Improving access to health care for chronic hepatitis B among migrant Chinese populations: A systematic mixed methods review of barriers and enablers

Abstract

SummaryMigrant Chinese populations in Western countries have a high prevalence of chronic hepatitis B but often experience poor access to health care and late diagnosis. This systematic review aimed to identify obstacles and supports to timely and appropriate health service use among these populations. Systematic searches resulted in 48 relevant studies published between 1996 and 2015. Data extraction and synthesis were informed by models of healthcare access that highlight the interplay of patient, provider and health system factors. There was strong consistent evidence of low levels of knowledge among patients and community members; but interventions that were primarily focused on increasing knowledge had only modest positive effects on testing and/or vaccination. There was strong consistent evidence that Chinese migrants tend to misunderstand the need for health care for hepatitis B and have low satisfaction with services. Stigma was consistently associated with hepatitis B, and there was weak but consistent evidence of stigma acting as a barrier to care. However, available evidence on the effects of providing culturally appropriate services for hepatitis B on increasing uptake is limited. There was strong consistent evidence that health professionals miss opportunities for testing and vaccination. Practitioner education interventions may be important, but evidence of effectiveness is limited. A simple prompt in patient records for primary care physicians improved the uptake of testing, and a dedicated service increased targeted vaccination coverage for newborns. Further development and more rigorous evaluation of more holistic approaches that address patient, provider and system obstacles are needed.

Determinants of uptake of hepatitis B testing and healthcare access by migrant Chinese in the England: a qualitative study

“…We interviewed 21 clinicians drawn from five localities from different settings (hospitals, primary care and the community) and from different specialities (primary care, infectious diseases, sexual health, nephrology, rheumatology and midwifery services). Interviews were guided by an interview schedule (see Additional file 3 ) which drew on our initial literature review [ 22 ] and early findings from the community study.…”

“…Audio recordings were transcribed verbatim and subsequently translated where necessary for further analysis. For the community study, a set of thematic codes was developed drawing on our literature review [ 22 ] and initial ethnographic fieldwork. The coding scheme was iteratively developed by reading and re-reading the transcripts and through research team discussions.…”

Cost-effectiveness of screening for chronic hepatitis B and C among migrant populations in a low endemic country

“…In our study we assumed a modest participation rate of 30% as baseline. Several interventions at low cost (see supplementary section 3) can improve engagement and compliance along the chronic viral hepatitis care continuum [ 47 , 48 ]. As in most general practices only a few patients will be eligible for screening, a close collaboration between GPs, Municipal Health Services (MHS) and community-based organisations seems valuable in which MHSs can take responsibility for coordinating the screening programme [ 13 , 14 , 25 , 26 ].…”

The association between protection motivation and hepatitis b vaccination intention among migrant workers in Tianjin, China: a cross-sectional study

“…While the HBV vaccine can effectively prevent the spread of HBV among adults, migrant workers' lower vaccination prevalence than permanent workers is due to their poorer cognition of HBV and the HBV vaccine, lower education level and poorer health awareness levels, living in groups and lower accessibility to health care services [8][9][10][11]. While previous Chinese studies have identi ed an individual's knowledge and cognition of HBV and the HBV vaccine as key factors explaining HBV vaccination intentions and behavior, these studies only employed partial measures of HBV cognition [12][13][14].…”