Barriers and opportunities for hepatitis B testing and contact tracing in a UK Somali population: a qualitative study.

BACKGROUND: Chronic hepatitis B virus (HBV) infection frequently causes liver disease, and early identification can improve outcome. The burden of chronic HBV infection in many economically developed nations lies in migrant populations. Targeted HBV testing of migrants, and contact tracing for those diagnosed, are public health objectives but uptake has been fragmentary. This qualitative study aimed to investigate understanding of hepatitis B and response to testing and contact tracing amongst people of Somali ethnicity living in Bristol, UK. METHODS: The views of 30 people of Somali ethnicity living in Bristol were explored through focus groups and semi-structured interviews. Transcripts of audio-recorded interviews and focus groups were imported into NVivo10 and inductive thematic analysis undertaken. RESULTS: Most participants lacked awareness of hepatitis B, and often co-identified hepatitis B with 'jaundice'. There were frequent misconceptions regarding transmission, natural history and diagnosis, with hepatitis B commonly viewed as a relatively trivial, short lived, symptomatic disease. Hepatitis B was generally not stigmatised. Lack of understanding of the disease was cited as the major barrier to targeted testing and contact tracing. CONCLUSION: These findings suggest public health initiatives to promote hepatitis B testing and contact tracing within migrant Somali populations should focus on improving hepatitis B understanding, particularly its natural history and diagnosis, and avoid translation of 'hepatitis B' into terms meaning 'jaundice' to address misperception of low susceptibility and low severity.

Living with joint hypermobility syndrome: patient experiences of diagnosis, referral and self-care.

BACKGROUND: Musculoskeletal problems are common reasons for seeking primary health care. It has been suggested that many people with 'everyday' non-inflammatory musculoskeletal problems may have undiagnosed joint hypermobility syndrome (JHS), a complex multi-systemic condition. JHS is characterized by joint laxity, pain, fatigue and a wide range of other symptoms. Physiotherapy is usually the preferred treatment option for JHS, although diagnosis can be difficult. The lived experience of those with JHS requires investigation. OBJECTIVE: The aim of the study was to examine patients' lived experience of JHS, their views and experiences of JHS diagnosis and management. METHODS: Focus groups in four locations in the UK were convened, involving 25 participants with a prior diagnosis of JHS. The focus groups were audio recorded, fully transcribed and analysed using the constant comparative method to inductively derive a thematic account of the data. RESULTS: Pain, fatigue, proprioception difficulties and repeated cycles of injury were among the most challenging features of living with JHS. Participants perceived a lack of awareness of JHS from health professionals and more widely in society and described how diagnosis and access to appropriate health-care services was often slow and convoluted. Education for patients and health professionals was considered to be essential. CONCLUSIONS: Timely diagnosis, raising awareness and access to health professionals who understand JHS may be particularly instrumental in helping to ameliorate symptoms and help patients to self-manage their condition. Physiotherapists and other health professionals should receive training to provide biopsychosocial support for people with this condition.

Men's knowledge and attitudes towards dietary prevention of a prostate cancer diagnosis: a qualitative study.

BACKGROUND: Prostate cancer (PC) incidence and progression may be influenced by dietary factors, but little is known about the acceptability of dietary modification to men at increased risk of PC. Qualitative interviews with men participating in the ProDiet study were undertaken to explore the feasibility of implementing dietary interventions for the prevention of prostate cancer. METHODS: An interview study nested within the ProDiet randomised feasibility trial of dietary interventions to prevent a PC diagnosis. Men (n = 133) who previously participated in community based prostate specific antigen (PSA) testing without PC but who were at increased risk of the disease were randomly allocation to both lycopene (lycopene or placebo capsules or lycopene rich diet) and green tea (green tea or placebo capsules or green tea drink) for 6 months. Semi-structured interviews were conducted with participants shortly after randomisation, to investigate attitudes towards dietary modification for PC prevention and dietary information. Interviews were audio-recorded, transcribed and analysed to identify common themes. RESULTS: Interviews were conducted with 21 participants aged 52-72 years with PSA levels between 2.5 and 2.95 ng/ml, or a negative prostate biopsy result. Most men identified the major causes of cancer in general to include diet, environment, ageing and genetic factors. This contrasted sharply with men's uncertainty about PC aetiology, and the function of the prostate. Men were confused by conflicting messages in the media about dietary practices to promote health overall, but were positive about the potential of lycopene and green tea in relation to PC prevention, valuing their natural components. Furthermore these men wanted tailored dietary advice for PC prevention from their clinicians, whom they considered a trusted source of information. CONCLUSION: Men at elevated risk of PC reported uncertainty about PC aetiology and the role of diet in PC prevention, but enthusiasm for dietary modifications that were perceived as 'simple' and 'natural'. The men looked to clinicians to provide consistent disease specific dietary advice. These factors should be taken into consideration by clinicians discussing elevated PSA results with patients and those planning to embark on future trials investigating dietary modification interventions for the prevention of a PC diagnosis.

"It's there and I'm stuck with it": patients' experiences of chronic pain following total knee replacement surgery.

OBJECTIVE: To gain insight into patients' experiences of adjustment to chronic pain following recovery from total knee replacement (TKR) surgery. METHODS: Participants were purposively sampled and comprised 28 individuals, 18 women and 10 men, ages 57-87 years, who had undergone a TKR between 2 and 5 years previously. Semistructured interviews explored participants' perceptions of their condition and its impact, including its causes and consequences. Thematic analysis, using the constant comparison technique, was used to identify and analyze patterns and themes from the transcripts. RESULTS: Although some individuals expressed acceptance of their continuing pain, others reported that it caused them considerable distress. Variation in expressed acceptance and distress was not related to self-reported pain severity. Various factors relating to adjustment emerged, including perceived improvement or deterioration in circumstances since TKR, surgeon input pre- and postsurgery, and beliefs about pain in the context of an individual's life. Participants described a sense of abandonment following TKR and discussed the support they felt they should have received. CONCLUSION: The data suggest that adjustment to chronic pain following recovery from TKR surgery is influenced by biomedical and psychosocial factors, including an individual's pain-related illness cognitions, beliefs, and their perceptions of their condition in a social context. Patient care could be improved by clinicians utilizing a biopsychosocial framework to acknowledge the impact of osteoarthritis of the knee as a multidimensional health condition.