Lee Andrew Chee Keng, Vedio Alicia, Liu Eva Zhi Hong, Horsley Jason, Jesurasa Amrita, Salway Sarah
Section of Public Health, the School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK.
Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
BMC Public Health. 2017 Sep 26;17(1):747. doi: 10.1186/s12889-017-4796-4.
Global migration from hepatitis B endemic countries poses a significant public health challenge in receiving low-prevalence countries. In the UK, Chinese migrants are a high risk group for hepatitis B. However, they are an underserved population that infrequently accesses healthcare. This study sought to increase understanding of the determinants of hepatitis B testing and healthcare access among migrants of Chinese ethnicity living in England.
We sought to obtain and integrate insights from different key stakeholders in the system. We conducted six focus group discussions and 20 in-depth interviews with community members and patients identifying themselves as 'Chinese', and interviewed 21 clinicians and nine health service commissioners. Data were thematically analysed and findings were corroborated through two validation workshops.
Three thematic categories emerged: knowledge and awareness, visibility of the disease, and health service issues. Low disease knowledge and awareness levels among community members contributed to erroneous personal risk perception and suboptimal engagement with services. Limited clinician knowledge led to missed opportunities to test and inaccurate assessments of infection risks in Chinese patients. There was little social discourse and considerable stigma linked to the disease among some sub-sections of the Chinese population. A lack of visibility of the issue and the population within the health system meant that these health needs were not prioritised by clinicians or commissioners. Service accessibility was also affected by the lack of language support. Greater use of community outreach, consultation aids, 'cultural competency' training, and locally adapted testing protocols may help.
Hepatitis B among migrants of Chinese ethnicity in England can be characterised as an invisible disease in an invisible population. Multi-modal solutions are needed to tackle barriers within this population and the health system.
从乙肝流行国家的全球移民给乙肝低流行的接收国带来了重大的公共卫生挑战。在英国，华裔移民是乙肝的高危群体。然而，他们是未得到充分服务的人群，很少获得医疗保健。本研究旨在增进对居住在英格兰的华裔移民乙肝检测和医疗保健获取的决定因素的理解。
我们试图从该系统的不同关键利益相关者那里获取并整合见解。我们对自认为是“华裔”的社区成员和患者进行了六次焦点小组讨论和20次深入访谈，并采访了21名临床医生和9名卫生服务专员。对数据进行了主题分析，并通过两次验证研讨会证实了研究结果。
出现了三个主题类别：知识与意识、疾病的可见性以及卫生服务问题。社区成员中疾病知识和意识水平较低导致个人风险认知错误以及与服务的参与度欠佳。临床医生知识有限导致检测机会错失以及对中国患者感染风险的评估不准确。在华裔人口的一些子群体中，与该疾病相关的社会讨论很少且存在相当大的污名化现象。该问题和人群在卫生系统中缺乏可见性意味着这些卫生需求未被临床医生或专员列为优先事项。语言支持的缺乏也影响了服务的可及性。更多地利用社区外展、咨询辅助工具、“文化能力”培训以及因地制宜的检测方案可能会有所帮助。
英格兰华裔移民中的乙肝可被描述为在一个隐形人群中的隐形疾病。需要采取多模式解决方案来应对该人群和卫生系统内部的障碍。
