'People Like Us Would Have No Clue If the Information Is Online': Exploring Understanding and Sources of Hepatitis B Information Among Vietnamese Australians.

Socio-cultural and behavioural factors are often not adequately considered in designing health promotion programs for culturally and linguistically diverse communities in Australia. Given that people of Vietnamese background are disproportionately impacted by hepatitis B, the aim of this research was to better understand these factors to inform hepatitis B health promotion messages for the Vietnamese community. Twenty participants (four living with hepatitis B) were interviewed by a Vietnamese-speaking researcher. The interview sessions explored beliefs about health, the body and liver; knowledge and attitudes about hepatitis B vaccines, testing, clinical management and stigma; and sources of health information and value given to information on social media. Participants had a range of understandings of health and hepatitis B which informed their responses to health education and intervention. Participants appeared to have limited knowledge and misconceptions about transmission, prevention, treatment, and management of hepatitis B. Stigma surrounding hepatitis B was apparent, with over half the participants reporting that they distanced themselves from people living with hepatitis B. Participants preferred online information resources for younger people and traditional media in the Vietnamese language for older people. By understanding what Vietnamese people know about hepatitis B and how they access health information, these findings can be used to inform health promotion campaigns using print, media, and radio to ensure wide reach. Knowledge of community specific information is key to reducing the burden of hepatitis B among culturally and linguistically diverse communities and ensuring they are able to access healthcare services for testing, monitoring, and care.

Understanding cultural inclusion in alcohol and other drug services in New South Wales, Australia and assessing the acceptability of a cultural inclusion audit.

INTRODUCTION: Cultural inclusion and competence are understood at the most basic level to be the practice of considering culture so as to provide effective services to people of different cultural backgrounds. In order to work better with clients from diverse backgrounds, alcohol and other drug (AOD) services need to offer a service that is designed to be accessible to all people, where systems in place operate in a way that considers different cultural needs. This research aimed to assess the extent to which non-government AOD services in New South Wales are positioned to support cultural inclusion as well as to evaluate the acceptability of a cultural inclusion audit across four AOD sites. METHODS: The research adopted a mixed methods approach comprising of a pre-audit online survey (n = 85) designed to assess AOD services' attitudes and practices towards cultural inclusion, and in-depth interviews that were conducted with nine AOD service staff and four cultural auditors to explore the acceptability of a cultural inclusion audit process. RESULTS: Findings from the survey indicate cultural inclusion practices are limited. Interview data highlight that while staff are not fully aware of what appropriate cultural inclusions entails, they are receptive to and want a cultural inclusion program. DISCUSSION AND CONCLUSIONS: The study illustrates the benefits of implementing a cultural inclusion audit process aimed at raising awareness of what cultural inclusion entails. Including a cultural inclusion service audit is likely to enhance AOD service provision to culturally and linguistically diverse groups and thereby improve treatment outcomes.

Factors associated with hepatitis B knowledge among people of Vietnamese ethnicity in Australia.

Despite high hepatitis B (HBV) prevalence among people of Vietnamese ethnicity in Australia and elsewhere, there is limited research on levels of HBV knowledge and factors associated with such knowledge. The aim of this study was to examine HBV knowledge and associated demographic and attitudinal factors among people of Vietnamese ethnicity in Australia. People of Vietnamese ethnicity (n = 966) were recruited through community events and social media groups to complete online surveys measuring HBV knowledge, attitudes towards HBV, levels of mistrust in Western medicine, and demographic characteristics. Findings of this study indicate that levels of knowledge are mixed, with gaps in knowledge related to transmission and treatment of the virus. Those with greater knowledge of HBV tended to be older, have higher levels of formal education, have been tested for HBV, and know someone living with HBV. Those with lower levels of knowledge tended to have more negative attitudes towards the virus and greater levels of mistrust in Western medicine. Given that health literacy is connected to effective communication from health providers, we suggest that there is a need for the development of health promotion and education resources targeted at people of Vietnamese ethnicity and translated into Vietnamese. We propose that such resources be developed in consultation with Vietnamese communities and health providers to ensure that they are culturally appropriate and sensitive to people of Vietnamese ethnicity living in Australia.

Hepatitis B screening and knowledge among Chinese and Vietnamese students in Australia.

Research has shown that there are significant gaps in hepatitis B knowledge among migrant communities who are at risk of hepatitis B, such as Chinese and Vietnamese communities. Many students studying within Australia come from countries with high prevalence of hepatitis B. However, there is very little research examining hepatitis B knowledge, screening, or vaccination among university students in Australia or worldwide. The aim of this paper was to measure both levels of and demographic differences in hepatitis B screening and knowledge among Chinese and Vietnamese students in Australia. Online surveys were completed by 112 Chinese- and 95 Vietnamese-identifying students in Australia, measuring knowledge of hepatitis B, engagement in screening and vaccination, and demographic characteristics. Results show that although engagement in screening and vaccination for hepatitis B was high, there were significant gaps in knowledge around transmission of hepatitis B. There were also some key demographic differences in screening and knowledge. For instance, those born in Australia were more likely to have been screened compared to those born Mainland China, Hong Kong, or Vietnam. Chinese students born in Australia had lower levels of knowledge compared to those born in Mainland China or Hong Kong. Among both samples, knowing someone living with hepatitis B was associated with higher levels of knowledge. Findings underscore the need for education-based interventions to address the significant gaps that exist in knowledge around hepatitis B, with a specific need for culturally appropriate resources in a range of languages to cater to the diverse communities who may be at risk of hepatitis B.

Reducing stigma towards people living with HIV and people who inject drugs using social norms theory: An online study with Australian health care workers.

BACKGROUND: Despite extensive evidence regarding the negative effects of stigma experienced by people living with HIV (PLHIV) and people who inject drugs within health care settings, comparatively little evidence exists regarding the effectiveness of initiatives to reduce this stigma. METHOD: This study developed and assessed brief online interventions based on social norms theory with a sample of Australian health care workers (n=653). Participants were randomly allocated to either 1) HIV intervention group, or 2) injecting drug use intervention group. They completed baseline measures of their attitudes towards either PLHIV or people who inject drugs, matching measures of their perceptions of their colleagues' attitudes, plus a series of items reflecting behavioural intentions and agreement with stigmatising behaviour towards PLHIV or people who inject drugs. Participants were presented with a social norms video before completing the measures again. RESULTS: At baseline, participants' agreement with stigmatising behaviour was correlated with their perceptions of how many of their colleagues would agree. After watching the video, participants reported more positive perceptions of their colleagues' attitudes towards PLHIV and people who inject drugs, as well as more positive personal attitudes towards people who inject drugs. Changes in perceptions of colleagues' support for stigmatising behaviour independently predicted changes in participants' personal agreement with that behaviour. CONCLUSION: Findings suggest that interventions based on social norms theory that address health care workers' perceptions of their colleagues' attitudes can play an important role in contributing to broader initiatives to reduce stigma in health care settings.

Optimising community health services in Australia for populations affected by stigmatised infections: What do service users want?

Stigma in health services undermines diagnosis, treatment and successful health outcomes for all communities, but especially for those affected by blood-borne viruses and sexually transmitted infections (STIs). This study sought to examine experiences in accessing and receiving health services, including what characteristics promoted better health, safety and well-being for people with blood-borne viruses or STIss. It conducted 46 in-depth interviews with people who inject drugs, gay men and other men who have sex with men, sex workers, people in custodial settings, culturally and linguistically diverse people, Indigenous Australians and young people in one Australian urban community setting. Findings reveal that stigma persists in the provision of healthcare services, and that previous experiences of discrimination or fear of mistreatment may result in a reluctance to continue to access services. On-going staff training and education are important to ensure healthcare environments are welcoming and inclusive. Specialised services and services that employed peers were seen as favourable. Attending different services for different health needs created particular access challenges and undermined participant ability to engage in more holistic healthcare. The fragmented structure of health services was thus seen as a barrier to accessing health services, and stronger collaboration between health services is recommended.

Health worker perceptions of the impact of COVID-19 on harm reduction services for people who inject drugs.

The COVID-19 pandemic has affected entire systems of health service provision globally, including health service closure, redeployment of staff and resources and implementation of infection prevention protocols. Harm reduction facilities face particular challenges responding to COVID-19, attempting to continue service provision to people who inject drugs with minimal service disruption whilst protecting their staff. This research assessed the impact of COVID-19 on staff working at harm reduction and alcohol and other drug (AOD) services in Australia in the first 9 months of the pandemic. The research employed mixed methods, using survey data to inform in-depth interviews. Surveys were completed by 207 participants working in the AOD sector and the harm reduction sector nationally. Interviews were conducted with 16 staff at three harm reduction sites in metropolitan Sydney and one regional NSW service. Staff felt able to respond to the trying circumstances of this pandemic, especially as practical messages around the COVID-19 response were similar to those already in place for clients in relation to blood-borne virus prevention. Staff felt that they were still able to provide core services to clients with some modifications in delivery. They were willing to take on additional responsibilities to ensure their own safety and that of clients, including conducting temperature checks and screening questions, whilst also adopting novel service provision strategies to reach clients during lockdowns such as postal services, outreach work and telehealth. NSP and AOD services were able to implement COVID-19 infection control strategies, whilst maintaining and expanding service access through remote and innovative strategies in a manner which supported both clients and service providers, during the first wave of the pandemic in 2020.

Establishing the impact of consumer participation in alcohol and other drug treatment settings in Australia.

It is generally recognised that engaging consumers to participate in policy making, programming, and practice is fundamental to effective alcohol and other drug (AOD) treatment, however, literature continues to document challenges and barriers to its implementation in AOD settings. This study reports on an evaluation of the Consumer Participation Project implemented in key non-government AOD services in Australia. Data collection consisted of an online survey of 86 staff members at the five participating AOD services and 27 consumer interviews. The survey examined staff attitudes towards and beliefs about consumer participation, perceived current levels of consumer participation and service changes as a result of the consumer participation project. The qualitative arm explored consumer's prior knowledge and current experiences of consumer participation. Staff who took part in the consumer participation training offered as part of the project were more likely to believe that service changes could encourage greater consumer participation rather than any barriers associated with consumer circumstances. Additionally, while services offered low-level involvement consumer activities, there were fewer examples of mid- and high-level activities being conducted at the different services. Consumers discussed the significance of being actively involved in their AOD treatment service while stressing the importance of proper training and support for those engaging in consumer participation. This research highlights the benefits of consumer participation in AOD treatment and suggests that most consumer participation activities undertaken at present are "low" level involvement concerned with providing and receiving information from consumers. Importantly, however, our study did demonstrate some support for "high" level involvement activities and service providers being open to doing more to encourage consumer participation.

Improving access to drug and alcohol treatment in NSW Australia: The role of self-determination and peer support.

One of the key issues in the alcohol and other drug (AOD) treatment sector concerns the reported difficulties that clients have in accessing treatment. This paper draws on qualitative interview data collected from clients undergoing treatment (n = 20) and stakeholders (n = 15) of five specialist non-government AOD treatment services in New South Wales, Australia, to offer an in-depth perspective about treatment entry experiences. We identified four key themes of positive treatment entry experiences: the presence of high-quality online information which enabled clients to best match themselves to treatment; flexible and simple intake procedures with skilled and welcoming staff; the presence and quality of social and other resources (such as families, peers and private health insurance) which enabled quicker access; and prior experience in the treatment system which helped clients to gain important knowledge and skills to improve future access. We discuss implications of these findings, including that waiting lists significantly exacerbate inequity, but that this could be ameliorated by providing peer-support to those trying to gain entry, especially clients who do not have family and friends for help during this period. The findings also point to the way that client self-determination is central to all positive treatment entry experiences, and that supporting clients to find 'the right fit' in relation to treatment options improves their experiences.

Identification with drug use among young adults who are at risk of transitioning to more serious use.

Understanding the drug use trajectories for at risk young adults can help reduce harms associated with serious drug use. This longitudinal study tracked young people to assess whether implicit and explicit identification with substance use predicts changes in use over time and whether patterns of use impacts identification with drugs. Two hundred and twenty-eight participants were initially recruited from homeless shelters, youth centers, drug health services, and parks where young people who use drugs are known to frequent. Over a 20-month period, 78 of these original participants were successfully recontacted and surveyed again. The survey assessed implicit and explicit identification with drug use, along with known risk factors, to determine if identification predicts changes in drug use over time as assessed by frequency, recency, and multiple drug use. Results revealed that implicit and explicit identification with drug use were stronger among participants who used more frequently, more recently, and used multiple drugs, although this finding only emerged cross-sectionally and not longitudinally. Overall, these results suggest that patterns of drug use are associated with the identity of the individual and that identification with drug use is a marker of drug-using behavior, but identification with drug use does not appear to be predictive of future behavior nor an outcome of prior drug use.

Implicit and explicit internalized stigma: Relationship with risky behaviors, psychosocial functioning and healthcare access among people who inject drugs.

INTRODUCTION: People who inject drugs (PWID) are stigmatized by society. Over time people may begin to internalize the stigma about their group. This research examines how implicit and explicit internalized stigma among PWID relates to health care and treatment access, psychosocial functioning, and engagement in risky behaviors. METHODS: PWID were recruited from a needle and syringe program (NSP) located in Sydney, Australia. Participants completed a survey examining explicit and implicit internalized stigma, risky behaviors (e.g., sharing injecting equipment, unprotected sex), health care and treatment access (e.g., comfort attending NSPs), and psychosocial functioning (e.g., mental health). Detailed demographic variables were also collected. RESULTS: A total of 115 clients completed the measures. To the degree that participants had internalized the stigma about their group (measured explicitly), they felt less comfortable attending NSPs, had greater severity of dependence, and experienced more depressive symptoms. The implicit measure of internalized stigma was related to treatment engagement and needle sharing, although the direction of these effects was unexpected. CONCLUSIONS: This research highlights the importance of ongoing research into the implications of internalized stigma for PWID. Assessing both explicit and implicit internalized stigma appears to be beneficial as these are related to different health and behavioral outcomes.

Discrimination by health care workers versus discrimination by others: countervailing forces on HCV treatment intentions.

Hepatitis C virus (HCV) infection is a major public health burden. Despite recent advances in HCV treatment, uptake remains low, particularly amongst people who inject drugs. HCV-related stigma and discrimination are common, especially within the health care sector. This research examines a more nuanced approach for how HCV-related stigma and discrimination impacts treatment access and uptake. Based on a social identity framework, we explore whether perceived HCV-related discrimination is associated with attempts to remove the stigma of being HCV-positive via HCV treatment intentions. Based on the results of prior research it was also hypothesised that the source of discrimination (health care workers versus others), and whether the discrimination is perceived to be directed to oneself or to the HCV-positive group, will differentially impact treatment intentions. The sample consisted of 416 people living with HCV in New South Wales, Australia, who acquired HCV from injecting drugs. Participants were asked about their experiences of perceived discrimination directed towards themselves versus their HCV-positive group and perceived discrimination within the health care sector. Findings indicate that discrimination towards the self is a more powerful indicator of treatment intentions than discrimination aimed at the HCV-positive group. This finding is consistent with social identity theory suggesting that people from low status groups are motivated to change their stigmatised status when it is possible to do so. The source of the perceived discrimination also matters, however, as participants who report experiencing discrimination from health workers have lowered intentions to engage with HCV treatment in the future. In combination, the results indicate that while perceived discrimination is commonly understood to act as a barrier to treatment uptake, the relationship is actually more complex than previously conceptualised.

The impact of pluralistic ignorance on the provision of health care for people who inject drugs.

Health workers who work with people who inject drugs may believe that their colleagues hold less favorable attitudes toward health services for people who inject drugs than themselves-a phenomenon termed pluralistic ignorance. This research explores whether the presumed attitudes of their colleagues, rather than their own attitudes, predict the behavioral intentions of health workers toward people who inject drugs. A total of 57 hospital-based health workers were surveyed to assess their attitudes toward harm reduction services for people who inject drugs and their perceptions of colleagues' attitudes. They then responded to a scenario assessing their likelihood of prescribing opiate-based medication to people who inject drugs. Data illustrate that participants support harm reduction services for people who inject drugs more than they believe their colleagues do, demonstrating pluralistic ignorance. Interestingly, participants' prescription of opiate-based pain medication was predicted by beliefs about their colleagues' support for services for people who inject drugs, rather than their own beliefs.

Evaluation of an integrated care service facility for people living with hepatitis C in New Zealand.

INTRODUCTION: People living with hepatitis C are a highly marginalised population who may not readily access health care. Existing models of hepatitis C care may not meet the needs of these patients. This research evaluates the experiences of patients attending an innovative hepatitis C clinic that offers integrated care and service delivery. METHOD: Surveys were completed by 120 clients and comprised of questions relating to changes in lifestyle habits since attending the clinic, hepatitis C knowledge, hepatitis C treatment and experiences with health care staff at the clinic. RESULTS: The majority of respondents indicated that attendance at the clinic has provided them with the information to better manage their hepatitis C and had given them confidence to make lifestyle changes. Participants demonstrated a very high knowledge of hepatitis C and reported experiencing a less discriminatory environment at the clinic compared to other health care settings. Respondents who had been attending the clinic for more than 6 months were significantly more likely to indicate a desire to commence hepatitis C treatment over the next 5 years. DISCUSSION: The findings point to the importance of integrated care in the community setting in providing clients with a positive experience of health care, which appears to increase their skills and desire to better manage their hepatitis C.