Title: Identifying interventional approaches to improve health care access for Hepatitis B in high prevalence groups. - A study of knowledge, beliefs, and attitudes about Hepatitis B among Chinese and Far East Asian residents of South Yorkshire and factors restricting appropriate risk evaluation, testing, preventative activities and referral for treatment to inform review of current policy.
Funder: Department of Health (England)

Abstract: Background: The high prevalence of hepatitis B inChinaand other Far East Asian countries has been well documented in international epidemiological studies. Transmission occurs most frequently vertically, but also sexually, among household contacts and through healthcare. Chronic carriage is frequent, with considerable disease burden including morbidity and mortality from cirrhosis and hepatocellular carcinoma. Early treatment can prevent complications; however, access to specialist healthcare is known to be impaired in this group. Aims: This study objective is to identify the factors associated with poor levels of diagnosis and treatment operating at three levels in theUK: the Chinese community, the health care providers and the health system. This in turn should provide a base to help formulate policy to improve prevention and care. Three aims are: 1 - To identify within the target communities health seeking behaviours as well as knowledge, attitudes and misconceptions in relation to hepatitis B, including its high prevalence in the community, its relation to liver cancer, awareness of prevention and transmission risks. 2 - To identify barriers to testing and referral to specialist care among healthcare professionals who are assessing risk in high prevalence populations. 3 - To identify current policy-making and implementation processes which may support or hinder the development of approaches that improve diagnosis and treatment levels among this population. Methods: Focus group discussions and key informant interviews aim to understand the Chinese population’s healthcare seeking behaviour, attitudes towards disease and the perceived role of healthcare. Healthcare staff interviews seek to identify gaps in risk assessment and wider contributing factors. Commissioner interviews aim to identify barriers to policy development in this area. Team: dr Vedio and dr Lee lead this research owing to their experience in the field. dr Vedio has studied the gap in diagnosis by offering dry blood spot testing in community settings and building strong links with the Chinese and other ethnic communities. dr Lee has expertise with project management of research studies and devising, conducting and analysing qualitative studies and conducting health needs assessments, communicable disease control at population level, and local primary care experience inSouth Yorkshire. The wider research team includes a senior social scientist (SS) and a senior public health researcher (EG) providing the necessary expertise in clinical management, public health, qualitative research and translation into policy outputs. A full-time research assistant with language and cultural competence skills will be appointed. Outputs and dissemination: The study is informed by knowledge translation principles. By identifying the knowledge gaps, both among Chinese residents and healthcare professionals, that may act as barriers to hepatitis B testing, preventative strategies and, where appropriate, treatment, this study will: inform development of tools supporting the Chinese community and health care professionals, in preparation for more widespread testing; guide commissioners, hepatitis B service providers in the design of more accessible and improved hepatitis B testing, prevention and treatment services; inform national policy makers to allow review and modification of current policy. Dissemination through meetings with the community and written or spoken local and national Chinese network media will aim to raise awareness and reduce stigma. Dissemination through professional workshops aims to improve understanding of barriers, to generate discussions in order to inform the development of commissioning toolkits and to help formulate policy recommendation. Where patients may be involved, NHS ethics approval will be sought. For all other public participation, ethics approval from the University of Sheffield will be obtained. This study will be conducted in accordance with good research practice.


Research activity codes: 4.3 INFLUENCES AND IMPACT;7.1 INDIVIDUAL CARE NEEDS
Health categories: INFECTION