Informing the design of a national screening and treatment programme for chronic viral hepatitis in primary care: Qualitative study of at-risk immigrant communities and healthcare professionals

The problem

Undiagnosed hepatitis infection is a major contributor to the growing burden of liver disease in the UK. Effective strategies are needed to provide screening and treatment for hepatitis B and C to immigrant groups at high risk of chronic infection. The success of a screening programme depends on how well it engages target groups, whose health beliefs and perspectives are likely to affect acceptance and uptake. No research to date has explored lay understandings of hepatitis B and C, or attitudes to screening and treatment, in at-risk immigrant communities in the UK. This study aimed to build an understanding of the knowledge, beliefs and attitudes towards hepatitis B and C and their management in a range of at-risk minority ethnic communities and health professionals, in order to inform the design of a screening and treatment programme in primary care.

The approach

Qualitative research was conducted in three sequential phases- (i) semi-structured interviews with key informants for at-risk immigrant communities- community support workers, hepatitis treatment specialists, and healthcare interpreters (n = 17), (ii) focus groups with people from Chinese, Pakistani, Roma, Somali, and French- and English-speaking African communities (n = 95) conducted in partnership with bilingual community support staff, and (iii) semi-structured interviews with general practitioners (n = 6). Datasets from each phase were analysed separately and findings were used to progressively focus the research.

Findings

Key informants and general practitioners perceived that there was limited knowledge and understanding about hepatitis B and C within at-risk immigrant communities, and felt that chronic viral hepatitis did not typically feature in community discourses about serious illness. Many focus group participants were confused about the differences between types of viral hepatitis, held misconceptions regarding transmission, and were unaware of the asymptomatic nature of chronic infection. Most welcomed the idea of a screening programme, but key informants and focus group participants also identified numerous practical barriers to engagement with primary care-based screening and treatment; including language and communication difficulties, limited time (due to long working hours), and (for some) low levels of trust and confidence in general practice-based care. General practitioners expressed concerns about the workload implications and sustainability of screening and treating immigrant patients for chronic viral hepatitis in primary care.Consequence Strategies to reduce the burden of chronic viral hepatitis in immigrant communities will need to consider how levels of understanding about hepatitis B and C within these communities, and barriers to healthcare, may affect capacity to engage with screening and treatment programmes. Services may need to work with community groups and language support services to provide information and wider encouragement for screening. Primary care services may need ongoing consultation regarding their support needs to deliver hepatitis screening and treatment programmes.

Credits

• Lorna Sweeney, Queen Mary University of London, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, UK
• John A Owiti, Internal Medicine and Gastroenterology, San Fernando General Hospital, San Fernando, Trinidad and Tobago
• Andrew Beharry, Queen Mary University of London, The Liver Unit, Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
• Kamaldeep Bhui, Internal Medicine and Gastroenterology, San Fernando General Hospital, San Fernando, Trinidad and Tobago
• Jessica Gomes, University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
• Graham R Foster, University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
• Trisha Greenhalgh