Environmental factors affecting self-management of chronic hepatitis B from the patients' perspective

Aims and objectives To explore factors affecting self-management experiences of patients with chronic hepatitis B within their social and cultural environments. Background Many cases of hepatitis B are not detected until they are in end-stage liver disease. Despite an increasing trend of indicating a lack of health awareness as the reason, studies have rarely referred to the personal, social and cultural environmental constraints from patients' perspectives. Design A descriptive qualitative study. Methods Forty-seven adults diagnosed with chronic hepatitis B were interviewed in a private area of a hospital clinic in Taiwan in 2018. Four open-ended questions relating to care self-management included the following: disease detection; disease control; preventive care; and perceptions of screening and follow-ups. Data were examined using content analysis. This study also adhered to the consolidated COREQ guidelines. Results Five main themes emerged: personal experiences, awareness of occupational health, the availability of conventional treatment, cultural beliefs about health care and family roles. Findings of note were that some participants became aware that they had never known the difference between follow-up for hepatitis B and regular adult/labourer health checks due to a lack of information within their living environment. Many participants added alternative treatments to their self-management strategies and others frequently ignored follow-up appointments because of different cultural health beliefs. Conclusions Patients' disease self-management perceptions are driven by dynamic influences suggesting that development of policies integrating personal, family, social and cultural environmental factors could enhance individual screening and subsequent health behaviours of patients with chronic hepatitis B. Relevance to practice Adding person-centred case management of hepatitis B could enhance patients' adherence to follow-up. Attention should be given to increasing provider awareness of the influence of their own attitude and communication on patients' participation in self-management.