Table 3 Summary of main research findings and implications for design of screening and treatment services

Limited knowledge and confusion about hepatitis B and C in at-risk communities

Community-based information campaigns

• Participants reported a lack of awareness of the asymptomatic nature of chronic infection with hepatitis B/C within at-risk communities. Many immigrants may not consider themselves at risk from hepatitis B/C if they have lived in the UK for many years.

• Information is needed regarding the asymptomatic nature of chronic infection and the potentially serious outcomes of untreated infection.

• Chronic viral hepatitis does not typically feature in community discourses about serious illness, because many people are unaware of the outcomes from chronic infection, because those diagnosed often have no symptoms of illness, and because hepatitis has not received the same health promotion/ media coverage as other illnesses. People are typically more worried about illnesses such as cancer, diabetes and HIV.

• Information is needed to improve understanding of how hepatitis B and C may be acquired in high-risk regions and to amend misunderstandings about transmission.

• We found uncertainty and confusion about the differences between the types of viral hepatitis within at-risk communities. Many people indicated a belief that hepatitis C was more serious than hepatitis B.

• Collaborative working is needed between health educators and community groups, faith organisations, etc. to communicate verbal information about hepatitis and screening.

• There was some awareness within the focus groups about the main transmission routes of hepatitis B/C, but misperceptions were also reported that indicated confusion with the transmission of hepatitis A and other causes of liver disease.

• High levels of stigma were generally not perceived for hepatitis, but stigma may arise due to perceived association with socially unacceptable behaviours, and due to fear of infection.

Barriers to hepatitis screening and treatment for immigrant patients

Service implications

• PRACTICAL BARRIERS

• Information about screening and treatment provision ought to be provided in the languages of the communities that are targeted for screening. Language support services will be needed to assist patients with making and attending appointments.

- Language and communication difficulties are a major barrier for immigrant communities in accessing primary care.

• Flexible/extended opening hours may be needed for hepatitis screening and treatment services.

- The long working hours and limited working rights (e.g. no sick pay) of many immigrants were viewed as a significant barrier to accessing screening and treatment services.

• People need to be fully informed in advance about what is involved in the testing and treatment process, and that treatment is free of charge.

- Screening invitation letters may be ignored, particularly if the person does not understand hepatitis or does not perceive a need for screening.

• GPs or other primary care staff may need to verbally explain the reasons for hepatitis screening to the patient, rather than relying on screening invitation letters.

• PSYCHOLOGICAL BARRIERS

• Collaborative working with community groups to provide support to patients during treatment.

- Screening uptake may be prevented by fear of diagnosis, fear of the testing process involved and fear of potential side effects from treatment.

• Patients may need to be provided with reassurance and confidence that they will receive effective treatment for hepatitis through primary care services.

• Problems with trust and confidence in primary care amongst immigrant communities may reduce uptake of screening and treatment.

General practitioner concerns

Policy implications

• Workload implications and concerns about sustainability may discourage general practice participation in the delivery of hepatitis screening and treatment services.

• Ongoing consultation with primary care services regarding support needs for delivery of hepatitis screening and treatment.