Social-demographic characteristics of the participants
A total of 50 participants diagnosed with hepatitis B were enrolled in this study. Table
1 shows the social-demographic characteristics of the participants. The majority of them were above 30 years old. Most participants received junior high school, senior high school, and undergraduate course (the percentages were 24, 16, and 18%, respectively). The most common occupation was workers (12%), following by the self-employed (10%), farmer (8%), office staff (8%), and civil servant (8%). Most of the participants lived in Chongqing (70%), and approximately a half (26/50) had family history of hepatitis B.
Table 1
Social-demographic characteristics of the participants
Age (years) | | Gender | |
≤ 19 | 1(2) | Male | 30(60) |
20–29 | 8(16) | Female | 20(40) |
30–39 | 15(30) | Occupation | |
40–49 | 11(22) | Barber | 1(2) |
50–59 | 12(24) | Civil servant | 4(8) |
≥ 60 | 1(2) | Company manager | 7(14) |
No record | 2(4) | Do odd jobs | 1(2) |
| | Driver | 1(2) |
Education | Farmer | 5(10) |
Primary school | 2(4) | No job | 1(2) |
Junior high school | 20(40) | Office staff | 2(4) |
High school | 13(26) | Retiree | 2(4) |
Undergraduate | 11(22) | Salesman | 2(4) |
Master | 4(8) | Self-employed laborer | 8(16) |
| | Student | 2(4) |
Location | Teacher | 3(6) |
Chongqing | 35(70) | Technician | 7(14) |
Sichuan | 5(10) | Worker in company/factory | 4(8) |
Guizhou | 2(4) | Does the family have a carrier or case | |
Hunan | 4(8) | Yes | 26(52) |
Other places | 1(2) | No | 21(42) |
No record | 3(6) | No record | 3(6) |
How did you find out you had been infected with HBV?
As shown in Table
2, the participants had been found themselves hepatitis B virus (HBV) infection from six ways. Nearly a half(22/50) was detected by specific physical examinations, including personal health examination, pregnancy check-ups, physical examination for college admission or employment, routine physical examination for schoool students or workers in factory/company. A noticeable proportion (15/50) was identified after their family members/neighbors/friends being diagnosed hepatitis B. Specially, only a small percentage(6/50) went to test by themselves since the emergence of mild disease symptoms.
Table 2
How do the participants being found hepatitis B infection
How to being found hepatitis B virus infection(n = 50) |
Specific physical examinations in different situations | 22 |
Go to test after family members diagnosed hepatitis B | 8 |
Go to test after friends or neighbors being found hepatitis B | 7 |
Go to test because of mild disease symptoms | 6 |
Being diagnosed when sick in hospital because of other diseases | 5 |
Test before blood donation/application for medical certificate of fitness | 2 |
Classification of specific physical examinations(n = 22) |
Personal health examination | 4 |
Pregnancy check-ups/Antenatal examination | 4 |
Routine physical examination for workers in factory/company | 5 |
Physical examination after being employed | 2 |
University entrance physical examination | 5 |
Routine physical examination for schoool students | 2 |
Specific physical examination
In 2004, companies focusing on enterprise health management began to appear on the market in China. In 2006, companies for personal health management emerged. In 2010, China issued corresponding laws and regulations to advocate regular physical examination. In 2011, a large number of health management companies emerged in the market. According to a respondent who has had a personal physical examination, “I went to check the hepatitis B antibody in May 2018. I had never done physical examination before. I found that I was infected with hepatitis B virus in my first physical examination. “ (YA 15,54 years old,female patient). A new patient reported that “half a year ago, I was found to have hepatitis B in the hospital of Dazu County. At that time, I felt a little tired, and I didn’t get any other symptoms. “ (YA 28,32 years old,male patient) Other patients described as “in 2012, I was firstly found hepatitis B because of physical examination, now I have been sick for nearly eight years, but physical examination showed no abnormality, no symptoms.” (YA 42,50 years old,male patient) Another patient mentioned that ‘It was discovered in the physical examination in 1994 or 1993. It has been more than twenty years. I have no symptoms and I do not care about the infection.” (YA 20,48 years old, female patient).
In 2001, The Maternal and Child Health Care Law began to be implemented in China, which requires medical and health institutions to provide free and basic prenatal care for all pregnant women in the country. In 2010, free hepatitis B screening was added to prenatal examination, but before that, it was not required. One interviewee who was detected hepatitis B through prenatal examination presented, “I was found a carrier of hepatitis B virus when I was pregnant more than ten years ago. At present, my test indicated that hepatitis B surface antigen is positive and liver function is abnormal.” (YA 27,57 years old, female patient).
In China, before 2010, HBV test is required in routine physical examination for workers in factory or company and physical examination after being employed. One patient expressed that “when I worked in Guangzhou, I participated the routine physical examination organized by our factory, the HBV test result was normal. But since last year, my transaminase was found elevated.” (YA 11,53 years old, female patient) Hepatitis B screening was also required for the entrance physical examination of universities in China between 2005 and 2010. As one patient mentioned “I was diagnosed with HBV-positive in the university entrance physical examination.” (YA 09,34 years old, female patient) The school routine physical examination started in 2007 in China. One patient said “in the first day of my junior high school, we had a physical examination and then knew that the level of my transaminase was relatively high. “(YA 25,21 years old, male patient) Another patient described “when I was a child in school, I was found as a hepatitis B carrier. My liver function was normal, I needed not to be treated.” (YA 22,34 years old, female patient).
Go for test after family members being diagnosed hepatitis B
There were eight patients decided to take a HBV test and found themselves HBV infection after their family members were diagnosed with hepatitis B. Among them, three took the advice on test from a doctor and the remaining five took the advice from their families. One patient said “After graduation from high school, considering my father was diagnosed hepatitis B, then I went to the hospital to do a test and found that I was also infected with HBV.” (YA 35,46 years old, male patient) Another patient said“When I was 18 years old ,my mother got hepatitis B, and the doctor suggested that I should also take a HBV test. The doctor did not recommend any medication based on my test results. “ (YA 16,29 years old, male patient).
Go for test after friends or neighbors being found hepatitis B
Seven of the participants went to the hospital to do HBV test after they heard that their neighbors or friends were HBV positive and finally confirmed that they also had HBV infection. A male patient described“In 2009, I went to the county hospital for physical examination. Because of the high prevalence of hepatitis B in my village at that time and the fact that many people died from liver cancer, I decided to do a physical examination and finally found that I was sick.”(YA 03,40 years old, male patient).
Go to test because of mild disease symptoms
Six patients were diagnosed with the HBV infection after they noticed some mild symptoms including fatigue, nausea, vomiting, and weakness. Patients recalled:“In 2004, I felt uncomfortable, and the main manifestation was soft feet. I went to the hospital to do a physical examination and I was told that my liver function was abnormal. “(YA 32,male patient) “I had symptoms and felt uncomfortable. I thought it was problem of my stomach. Then I was diagnosed with hepatitis B.” (YA 41,55 years old, female patient).
Being diagnosed when sick in hospital because of other diseases
A small number of patients were diagnosed with hepatitis B while they were examined for other diseases. One patient said “my hepatitis B was first identified during a blood test in a hospital because of a cold, and was eventually diagnosed in 2017 when I was in hospital due to cerebral hemorrhage” (YA 08,51 years old, male patient).
Test before blood donation/application for medical certificate of fitness
Only two patients found out that they had hepatitis B when they donated blood or applied for a medical certificate of fitness. They all described that they were not aware of it when they were infected with HBV. One female patient said“While donating blood on the local street, I was taken a small amount of blood for pre-examination. Then I was told that I had HBV infection.”(YA 01,42 years old, female patient) Another patient remembered that “while applying a medical certificate of fitness two years ago, I found my liver function abnormal by a blood test. Then I was diagnosed with HBV infection at the First Affiliated Hospital of Chongqing Medical University.” (YA 38,30 years old, male patient).
Patient’s signs and symptoms before diagnosis
Many participants reported that they had no obvious symptoms related to hepatitis B before diagnosis. One participant said “At that time, I felt no discomfort, so I didn’t feel bad.” The early symptoms they referred mainly include nausea, decreased sleep quality, fatigue and indigestion. Before diagnosis, patients had no or few symptoms similar to those of other diseases, so hepatitis B can be easily overlooked. Years later, if for many reasons, the patients failed to take liver function tests to detect the possible pathologic changes, some patients may suffer permanent liver damage. Patients recollected“At that time, there was no physical discomfort, so I didn’t feel anything. Later, hepatitis B was detected.”(YA 01,42 years old, female patient) “Two years ago, I had a bad stomach and slept poorly. Since I lived in a rural area at the time, I didn’t go for check-ups nor pay any attention to these diseases. It didn’t feel like it mattered physically, I only had poor digestion and my stomach was swollen.”(YA 08,51 years old, male patient).
Patients’ feeling when being diagnosed as hepatitis B
When patients were diagnosed with hepatitis B, they had two different kinds of feeling. Ten participants expressed their feelings very clearly in the interview. The three of them did not present any negative emotion towards the disease. As they explained, in the early stage of hepatitis B, they had no obvious symptoms and their lives were not affected, hence they could live and work as before. One participant described, “at that time I didn’t know about the disease, I didn’t feel anything, and the doctor said it was nothing serious”. (YA 01,42 years old, female patient) “At that time, I did not know what hepatitis B was. I thought it was a minor disease, and I had no understanding about hepatitis B for many years.”(YA 41,55 years old, female patient) “I felt nothing. I do not feel any physical discomfort, so I did not pay any attention to it.”(YA 11,53 years old, female patient).
Most of the patients talked about their anxiety, fear and depression due to the diseases. Patients experienced these feelings after they learned through the Internet and other means that hepatitis B is currently incurable. Besides, they were worried that the disease would be spread to their families especially their children. One patient said “when I was found to have cirrhosis, I was getting scaled because one day it may become liver cancer. After all, I was still young, and my child had just started working.”(YA 09,44 years old, female patient) However, for most of the patients, if their diseases were not very serious, they could accept the fact day by day. One patient recalled “at that time, I was really depressed when I was found out to have hepatitis B because I searched online and found out that hepatitis B cannot be cured, and this made me scared. I was very afraid of it. But now I’m very optimistic and I’m willing to talk to someone about it.”(YA 36,50 years old, male patient).
Doctor’s advice to the patient
Doctors provided different advices to patients acorrding to stage of the disease. For patients who had no symptoms and their laboratory test indicated no liver damage, they were asked to take healthy food, have a good rest, and check their liver function per six months. Patients who needed treatment were requested to take medication on time and have regular medical check-ups to prevent from liver cancer. Interestingly, most patients were able to remember their doctor’s instructions about healthy diet or good rest, but they were not impressed by the doctor’s reminder of regular follow-up and liver function test. Dietary advice included less oil and salt, avoiding cold, hard, fried foods and drinking alcohol. As one interviewee said,“at that time, the doctor told me that I was the carrier, it does not matter much, I need not to pay much attention. After the treatment started, the doctor ordered that I should pay attention to my diet. Do not eat cold or hard food, oily things, or things that are bad for my liver.”YA 01,(42 years old, female patient) Another patient also got this advice “In our daily life, we should not eat stimulating food, cold food, hard food or fat food.”(YA 39,54 years old, male patient) Many patients could recall doctors’ suggestion on taking a good rest very clearly. As one patient mentioned “the doctor told me we should live a regular life, take a good rest and do not engage in excessive physical activities.” Another participant also reported “the doctor asked me to take more rest, but should not drink nor stay up late, we should sleep well.”(YA 11,53 years old, female patient) Very few patients could remember the doctors’ advice on regular check-ups. One patient pointed out this “the doctor said I should take medical check-ups every six months.”(YA 42,50 years old, male patient).