Shared learning database

Sheffield Teaching Hospitals NHS Foundation Trust
Published date:
April 2013

This service development is aligned to NICE PH43 and more specifically Recommendation 2 'Awareness-raising for people at increased risk of hepatitis B or C infection'.

In 2009 Sheffield Teaching Hospitals offered viral hepatitis information and testing in community settings, including the Kinhon Chinese Health Project. An information leaflet was developed in English and Chinese that provided information about hepatitis B and advice about transmission, prevention, vaccination, alcohol and treatment. Dry blood spot testing was used for those who chose to be tested. A similar approach was offered to other affected populations including Pakistani, Slovak, Somali and Yemeni at local community events as part of the Healthy Communities Programme led by the Primary Care Trust (PCT).

In 2011 a complementary online educational package about hepatitis B and C was designed and tried in the groups above and in one GP surgery.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim of the projects were to address inequality in health for the groups mentioned in respect to hepatitis B and C which in turn will prevent late diagnosis, ongoing transmission and complications that incur expensive health care procedures. This inequality cause may be complex and in previous studies has been attributed to the population affected, the caring professionals and the local health system.

The objectives were to:
1) Raise awareness among the populations affected.
2) Provide an easy to understand information tool that can be shown also to people with illiteracy.
3) To offer testing in convenient places where translators are regularly or intentionally available.
4) To provide a source of information for professionals that will help risk assessment, interpretation of results and easy access to basic epidemiology

Reasons for implementing your project

Estimated numbers of residents with high prevalence of viral hepatitis in Sheffield are:

Pakistani: 17,000
Chinese 6,000
Somali: 8,000
Slovak-Roma: 3,000 (rapidly increasing with an estimated prevalence of hepatitis B of 9.4%, data presented at British Association for Study of the Liver 2013, Page Hall Surgery and STH)

The diagnosis and referrals to the hospital department of people with hepatitis B and C in these at high risk groups did not correspond to the existing numbers (prevalence is expected to be similar to that of the country of origin).

There has been a disparity from diverse populations known in the UK since the mid 1980s and systems have been put in place to address this, however these are not fully effective and a significant number of individuals are diagnosed late with liver cancer or decompensated liver cirrhosis prompting recurrent admissions to hospital.

Testing of hepatitis B in Sheffield is routinely offered in antenatal clinics and hepatitis C testing is offered if the patient has a history of injecting drug use. Testing for both hepatitis B and C is offered routinely in substance misuse services, the blood transfusion service as well as genitourinary medicine departments and surgeries specialising in asylum health to those at increased risk of infection.

How did you implement the project

- Links with the Chinese community health promotion workers (PCT funded) were in place as they support patients attending the hospital clinic, and doctors had provided talks on hepatitis B and HIV in the community.
- Contacts with the PCT office provided the links for communities targeted by the Healthy Communities Programme established by the Department of Health.
- The website, Hepatitis Information and Testing - , provides basic pictorial and animated clips addressing essential issues surrounding hepatitis B and C.
- The costs originated by both pilots were funded by the Gilead UK and Ireland Fellowship Programmes. These were in 2009 when a feasibility study of community testing by dry blood spot was carried out and then in 2011 when a further pilot was undertaken for the development, roll-out and evaluation of the educational pack described above (additionally dry blood spot testing was also offered).
- The educational pack included world maps, transmission awareness, prevention (including neonatal and contact's vaccination; and alcohol advice) and availability of treatment. A forum and a professionals' page provides a resource for health professionals.

Key findings

The hospital monitored acceptance of information and dry blood spot procedure during the first pilot and this showed not only good acceptance but a significant number of people expressed their gratitude for being given the opportunity to discuss the issue and to be tested. During the 8 months, the pilot succeeded in testing 155 Chinese and 24 South East Asian/Middle Eastern people previously untested with 12 hepatitis B and 1 hepatitis C new diagnosis made. The test was voluntary and openly offered after informative talks and those interested requested testing.

The information website and videos were evaluated by assessing acceptance and relevance of the information and it was found from 75 people interviewed from different groups that they felt the clips were easy to understand, gave important information, were useful for the community and were culturally respectful. When offered testing, this was accepted by the majority of people.

The next step for the project is to evaluate whether increased awareness addresses barriers and has a significant impact in the uptake of testing. This work will start in September 2013 as we have received funding from the Policy Research Programme 2012 for a 2 year study to evaluate barriers of access to health care and write recommendations for practice.

Key learning points

It is essential to build links with the organised groups and their representatives, and to request their involvement in the setting of any service directed to the community. Setting and timing of sessions were organised by the PCT funded health promotion workers belonging to the community affected, and they provided also the interpretation during testing.

Cross-cultural health provision is complex and training is advised to improve understanding of the health system by the users and of the difficulties experienced in the minority group by professionals and health workers alike. A session in cross cultural understanding helps visualise the possible difficulties that outreach may present. A DVD was available in Chinese for users to understand the NHS. By receiving support of the community workers we were able to understand difficulties of migrants attending health services or requesting appropriate tests or reviews by health professionals.

Contact details

Alicia Vedio
Infectious Diseases Physician
Sheffield Teaching Hospitals NHS Foundation Trust

Primary care
Is the example industry-sponsored in any way?