Trust imperative for reaching multicultural communities with hepatitis B care

April 16, 2024

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In Australia, chronic hepatitis B disproportionately affects people born overseas. More than two-thirds of those living with the infection were born overseas or are Aboriginal and Torres Strait Islander people.

It is therefore vital that hepatitis B programs, services and care are culturally appropriate and safe. If Australia is to reach its hepatitis B treatment targets, we must be actively working with the communities most at risk of infection.

Ethnic Communities Council of Queensland (ECCQ) is making sure people born overseas are front and centre in conversations about hepatitis B. As an organisation focused on working with and advocating for the needs of multicultural communities, ECCQ has a well-established HIV, hepatitis and sexual health program called the Love Health Program, which ensures these communities are represented in BBV and sexual health care.

“We have a very low number of people with hepatitis B who are engaged in care – about 26% nationally. That should be 100%”

As close collaborators with ECCQ, ASHM spoke with two members of the Love Health Program team to understand what clinicians need to know to ensure hepatitis B care is culturally accessible.

Zhihong Gu, Program Manager at ECCQ, says that ECCQ is an organisation with a broad remit, that has grown to match the needs of the multicultural communities it serves.

“Originally when it started more than forty years ago, ECCQ was providing things like aged care services and a few different specific projects including sexual health, and it’s just grown from there,” says Zhihong.

“We engage in a range of issues for multicultural communities, providing advocacy, support and services, as well as programs for health like the Hepatitis, HIV/AIDS and Sexual Health Program,” she says.

Zhihong, who has worked in the program for more than 15 years, says that in her experience, GPs can make an enormous positive impact for multicultural communities affected by hepatitis B by increasing their engagement with patients on this health issue.

“Due to their busy schedules, some GPs still refer their patients to specialists right away, even though they could manage them,” says Zhihong.

“But having GPs who can manage and treat hepatitis B is so valuable for people with hepatitis B, because they can often access GPs much more easily than they can go to hospitals. That’s why GPs doing the hepatitis B training or prescriber course is so important,” she says.

Hep B care. It’s primary care, too.

This suite of resources has been developed to support primary care clinicians at the time of diagnosis or engagement through what needs to happen next, as well as options for ongoing management and care.

Marrianne Black, a Registered Nurse who has worked at ECCQ for seven years, agrees. Marrianne says that trust – like that built between a GP and their patient – is critically important for many people with hepatitis B, especially in multicultural communities.

“Trust is really important, particularly in relation to hepatitis B,” says Marrianne.

“[For example], there were a lot of concerns around having hepatitis B and it potentially impacting your ability to get a permanent visa, and while that’s no longer the case, people still worry about it. There is a lot of misinformation out there that you need to be able to build trust in order to correct this,” she says.

A survey presented at the World Hepatitis Summit 2024 found that half of Europeans living with hepatitis B or C say they have difficulty telling others about it because of stigma – meaning the value of trusted relationships in this arm of healthcare cannot be understated.  

“Ideally for multicultural communities, this trust is going to be built in-language,” says Marrianne.

 “As clinicians, sometimes we need to take a step back and think about what they’re experiencing from a cultural point of view.”

“Especially if you don’t speak a patient’s language, you need to take the time to consider how they’ll hear things, use an interpreter where you can, and utilise the organisations and services you have available to you. This will all help to make sure they get the information they need accurately,” she says.

For clinicians wanting to find out more about connecting with and building trust with patients who they don’t share a first language with, Marrianne recommends reaching out to local multicultural organisations who specialise in supporting their communities.

“It’s about knowing what your local services are like and who you can reach out to,” she says.

“Look at established services that have a track record in these things, because it’s a much better investment than trying to reinvent the wheel. [For example, ECCQ] have a well-established bilingual team of healthcare workers who have developed trust in their communities, and we work with GP practices regularly,” says Marrianne.

To find out more about ECCQ, the services they provide and their Hepatitis, HIV/AIDS and Sexual Health Program, you can visit their website.

Culturally Responsive Care and Hepatitis B – Expression of Interest

This webinar will help equip primary health practitioners and other healthcare workers with knowledge and strategies for providing culturally responsive CHB management and care to migrant and refugee patients.

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