Illness perceptions and explanatory models of viral hepatitis B & C among immigrants and refugees: a narrative systematic review
Research article
1 Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Charterhouse Square, Queen Mary University of London, Centre for Psychiatry, London, EC1M 6BQ, UK
2 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, London, E1 2AB, UK
3 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, London, E1 2AT, UK
BMC Public Health 2015, 15:151Â
doi:10.1186/s12889-015-1476-0
Published: 15 February 2015
Abstract (provisional)
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.