Table 3 Poor knowledge, beliefs and perceptions of the population and the disease by the community, clinicians and commissioners

What the Chinese know about the disease and services (including myths and misunderstandings)

“[We] really know nothing about this (disease).” (Community focus group)

“In China we heard that it’s curable. How come it becomes incurable in the UK?” (Community focus group)

‘Are there services? Are they reliable?’ (Community focus group)

What are the cultural norms, beliefs and expectations

“In China there are all sorts of stuff that doctors would prescribe to us to strengthen the immunity or detoxify the liver.” (Individual interviewee, person with hepatitis B)

“What’s the point of taking all the blood tests, and (getting) no treatment?” (Individual interviewee, person with hepatitis B)

What stigma exists about disease and persons with the disease, as well as associated services

“Chinese people believe HBV is easily transmitted through social contacts, so HBV carriers are often treated as a public nuisance, who are expected to inform people about his condition and keep their distance” (Community focus group)

‘What if other people see me going into a sexual health clinic (for a hepatitis B test)? What will they think about me?’ (Individual interviewee)

What clinicians and commissioners know of the disease and its management

“I reckon if you were to put down some hepatitis B results in front of any of us … I suspect we would probably have to go and have a little read on the internet or in the books.” (Clinician interviewee, General practitioner) 

“Because most of us trained more than ten years ago, there’s a perception that well there’s no point in treating hepatitis. So there’s something about educating the decision makers.” (Commissioner interviewee, regional public health consultant)

What clinicians know about the Chinese and how they deal with it

“… we need to be careful about stereotyping people … there is a huge amount of in-group diversity.” (Clinician interviewee, hospital physician)

“I’m hoping that there will be more ethnic training certainly in the primary care setting because as a primary care GP I think there’s desperately a lack of (training).” (Clinician interviewee, general practitioner)

Perception of risk of infection in Chinese persons

“… perception that (the Chinese) are much easier because they don’t have any problems …” (Clinician)

“I am not sure that any GP is going to have a sufficient population of Chinese to know that this is a major risk factor … If we make a bizarre comparison, if you see a Black patient you think of sickle cell. If you see a Chinese patient you don’t think about hepatitis B.” (Commissioner interviewee, regional public health consultant)