{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:33:36Z","timestamp":1791282816609,"version":"4.1.0"},"reference-count":47,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T00:00:00Z","timestamp":1628726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001102","name":"Cancer Council NSW","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100001102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Chronic hepatitis B (CHB) is a significant global health challenge given an increasing morbidity and inadequate public health response, Migrant populations are primarily affected by CHB in industrialised countries, and while more than 7% of Australians with CHB were born in Africa or the Middle East, little is known of their awareness or knowledge of viral hepatitis and its impact. This qualitative study, using semi-structured interviews with Assyrian and Arabic community leaders and focus groups (FG) with 66 community members sought to identify hepatitis and liver cancer knowledge and awareness among local Arabic and Assyrian-speaking communities in Western Sydney. Interviews were thematically analysed, with findings framing the topics for the FGs which were analysed using a framework analysis. Themes identified across both methods included limited awareness or knowledge of viral hepatitis or liver cancer, stigma associated with both conditions, variable levels of health literacy and trust in medical practitioners, and fear that receiving \u201cbad news\u201d would deter people from seeking care. Preferred sources of health information were family doctors, family members, the internet and the ethnic media. The study gave valuable information for the design of an educational program and provided useful information for the planning of culturally appropriate hepatitis screening and treatment services for these communities.<\/jats:p>","DOI":"10.3390\/ijerph18168534","type":"journal-article","created":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T10:54:41Z","timestamp":1628765681000},"page":"8534","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Hepatitis B and Liver Cancer: Community Awareness, Knowledge and Beliefs of Middle Eastern Migrants in Sydney, Australia"],"prefix":"10.3390","volume":"18","author":[{"given":"Monica C.","family":"Robotin","sequence":"first","affiliation":[{"name":"School of Medicine, The University of Notre Dame, Sydney, NSW 2007, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4738-7316","authenticated-orcid":false,"given":"Jack","family":"Wallace","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, VIC 3004, Australia"},{"name":"Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia"},{"name":"Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Bundoora, VIC 3086, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3243-8176","authenticated-orcid":false,"given":"Gisselle","family":"Gallego","sequence":"additional","affiliation":[{"name":"Auburn Clinical School, School of Medicine, The University of Notre Dame, Sydney, NSW 2007, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"George","sequence":"additional","affiliation":[{"name":"Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney, NSW 2145, Australia"},{"name":"Westmead Clinical School, The University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,12]]},"reference":[{"key":"ref_1","unstructured":"(2020). AIHW (Australian Institute of Health and Welfare) 2020 Cancer Data in Australia, AIHW."},{"key":"ref_2","unstructured":"MacLachlan, J., Smith, C., Towell, V., and Cowie, B. (2020). Viral Hepatitis Mapping Project: National Report 2018\u20132019, Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM)."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1111\/1753-6405.12049","article-title":"The burden of chronic hepatitis B virus infection in Australia, 2011","volume":"37","author":"MacLachlan","year":"2013","journal-title":"Aust. N. Z. J. Public Health"},{"key":"ref_4","unstructured":"Supramaniam, R., O\u2019Connell, D.L., Tracey, E., and Sitas, F. (2006). Cancer Incidence in New South Wales Migrants 1991 to 2001, The Cancer Council NSW."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Rossi, C., Shrier, I., Marshall, L., Cnossen, S., Schwartzman, K., Klein, M.B., Schwarzer, G., and Greenaway, C. (2012). Seroprevalence of chronic hepatitis B virus infection and prior immunity in immigrants and refugees: A systematic review and meta-analysis. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0044611"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/S0264-410X(99)00456-9","article-title":"Hepatitis B epidemiology in Asia, the Middle East and Africa","volume":"18","author":"Andre","year":"2000","journal-title":"Vaccine"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Khan, F., Akbar, H., Idrees, M., Khan, H., Shahzad, K., and Kayani, M.A. (2011). The prevalence of HBV infection in the cohort of IDPs of war against terrorism in Malakand Division of Northern Pakistan. BMC Infect. Dis., 11.","DOI":"10.1186\/1471-2334-11-176"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3163","DOI":"10.1007\/s10620-011-1840-6","article-title":"Barriers to screening for hepatitis B virus infection in Asian Americans","volume":"56","author":"Hu","year":"2011","journal-title":"Dig. Dis. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1353\/hpu.2007.0013","article-title":"Knowledge, attitudes, and behaviors of hepatitis B screening and vaccination and liver cancer risks among Vietnamese Americans","volume":"18","author":"Ma","year":"2007","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"178","DOI":"10.5993\/AJHB.32.2.7","article-title":"Knowledge, attitudes, and behaviors of Chinese hepatitis B screening and vaccination","volume":"32","author":"Ma","year":"2008","journal-title":"Am. J. Health Behav."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s10900-005-7282-3","article-title":"Hepatitis B awareness, testing, and knowledge among Vietnamese American men and women","volume":"30","author":"Taylor","year":"2005","journal-title":"J. Community Health"},{"key":"ref_12","first-page":"51","article-title":"Hepatitis B knowledge among Vietnamese immigrants: Implications for prevention of hepatocellular carcinoma","volume":"15","author":"Taylor","year":"2000","journal-title":"J. Cancer Educ."},{"key":"ref_13","first-page":"313","article-title":"Hepatitis B knowledge and practices among Chinese immigrants to the United States","volume":"7","author":"Taylor","year":"2006","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.aogh.2017.02.002","article-title":"Practice, Knowledge, and Barriers for Screening of Hepatocellular Carcinoma Among High-Risk Chinese Patients","volume":"83","author":"Xu","year":"2017","journal-title":"Ann. Glob. Health"},{"key":"ref_15","first-page":"401","article-title":"Hepatitis B knowledge and vaccination levels in California Hmong youth: Implications for liver cancer prevention strategies","volume":"6","author":"Butler","year":"2005","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2955","DOI":"10.1002\/cncr.21518","article-title":"Hepatitis B and liver cancer beliefs among Korean immigrants in Western Washington","volume":"104","author":"Choe","year":"2005","journal-title":"Cancer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s10900-010-9277-y","article-title":"Chumnguh thleum: Understanding liver illness and hepatitis B among Cambodian immigrants","volume":"36","author":"Burke","year":"2011","journal-title":"J. Community Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/j.1467-842X.2005.tb00751.x","article-title":"Knowledge about hepatitis and previous exposure to hepatitis viruses in immigrants and refugees from the Mekong Region","volume":"29","author":"Caruana","year":"2005","journal-title":"Aust. N. Z. J. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1071\/SH07084","article-title":"Low knowledge and high infection rates of hepatitis in Vietnamese men in Sydney","volume":"5","author":"Shaw","year":"2008","journal-title":"Sex. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/j.1753-6405.2007.00119.x","article-title":"Knowledge of STIs and blood-borne viruses among Vietnamese men in metropolitan Sydney","volume":"31","author":"Wen","year":"2007","journal-title":"Aust. N. Z. J. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1177\/1010539510390205","article-title":"Hepatitis B knowledge, testing, and vaccination among Chinese and Vietnamese adults in Australia","volume":"24","author":"Vu","year":"2012","journal-title":"Asia Pac. J. Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1071\/SH10137","article-title":"Challenges to the effective delivery of health care to people with chronic hepatitis B in Australia","volume":"9","author":"Wallace","year":"2012","journal-title":"Sex. Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1177\/00333549161310S218","article-title":"Increasing Hepatitis B Testing and Linkage to Care of Foreign-Born Asians, Sacramento, California, 2012\u20132013","volume":"131","author":"Dang","year":"2016","journal-title":"Public Health Rep."},{"key":"ref_24","first-page":"e40","article-title":"Hepatitis B in the Greater San Francisco Bay Area: An integrated programme to respond to a diverse local epidemic","volume":"18","author":"Gish","year":"2010","journal-title":"J. Viral. Hepat."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"130258","DOI":"10.5888\/pcd11.130258","article-title":"Effect of a liver cancer education program on hepatitis B screening among Asian Americans in the Baltimore-Washington metropolitan area, 2009\u20132010","volume":"11","author":"Juon","year":"2014","journal-title":"Prev. Chronic Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1377\/hlthaff.2011.0700","article-title":"A comprehensive screening and treatment model for reducing disparities in hepatitis B","volume":"30","author":"Pollack","year":"2011","journal-title":"Health Aff."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"374","DOI":"10.2471\/BLT.13.130344","article-title":"Community-based prevention of hepatitis-B-related liver cancer: Australian insights","volume":"92","author":"Robotin","year":"2014","journal-title":"Bull. World Health Organ."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1177\/009145091003700408","article-title":"Hepatitis C in an Australian migrant community: Knowledge of and attitudes towards transmission and infection","volume":"37","author":"Horwitz","year":"2010","journal-title":"Contemp. Drug Probl."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Mude, W., Fisher, C., Richmond, J., Wallace, J., and Le Gautier, R. (2019). A qualitative investigation of barriers, support-seeking and coping among South Sudanese people with chronic hepatitis B in Australia. Aust. J. Prim. Health, Online ahead of print.","DOI":"10.1071\/PY19015"},{"key":"ref_30","unstructured":"MacLachlan, J., and Cowie, B. (2013). Hepatitis B Mapping Project: Estimates of Chronic Hepatitis B Prevalence and Cultural and Linguistic Diversity by Medicare Local, 2011\u2014National Report, Australasian Society for HIV Medicine."},{"key":"ref_31","unstructured":"Department of Health and Ageing (2018). Third National Hepatitis B Strategy 2018\u20132022, Australian Government."},{"key":"ref_32","unstructured":"Wikipedia (2019, February 07). Iraqi Australians. Available online: https:\/\/en.wikipedia.org\/wiki\/Iraqi_Australians."},{"key":"ref_33","unstructured":"Ritchie, J.S.L. (2003). Carrying out qualitative analysis. Qualitative Research Practice: A Guide for Social Science Students and Researchers, Sage."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Gale, N.K., Heath, G., Cameron, E., Rashid, S., and Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med. Res. Methodol., 13.","DOI":"10.1186\/1471-2288-13-117"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1002\/pon.1884","article-title":"Knowledge, attitudes and beliefs of Arabic-Australians concerning cancer","volume":"21","author":"Saleh","year":"2012","journal-title":"Psychooncology"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Sweeney, L., Owiti, J.A., Beharry, A., Bhui, K., Gomes, J., Foster, G.R., and Greenhalgh, T. (2015). Informing the design of a national screening and treatment programme for chronic viral hepatitis in primary care: Qualitative study of at-risk immigrant communities and healthcare professionals. BMC Health Serv. Res., 15.","DOI":"10.1186\/s12913-015-0746-y"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"943","DOI":"10.15171\/ijhpm.2018.53","article-title":"Community Health Worker Programs to Improve Healthcare Access and Equity: Are They Only Relevant to Low- and Middle-Income Countries?","volume":"7","author":"Javanparast","year":"2018","journal-title":"Int. J. Health Policy Manag."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1007\/s10903-011-9523-0","article-title":"Hepatitis B and liver cancer among three Asian American sub-groups: A focus group inquiry","volume":"14","author":"Philbin","year":"2012","journal-title":"J. Immigr. Minor. Health"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Van der Veen, Y.J., Voeten, H.A., de Zwart, O., and Richardus, J.H. (2010). Awareness, knowledge and self-reported test rates regarding Hepatitis B in Turkish-Dutch: A survey. BMC Public Health, 10.","DOI":"10.1186\/1471-2458-10-512"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Wallace, J., McNally, S., Richmond, J., Hajarizadeh, B., and Pitts, M. (2011). Managing chronic hepatitis B: A qualitative study exploring the perspectives of people living with chronic hepatitis B in Australia. BMC Res. Notes, 4.","DOI":"10.1186\/1756-0500-4-45"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"262","DOI":"10.3389\/fpubh.2018.00262","article-title":"The Health of Arab Americans in the United States: An Updated Comprehensive Literature Review","volume":"6","author":"Abuelezam","year":"2018","journal-title":"Front. Public Health"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Sultan, N.Y., YacoobMayet, A., Alaqeel, S.A., and Al-Omar, H.A. (2018). Assessing the level of knowledge and available sources of information about hepatitis C infection among HCV-infected Egyptians. BMC Public Health, 18.","DOI":"10.1186\/s12889-018-5672-6"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.23937\/2474-3658\/1510036","article-title":"Knoweged, attitudes and practice on hepatitis B: A survy among the in tenet users in TAif, Kingdon of Saudi Arabia","volume":"3","author":"Elbur","year":"2017","journal-title":"J. Infect. Dis. Epidemiol."},{"key":"ref_44","first-page":"1","article-title":"Prevalence, knowledge and practices of hepatitis B and C viruses among paiens undergoing surgery in Sulaimani City","volume":"2","author":"Ibrahem","year":"2016","journal-title":"J. Rare Disord. Diagn. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/s10900-005-9000-6","article-title":"Lay beliefs about hepatitis among North American Chinese: Implications for hepatitis prevention","volume":"31","author":"Chen","year":"2006","journal-title":"J. Community Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1177\/1558689812437100","article-title":"Triangulation and mixed methods research: Provocative positions","volume":"6","author":"Mertens","year":"2012","journal-title":"J. Mix. Methods Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s10900-008-9138-0","article-title":"Evaluation of a hepatitis B lay health worker intervention for Chinese Americans and Canadians","volume":"34","author":"Taylor","year":"2009","journal-title":"J. Community Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/16\/8534\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:44:52Z","timestamp":1760165092000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/16\/8534"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,12]]},"references-count":47,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["ijerph18168534"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18168534","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,12]]}}}