Identifying factors influencing practitioners’ role in access to health care for hepatitis B in Chinese populations in England

Background: Access to health care for chronic hepatitis B (CHB) is poor in migrant populations of Chinese ethnicity in England. Previous worldwide studies focusing on this problem have largely addressed population factors with few studies focusing on practitioner roles and service-related factors. The aim of this study was to identify and explore practitioner and service related barriers and facilitators to access to health care for CHB affecting Chinese populations in England. Methods: Semi-structured interviews were conducted with 21 frontline health care practitioners and two key informants to examine practitioners’ roles, attitudes and practices in relation to CHB and with Chinese populations. Thematic interpretive analysis was undertaken to identify modifiable factors in primary and secondary care and wider service factors. Relevant models guided design and analysis. Results: Factors were identified at individual practitioner level, during interaction with patients and at organizational level. Practitioners balanced complex responsibilities and CHB is low in their priorities. Professional principles, skills and knowledge are not sufficient in facilitating access in the face of clinical uncertainty, unclear policy and conflicts in funding that reflect structural barriers. Factors acting in the interaction with patients include difficulties with interpreters and understanding patient expectations from services. Facilitators were identified and included bespoke services and active interaction with Chinese community services. Organizational issues including increasing workload, lack of support and financial limitations and conflicts, were also acting as barriers to appropriate identification and referral of patients. Conclusion: Practitioners balanced numerous demands that may hamper the decision-making process, hindering the role of facilitating access to care for asymptomatic, low priority conditions. Individual patient preferences could be addressed more effectively using cross-cultural care approaches. In addition, addressing dimensions of structural racism, including the lack of effective access pathways, lack of practical support and of dissemination of clinical guidance could help address service barriers