Globally, it is estimated that 240 million people are infected with chronic viral hepatitis B and in excess of 185 million people with chronic hepatitis C. The burden of disease from hepatitis is concentrated in developing countries where transmission of HBV occurs predominantly from mother to child (vertical transmission) and transmission of HCV through unsafe medical procedures and the transfusion of unscreened blood products. Global patterns of migration favour the movement of individuals from countries with medium or high risk prevalence of chronic viral hepatitis to countries with traditionally low prevalence among their indigenous populations, including the United Kingdom (UK). In excess of 3.2% of the global population are international migrants, posing important implications for healthcare systems in host nations. It is predicted that up to 7 million first and second generation immigrants, originating from high prevalence countries for viral hepatitis now reside permanently in the UK. However, as a result of deficiencies in screening initiatives, the prevalence and associated burden of these diseases in these high-risk populations residing in the UK is yet to be determined. In order to establish the feasibility of inviting first and second generation immigrant populations to participate in viral hepatitis testing in primary care, as well to determine the prevalence and demography of viral hepatitis in four areas of the UK, a randomised controlled cross sectional cluster trial was conducted. In HepFree clinical computer systems in general practice surgeries were interrogated to identify the target population that was then approached using a variety of different invitations to determine the most appropriate method for engaging this population. The outcomes of viral hepatitis testing from practices in one area of the UK are described in this thesis. Despite multiple challenges encountered both in engaging practices and individuals in trial participation, results of this investigation suggest that if it is found to be cost effective, then viral hepatitis screening is feasible and the burden of disease in the UK is concentrated in first generation immigrants.

In our increasingly interconnected world, intercultural communication has gained paramount significance, particularly in contexts characterized by unprecedented cultural diversity, such as healthcare settings. The influx of newcomers from diverse cultural backgrounds necessitates effective intercultural communication, yet this challenge remains uncharted. Nonverbal behaviours, a key communication component, also remain understudied despite their significant cultural variation and influence on the perception of effective communication. Thus, healthcare professionals face the challenge of navigating intricate cultural norms and communication styles without evidence-based guidelines. This dissertation seeks to unravel the interplay between cultural intelligence and empathic communication through three papers exploring the communication recipient's perspective, nonverbal behaviours' role, and the communication senders' implications. The findings challenge the previous focus on empathy senders and highlight the role of empathy recipients. Nonverbal cues are recognized as pivotal in communication, and culture plays a significant role in interpreting these cues, influencing how empathy is conveyed across cultural boundaries. The dissertation's significance extends beyond healthcare, offering valuable insights for policymakers, international managers, and individuals engaged in intercultural interactions. Education on culturally specific nonverbal cues can enhance self-awareness and improve the capability to provide empathic services to clients from diverse cultural backgrounds. In conclusion, this dissertation is a substantial stride forward in understanding intercultural communication within healthcare, emphasizing the importance of empathy, cultural intelligence, and nonverbal communication. Recognizing cultural differences in nonverbal cues and fostering cultural competence is crucial for healthcare providers to improve patient experiences and their quality of care.

Doctor of Philosophy / Department of Family Studies and Human Services / William H. Meredith Jr / Walter R. Schumm / This study addresses a social capital literature that has mostly targeted a White majority population in the United States. Hispanic audiences, especially new immigrant populations, have not been primary survey respondents in most studies. Information about the social connectedness of minorities has come from secondary sources. The goal of this study was to understand to what extent Hispanic, compared to Anglo, families in rural Kansas experienced different levels of social capital in terms of social connectedness and community involvement. This study was done in English and Spanish in order to reach the under-represented population. According to political scientist, Robert Putnam (2000), it is through experiences of face-to-face interaction with those from different backgrounds that people learn to trust each other. Connections create networks that allow social trust to spread throughout society. At the individual level, there has been strong, consistent evidence that social connectedness has positive consequences. Individuals have the capacity and the choice to build their social connectedness and community engagement. Then those assets can be shared with the collective; be it family, organization, community, state, or country. When individuals have access to networks of supportive and accepting associates, it can generate an array of personal and societal benefits that include preventing or overcoming illness, preventing crime, mitigating poverty, addressing racial inequalities, supporting child development, improving health, and addressing other social ills. When one builds a stock of personal relationships and other social connections from which he or she can call upon in times of need, it is called social capital. This study, in part, assessed social connectedness and community engagement of people in Southwest County, a rural location in Southwest Kansas which has a 30% Hispanic population. Surveys were sent to selected households in English and Spanish, and two small focus groups were conducted in the two languages. Statistical analyses indicated support for the hypotheses when the independent variables gender, age, race/ethnicity, education, income, and community longevity were analyzed with dependent variables made up of scaled items to measure social connectedness and community engagement. Race/ethnicity, education, and income appeared to be the strongest predictors of social connectedness and community engagement. Implications of the results are discussed.

Aging Hispanic populations are expected to increase in the United States (U.S.) to 21.5 million by 2060 according to the National Council on Aging (NCA) (2014). Although actual estimates vary, Gates (2013) asserts that over one million Hispanics identify as gay or bisexual and their unique needs must be explored (Clover, 2006; Cohn & Taylor, 2010; Fenkl, 2014). Unfortunately, few studies examine aging Hispanic men who identify as gay or bisexual according to the National Hispanic Council on Aging (NHCOA) (2013). The objective of the current study was to extend the limited research on aging gay/bisexual men in the southeastern U.S. (e.g., Fenkl, 2014) by focusing on Hispanic gay/bisexual men in South Florida. The current study identifies social networks that serve to help this population’s health and well-being concerns related to aging. Findings from the 20 male participants in the current study provided evidence that there are unique health concerns associated with aging within this population. The current project has the potential to help health care providers, social service providers and policy makers, with an increased understanding of the special needs and challenges experienced by aging gay ethnic minorities in communities throughout the U.S.