title: Illness perceptions and explanatory models of viral hepatitis B & C among immigrants and refugees: a narrative systematic review.
abstract: BACKGROUND
  Hepatitis 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.
  
  
  METHODS
  Five 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.
  
  
  RESULTS
  We 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.
  
  
  CONCLUSIONS
  Immigrants 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.
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Charterhouse Square, Queen Mary University of London, Centre for Psychiatry, EC1M 6BQ, London, UK. j.a.owiti@qmul.ac.uk.
authors.forename: John A
authors.initials: JA
authors.lastname: Owiti
authors.affiliation: Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Primary Care and Public Health, Yvonne Carter Building, 58 Turner Street, E1 2AB, London, UK. p.greenhalgh@qmul.ac.uk.
authors.forename: Trisha
authors.initials: T
authors.lastname: Greenhalgh
authors.affiliation: Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Primary Care and Public Health, Yvonne Carter Building, 58 Turner Street, E1 2AB, London, UK. l.sweeney@qmul.ac.uk.
authors.forename: Lorna
authors.initials: L
authors.lastname: Sweeney
authors.affiliation: Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, The Liver Unit, Centre for Digestive Diseases, 4 Newark Street, E1 2AT, London, UK. g.r.foster@qmul.ac.uk.
authors.forename: Graham R
authors.initials: GR
authors.lastname: Foster
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Charterhouse Square, Queen Mary University of London, Centre for Psychiatry, EC1M 6BQ, London, UK. k.s.bhui@qmul.ac.uk.
authors.forename: Kamaldeep S
authors.initials: KS
authors.lastname: Bhui
mesh_terms: D001210:Asia, Southeastern / Q000208:ethnology; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006509:Hepatitis B / Q000635:transmission; D006526:Hepatitis C / Q000635:transmission; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D015995:Prevalence; D012036:Refugees / Q000523:psychology*