Illness perceptions and explanatory models of viral hepatitis B & C among immigrants and refugees: a narrative systematic review

Abstract

BackgroundHepatitis B and C (HBV, HCV) infections are associated with high morbidity and mortality. Many countries with traditionally low prevalence (such as UK) are now planning interventions (screening, vaccination, and treatment) of high-risk immigrants from countries with high prevalence. This review aimed to synthesise the evidence on immigrants’ knowledge of HBV and HCV that might influence the uptake of clinical interventions. The review was also used to inform the design and successful delivery of a randomised controlled trial of targeted screening and treatment.MethodsFive databases (PubMed, CINHAL, SOCIOFILE, PsycINFO & Web of Science) were systematically searched, supplemented by reference tracking, searches of selected journals, and of relevant websites. We aimed to identify qualitative and quantitative studies that investigated knowledge of HBV and HCV among immigrants from high endemic areas to low endemic areas. Evidence, extracted according to a conceptual framework of Kleinman’s explanatory model, was subjected to narrative synthesis. We adapted the PEN-3 model to categorise and analyse themes, and recommend strategies for interventions to influence help-seeking behaviour.ResultsWe identified 51 publications including quantitative (n = 39), qualitative (n = 11), and mixed methods (n = 1) designs. Most of the quantitative studies included small samples and had heterogeneous methods and outcomes. The studies mainly concentrated on hepatitis B and ethnic groups of South East Asian immigrants residing in USA, Canada, and Australia. Many immigrants lacked adequate knowledge of aetiology, symptoms, transmission risk factors, prevention strategies, and treatment, of hepatitis HBV and HCV. Ethnicity, gender, better education, higher income, and English proficiency influenced variations in levels and forms of knowledge.ConclusionImmigrants are vulnerable to HBV and HCV, and risk life-threatening complications from these infections because of poor knowledge and help-seeking behaviour. Primary studies in this area are extremely diverse and of variable quality precluding meta-analysis. Further research is needed outside North America and Australia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1476-0) contains supplementary material, which is available to authorized users.

Environmental factors affecting self‐management of chronic hepatitis B from the patients’ perspective

“…Studies of patients with liver disease worldwide have suggested that patients' explanations of symptoms (such as fatigue and tiredness) may be influenced by folk health beliefs, which affect the health behaviours and management of the disease, including adopting new lifestyles or alternative/traditional treatments (Brener et al, 2016 (Fang & Stewart, 2018), remedial or healing herbs (Fang & Stewart, 2018;Giles-Vernick et al, 2016). In the patients' experience, these treatments are often used as alternative treatments instead of usual medical treatment (Fang & Stewart, 2018;Lee et al, 2017;Owiti et al, 2015). To date, conventional medical treatments for chronic hepatitis B include active adherence to antiviral medications and follow-up enhanced by developing a self-management programme (Kong et al, 2018).…”

“…Studies of patients with liver disease worldwide have suggested that patients’ explanations of symptoms (such as fatigue and tiredness) may be influenced by folk health beliefs, which affect the health behaviours and management of the disease, including adopting new lifestyles or alternative/traditional treatments (Brener et al, ; Burnham et al, ; Owiti, Greenhalgh, Sweeney, Foster, & Bhui, ). Traditional treatments are often related to cultural beliefs, including spiritual healing (Fang & Stewart, ), remedial or healing herbs (Fang & Stewart, ; Giles‐Vernick et al, ).…”

“…Traditional treatments are often related to cultural beliefs, including spiritual healing (Fang & Stewart, ), remedial or healing herbs (Fang & Stewart, ; Giles‐Vernick et al, ). In the patients' experience, these treatments are often used as alternative treatments instead of usual medical treatment (Fang & Stewart, ; Lee et al, ; Owiti et al, ). To date, conventional medical treatments for chronic hepatitis B include active adherence to antiviral medications and follow‐up enhanced by developing a self‐management programme (Kong et al, ).…”

Geographic integration of hepatitis C virus: A global threat

“…Likewise, the prevalence of chronic HCV in the United Kingdom among South Asians, and especially among migrants from Pakistan, may be as high as 2.7%, which is over fivefold higher than in the general population (0.5%)[64]. In Italy, the prevalence of HCV among Sub-Saharan refugees varied between 2.7% and 7.1%, while in Spain it was 12.5%, considerably higher than in the autochthonous population[65].…”

“…The prevalence of genotype 4 among high-risk individuals in France increased from 15% of infections in 2003 to 22% in 2012. These changes in the trends of genotypes in these countries corresponds well with the increasing numbers of migrants from Africa[64]. As the foreign-born populations expand, the integration dynamics of HCV will become globally imminent[67].…”