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Table 5 Structural barriers to health seeking and testing

From: Determinants of uptake of hepatitis B testing and healthcare access by migrant Chinese in the England: a qualitative study

Themes Definitions Sample quotes
Health system issues Incentives, roles and responsibilities for providing hepatitis B-related services “Then it comes to something like hepatitis screening. Good evidence for it in my opinion. Very logical to do. (But) there are all sorts of perverse incentives in the health system: so you are not paid (to test), there is no reward for being good at doing it … It costs you to do it, it takes time to do it, it’s hard to do it, it uses (hospital) referrals and actually is one of the areas where very often people are often over followed-up …” (Clinician interviewee, general practitioner)
  How one navigates the health system “Maybe they have no understanding of the NHS system. Maybe they are new to this country. I mean if somebody said to me we want you to go to Bulgaria and sort yourself out a Hep B test, what the hell would I do? … that’s what we are trying to do here and that’s difficult.” (Commissioner interviewee, local commissioning manager)
  How accessible are health services “Getting to see a doctor is harder than getting to meet an emperor.” (Community focus group) 
  “They (the doctors) always sound as if you are making a mountain out of a molehill. They make you feel that you just don’t need to come. So I try not to bother my GP unless it is really serious...” (Community focus group)
  Whether services are tailored to the community “I think the problem is that at the moment I don’t think services are particularly commissioned to take into account different ethnic groups or different areas of need.” (Commissioner interviewee, regional public health director) 
  “Going out into communities is definitely the way forward for certain groups because … they wouldn’t (come in). Obviously language is a barrier and stigma. They don’t like to come into hospital.” (Commissioner interviewee, local commissioning manager) 
  “It is really to get the understanding of what they would like, how they would like it, because anything we come up with might fall flat mightn’t it? That working with the communities is the key thing.” (Commissioner interviewee, regional public health consultant)
  What consultation and communication aids are present “So if there’s a different language (involved) you know you definitely have to make sure that what you’ve said is being understood. And then there’s a lot more checking back as well when they answer.” (Clinician interviewee, general practitioner) 
  “So although we tend to use phone interpreters, you can never be assured exactly what is being explained to (the patient).” (Clinician interviewee, general practitioner)