide flexibility in approaches to care. Investment in peer support for people living with CHB could increase diagnosis, improve retention in care, and support design and roll out of interventions that can contribute to global elimination goals.
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Affiliation(s)
- Louise O Downs
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kenneth Kabagambe
- The National Organization for People Living with Hepatitis B (NOPLHB), Kampala, Uganda
| | | | | | | | - Sheila F Lumley
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Robert Newton
- Uganda Virus Research Institute, Entebbe, Uganda
- Department of Health Sciences, University of York, York, UK
| | - Joy Ko
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
| | - Emily Martyn
- London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Diseases, University College London Hospitals, London, UK
| | - Jessica Carter
- The Institute for Infection and Immunity, St George's University of London, London, UK
| | - Agnieszka Kemper
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
| | - Fernando Monteiro
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
| | - Sive O'Regan
- Find and Treat, University College London Hospitals, London, UK
| | - Julian Surey
- Find and Treat, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
| | - Binta Sultan
- Department of Infectious Diseases, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
| | - Alistair Story
- Find and Treat, University College London Hospitals, London, UK
| | - Douglas MacDonald
- Department of Hepatology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Thomas Tu
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Sydney Infectious Diseases Institute, The University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
- HepBCommunity.org, Sydney, New South Wales, Australia
- Hepatitis B Voices Australia, Melbourne, Victoria, Australia
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Geoffrey Dusheiko
- Department of Hepatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Tongai Maponga
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Cape Town, South Africa
| | - Monique I Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Su Wang
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
- Cooperman Barnabas Medical Center, Florham Park, New Jersey, USA
| | - Danjuma Adda
- World Hepatitis Alliance, London, UK
- CFID/CCT Taraba, Tarabba, Nigeria
| | | | - Rachel Halford
- World Hepatitis Alliance, London, UK
- The Hepatitis C Trust, London, UK
| | - Kathryn Jack
- Hepatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Indrajit Ghosh
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
- Find and Treat, University College London Hospitals, London, UK
| | - Ahmed M Elsharkawy
- Liver Unit and National Institute for Health Research Biomedical Research Centre at the University Hospitals Birmingham, University of Birmingham, Birmingham, UK
| | - Philippa C Matthews
- The Francis Crick Institute, London, UK
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
- Department of Infectious Diseases, University College London Hospitals, London, UK
| | - Stuart Flanagan
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
- Department of Infectious Diseases, University College London Hospitals, London, UK
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Ibrahim Y, Zovich B, Ansah B, Freeland C, Jackson M, Tu T, Cohen C. Quality of life of people living with chronic hepatitis B: The role of social support system. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003103. [PMID: 38669220 PMCID: PMC11051608 DOI: 10.1371/journal.pgph.0003103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
People living with chronic hepatitis B (PLCHB) are recommended to follow a lifelong monitoring regimen and face increased risk of liver cancer. Additionally, PLCHB frequently encounter stigma and discrimination, and relationship disruptions because of their chronic hepatitis B (CHB). Social support plays a key role in coping with chronic illnesses; however, this is inadequately assessed for PLCHB. This study aims to assess the physical, social, and mental impacts of living with CHB, the strategies PLCHB utilize to cope with their disease, and how social support-or lack of-impacts their journey with hepatitis B. The study was promoted through the Hepatitis B Foundation social media platforms, interested individuals filled-in a form expressing their interest to participate. The researcher conducted 24 telephone interviews in English, with PLCHB ≥18 years of age residing in the United States (U.S.) and Canada. Questions focused on the lived experiences of CHB and explored social support mechanisms that helped PLCHB. PLCHB experience a wide range of impacts (physical, social, and mental) that negatively affect their quality of life. Participants reported that receiving social support from their close network of individuals, hepatitis B community, or healthcare providers positively influenced their perspective on their future health and helped them adhere to treatment. The physical, social, and mental impacts of living with hepatitis B significantly affect the quality of life of PLCHB, calling for more research to document these impacts, and design integrated care models to address them. Social support appears to play an essential role in helping PLCHB cope with their disease and should be further studied.
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Affiliation(s)
- Yasmin Ibrahim
- Hepatitis B Foundation, Doylestown, Pennsylvania, United States of America
| | - Beatrice Zovich
- Hepatitis B Foundation, Doylestown, Pennsylvania, United States of America
| | - Bright Ansah
- Hepatitis B Foundation, Doylestown, Pennsylvania, United States of America
| | - Catherine Freeland
- Hepatitis B Foundation, Doylestown, Pennsylvania, United States of America
| | - Michaela Jackson
- Hepatitis B Foundation, Doylestown, Pennsylvania, United States of America
| | - Thomas Tu
- Storr Liver Centre, Westmead Clinical School and Westmead Institute for Medical Research, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Sydney Institute for Infectious Diseases, University of Sydney at Westmead Hospital, Westmead, Australia
- HepBCommunity.org, Sydney, Australia
| | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, United States of America
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Natour RT, Midlej A, Mahajna E, Kopelman Y, Abo-Mouch S, Baker FA. Chronic hepatitis B beyond clinical burden: Psychosocial effects and impact on quality of life. J Viral Hepat 2024; 31:12-20. [PMID: 37920135 DOI: 10.1111/jvh.13894] [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] [Received: 05/13/2023] [Revised: 09/14/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
Chronic hepatitis B (CHB) infection has far-reaching implications for patients' quality of life (QOL), regardless of cirrhosis or complications. However, limited research exists on the psychosocial impact of CHB, particularly in asymptomatic, noncirrhotic patients. Noncirrhotic CHB patients without comorbidities affecting QOL were evaluated in hepatology clinics. Patients underwent a standardized interview and completed the Short Form-12 (SF-12) questionnaire. Multiple social and psychological parameters were compared between patients receiving chronic treatment and untreated controls with HBeAg-negative chronic infections. A total of 41 CHB patients were included in the study, with 41% in the treatment group and 59% in the control group. Both groups showed a male predominance, and their average age, ethnic distribution and family status were comparable. High unemployment rates and discrimination at work due to HBV status were prevalent, with many patients feeling their career choices were influenced by HBV, particularly among untreated patients. Treated patients reported significantly lower scores in general health perception (41% vs. 13%; p = .06) and limitation of usual activity secondary to CHB (29% vs. 0%; p = .008), resulting in a substantial impact on overall health-related QOL. This study highlights the psychosocial implications of CHB in asymptomatic, noncirrhotic patients, underscoring the importance of comprehensive support and increased awareness. Additionally, addressing challenges related to long-term treatment, such as adherence and cost, may have the potential to improve patient well-being and outcomes.
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Affiliation(s)
- Randa Taher Natour
- Department of Internal Medicine, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
- Department of gastroenterology and hepatology, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Amir Midlej
- Medicine faculty of the Technion Faculty of Medicine, Haifa, Israel
| | - Elisabeth Mahajna
- Department of gastroenterology and hepatology, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Yael Kopelman
- Department of gastroenterology and hepatology, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Saif Abo-Mouch
- Department of Internal Medicine, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Fadi Abu Baker
- Department of gastroenterology and hepatology, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
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Lanyo TN, Adjei CA, Ani-Amponsah M. Informational and Practical Needs of Expectant Mothers with Chronic Hepatitis B in Ghana. SAGE Open Nurs 2024; 10:23779608241255183. [PMID: 38828400 PMCID: PMC11141223 DOI: 10.1177/23779608241255183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 03/24/2024] [Accepted: 04/28/2024] [Indexed: 06/05/2024] Open
Abstract
Hepatitis B virus infection is a global public health problem with disproportionately high endemicity in Africa and Ghana. The current national prevalence of hepatitis B among pregnant women in Ghana stands at 7.44%, highlighting the considerable threat of chronic hepatitis B on pregnant women and their general well-being. The study explored the informational and practical needs of pregnant women with chronic hepatitis B in Ghana. Fourteen pregnant women were selected purposefully using the exploratory descriptive qualitative design. Data were analyzed using thematic analysis. The findings showed that pregnant women with chronic hepatitis B lacked knowledge about the infection and were in great need of hepatitis B-related information. The study also revealed significant financial implications for treating the infection, necessitating policy reforms and stakeholder actions. To achieve effective coping, better health-seeking, and health-promoting behaviors for better health outcomes, it is crucial to provide targeted care that comprehensively covers the specific needs of pregnant women with chronic hepatitis B. It is also essential to consider including hepatitis B management in the National Health Insurance package to improve care quality.
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Affiliation(s)
- Theresa Norpeli Lanyo
- Department of Women and Children, University of Ghana Medical Centre, Accra, Greater Accra, Ghana
| | - Charles Ampong Adjei
- Department of Public Health Nursing, University of Ghana, School of Nursing and Midwifery, Legon, Greater Accra, Ghana
| | - Mary Ani-Amponsah
- Department of Maternal and Child Health, University of Ghana, School of Nursing and Midwifery, Legon, Greater Accra, Ghana
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Adekanle O, Komolafe AO, Ijarotimi O, Olowookere AS, Ndububa DA. Gender disparity and stigma experience of patients with chronic hepatitis B virus infection: A prospective cross-sectional study from a hospital in Nigeria. J Infect Prev 2022; 23:263-268. [PMID: 36277856 PMCID: PMC9583437 DOI: 10.1177/17571774221127546] [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: 02/05/2020] [Accepted: 06/13/2022] [Indexed: 11/03/2023] Open
Abstract
Backgound Hepatitis B virus (HBV) infected persons often suffer stigma. Stigma can come from the society or be self-induced. This study assessed the gender differences and stigma experience of patients with HBV. Methods Prospective cross-sectional design with a qualitative element using a pretested interviewer administered questionnaire and an in-depth oral interview of HBV infected patients. Quantitative data obtained were entered into SPSS version 20 and analyzed using simple descriptive and inferential statistics, while content analysis was used for the qualitative data. Results Total of 242 respondents answered the quantitative questionnaire. There were 142(58.7%) males and 100 (41.3%) females; age range was 18-72 years with mean (SD) of 35.4(10.7) years. Overall stigma rate was 23.1%. Stigma resulted from a positive HBsAg test, and the experience was unaffected by other markers of HBV infection. Stigma was higher in the domain of disease transmission for both single and married respondents and was particularly higher among males than females. Stigma among females affected pre-marital engagements and also caused marital disharmony among married respondents. In-depth oral interview of 23 HBV infected respondents revealed that many exhibited self-stigma, had wrong knowledge of HBV infection modes, complications, and interpretation of HBV internet information which aggravated stigma reactions. Conclusions Stigma of HBV is high and majorly in the domain of disease transmission. It is higher in males than females. Enlightenment campaign targeting singles and married couples and HBV infection modes is advocated.
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Affiliation(s)
- Olusegun Adekanle
- 54715Obafemi Awolowo University and Obafemi Awolowo
University Teaching Hospitals, Ile-Ife, Nigeria
| | | | - Oluwasegun Ijarotimi
- 54715Obafemi Awolowo University and Obafemi Awolowo
University Teaching Hospitals, Ile-Ife, Nigeria
| | - Anu Samuel Olowookere
- 54715Obafemi Awolowo University and Obafemi Awolowo
University Teaching Hospitals, Ile-Ife, Nigeria
| | - Dennis A Ndububa
- 54715Obafemi Awolowo University and Obafemi Awolowo
University Teaching Hospitals, Ile-Ife, Nigeria
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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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Kolbila L, Adjei CA, Kyei JM, Agyemang-Prempeh C, Fosu PK. Perceived Supportive Care Needs of Adolescents With Chronic Hepatitis B in a Resource-limited Setting. J Patient Exp 2022; 9:23743735221106596. [PMID: 35694016 PMCID: PMC9185008 DOI: 10.1177/23743735221106596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In Ghana, adolescents are disproportionately affected by hepatitis B. However, studies
into adolescents’ supportive care needs are lacking. The purpose of this exploratory
qualitative study was to explore the supportive care needs of 18 adolescents with chronic
hepatitis B who were receiving care at a tertiary hospital in Ghana. The data were
processed using QSR Nvivo version 11.0 and analyzed using the Braun and Clarke procedure
for thematic data analysis. According to the findings, adolescents with chronic hepatitis
B have unmet supportive care needs ranging from information to financial need,
psychological support, and social support. Explicitly, participants reportedly had a
dilemma as to whether to keep or terminate their pregnancy to prevent transmission of the
virus to their newborns. Physicians and nurses were perceived to be preoccupied with
medication prescription and laboratory request writing rather than giving pretest and
posttest counseling following diagnosis. This study highlights the need to have a
tailor-made liver care for adolescents. Pretest and posttest counseling for adolescents
with hepatitis B are also required.
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Affiliation(s)
| | | | - Josephine M Kyei
- School of Nursing and Midwifery, University of Ghana, Accra, Ghana
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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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Cama E, Brener L, Broady T, Hopwood M, Treloar C. Australian health and medical workers' concerns around providing care to people living with hepatitis B. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e431-e439. [PMID: 33825261 DOI: 10.1111/hsc.13368] [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: 05/25/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
There is established literature on health workers' attitudes towards working with people living with stigmatised health conditions and behaviours, such as HIV, hepatitis C and injecting drug use. Less is known about health workers' attitudes and concerns around providing care to people living with hepatitis B virus (HBV), which is concerning as research indicates that negative attitudes may impact on the quality of care provided to these populations, with adverse health outcomes for clients. The aim of this paper is to examine health and medical workers' concerns about providing care to people living with HBV, and the factors that may influence these concerns. Australian health and medical workers (n = 551) completed an online survey measuring their concerns about providing care to people living with HBV, stigmatising attitudes towards this group, perceived comfort of themselves and colleagues in providing care towards clients with HBV, and witnessing their colleagues behaviour in a discriminatory way towards clients with HBV. Multiple regression was used to ascertain factors predictive of health workers' concerns about working with clients with HBV. Results showed that older participants and those who had spent less time working in the health and medical field had greater concerns about caring for people living with HBV. Workers who did not know someone living with HBV, who were less comfortable around clients with HBV, who perceived their colleagues to be less comfortable working with clients with HBV, and who had more negative attitudes towards this group also had greater concerns around providing care to people living with HBV. Efforts should be made to improve health and medical workers' attitudes towards working with people with HBV. This may also improve workers' level of comfort with people with HBV and reduce the reported reticence they have towards working with this client group.
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Loren Brener
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Timothy 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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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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12
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Kumar P, Freeland C, Bodor S, Farrell S, Cohen C, Frasso R. Needs of Individuals Living With Hepatitis Delta Virus and Their Caregivers, 2016-2019. Prev Chronic Dis 2020; 17:E159. [PMID: 33337297 PMCID: PMC7769086 DOI: 10.5888/pcd17.200324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Hepatitis delta virus (HDV) is a serious coinfection of the hepatitis B virus (HBV) that is estimated to affect between 48 to 72 million people worldwide. Data are limited on the informational needs of people living with HDV. The Hepatitis B Foundation, a US-based nonprofit organization that provides support to people living with HBV and HDV, receives emails (queries) as part of a helpline, a service to provide information, resources, and support to people affected by HBV and HDV. Methods Query content was analyzed to assess the impact of HDV at the individual level. A total of 65 HDV-related queries from 17 countries were received from October 2016 to January 2019, and all were analyzed for this study. Results Thematic analysis of queries indicated 4 dominant themes. Three were related to a need for information about 1) the disease and prevention of it, 2) disease symptoms and outcomes, and 3) treatment options. The fourth theme was related to barriers and quality of life. Individuals requested information on treatment options, medication access, diagnostic test interpretation, and clinical trials. Conclusion Our study highlights the needs and lived experience of patients with HDV and summarizes critical information gaps. Findings can inform health care providers, public health professionals, and the pharmaceutical and biotechnology industries about the informational needs and lived experiences of individuals living with HDV and help create future HDV-related educational resources, care, and clinical trials.
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Affiliation(s)
- Priyanka Kumar
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.,Jefferson College of Population Health, Philadelphia, Pennsylvania.,101 The City Drive S, Suite 400, Orange, CA 92868.
| | - Catherine Freeland
- Jefferson College of Population Health, Philadelphia, Pennsylvania.,Hepatitis B Foundation, Doylestown, Pennsylvania
| | - Sierra Bodor
- Hepatitis B Foundation, Doylestown, Pennsylvania
| | - Sean Farrell
- Jefferson College of Population Health, Philadelphia, Pennsylvania.,Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania
| | - Rosemary Frasso
- Jefferson College of Population Health, Philadelphia, Pennsylvania
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13
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Adekanle O, Komolafe AO, Olowookere SA, Ijarotimi O, Ndububa DA. Hepatitis B Infection: A Mixed Methods of Disclosure Pattern and Social Problems in the Nigerian Family. J Patient Exp 2020; 7:208-216. [PMID: 32851142 PMCID: PMC7427354 DOI: 10.1177/2374373519827965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Hepatitis B virus (HBV) infection has a high prevalence rate in Nigeria. Disclosure of infection status to close partner and the public attracts support for infected people. This study looks at disclosure and social challenges of infected persons. Methods Mixed methods of patients' administered questionnaire and an in-depth interview conducted on HBV-infected respondents in a hospital in Nigeria were used. The study recruited all participants who satisfied the inclusion criteria. Data were entered into SPSS version 20 and analyzed using simple and inferential statistics and content analysis for the in-depth interview. Results A total of 205 participants completed the questionnaire study. Mean (standard deviation) age was 35.3 (±11.0) years. There were 121 married, 37 singles with noncohabiting partners and 47 singles without partners with disclosure rates being 96.7% versus 97.9% versus 89.2%, respectively. Singles disclosed infection more to their parents while married respondents disclosed infection more to their spouses. Singles had high rate of denial of sexual relationship (22.6%), emotional trauma (34.5%), broken relationships (11.4%), and surreptitious use of contraception for protection (67.6%). Married respondents had the highest rate of HBV vaccination of their family members (40.1%). Infection prevention and allaying fears of family members were their counseling needs. In-depth interview revealed that infected respondents usually expressed shock and depression at a positive test leading to fear and deception that put close associates at risk. Conclusion Hepatitis B virus-infected respondents have high rate of disclosure. Family problems of these people can therefore be solved through public enlightenment and individual counseling.
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Affiliation(s)
- Olusegun Adekanle
- Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
- Olusegun Adekanle, Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolwo University, Ile-Ife, Osun State, Nigeria.
| | - Akinwumi Oluwole Komolafe
- Department of Morbid Anatomy, Faculty of Basic Medical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Samuel A Olowookere
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Oluwasegun Ijarotimi
- Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Dennis Amajuoyi Ndububa
- Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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14
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Adjei CA, Stutterheim SE, Naab F, Ruiter RAC. "To die is better than to tell": reasons for and against disclosure of chronic hepatitis B status in Ghana. BMC Public Health 2020; 20:663. [PMID: 32398150 PMCID: PMC7216649 DOI: 10.1186/s12889-020-08811-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/29/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People with a condition subject to stigmatisation, such as chronic hepatitis B, face the dilemma of whether or not to disclose their status. In Ghana, 12.3% of the adult population has the hepatitis B virus (HBV). One key strategy for breaking the cycle of hepatitis B transmission is the disclosure of hepatitis B status by people with chronic hepatitis B (PWHB). Disclosure can facilitate preventive actions to reduce hepatitis B transmission (e.g., not sharing personal items and avoiding contact with blood and body fluids). Disclosure can also motivate family members of PWHB to get tested, linked to care and clinically managed in order to reduce the progression of hepatitis B to liver cirrhosis and cancer. Given the importance of disclosure, we set out to explore reasons for and against disclosure of chronic hepatitis B status in the Greater Accra and Upper East region of Ghana. METHODS In this exploratory qualitative study, 18 participants (10 from the Greater Accra region and 8 from the Upper East region) were recruited for semi-structured interviews. Interviews were recorded and transcribed verbatim. Data were then processed using QSR Nvivo version 10.0 and analysed for themes. RESULTS Participants were selective disclosers, disclosing in some contexts and not in others. Reasons for non-disclosure of chronic hepatitis B status were: 1) fear of stigmatisation and 2) previous negative experiences with disclosure. Reasons for disclosure were: 1) wanting close contacts to get tested or vaccinated, 2) trusting the disclosure target(s), and 3) needing social and/or financial support. CONCLUSIONS Our findings highlight various reasons for and against disclosure of chronic hepatitis B status in Ghana. Because anticipated, observed, and experienced stigma were important motivations for non-disclosure of chronic hepatitis B status, we recommend the development and implementation of theory and evidence-based stigma reduction interventions that are culturally appropriate, and that prioritize the participation of target populations. We also recommend the provision of counselling and support services that assist PWHB in their disclosure decision-making processes.
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Affiliation(s)
- Charles Ampong Adjei
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands.
- Department of Community Health Nursing, University of Ghana, Accra, Ghana.
| | - Sarah E Stutterheim
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
| | - Florence Naab
- Department of Maternal and Child Health, University of Ghana, Accra, Ghana
| | - Robert A C Ruiter
- Department of Maternal and Child Health, University of Ghana, Accra, Ghana
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15
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The Lived Experience of Chronic Hepatitis B: A Broader View of Its Impacts and Why We Need a Cure. Viruses 2020; 12:v12050515. [PMID: 32392763 PMCID: PMC7290920 DOI: 10.3390/v12050515] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic hepatitis B (CHB) is one of the most widespread liver diseases in the world. It is currently incurable and can lead to liver cirrhosis and cancer. The considerable impacts on society caused by CHB through patient mortality, morbidity, and economic loss are well-recognised in the field. This is, however, a narrow view of the harms, given that people living with CHB can be asymptomatic for the majority of their life-long infection. Of less-appreciated importance are the psychosocial harms, which can continue throughout an affected person's lifetime. Here we review the broad range of these impacts, which include fear and anxiety; financial loss and instability; stigma and discrimination; and rejection by society. Importantly, these directly affect patient diagnosis, management, and treatment. Further, we highlight the roles that the research community can play in taking these factors into account and mitigating them. In particular, the development of a cure for hepatitis B virus infection would alleviate many of the psychosocial impacts of CHB. We conclude that there should be a greater recognition of the full impacts associated with CHB to bring meaningful, effective, and deliverable results to the global community living with hepatitis B.
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16
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Smith-Palmer J, Cerri K, Sbarigia U, Chan EKH, Pollock RF, Valentine WJ, Bonroy K. Impact of Stigma on People Living with Chronic Hepatitis B. PATIENT-RELATED OUTCOME MEASURES 2020; 11:95-107. [PMID: 32214859 PMCID: PMC7082540 DOI: 10.2147/prom.s226936] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/14/2020] [Indexed: 12/17/2022]
Abstract
Background People with chronic infectious diseases such as hepatitis B can face stigma, which can influence everyday life as well as willingness to engage with medical professionals or disclose disease status. A systematic literature review was performed to characterize the level and type of stigma experienced by people infected with hepatitis B virus (HBV) as well as to identify instruments used to measure it. Methods A literature review was performed using the PubMed, Embase and Cochrane Library databases to identify studies describing HBV-related stigma. For inclusion, articles were required to be published in full-text form, in English and report quantitative or qualitative data on HBV-related stigma that could be extracted. Results A total of 23 (17 quantitative and 6 qualitative) articles examined HBV-related stigma. The scope of the review was global but nearly all identified studies were conducted in countries in the WHO Southeast Asia or Western Pacific regions or within immigrant communities in North America. Several quantitative studies utilized tools specifically designed to assess aspects of stigma. Qualitative studies were primarily conducted via patient interviews. Internalized and social stigma were common among people living with chronic HBV . Some people also perceived structural/institutional stigma, with up to 20% believing that they may be denied healthcare and up to 30% stating they may experience workplace discrimination due to HBV. Conclusion HBV-related stigma is common, particularly in some countries in Southeast Asia and the Western Pacific region and among Asian immigrant communities, but is poorly characterized in non-Asian populations. Initiatives are needed to document and combat stigma (particularly in settings/jurisdictions where it is poorly described) as well as its clinical and socioeconomic consequences.
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17
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Adjei CA, Stutterheim SE, Naab F, Ruiter RAC. Barriers to chronic Hepatitis B treatment and care in Ghana: A qualitative study with people with Hepatitis B and healthcare providers. PLoS One 2019; 14:e0225830. [PMID: 31794577 PMCID: PMC6890212 DOI: 10.1371/journal.pone.0225830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hepatitis B viral (HBV) infection remains an important public health concern particularly in Africa. Between 1990 and 2013, Hepatitis B mortality increased by 63%. In recent times, effective antiviral agents against HBV such as Nucleos(t)ide analogs (NAs) are available. These drugs are capable of suppressing HBV replication, preventing progression of chronic Hepatitis B to cirrhosis, and reducing the risk of hepatocellular carcinoma and liver-related death. Notwithstanding, these treatments are underused despite their effectiveness in managing Hepatitis B. This study sought to explore barriers to treatment and care for people with Hepatitis B (PWHB) in Ghana, paying particular attention to beliefs about aetiology that can act as a barrier to care for PWHB. METHODS We used an exploratory qualitative design with a purposive sampling technique. Face-to-face interviews were conducted for 18 persons with Hepatitis B (PWHB) and 15 healthcare providers (HCP; physicians, nurses, and midwives). In addition, four focus group discussions (FGD) with a composition of eight HCPs in each group were done. Participants were recruited from one tertiary and one regional hospital in Ghana. Data were processed using QSR Nvivo version 10.0 and analysed using the procedure of inductive thematic analysis. Participants were recruited from one tertiary and one regional hospital in Ghana. RESULTS Three main cultural beliefs regarding the aetiology of chronic Hepatitis B that act as barriers to care and treatment were identified. These were: (1) the belief that chronic Hepatitis B is a punishment from the gods to those who touch dead bodies without permission from their landlords, (2) the belief that bewitchment contributes to chronic Hepatitis B, and (3) the belief that chronic Hepatitis B is caused by spiritual poison. Furthermore, individual level barriers were identified. These were the absence of chronic Hepatitis B signs and symptoms, perceived efficacy of traditional herbal medicine, and PWHB's perception that formal care does not meet their expectations. Health system-related barriers included high cost of hospital-based care and inadequate Hepatitis B education for patients from HCPs. CONCLUSION Given that high cost of hospital based care was considered an important barrier to engagement in care for PWHB, we recommend including the required Hepatitis B laboratory investigations such as viral load, and the recommended treatment in the National Health Insurance Scheme (NHIS). Also, we recommend increasing health care providers and PWHB Hepatitis B knowledge and capacity in a culturally sensitive fashion, discuss with patients (1) myths about aetiology and the lack of efficacy of traditional herbal medicines, and (2) patients' expectations of care and the need to monitor even in the absence of symptoms.
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Affiliation(s)
- Charles Ampong Adjei
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
- School of Nursing and Midwifery University of Ghana, Accra, Ghana
- * E-mail:
| | - Sarah E. Stutterheim
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
| | - Florence Naab
- School of Nursing and Midwifery University of Ghana, Accra, Ghana
| | - Robert A. C. Ruiter
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
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18
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Adjei CA, Stutterheim SE, Naab F, Ruiter RAC. Chronic Hepatitis B stigma in Ghana: a qualitative study with patients and providers. BMJ Open 2019; 9:e025503. [PMID: 31248915 PMCID: PMC6597648 DOI: 10.1136/bmjopen-2018-025503] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study explored beliefs contributing to Hepatitis B stigma, and the ways in which Hepatitis B stigma manifests, from the perspectives of people with chronic Hepatitis B as well as healthcare providers in Northern and Southern Ghana. DESIGN We used an exploratory qualitative design with a purposive sampling technique. Face-to-face interviews and focus group discussions were conducted. Data were processed using QSR Nvivo V.10.0 and analysed using inductive thematic analysis. SETTINGS Participants were recruited from one tertiary and one regional hospital in Ghana between February and November 2017. PARTICIPANTS Overall, 18 people with chronic Hepatitis B (PWHB) and 47 healthcare providers (primary care physicians, nurses and midwives) between the ages of 21 and 57 years participated in the study. RESULTS PWHB face stigma in their sociocultural context and the healthcare environment. Three main beliefs underlying stigma were found: (1) the belief that Hepatitis B is highly contagious; (2) the belief that Hepatitis B is very severe and (3) the belief that Hepatitis B is caused by curses. Stigmatisation manifested as avoidance and social isolation (discrimination). In healthcare settings, stigmatisation manifested as excessive cautiousness, procedure postponement or avoidance, task-shifting and breaches of confidentiality. CONCLUSIONS Given the prevalence of incorrect knowledge, as reflected in the beliefs about Hepatitis B, we recommend public awareness campaigns that emphasise Hepatitis B transmission routes. Also, given the manifestations of the stigma in healthcare settings, we recommend the development and implementation of a continuing professional development programme on Hepatitis B and adjusted policy on Hepatitis B vaccination for Healthcare providers (HCPs).
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Affiliation(s)
- Charles Ampong Adjei
- Community Health Nursing Department, University of Ghana, Accra, Ghana
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Sarah E Stutterheim
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Florence Naab
- Department of Maternal and Child Health, University of Ghana, Accra, Ghana
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
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19
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Mokaya J, McNaughton AL, Burbridge L, Maponga T, O'Hara G, Andersson M, Seeley J, Matthews PC. A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection - A systematic review. Wellcome Open Res 2018; 3:29. [PMID: 30483598 PMCID: PMC6234740 DOI: 10.12688/wellcomeopenres.14273.2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Stigma, poverty, and lack of knowledge present barriers to the diagnosis and treatment of chronic infection, especially in resource-limited settings. Chronic Hepatitis B virus (HBV) infection is frequently asymptomatic, but accounts for a substantial long-term burden of morbidity and mortality. In order to improve the success of diagnostic, treatment and preventive strategies, it is important to recognise, investigate and tackle stigma. We set out to assimilate evidence for the nature and impact of stigma associated with HBV infection, and to suggest ways to tackle this challenge. Methods: We carried out a literature search in PubMed using the search terms ‘hepatitis B’, ‘stigma’ to identify relevant papers published between 2007 and 2017 (inclusive), with a particular focus on Africa. Results: We identified a total of 32 articles, of which only two studies were conducted in Africa. Lack of knowledge of HBV was consistently identified, and in some settings there was no local word to describe HBV infection. There were misconceptions about HBV infection, transmission and treatment. Healthcare workers provided inaccurate information to individuals diagnosed with HBV, and poor understanding resulted in lack of preventive measures. Stigma negatively impacted on help-seeking, screening, disclosure, prevention of transmission, and adherence to treatment, and had potential negative impacts on mental health, wellbeing, employment and relationships. Conclusion: Stigma is a potentially major barrier to the successful implementation of preventive, diagnostic and treatment strategies for HBV infection, and yet we highlight a ‘blind spot’, representing a lack of data and limited recognition of this challenge. There is a need for more research in this area, to identify and evaluate interventions that can be used effectively to tackle stigma, and to inform collaborative efforts between patients, clinical services, policy makers, traditional healers, religious leaders, charity organisations and support groups.
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Affiliation(s)
- Jolynne Mokaya
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Anna L McNaughton
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Lela Burbridge
- Department of Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tongai Maponga
- Department of Virology, University of Stellenbosch, Tygerberg Hospital, Bellville, Cape Town , 7500, South Africa
| | - Geraldine O'Hara
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, 51/59 Nakiwogo Rd, Entebbe, Uganda
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK.,Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
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20
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Mokaya J, McNaughton AL, Burbridge L, Maponga T, O'Hara G, Andersson M, Seeley J, Matthews PC. A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection - A systematic review. Wellcome Open Res 2018; 3:29. [PMID: 30483598 DOI: 10.12688/wellcomeopenres.14273.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Stigma, poverty, and lack of knowledge present barriers to the diagnosis and treatment of chronic infection, especially in resource-limited settings. Chronic Hepatitis B virus (HBV) infection is frequently asymptomatic, but accounts for a substantial long-term burden of morbidity and mortality. In order to improve the success of diagnostic, treatment and preventive strategies, it is important to recognise, investigate and tackle stigma. We set out to assimilate evidence for the nature and impact of stigma associated with HBV infection, and to suggest ways to tackle this challenge. Methods: We carried out a literature search in PubMed using the search terms 'hepatitis B', 'stigma' to identify relevant papers published between 2007 and 2017 (inclusive), with a particular focus on Africa. Results: We identified a total of 32 articles, of which only two studies were conducted in Africa. Lack of knowledge of HBV was consistently identified, and in some settings there was no local word to describe HBV infection. There were misconceptions about HBV infection, transmission and treatment. Healthcare workers provided inaccurate information to individuals diagnosed with HBV, and poor understanding resulted in lack of preventive measures. Stigma negatively impacted on help-seeking, screening, disclosure, prevention of transmission, and adherence to treatment, and had potential negative impacts on mental health, wellbeing, employment and relationships. Conclusion: Stigma is a potentially major barrier to the successful implementation of preventive, diagnostic and treatment strategies for HBV infection, and yet we highlight a 'blind spot', representing a lack of data and limited recognition of this challenge. There is a need for more research in this area, to identify and evaluate interventions that can be used effectively to tackle stigma, and to inform collaborative efforts between patients, clinical services, policy makers, traditional healers, religious leaders, charity organisations and support groups.
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Affiliation(s)
- Jolynne Mokaya
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Anna L McNaughton
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Lela Burbridge
- Department of Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tongai Maponga
- Department of Virology, University of Stellenbosch, Tygerberg Hospital, Bellville, Cape Town , 7500, South Africa
| | - Geraldine O'Hara
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, 51/59 Nakiwogo Rd, Entebbe, Uganda
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK.,Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
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21
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Valizadeh L, Zamanzadeh V, Zabihi A, Negarandeh R, Jafarian Amiri SR. Qualitative study on the experiences of hepatitis B carriers in coping with the disease. Jpn J Nurs Sci 2018; 16:194-201. [PMID: 30088344 DOI: 10.1111/jjns.12229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 11/23/2017] [Accepted: 05/29/2018] [Indexed: 12/28/2022]
Abstract
AIM Hepatitis is a systemic infection that causes restrictions in the life of many patients due to its chronic nature and it necessitates the use of coping strategies to improve the quality of life. This study aims to demonstrate the experiences of hepatitis B carriers in coping with the disease. METHODS The present study was conducted by using a qualitative content analysis. The data were collected through 18 unstructured and in-depth interviews from 2014 to 2016 at medical centers, a gastrointestinal and liver diseases research center in the cities of Babol and Amol (northern Iran) and Tabriz (north-western Iran) with patients infected with hepatitis B. The study was carried out by using purposive sampling. RESULTS The data analysis led to the extraction of the main theme, "attempting an active expansion of interactions," and its three subthemes, including: "denial of the disease," "protecting oneself or others," and "coping with the disease." CONCLUSION Patients with hepatitis B use different strategies to cope with this disease. In order for patients to properly face the disease and to live with minimum challenges and limitations, they need to be suitably understood and supported. Therefore, consideration of education and consultation programs regarding the different aspects of this disease is urgent.
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Affiliation(s)
- Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Zabihi
- Department of Nursing, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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22
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Abstract
The social stigma in patients with hepatitis B virus infection has caused several complications for both the patients and the associated medical system. This study aimed at demonstrating the social stigma experienced by these patients in Iran. This is a qualitative study using a content analysis approach with references to primary and secondary sources. The data were collected through 15 unstructured and in-depth interviews conducted in 2014. By analyzing the data, two main themes were noted: extrinsic concepts of social stigma (causing reprehension, embarrassment, and discrimination) and intrinsic concepts of social stigma (sense of rejection, isolation, and frustration). The analysis of participants' experiences showed that social stigma is a simple lack of knowledge among the patients and society and it is more intense in the first days after the diagnosis. Stigma is prevalent among patients with hepatitis B virus, causes them to hide the disease, and provokes various complications for them as well as society. This study emphasizes the necessity of implementing health education programs about hepatitis B and its associated stigma, especially considering the potential impact of a mass media campaign.
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23
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Adjei CA, Naab F, Donkor ES. Beyond the diagnosis: a qualitative exploration of the experiences of persons with hepatitis B in the Accra Metropolis, Ghana. BMJ Open 2017; 7:e017665. [PMID: 29102991 PMCID: PMC5722085 DOI: 10.1136/bmjopen-2017-017665] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study explored the experiences of people with hepatitis B in the Accra metropolis. DESIGN The study employed qualitative exploratory descriptive design with purposive sampling technique. Data were collected through face-to-face interview and transcribed verbatim. The data were analysed using content analysis. SETTINGS Participants were recruited from one government and one mission hospital in Ghana. PARTICIPANTS Fourteen individuals aged between 26 and 45 years with hepatitis B infection were interviewed. RESULTS The findings of the study showed that people with hepatitis B in the Accra metropolis were unclear about the impact of their infection. Furthermore, they experienced psychological and social problems especially when they were initially informed about their hepatitis B status. Sadness, fear, shock, shame and disbelief were some of the experiences reported by participants. Coping strategies adopted include religiosity, denial and lifestyle modification. CONCLUSIONS It is, therefore, necessary as a country to integrate hepatitis B counselling into the already existing HIV structures in the health delivery system to offer support for individuals diagnosed with hepatitis B. Furthermore, it is important to draw lessons from the process used in the diagnosis of HIV, particularly in ensuring that people provide consent for being tested.
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Affiliation(s)
| | - Florence Naab
- Department of Maternal and Child Health, School of Nursing, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernestina S Donkor
- Department of Maternal and Child Health, School of Nursing, College of Health Sciences, University of Ghana, Accra, Ghana
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Taheri Ezbarami Z, Hassani P, Zagheri Tafreshi M, Alavi Majd H. A qualitative study on individual experiences of chronic hepatitis B patients. Nurs Open 2017; 4:310-318. [PMID: 29085657 PMCID: PMC5653392 DOI: 10.1002/nop2.100] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 08/29/2017] [Indexed: 12/26/2022] Open
Abstract
Aim The aim of this study was to explain the perception of patients with chronic hepatitis B regarding problems in the Iranian society. Design Descriptive qualitative research. Methods In this qualitative study, 27 patients with chronic hepatitis B in Iran were selected through purposive sampling. The data were collected over 22 months, in 2015–2016, by means of semi‐structured interviews and field notes. The interview transcripts were coded using MAXQDA10 software®. To extract categories and themes, the thematic analysis approach was used. Results The participants’ age ranged from 25–52 years. Analysis of the data revealed seven themes: insufficient self‐care, misperceptions, stigmatization, psychological consequences, failure, spiritual struggle and post‐traumatic growth.
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Affiliation(s)
- Zahra Taheri Ezbarami
- School of Nursing and Midwifery Shahid Beheshti University of Medical Sciences TehranIran
| | - Parkhideh Hassani
- School of Nursing and Midwifery Shahid Beheshti University of Medical Sciences TehranIran
| | | | - Hamid Alavi Majd
- School of Paramedical Sciences Faculty of Paramedical Sciences Department of Biostatistics Shahid Beheshti University of Medical Sciences TehranIran
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Yi S, Ngin C, Tuot S, Chhoun P, Fleming T, Brody C. Utilization of traditional, complementary and alternative medicine and mental health among patients with chronic diseases in primary health care settings in Cambodia. Int J Ment Health Syst 2017; 11:58. [PMID: 29021821 PMCID: PMC5612333 DOI: 10.1186/s13033-017-0167-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/18/2017] [Indexed: 12/23/2022] Open
Abstract
Background Coping with chronic illnesses often involves major lifestyle changes that may lead to poor mental health. Furthermore, in order to treat the chronic conditions, many sufferers in Asia turn to traditional, complementary and alternative medicines (TCAM). This study explores prevalence of TCAM use and factors associated with anxiety and depressive symptoms among patients with chronic diseases in Cambodia. Methods In 2015, this cross-sectional study was conducted with outpatients receiving treatment and care for chronic diseases in two urban and two rural primary health centers. Every eligible patient was randomly selected at the health centers using a systematic sampling procedure. Symptoms of anxiety and depression were assessed by using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression models were constructed to explore factors associated with anxiety and depressive symptoms. Results The study participants included 1528 patients, of whom 77.2% were female, with a mean age of 46.5 years (SD = 15.3). After adjustment, patients with depressive symptoms remained significantly more likely to be in the age groups between 41 and 60 years old and to be married, separated/divorced or widowed compared to those without depressive symptoms. Regarding the use of TCAM, patients with depressive symptoms remained significantly more likely to report using an herbalist, practicing visualization and praying for own health, but less likely to report using vitamins or supplements in the past 12 months. For quality of life, patients with depressive symptoms remained significantly less likely to agree that they had enough energy for their everyday life and had enough money to meet their daily needs. Similar risk factors were also found to be significantly associated with anxiety symptoms. Conclusions Cambodian patients with chronic diseases who experienced symptoms of anxiety or depression were more likely to report reduced quality of life, greater chronic disease-related stigma and more TCAM use. Given the potential interaction of TCAM, mental health and other chronic conditions, a history of TCAM use and mental health should be elicited in clinical practices in primary health care settings, particularly in developing countries.
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Affiliation(s)
- Siyan Yi
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia.,Public Health Program, Touro University California, Vallejo, CA USA
| | - Chanrith Ngin
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Tyler Fleming
- Public Health Program, Touro University California, Vallejo, CA USA
| | - Carinne Brody
- Public Health Program, Touro University California, Vallejo, CA USA
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Banerjee S, Gunda P, Drake RF, Hamed K. Telbivudine for the treatment of chronic hepatitis B in HBeAg-positive patients in China: a health economic analysis. SPRINGERPLUS 2016; 5:1719. [PMID: 27777855 PMCID: PMC5052247 DOI: 10.1186/s40064-016-3404-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 09/28/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Nucleos(t)ide analogs (NUCs) are the standard of care for chronic hepatitis B (CHB). The present analysis aimed to determine the cost effectiveness of NUCs in Chinese healthcare settings. METHODS A Markov model was used to simulate two therapeutic strategies for a hypothetical patient cohort diagnosed with hepatitis B e antigen-positive CHB, unwilling or unable to receive interferon therapy, and about to start treatment with any NUC. The first strategy included NUC monotherapy without sequencing (telbivudine [LDT], entecavir [ETV], tenofovir [TDF], lamivudine [LAM], adefovir dipivoxil [ADV], and combination therapies of either LDT and ADV or LDT and TDF, followed by best supportive care [BSC]). The second strategy included sequential therapies of individual NUCs: LAM → ADV, ADV → LAM, LDT → ADV, and ETV → ADV, followed by BSC. The analysis included two scenarios: with and without costs due to nephrotoxicity. Renal impact was quantified as costs alone, without consideration for quality of life decrements. RESULTS When renal impact was not considered, without treatment sequencing, LDT was cost effective compared with other NUCs. Amongst the strategies with sequencing, LDT → ADV was cost effective. The results were similar when renal impact was considered. However, LDT strategy demonstrated better cost effectiveness. In probabilistic sensitivity analysis, in both scenarios, LDT → ADV sequence was cost effective with 51 % probability even at willingness to pay of $20,000. CONCLUSION Use of LDT, as compared with other NUCs, is cost effective in CHB treatment in Chinese healthcare settings. Considering the detrimental renal impact, overall costs for all treatment options were increased. However, the increase for LDT was comparatively small.
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Affiliation(s)
- S Banerjee
- Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | - P Gunda
- Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | - R F Drake
- Novartis Pharma AG, Basel, Switzerland
| | - K Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ USA
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Hajarizadeh B, Richmond J, Ngo N, Lucke J, Wallace J. Hepatitis B-Related Concerns and Anxieties Among People With Chronic Hepatitis B in Australia. HEPATITIS MONTHLY 2016; 16:e35566. [PMID: 27630722 PMCID: PMC5010884 DOI: 10.5812/hepatmon.35566] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/02/2016] [Accepted: 04/15/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The psychological wellbeing of people with chronic hepatitis B (CHB) may be negatively affected due to the chronic and transmissible nature of the disease, and possible serious complications (e.g. cirrhosis and liver cancer). There are limited data investigating concerns and anxieties among people living with CHB. OBJECTIVES This study examined feelings about having hepatitis B among people with CHB, including hepatitis B-related concerns and anxieties. PATIENTS AND METHODS Using convenience sampling, people with CHB attending four public liver clinics and one general practice in three Australian jurisdictions between April and September 2013 completed a self-administered questionnaire about their feelings about having hepatitis B. RESULTS Ninety-three people completed the survey. Mean age was 45 years, 57% were men, and 93% were born overseas (75% from Asia). Seventy-six percent of participants reported having hepatitis B-related concerns and anxieties. The most common concerns were of developing liver cancer (57%), and infecting other people (53%). Thirty-five percent of participants were unwilling to talk to anyone about their hepatitis B while 25% changed how they lived as a result of having hepatitis B. Lower educational level was associated with feeling scared of hepatitis B (adjusted Odds Ratio [OR]: 4.04; 95%CI: 1.09, 14.90; P = 0.04), and an unwillingness to talk to anyone about hepatitis B (adjusted OR: 4.41; 95%CI: 1.09, 17.83; P = 0.04). Very good English proficiency was associated with a higher likelihood of participants changing how they lived (adjusted OR: 12.66; 95%CI: 2.21, 72.42; P < 0.01), and seeing life differently as a result of having hepatitis B (adjusted OR: 21.10; 95%CI: 3.70, 120.19; P < 0.01). Health professionals were the key person for 34% of participants in helping them cope with having hepatitis B, while 18% reported that no one supported them. CONCLUSIONS Hepatitis B-related concerns and anxieties are prevalent among people with CHB. Clinical management of people with CHB must address their psychological support needs as an essential component of comprehensive care.
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Affiliation(s)
- Behzad Hajarizadeh
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, Australia
- Corresponding Author: Behzad Hajarizadeh, Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia. Tel: +61-394798736, Fax: +61-392855220, E-mail:
| | - Jacqui Richmond
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - Naomi Ngo
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
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Valizadeh L, Zamanzadeh V, Negarandeh R, Zamani F, Hamidia A, Zabihi A. Psychological Reactions among Patients with Chronic Hepatitis B: a Qualitative Study. J Caring Sci 2016; 5:57-66. [PMID: 26989666 PMCID: PMC4794545 DOI: 10.15171/jcs.2016.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/02/2015] [Indexed: 01/05/2023] Open
Abstract
Introduction: Hepatitis B is the most prevalent type of
viral hepatitis. Psychological reactions among patients with hepatitis B infection is
considerably different and affects their decision about treating and following up the
disease. The present study aims at explaining the psychological demonstrations experienced
by these patients. Methods: In this qualitative study, a total of 18 patients
with hepatitis B (8 women and 10 men) were selected by purposive sampling method. Data
were collected by unstructured in-depth interviews during 2014-2015 in the medical centers
of three cities in Iran. All interviews were recorded, typed and analyzed by the
conventional content analysis approach. Results: By analyzing the data, the main theme including
psychological instability, with three sub-themes were emerged: grief reaction (stupor,
denial, anger and aggression), emotional challenges (worry and apprehension, contradiction
with beliefs, fear of deprivation, fear of stigma, waiting for death and prognosis
ambiguity) and inferiority complex (social withdrawal, sense of humiliation and
embarrassment and sense of guilt and blame) were acquired. Conclusion: The findings indicate that patients with
hepatitis B experience various psychological reactions that need to be controlled and
managed by themselves or healthcare providers. Thus, implementation of health
interventions with emphasis on psychological care to prevent problems and execution of
educational and consultation programs about hepatitis especially by medical centers and
mass media is seems necessary.
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Affiliation(s)
- Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Angela Hamidia
- Department of Psychiatry, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Ali Zabihi
- Department of Community Health, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Lee H, Fawcett J, Kim D, Yang JH. Correlates of Hepatitis B Virus-related Stigmatization Experienced by Asians: A Scoping Review of Literature. Asia Pac J Oncol Nurs 2016; 3:324-334. [PMID: 28083549 PMCID: PMC5214865 DOI: 10.4103/2347-5625.195896] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: Although remarkable progress in the pharmacological components of the prevention and treatment of hepatitis B virus (HBV) and liver cancer has been achieved, HBV-related stigma is recognized as a major barrier to HBV management. The purpose of this Revised Social Network Model (rSNM)-guided review was to examine the existing research literature about HBV-related stigma among Asians and Asian immigrants residing in other countries. Methods: A scoping review of literature was conducted to determine the depth and breadth of literature. Totally, 21 publications were identified. The review findings were linked with the concepts of rSNM to demonstrate how individual factors and sociocultural contexts shape and affect the experience of HBV-related stigma. Results: Most studies were quantitative cross-sectional surveys or qualitative methods research that had been conducted among Chinese in China and in the USA. The three concepts in rSNM that have been identified as important to stigma experience are individual factors, sociocultural factors, and health behaviors. The major factors of most studies were on knowledge and attitudes toward HBV; only three studies focused on stigma as the primary purpose of the research. Few studies focused on the measurement of stigma, conceptual aspects of stigma, or interventions to alleviate the experience of being stigmatized. Conclusions: The scoping review revealed the existing depth and breadth of literature about HBV-related stigma. Gaps in the literature include lack of research address group-specific HBV-related stigma instruments and linkages between stigma and stigma-related factors.
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Affiliation(s)
- Haeok Lee
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Jacqueline Fawcett
- Department of Nursing, University of Massachusetts Boston, Boston, MA, USA
| | - Deogwoon Kim
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Jin Hyang Yang
- Department of Nursing, School of Medicine, Inje University, Busan, South Korea
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Valery PC, Powell E, Moses N, Volk ML, McPhail SM, Clark PJ, Martin J. Systematic review: unmet supportive care needs in people diagnosed with chronic liver disease. BMJ Open 2015; 5:e007451. [PMID: 25854973 PMCID: PMC4390721 DOI: 10.1136/bmjopen-2014-007451] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE People with chronic liver disease, particularly those with decompensated cirrhosis, experience several potentially debilitating complications that can have a significant impact on activities of daily living and quality of life. These impairments combined with the associated complex treatment mean that they are faced with specific and high levels of supportive care needs. We aimed to review reported perspectives, experiences and concerns of people with chronic liver disease worldwide. This information is necessary to guide development of policies around supportive needs screening tools and to enable prioritisation of support services for these patients. DESIGN Systematic searches of PubMed, MEDLINE, CINAHL and PsycINFO from the earliest records until 19 September 2014. Data were extracted using standardised forms. A qualitative, descriptive approach was utilised to analyse and synthesise data. RESULTS The initial search yielded 2598 reports: 26 studies reporting supportive care needs among patients with chronic liver disease were included, but few of them were patient-reported needs, none used a validated liver disease-specific supportive care need assessment instrument, and only three included patients with cirrhosis. Five key domains of supportive care needs were identified: informational or educational (eg, educational material, educational sessions), practical (eg, daily living), physical (eg, controlling pruritus and fatigue), patient care and support (eg, support groups), and psychological (eg, anxiety, sadness). CONCLUSIONS While several key domains of supportive care needs were identified, most studies included hepatitis patients. There is a paucity of literature describing the supportive care needs of the chronic liver disease population likely to have the most needs--namely those with cirrhosis. Assessing the supportive care needs of people with chronic liver disease have potential utility in clinical practice for facilitating timely referrals to support services.
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Affiliation(s)
- Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Powell
- Centre for Liver Disease Research, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Neta Moses
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael L Volk
- Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Steven M McPhail
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Paul J Clark
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jennifer Martin
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
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Zhang H, Chao J, Zhu L, Song L, Li X, Liu P. Direct economic burden and influencing factors in patients with hepatitis B virus related diseases in Jiangsu, China. Asia Pac J Public Health 2014; 27:41S-8S. [PMID: 25416293 DOI: 10.1177/1010539514560057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The purpose of this study was to explore direct economic burden and its influencing factors in patients with hepatitis B virus (HBV) related diseases. Time phasing continuous sampling was used to select patients from August 1, 2012, to December 31, 2012, in 3 county hospitals of 3 model regions in Jiangsu Province, China. A total of 436 outpatients and 196 inpatients were observed. The average direct economic burden of HBV-associated admission was US$107.11 for outpatients, and drug fees accounted for 74%; the burden was US$3193.47 for inpatients, and the direct medical costs accounted for 96%. Multivariate linear regression analysis showed that drug fee, examination fee, and antiviral therapy were influencing factors for outpatients, while hospitalization stay, drug ratio, and patient's age were influencing factors for inpatients. It can be concluded that the direct economic burden of patients with HBV-related diseases was high compared to their household income. Measures should be taken to reduce the economic burden of patients.
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Affiliation(s)
- Hua Zhang
- Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Jianqian Chao
- Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Liguo Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Long Song
- Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Xiyan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Pei Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China
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Carabez RM, Swanner JA, Yoo GJ, Ho M. Knowledge and fears among Asian Americans chronically infected with hepatitis B. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:522-528. [PMID: 24395631 DOI: 10.1007/s13187-013-0585-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Asian Americans are disproportionately affected by hepatitis B (HBV) infection. In the USA, one in ten Asian Americans is infected with HBV. The purpose of the study was to explore knowledge, fears and follow-up care among Asian Americans chronically infected with hepatitis B. A sample of 154 completed an online survey which included demographic information, follow-up treatment information, and HBV knowledge and fears/concerns. Our findings indicate that there are differences by ethnicity and birthplace among Asian Americans in terms of follow-up care and treatment. In addition, our study indicates that there were substantial knowledge gaps regarding contracting HBV, transmission, and prevention. We found that HBV-infected respondents had many fears about their infection. Three primary concerns were identified: (a) concerns related to liver cancer and overall health, (b) transmission to loved ones, and (c) stigma. Our findings indicate that Asian Americans chronically infected with HBV need more education to manage HBV including information on the importance of follow-up treatment and care and education on preventing transmission, risk for liver cancer, and HBV impact on overall health.
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Affiliation(s)
- Rebecca M Carabez
- School of Nursing, Community/Public Health Nursing, San Francisco State University, 1600 Holloway, Burk Hall 357, San Francisco, CA, 94132, USA
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Chao J, Song L, Zhang H, Zhu L, Tian L, Jin H, Liu P. Effects of comprehensive intervention on health-related quality of life in patients with chronic hepatitis B in China. BMC Health Serv Res 2013; 13:386. [PMID: 24093163 PMCID: PMC3852560 DOI: 10.1186/1472-6963-13-386] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/30/2013] [Indexed: 01/28/2023] Open
Abstract
Background Hepatitis B virus (HBV) infection is a significant global health problem, especially in China. Chronic liver disease affects health related quality of life (HRQOL). The intervention method to improve HRQOL in patients with hepatitis B has been one-dimensional with inconsistent results. The purpose of this study was to evaluate the effect of comprehensive intervention on health-related quality of life and provide guidance on improving HRQOL for patients with chronic hepatitis B. Methods Patients with chronic hepatitis B eligible for our study were randomly selected in three model regions of Jiangsu Province in June 2010. 272 patients were invited and 254 took part, with a refusal rate of 6.62%. Comprehensive intervention included government support, technical guidance from the Chinese Centre for Disease Control and Prevention, standardised medical care, and community involvement. HRQOL before and 1 year after intervention was measured with the Short Form 36 and HBV-specific health surveys. Chi-square test, t-test and multiple linear regressive analyses were used. Results After comprehensive intervention, the HRQOL in patients with chronic hepatitis B showed significantly improvements in bodily pain, vitality, social functioning, and mental, as well as physical and mental component score (p < 0.05). Family and social support increased, and financial concerns decreased (p < 0.05). Marital status, duration of illness-related absence from work, education level, family financial status, and health insurance type were important factors affecting HRQOL change between the baseline and final assessment in patients with chronic hepatitis B. Conclusion The comprehensive intervention was effective in improving the HRQOL of patients with chronic hepatitis B. Trial registration ChiCTR-OCH-12001882
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Affiliation(s)
- Jianqian Chao
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
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Mohamed R, Ng CJ, Tong WT, Abidin SZ, Wong LP, Low WY. Knowledge, attitudes and practices among people with chronic hepatitis B attending a hepatology clinic in Malaysia: a cross sectional study. BMC Public Health 2012; 12:601. [PMID: 22856889 PMCID: PMC3528623 DOI: 10.1186/1471-2458-12-601] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 07/17/2012] [Indexed: 02/07/2023] Open
Abstract
Background Hepatitis B (HBV) is the leading cause of cirrhosis and hepatocellular carcinoma worldwide. This study assessed the knowledge, attitudes and practices of people with chronic HBV and the associated factors. Methods This cross-sectional study was conducted at an outpatient adult hepatology clinic at a tertiary hospital in Kuala Lumpur. A self-administered questionnaire was administered on a one-to-one basis to assess knowledge, attitudes, and lifestyle practices of people with chronic HBV. Results The response rate was 89% (n = 483/543). Participants had a mean age of 46.3 (±14.7) years and the mean duration of HBV from time of diagnosis was 12.2 (±8.8) years. The mean knowledge score was 12.57/20 (standard deviation: ±4.4, range: 0–19). Participants aged 30–39 years, with higher educational attainment, employed in professional jobs, longer duration of diagnosis and those without cirrhosis had significantly higher knowledge scores. Age, education level and duration of diagnosis were significant predictors of the knowledge score on standard multiple regression analysis. More than half of the participants were worried of spreading HBV infection to family and friends and worried since the diagnosis. A third of the participants (33.5%) were embarrassed to reveal their diagnosis to the public but most of them (93.6%) would inform their family. Those who reported feeling worried since their diagnosis were more likely to be middle-aged, of Malay ethnicity, have shorter duration of diagnosis of less than 10 years and have received therapy. About half of the participants (50.6%) did not share dining utensils and the majority (93.2%) believed that HBV can be transmitted by sharing of eating and drinking utensils. Older patients were significantly less likely to share utensils. Those who felt worried since diagnosis had significant higher knowledge of HBV. Conclusion The findings highlight the stigma and misconceptions that still exist among the HBV patients. More patient and public education about HBV and its prevention are essential to increase awareness and to demystify the disease.
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Affiliation(s)
- Rosmawati Mohamed
- Department of Medicine, Faculty of Medicine, University of Malaya, Malaya 50603, Kuala Lumpur, Malaysia.
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