title: Informing the design of a national screening and treatment programme for chronic viral hepatitis in primary care: qualitative study of at-risk immigrant communities and healthcare professionals.
abstract: BACKGROUND
  Effective strategies are needed to provide screening and treatment for hepatitis B and C to immigrant groups in the UK at high risk of chronic infection. This study aimed to build an understanding of the knowledge, beliefs and attitudes towards these conditions and their management in a range of high-risk minority ethnic communities and health professionals, in order to inform the design of a screening and treatment programme in primary care.
  
  
  METHODS
  Qualitative data collection consisted of three sequential phases- (i) semi-structured interviews with key informants (n = 17), (ii) focus groups with people from Chinese, Pakistani, Roma, Somali, and French- and English-speaking African communities (n = 95), and (iii) semi-structured interviews with general practitioners (n = 6). Datasets from each phase were analysed using the Framework method.
  
  
  RESULTS
  Key informants and general practitioners perceived that there was limited knowledge and understanding about hepatitis B and C within high-risk immigrant communities, and that chronic viral hepatitis did not typically feature in community discourses about serious illness. Many focus group participants were confused about the differences between types of viral hepatitis, held misconceptions regarding transmission, and were unaware of the asymptomatic nature of chronic infection. Most welcomed the idea of a screening programme, but key informants and focus group participants also identified numerous practical barriers to engagement with primary care-based screening and treatment; including language and communication difficulties, limited time (due to long working hours), and (for some) low levels of trust and confidence in general practice-based care. General practitioners expressed concerns about the workload implications and sustainability of screening and treating immigrant patients for chronic viral hepatitis in primary care.
  
  
  CONCLUSIONS
  Strategies to reduce the burden of chronic viral hepatitis in immigrant communities will need to consider how levels of understanding about hepatitis B and C within these communities, and barriers to accessing healthcare, may affect capacity to engage with screening and treatment. Services may need to work with community groups and language support services to provide information and wider encouragement for screening. Primary care services will need ongoing consultation regarding their support needs to deliver hepatitis screening and treatment programmes.
authors.affiliation: Institute for Health and Human Development, University of East London, UH250, Stratford Campus, Water Lane, London, E15 4LZ, UK. l.sweeney@uel.ac.uk.
authors.forename: Lorna
authors.initials: L
authors.lastname: Sweeney
authors.affiliation: Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK. j.a.owiti@qmul.ac.uk.
authors.forename: John A
authors.initials: JA
authors.lastname: Owiti
authors.affiliation: Internal Medicine and Gastroenterology, San Fernando General Hospital, Independence Avenue, San Fernando, Trinidad and Tobago. a_beharry@yahoo.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: Beharry
authors.affiliation: Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK. k.s.bhui@qmul.ac.uk.
authors.forename: Kamaldeep
authors.initials: K
authors.lastname: Bhui
authors.affiliation: The Liver Unit, Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK. j.gomes@qmul.ac.uk.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gomes
authors.affiliation: The Liver Unit, Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK. g.r.foster@qmul.ac.uk.
authors.forename: Graham R
authors.initials: GR
authors.lastname: Foster
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. trish.greenhalgh@phc.ox.ac.uk.
authors.forename: Trisha
authors.initials: T
authors.lastname: Greenhalgh
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D000368:Aged; D002681:China / Q000208:ethnology; D054242:Emigrants and Immigrants; D005006:Ethnicity; D005260:Female; D017144:Focus Groups; D006282:Health Personnel; D006297:Health Services Accessibility; D006509:Hepatitis B / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology*; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010154:Pakistan / Q000208:ethnology; D011320:Primary Health Care; D036301:Qualitative Research; D012017:Referral and Consultation; D006178:Romani People / Q000208:ethnology; D006113:United Kingdom