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Tayyaba M, Zahra SM, Naeem F, Sohail M. Family System and Gender as Predictors of Religious Coping in Pakistani Patients with Hepatitis C. JOURNAL OF RELIGION AND HEALTH 2024; 63:2466-2481. [PMID: 38085450 DOI: 10.1007/s10943-023-01970-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 05/02/2024]
Abstract
Pakistan has the second-largest number of HCV infections in the world with homogeneity across provinces and no evidence of decline over the past 30 years (Mahmud et al. in BMC Infect Dis 19(1):1-11, 2019). Currently, one in every 20 Pakistanis is suffering from HCV (Haqqi et al. in Viral Immunol 32(9):402-413, 2019). The disease significantly interferes with the everyday life of the patient (Silberbogen et al. in Psychosomatics 50(2):114-122, 2009; Foster in Viral Hepat 16(9):605-611, 2009). The present research aimed to find the role of gender, family system, and social support in predicting coping in patients with hepatitis C (HCV). A sample of 100 HCV patients was taken using purposive sampling from different public and private hospitals in Lahore, Pakistan. For assessment, the Multidimensional Scale of Perceived Social Support and Brief Cope Inventory were used. Results showed that male hepatitis C patients used a higher level of religious coping. Hepatitis C patients living in a joint family system used a higher level of religious coping. It also showed that there was no significant relationship between social support and coping. Patients suffering from hepatitis C for 2 years or more adopted avoidant coping strategies as compared to the patients diagnosed for 1 year or more. This research has important implications for psychologists, paramedical staff, doctors, social workers, caregivers, peers, and families of patients suffering from HCV. It would help in formulating effective therapeutic interventions. It would also add to the literature in the field of health psychology.
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Affiliation(s)
- Mubashra Tayyaba
- Department of Psychology, Lahore Garrison University, Sector C, DHA Phase 6, Lahore, Pakistan
| | - Syeda Mehreen Zahra
- Department of Psychology, Lahore Garrison University, Sector C, DHA Phase 6, Lahore, Pakistan
| | - Fatima Naeem
- Department of Psychology, Lahore Garrison University, Sector C, DHA Phase 6, Lahore, Pakistan
| | - Marva Sohail
- Department of Psychology, Lahore Garrison University, Sector C, DHA Phase 6, Lahore, Pakistan.
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Moulaei K, Sharifi H, Bahaadinbeigy K, Haghdoost AA, Nasiri N. Machine learning for prediction of viral hepatitis: A systematic review and meta-analysis. Int J Med Inform 2023; 179:105243. [PMID: 37806178 DOI: 10.1016/j.ijmedinf.2023.105243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Lack of accurate and timely diagnosis of hepatitis poses obstacles to effective treatment, disease progression prevention, complication reduction, and life-saving interventions of patients. Utilizing machine learning can greatly enhance the achievement of timely and precise disease diagnosis. Therefore, we carried out this systematic review and meta-analysis to explore the performance of machine learning algorithms in predicting viral hepatitis. METHODS Using an extensive literature search in PubMed, Scopus, and Web of Science databases until June 15, 2023, English publications on hepatitis prediction using machine learning algorithms were included. Two authors independently extracted pertinent information from the selected studies. The PRISMA 2020 checklist was followed for study selection and result reporting. The risk of bias was checked using the International Journal of Medical Informatics (IJMEDI) checklist. Data were analyzed using the 'metandi' command in Stata 17. RESULTS Twenty-one original studies were included, covering 82 algorithms. Sixteen studies utilized five algorithms to predict hepatitis B. Ten studies used five algorithms for hepatitis C prediction. For hepatitis B prediction, the SVM algorithms demonstrated the highest sensitivity (90.0%; 95% confidence interval (CI): 77.0%-96.0%), specificity (94%; 95% CI: 90.0%-97.0%), and a diagnostic odds ratio (DOR) of 145 (95% CI: 37.0-559.0). In the case of hepatitis C, the KNN algorithms exhibited the highest sensitivity (80%; 95% CI:30.0%-97.0%), specificity (95%; 95% CI: 58.0%-99.0%), and DOR (72; 95% CI: 3.0-1644.0) for prediction. CONCLUSION SVM and KNN demonstrated superior performance in predicting hepatitis. The proper algorithm along with clinical practice could improve hepatitis prediction and management.
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Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Naser Nasiri
- School of Public Health, Jiroft University of Medical Sciences, Jiroft, Kerman, Iran.
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Sælør KT, Carlsen SEL, Fadnes LT, Lorås L. Experiences of Hope after Treatment of Hepatitis C Infection-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15732. [PMID: 36497807 PMCID: PMC9738947 DOI: 10.3390/ijerph192315732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
The aim of this study was to explore the experiences of hope people had after undergoing treatment for a hepatitis C virus infection (HCV). Between October 2019 and May 2020, 19 one-on-one interviews were conducted with people who inject drugs and had undergone HCV treatment. All participants had completed treatment and were documented as being virus-free. Data were audio recorded and then transcribed verbatim and analysed; a method inspired by reflexive thematic analysis. Those interviewed conveyed rich and nuanced descriptions of experiences of a life with HCV. Through the course of the analysis we developed four themes. The themes were formulated as metaphors aimed at capturing commonalities about how the participants seemed to "turn their gaze" after receiving HCV treatment: (1) turning their gaze backward; (2) turning their gaze inwards; (3) turning their gaze toward others and (4) turning their gaze forward. Participants' descriptions of their experiences relating to HCV were somewhat gloomy, and HCV treatment seemed to inspire hope and a brighter outlook on several areas of life.
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Affiliation(s)
- Knut Tore Sælør
- Department of Health, Social and Welfare Studies, Center for Mental Health and Substance Abuse, University of South-Eastern Norway, 3007 Drammen, Norway
| | | | - Lars Thore Fadnes
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, 5009 Bergen, Norway
| | - Lennart Lorås
- Department of Welfare and Participation, Western Norway University of Applied Sciences, 5063 Bergen, Norway
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Côco LT, Silva GF, Romeiro FG, Cerqueira ATDAR. Factors associated with hepatitis C treatment adherence: an integrative review. CIENCIA & SAUDE COLETIVA 2022; 27:1359-1376. [PMID: 35475818 DOI: 10.1590/1413-81232022274.06942021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/13/2021] [Indexed: 11/21/2022] Open
Abstract
This integrative review examined factors associated with hepatitis C treatment adherence. The articles included were published in English, Spanish and Portuguese in the Lilacs, Medline, PsycINFO, Web of Science, Scopus and CINAHL databases, between 2000 and 2019. Initially, 540 publications were found and, after applying the study inclusion criteria, 22 articles were selected. Percentage non-adherence to treatment ranged from 12% to 32%. The variables identified as facilitating adherence were: receiving treatment for psychiatric disorders identified during treatment; knowing about medications and disease; receiving less complex treatment with greater likelihood of cure; fewer adverse events; social support; doctor-patient communication; and/or being in relationships. Barriers to adherence identified were: presence of depressive symptoms and other mental disorders; abuse of alcohol and psychoactive substances; education; age; ethnicity; unemployment; not having a steady partner; stigma; distance from health services; and the complexity and adverse effects of treatment. This review identified gaps in research on adherence.
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Affiliation(s)
- Layla Tatiane Côco
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP). Av. Prof. Mário Rubens Guimarães Montenegro s/n, Distrito de Rubião Júnior. 18618-970 Botucatu SP Brasil.
| | - Giovanni Faria Silva
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, UNESP. Botucatu SP Brasil
| | - Fernando Gomes Romeiro
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, UNESP. Botucatu SP Brasil
| | - Ana Teresa de Abreu Ramos Cerqueira
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP). Av. Prof. Mário Rubens Guimarães Montenegro s/n, Distrito de Rubião Júnior. 18618-970 Botucatu SP Brasil.
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Ullah S, Ali S, Daud M, Paudyal V, Hayat K, Hamid SM, Ur-rehman T. Illness perception about hepatitis C virus infection: a cross-sectional study from Khyber Pakhtunkhwa Pakistan. BMC Infect Dis 2022; 22:74. [PMID: 35062889 PMCID: PMC8783479 DOI: 10.1186/s12879-022-07055-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection is a debilitating chronic health problem and can be fatal if left untreated. Illness perceptions are self-manifested beliefs that influence the ability of individuals to cope with their disease and perceive it as manageable or threatening condition. Limited evidence is available from low resource settings regarding patient perception about HCV. In this study, we aimed to assess the perception of individuals with HCV, the impact of their sociodemographic and clinical characteristics on their HCV perception, and its link to patient-oriented treatment outcomes. Methods A cross-sectional survey was undertaken enrolling individuals with HCV who attended Hepatitis C clinics at two hospitals of Khyber Pakhtunkhwa, Pakistan. Illness perception was measured using Brief Illness Perception Questionnaire (BIPQ). Descriptive statistics, Kruskal Wallis tests and Mann Whitney U tests were performed to study patient sociodemographic and clinical characteristics and to analyze the questionnaire results. Multivariable linear regression was used to assess determinants associated with perception scores. Results Participants represented poor HCV perception and their overall mean BIPQ score was 43.35, SD = 13.15. Participants had a low degree of understanding about their illness (mean coherence score = 2.92, SD = 1.85). Individuals with more than four years, compared to less than one year, of estimated HCV infection were more likely to view that their illness would continue (mean timeline score = 6.27, SD = 2.50 versus 5.36, SD = 2.53; respectively, p < 0.01). Similarly, individuals with hepatic cirrhosis, compared to without, were more likely to attribute symptoms to their disease (mean identity score = 5.48, SD = 2.14 versus 4.89, SD = 2.38; respectively, p = 0.04). Female participants reported higher degrees at which the illness affected them emotionally (i.e., emotional representation) and lower coherence about HCV than males (p = 0.04 and 0.006, respectively). Individuals who did not achieve sustained virological response 24 weeks after treatment with interferon-based therapy, compared to treatment naïve individuals, reported lower trust in being successfully treated with newer anti-HCV agents (i.e., direct acting antivirals) (p = 0.029). However, multivariable linear regression revealed that no sociodemographic or clinical determinants were associated with a higher BIPQ score (i.e., more threatening, or negative perceptions). Conclusion Individuals with HCV in Pakistan generally report threatening or negative views about HCV infection. Lack of trust in treatment efficacy was also apparent, especially in those who experienced failed anti-HCV treatments in the past. Healthcare professionals should consider these perceptions when treating individuals with HCV to optimize their compliance by aligning their perception with the high effectiveness of current anti-HCV therapies. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07055-5.
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6
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Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment. BMC Infect Dis 2020; 20:702. [PMID: 32972393 PMCID: PMC7517680 DOI: 10.1186/s12879-020-05426-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Background Hepatitis C virus (HCV) infections in people who inject drugs (PWID) can now be treated and cured. However, the impact that HCV treatment has on drug-user health, practices and wellbeing is not known. The aim of this research was to understand the non-clinical impact that HCV treatment has in PWID and their reasons for accessing and completing treatment. Methods Participants aged 25–67 years who had injected opioids or stimulants (currently or in the past) and had completed direct-acting antiviral treatment were recruited from seven European countries. Participants completed a 30-min online survey administered face-to-face between September 2018 and April 2019. The questionnaire responses were used to assess the mental and physical impact of having completed treatment. Results Of the 124 participants who completed the survey questionnaire, 75% were male, 69% were over 45 years old and 65% were using opioids and/or stimulants at the start of HCV treatment. Participants reported improvements in the following areas after completing HCV treatment: outlook for the future (79%); self-esteem (73%); ability to plan for the future (69%); belief in their abilities (68%); confidence (67%); empowerment (62%); energy levels (59%); and ability to look after themselves (58%). The most common reasons for starting HCV treatment were: becoming aware of treatments that were well tolerated (77%) and effective (75%); and understanding the potentially severe consequences of HCV (75%). Conclusions The benefits of HCV treatment go beyond clinical outcomes and are linked to improved drug-user health and wellbeing. Sharing information about well-tolerated and effective HCV treatments, and raising awareness about the potentially severe consequences of untreated HCV are likely to increase the number of PWID who are motivated to access and complete HCV treatment in future.
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Cho HJ, Park E. Development and Evaluation of an Antiviral Agent Medication Adherence Education Program for Patients with Chronic Hepatitis C. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186518. [PMID: 32906842 PMCID: PMC7558411 DOI: 10.3390/ijerph17186518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 01/18/2023]
Abstract
This study aimed to develop and evaluate a goal attainment theory-based antiviral agent medication adherence education program (AMAEP) for patients with chronic hepatitis C. A nonequivalent control group pretest-posttest design was used. Data were collected from December 2019 to March 2020 from a control group of 35 outpatients and an experimental group of 28 outpatients older than 20 years old who had been diagnosed with chronic hepatitis C. The data analysis included an independent t-test, a χ2-test or Fisher’s exact test, a Kolmogorov–Smirnov test, an analysis of covariance, and a Mann–Whitney U test. The results showed the effectiveness of the education program for patients with chronic hepatitis C. There were significant differences between the control group and experimental group in patients’ knowledge of chronic hepatitis C (Z = −5.91, p < 0.001), medication self-efficacy (Z = −5.02, p < 0.001), medication adherence rate (t = −3.88, p < 0.001), medication misuse behavior (Z = −5.00, p < 0.001), and patients’ satisfaction with their interaction with healthcare practitioners (Z = −6.61, p < 0.001). Therefore, we hope that the education program developed in this study will be utilized as an intervention for patients with chronic hepatitis C and be further developed for other patients with viral hepatitis.
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Affiliation(s)
| | - Euna Park
- Correspondence: ; Tel.: +82-51-629-5785
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8
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George N, Liapakis A, Korenblat KM, Li T, Roth D, Yee J, Fowler KJ, Howard L, Liu J, Politi MC. A Patient Decision Support Tool for Hepatitis C Virus and CKD Treatment. Kidney Med 2020; 1:200-206. [PMID: 32734200 PMCID: PMC7380397 DOI: 10.1016/j.xkme.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Rationale & Objective Patient education and decision support tools could facilitate decisions around the timing of antiviral therapy in patients living with both hepatitis C virus (HCV) infection and chronic kidney disease (CKD). We previously developed a tool through the HELP (Helping Empower Liver and Kidney Patients) study. This article evaluates the preliminary efficacy and usability of the tool among participants with both HCV infection and CKD. Study Design Pre-post study pilot evaluation. Setting & Participants Participants were at least 18 years old, were English speaking, and had a diagnosis of chronic HCV infection and CKD; they were seen in CKD clinics, dialysis units, and/or hepatology and liver transplantation clinics. Intervention Electronic patient decision support tool. Outcomes Participants' change in knowledge, certainty about choice, decision self-efficacy, patients' treatment preferences, and tool usability. Results 70 participants were recruited; 56 of 70 (80.0%) completed study procedures. Nearly all (51/56; 91.1%) requested paper-based study procedures despite the electronic design of the tool. Participants reported that they were most worried about the following treatment factors: (1) cost of drugs to treat HCV infection, (2) how their HCV infection affected their CKD, and (3) wait times for a kidney transplant. After using the decision tool, participants had significantly higher HCV infection and CKD knowledge (mean posttest percent of questions answered correctly = 65.74% vs pretest percent of questions answered correctly = 53.44%; P < 0.001) and more certainty about choice (mean posttest = 3.13 vs pretest = 2.65; P = 0.05). There were no significant changes in decision self-efficacy (mean posttest = 86.62 vs pretest = 84.68; P = 0.48). Limitations Single-site pilot study to explore preliminary tool efficacy and usability. Conclusions This study suggests that a decision tool may support informed patient-centered choices among patients with HCV infection and CKD. Future studies should evaluate ways to improve care decisions in a larger sample using both paper-based and electronic materials. Funding Merck & Co, Inc, Kenilworth, NJ. Trial Registration Registered at clinicaltrials.gov with study number NCT03426787.
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Affiliation(s)
- Nerissa George
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - AnnMarie Liapakis
- Section of Digestive Disease, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Kevin M Korenblat
- Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Tingting Li
- Division of Nephrology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - David Roth
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL
| | - Jerry Yee
- Division of Nephrology, Hypertension & Transplant, Henry Ford Hospital and Medical Center, Detroit, MI
| | | | | | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
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Serumondo J, Penkunas MJ, Niyikora J, Ngwije A, Kiromera A, Musabeyezu E, Umutesi J, Umuraza S, Musengimana G, Nsanzimana S. Patient and healthcare provider experiences of hepatitis C treatment with direct-acting antivirals in Rwanda: a qualitative exploration of barriers and facilitators. BMC Public Health 2020; 20:946. [PMID: 32546216 PMCID: PMC7298738 DOI: 10.1186/s12889-020-09000-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Direct-acting antivirals (DAAs) are increasingly accessible to patients with hepatitis C (HCV) worldwide and are being introduced through national health systems in sub-Saharan Africa. DAAs are highly efficacious when tested in controlled trials, yet patients treated outside of study settings often encounter challenges in completing the full treatment and follow-up sequence. Little information is available on the influences of successful DAA implementation in sub-Saharan Africa. This qualitative study explored the individual- and system-level barriers and enablers of DAA treatment in Rwanda between March 2015 and November 2017. METHODS Face-to-face interviews were conducted with 39 patients who initiated care at one of four referral hospitals initially offering DAAs. Ten healthcare providers who managed HCV treatment participated in face-to-face interviews to examine system-level barriers and facilitators. Interview data were analyzed using a general inductive approach in alignment with the a priori objective of identifying barriers and facilitators of HCV care. RESULTS Barriers to successful treatment included patients' lack of knowledge surrounding HCV and its treatment; financial burdens associated with paying for medication, laboratory testing, and transportation; the cumbersome nature of the care pathway; the relative inaccessibility of diagnostics technology; and heavy workloads of healthcare providers accompanied by a need for additional HCV-specific training. Patients and healthcare providers were highly aligned on individual- and system-level barriers to care. The positive patient-provider relationship, strong support from community and family members, lack of stigma, and mild side effect profile of DAAs all positively influenced patients' engagement in treatment. CONCLUSIONS Several interrelated factors acted as barriers and facilitators to DAA treatment in Rwanda. Patients' and healthcare providers' perceptions were in agreement, suggesting that the impeding and enabling factors were well understood by both groups. These results can be used to enact evidence-informed interventions to help maximize the impact of DAAs as Rwanda moves towards HCV elimination.
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Affiliation(s)
| | | | | | - Alida Ngwije
- Clinton Health Access Initiative (CHAI), Kigali, Rwanda
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10
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Sohail MM, Ahmad S, Maqsood F. The Role of Socio-demographics in Adoption of Religious-Spiritual and Other Coping Strategies Among Muslim Chronic Patients with Hepatitis C in Pakistan. JOURNAL OF RELIGION AND HEALTH 2020; 59:234-256. [PMID: 30659406 DOI: 10.1007/s10943-019-00761-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Coping has emerged as a vital indicator among patients in the chronic conditions. The current study examined the role of demographic characteristics (such as age, education, gender, marital status, residential background, family type and number of children) in adoption of coping (emotion-focused, problem-solving, religious-spiritual) strategies for nursing among hepatitis patients. A sample of 500 patients (of hepatitis C) was drawn from five most populous districts (Lahore, Faisalabad, Rawalpindi, Gujranwala and Multan) of Punjab, Pakistan, by using Epi Info software with an alpha level of 0.03. The data were collected using a well-structured multi-sectional interview schedule through multistage proportionate sampling technique. Descriptive analysis, regression analysis and reliability analysis were computed using SPSS (version 21.0). In the overall adoption of coping strategies, lower monthly household income, lower education, rural residences, nuclear family setting and married status were contributing to the adoption of higher coping strategies among Muslim chronic patients with hepatitis C. The results of socio-demographics are also discussed with other coping strategies (such as religious-spiritual coping strategies, problem-solving coping strategies, emotion-focused coping strategies and constructive coping strategies). It was the first quantitative study of adoption of coping strategies among Muslim hepatitis patients in Pakistan. The study highlighted the importance of socio-demographic resources to cope with chronic illness. The empirical findings would start a new discussion from hepatic, counseling and nursing perspective. For terminal patients, these socio-demographic characteristics can serve as a guideline to provide community sources of social support. Medical social workers and healthcare experts need to facilitate the efforts of patients to cope with chronic illness through revision of nursing policy according to the socio-demographic and spiritual-religious needs of the patients.
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Affiliation(s)
| | - Saeed Ahmad
- Department of Sociology, University of Gujrat, Room#A8, Al-Farabi Block, Hafiz Hayat Campus, Gujrat, 50700, Pakistan.
| | - Fauzia Maqsood
- Department of Sociology, University of Gujrat, Room#A8, Al-Farabi Block, Hafiz Hayat Campus, Gujrat, 50700, Pakistan
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Mude W, Fisher C, Richmond J, Wallace J, Le Gautier R. A qualitative investigation of barriers, support-seeking and coping among South Sudanese people with chronic hepatitis B in Australia. Aust J Prim Health 2019; 25:264-274. [PMID: 31213224 DOI: 10.1071/py19015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/08/2019] [Indexed: 12/21/2022]
Abstract
This inquiry examines health-seeking practices and challenges among South Sudanese people from refugee backgrounds with chronic hepatitis B in Australia. Fifteen semi-structured interviews were conducted. Using interpretative thematic analysis, the results revealed four themes, consisting of barriers and facilitators to clinical follow up, treatment and support-seeking practices and coping responses. Time constraints, having divergent views about treatment decisions and perceived inadequate clinical support were also identified as barriers. Being referred to a specialist, being aware of the risk associated with liver cancer and sending reminders about appointments were identified as facilitators to clinical follow up. Treatment-seeking practices involved both biomedical and alternative therapies. Participants mainly drew on their social networks and supports, religious beliefs and individual resilience as coping strategies. The findings are important for improving access to treatment and care and support for people with chronic hepatitis B from the South Sudanese community.
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Affiliation(s)
- William Mude
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Building NR6, Bundoora, Vic. 3086, Australia; and Corresponding author
| | - Christopher Fisher
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Building NR6, Bundoora, Vic. 3086, Australia
| | - Jacqui Richmond
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Building NR6, Bundoora, Vic. 3086, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Building NR6, Bundoora, Vic. 3086, Australia
| | - Roslyn Le Gautier
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Building NR6, Bundoora, Vic. 3086, Australia
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Sims OT, Hong BA, Ji S, Pollio DE, North CS. A Systematic Comparison of African American and Non-African American Patients on Psychosocial Aspects of Hepatitis C Infection. JOURNAL OF RELIGION AND HEALTH 2018; 57:1764-1770. [PMID: 29411232 DOI: 10.1007/s10943-018-0565-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The purpose of this study was to compare African American and non-African American hepatitis C virus (HCV) patients on self-reported symptoms of HCV liver disease and psychosocial characteristics commonly affected by it in a sample of 309 patients enrolled in a randomized controlled trial. African Americans (n = 196) rated a higher reliance on religion/spirituality for coping with HCV compared to non-African Americans. This study's findings are a basis for encouragement of public health efforts and programs to seek partnerships with African American faith and religious communities to identify and treat undiagnosed cases of HCV and promote HCV awareness.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
- Comprehensive Center for Healthy Aging, School of Medicine, University of Alabama at Birmi, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
| | - Barry A Hong
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Shaonin Ji
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E Pollio
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA
| | - Carol S North
- The Altshuler Center for Education and Research, Metrocare Services, Dallas, TX, USA
- Department of Psychiatry, School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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13
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Tsai SM, Kao JT, Tsai YF. Illness trajectory of initial infection for patients with hepatitis C: A qualitative study. Nurs Health Sci 2018; 21:112-118. [PMID: 30251452 DOI: 10.1111/nhs.12568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 07/08/2018] [Accepted: 07/27/2018] [Indexed: 01/08/2023]
Abstract
Little is known about how the initial infection and diagnosis of hepatitis C virus (HCV) impacts a patient's experience of living with and adjusting to the disease. In the present qualitative, descriptive study, we explored the initial experiences of patients in Taiwan diagnosed with HCV. Eighteen participants were recruited from hepatology clinics of a teaching hospital in Taichung, Taiwan by purposive sampling. Data were collected via in-depth face-to-face interviews and analyzed by conventional content analysis. The core theme describing the illness trajectory was "Oasis in the desert". Two main themes described the participants' experiences and adjustment to the diagnosis of hepatitis C: "Getting lost in the journey" and "The calm after the storm". Our findings highlight the need for health-care providers to coordinate interactions between patients and multi-disciplinary teams to manage the integration of different treatment options. There is a demand for educational interventions and online information for patients and the general population, which could improve knowledge of HCV.
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Affiliation(s)
- Shu-Mei Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan, Taiwan
| | - Jung-Ta Kao
- School of Medicine, China Medical University, Taichung, Taiwan.,Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
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14
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Valizadeh L, Zamanzadeh V, Zabihi A, Negarandeh R, Jafarian Amiri SR. Qualitative study on the experiences of hepatitis B carriers in coping with the disease. Jpn J Nurs Sci 2018; 16:194-201. [PMID: 30088344 DOI: 10.1111/jjns.12229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 11/23/2017] [Accepted: 05/29/2018] [Indexed: 12/28/2022]
Abstract
AIM Hepatitis is a systemic infection that causes restrictions in the life of many patients due to its chronic nature and it necessitates the use of coping strategies to improve the quality of life. This study aims to demonstrate the experiences of hepatitis B carriers in coping with the disease. METHODS The present study was conducted by using a qualitative content analysis. The data were collected through 18 unstructured and in-depth interviews from 2014 to 2016 at medical centers, a gastrointestinal and liver diseases research center in the cities of Babol and Amol (northern Iran) and Tabriz (north-western Iran) with patients infected with hepatitis B. The study was carried out by using purposive sampling. RESULTS The data analysis led to the extraction of the main theme, "attempting an active expansion of interactions," and its three subthemes, including: "denial of the disease," "protecting oneself or others," and "coping with the disease." CONCLUSION Patients with hepatitis B use different strategies to cope with this disease. In order for patients to properly face the disease and to live with minimum challenges and limitations, they need to be suitably understood and supported. Therefore, consideration of education and consultation programs regarding the different aspects of this disease is urgent.
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Affiliation(s)
- Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Zabihi
- Department of Nursing, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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15
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Olson A, Reiland S, Davies S, Koehler AR. Learning about the experience of living with chronic conditions: A framework analysis of nursing students' reflections on their conversations with older adults. GERONTOLOGY & GERIATRICS EDUCATION 2018; 39:295-315. [PMID: 27749153 DOI: 10.1080/02701960.2016.1247067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Preparing nursing students to work effectively with older adults is an important element of undergraduate nursing education. Reflective journals written as course assignments represent a source of data about students' learning. The aim of this study was to analyze nursing students' reflective journals based on conversations with older adults who are community dwelling, to identify learning in relation to experiences of living with a chronic condition. This was one element of a wider study to evaluate learning partnerships between older adults who are community dwelling and nursing students as an alternative to traditional clinical placements in long-term care settings. Nursing students worked with faculty to complete a qualitative secondary analysis of 47 journals utilizing framework analysis. Students learned about three main aspects of living with chronic conditions: beliefs about chronic conditions, managing chronic conditions, and experiencing chronic conditions, with some evidence that these themes may be interconnected. Findings suggest that learning partnerships with older adults combined with reflective journaling enable nursing students to understand the experience of chronic conditions in later life as reflected within current literature and to identify interventions for gerontological nursing practice. Enabling nursing students to recognize the highly skilled nature of working with older adults with chronic illness has the potential to influence their future career choices.
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Affiliation(s)
| | | | - Susan Davies
- c Department of Nursing, Winona State University , Minnesota , USA
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North CS, Pollio DE, Sims OT, Jain MK, Hong BA. Prospective Longitudinal Substance Use Patterns in Patients Preparing for Hepatitis C Treatment. J Dual Diagn 2018; 14:60-69. [PMID: 29035169 PMCID: PMC6072267 DOI: 10.1080/15504263.2017.1380246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study prospectively examined the independent courses of alcohol, drugs, and smoking over 18 months in 154 patients preparing for hepatitis C virus (HCV) treatment in relation to functioning, negative coping, and satisfaction with quality of life in data collected from a randomized controlled trial of multiple-family group psychoeducation for patients preparing for HCV treatment. Patients with HCV who had consistent abstinence, consistent use, or achievement of abstinence after study entry were examined for outcomes pertaining to functioning in the context of HCV, negative coping, and satisfaction with quality of life. METHODS Of 309 patients considering treatment for HCV recruited from outpatient clinics at two major university medical centers and a Veterans Affairs medical center for a randomized controlled trial of a psychoeducation intervention, 154 completed baseline, 6-month, and 18-month assessments. The assessments included structured diagnostic interviews; questionnaires examining functioning, coping, and satisfaction with quality of life; medical record review; and urine testing for substances of abuse. For these analyses, substance use patterns were determined as consistent abstinence, consistent use, and achieving abstinence after study entry for alcohol and drug use and smoking. RESULTS The entire sample generally improved in all of these three outcomes over the course of the study. The course of alcohol, drugs, and smoking predicted HCV-related functioning, negative coping, and satisfaction with quality-of-life outcomes over 18 months. Three specific patterns of use (consistent abstinence, consistent use, and achievement of abstinence after study entry) of these substances diverged in association with outcomes related to functioning, negative coping, and satisfaction with quality of life, not only across trajectories over time within substance types but also among types of substances. CONCLUSIONS This study's finding that different substances were associated with distinct clinical outcomes suggests the need to conceptually unbundle different types of substances in managing HCV. Future research is needed to examine the clinical utility of further unbundling these substances and also to further investigate effects of various amounts of use of these substances.
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Affiliation(s)
- Carol S North
- a The Altshuler Center for Education and Research at Metrocare Services and Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - David E Pollio
- b The University of Alabama at Birmingham , Department of Social Work, College of Arts and Sciences , Birmingham , Alabama , USA
| | - Omar T Sims
- b The University of Alabama at Birmingham , Department of Social Work, College of Arts and Sciences , Birmingham , Alabama , USA
| | - Mamta K Jain
- c The University of Texas Southwestern Medical Center , Department of Internal Medicine/Division of Infectious Diseases , Dallas , Texas , USA
| | - Barry A Hong
- d Washington University School of Medicine , Department of Psychiatry , St. Louis , Missouri , USA
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Zenlea IS, Thompson B, Fierheller D, Green J, Ulloa C, Wills A, Mansfield E. Walking in the shoes of caregivers of children with obesity: supporting caregivers in paediatric weight management. Clin Obes 2017; 7:300-306. [PMID: 28703480 DOI: 10.1111/cob.12202] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/08/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
To incorporate the perspectives and experiences of family caregivers of children with obesity, the KidFit Health and Wellness Clinic, a paediatric weight management programme, embedded feedback opportunities into various stages of programme development. Caregivers were eligible to participate if their children had completed initial 4-week group-based pilot programming or were currently receiving treatment in 10 or 12 week group-based programming. Data were collected through feedback session discussions, audio-recorded, transcribed verbatim and analysed thematically. In total, 6 caregivers participated in the pilot group feedback session and 32 caregivers participated in the structured group feedback sessions. Caregivers reported that healthy lifestyle strategies first communicated by clinic staff to children during group sessions provided expert validation and reinforcement when discussing similar messages at home. Caregivers reported feeling isolated and blamed for causing their children's obesity and appreciated the supportive forum that group-based programming provided for sharing experiences. Since experiences of blame and isolation can burden caregivers of children with obesity, paediatric weight management programmes might consider including peer support opportunities and discussion forums for ongoing social support in addition to education about lifestyle change.
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Affiliation(s)
- I S Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - B Thompson
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - D Fierheller
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - J Green
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - C Ulloa
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - A Wills
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - E Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Primary Care and Hepatology Provider-Perceived Barriers to and Facilitators of Hepatitis C Treatment Candidacy and Adherence. Dig Dis Sci 2017; 62:1933-1943. [PMID: 28523579 DOI: 10.1007/s10620-017-4608-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/04/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Provider perceptions regarding barriers to and facilitators of hepatitis C (HCV) treatment initiation and adherence have not been fully evaluated in the interferon-free treatment era. New treatments have provided opportunities for non-specialists to treat HCV, underscoring the importance of understanding primary care provider (PCP) and specialist perspectives. METHODS Based on qualitative sampling principles, 12 PCPs and 12 hepatology providers (HPs) from the VA Pittsburgh Healthcare System completed audio-recorded semi-structured interviews. Qualitative analysts coded perceived barriers and facilitators from the interviews with 100% double coding. Codes were thematized and analyzed using Atlas.ti. RESULTS Key barriers to treatment described by HPs and PCPs included patients' substance use disorders, mental health, transportation availability, history of non-adherence, and concern about side effects. PCPs also focused on medication cost as a system-based barrier. The main facilitators of treatment initiation and adherence described by both HPs and PCPs were provider education and encouragement. HPs focused almost exclusively on provider-based facilitators, while PCPs noted patient-based facilitators including past adherence, media exposure to information about HCV medications, a desire to clear the virus, and positive feedback regarding treatment response. CONCLUSIONS Providers generally focused on perceived patient-level barriers to HCV treatment initiation and adherence, as well as provider-level facilitators; PCPs additionally noted patient preferences and system-level issues that guide decision making regarding treatment initiation. While HPs focused almost exclusively on provider-level facilitators, PCPs additionally focused on patient-level facilitators of treatment. These data provide novel insights and suggest focusing on patient, provider, and system-level strategies to further improve HCV treatment initiation and adherence.
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19
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Cho HJ, Park E. Quality of Life of Chronic Hepatitis C Patients and Its Associated Factors. Osong Public Health Res Perspect 2017; 8:124-129. [PMID: 28540156 PMCID: PMC5441437 DOI: 10.24171/j.phrp.2017.8.2.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 02/06/2023] Open
Abstract
Objectives This study aimed to investigate the factors affecting the health-related quality of life (HRQOL) of patients with chronic hepatitis C (CHC). Methods This study is based on a descriptive survey and involved 125 gastroenterology outpatients visiting a university hospital in South Korea as the participants. HRQOL was assessed using the Liver Disease Quality of Life 1.0, which consisted of Short Form-36 (SF-36) and the Liver Disease Targeted Scale. Data were collected from December 2015 to April 2016, which were then analyzed through multiple regression analysis. Results HRQOL had a statistically significant correlation with age, sex, educational level, living type, employment status, monthly income level, and comorbidity status. This study showed that age > 51 years, female sex, high educational level, living alone, unemployment status, low monthly income, and presence of comorbidity had negative effects on the HRQOL of patients with CHC (R2 = 8.7%–34.6%). Conclusion Based on the result of this study, intervention for patients with CHC needs to be developed to enhance their HRQOL. The findings can serve as a useful reference for nursing personnel in the development of therapeutic plans to upgrade the care of CHC patients.
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Affiliation(s)
- Hoo Jeung Cho
- Clinical Research Center, Pusan National University Hospital, Busan, Korea
| | - Euna Park
- Department of Nursing, Pukyong National University, Busan, Korea
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20
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Grigorovich A, Stergiou-Kita M, Damianakis T, Le Dorze G, Lemsky C, Hebert D. Persons with brain injury and employment supports: Long-term employment outcomes and use of community-based services. Brain Inj 2017; 31:607-619. [DOI: 10.1080/02699052.2017.1280855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Alisa Grigorovich
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mary Stergiou-Kita
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Institute of Work & Health, Toronto, ON, Canada
| | | | - Guylaine Le Dorze
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Montreal, Montreal, QC, Canada
| | | | - Debbie Hebert
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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21
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Living with Hepatitis C Virus: A Systematic Review and Narrative Synthesis of Qualitative Literature. Can J Gastroenterol Hepatol 2017; 2017:3268650. [PMID: 28529936 PMCID: PMC5424189 DOI: 10.1155/2017/3268650] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/20/2017] [Indexed: 02/07/2023] Open
Abstract
Background and Aims. The lived experience of HCV has not been well documented in the literature. The aim of this systematic review was to understand the experiences of living with Hepatitis C Virus (HCV). Methods. Five databases were searched from inception until January 19, 2015. Studies were included if they focused on adults diagnosed with HCV; reported experience living with HCV; and described original research. Results. 46 studies were included. Studies found that participants had reduced quality of life due to physical symptoms. Due to physical symptoms and discrimination, many participants switched to part-time work or quit their jobs. Many individuals reported negative experiences with the healthcare system; themes of feeling unsupported, not having adequate information, and not feeling involved in decisions were reported. Stigma significantly impacted those living with HCV. Conclusions. Published literature indicates that those with HCV often feel stigmatized and unsupported in their care, relationships, and work environments, while simultaneously coping with physical and psychological symptoms. This synthesis points to areas where greater education, compassion, and patient-centered healthcare could improve the experience of people living with HCV.
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Illness Experience of Patients with Chronic Hepatitis C Participating in Clinical Trials. Osong Public Health Res Perspect 2016; 7:394-399. [PMID: 28053846 PMCID: PMC5194226 DOI: 10.1016/j.phrp.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/20/2016] [Accepted: 11/02/2016] [Indexed: 02/07/2023] Open
Abstract
Objectives To understand the illness experience of patients with chronic hepatitis C participating in clinical trials in the sociocultural context of Korea in an in-depth and comprehensive manner. Methods A focused ethnography approach was used to discover the pattern of illness experience of patients with chronic hepatitis C in the cultural background of Korea. Interviews were conducted with 11 patients with chronic hepatitis C participating in clinical trials and the collected data were analyzed with the domain analysis, taxonomical analysis, componential analysis, and theme analysis proposed by Spradley. Results With the cultural theme of “less-known illness, less-familiar illness,” four categories were derived: “my illness discovered by accident,” “shaken life,” “scary but inevitable treatment method,” and “precious life that can't be wasted,” along with 12 properties. Conclusion Public campaigns or education programs are needed to meet the needs for information on the disease for patients with chronic hepatitis C participating in clinical trials and help the general public acquire knowledge or change view on this disease.
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Health Beliefs and Co-morbidities Associated with Appointment-Keeping Behavior Among HCV and HIV/HCV Patients. J Community Health 2016; 41:30-7. [PMID: 26179172 DOI: 10.1007/s10900-015-0059-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Appointment-keeping behavior is an important requisite for HCV linkage and treatment initiation. In this study we examine what impact hepatitis C (HCV) knowledge and attitudes has on appointment-keeping behavior among a cohort of HCV and HCV/HIV patients. Knowledge scores and attitude scales, obtained from a cross-sectional survey, were correlated with proportion of appointments kept 1 year prior to taking the survey. Independent risk factors for missing appointments were examined by multiple regression analysis. 292 HCV patients completed the survey, and 149 (51%) were co-infected with HIV. HCV patients kept 67.5 ± 17.4% of their total appointments and a similar proportion (67 ± 38.2) of Liver Clinic appointments, but they attended a higher proportion (73 ± 24.4) of Primary Care Clinic appointments. However, certain health beliefs, psychiatric illness, and HIV co-infection were independently associated with lower levels of appointment-keeping behavior. HCV knowledge was not associated with appointment-keeping behavior. Health beliefs, psychiatric illness, and HIV co-infection are associated with missing appointments, but no link between knowledge and appointment keeping behavior is apparent. In order to increase engagement into HCV care, HCV care coordination programs need to focus on addressing health beliefs and providing resources to those at highest risk for missing appointments.
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Sublette VA, Smith SK, George J, McCaffery K, Douglas MW. Listening to both sides: A qualitative comparison between patients with hepatitis C and their healthcare professionals' perceptions of the facilitators and barriers to hepatitis C treatment adherence and completion. J Health Psychol 2016; 23:1720-1731. [PMID: 27682337 DOI: 10.1177/1359105316669858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This qualitative study compares and contrasts the perspectives of healthcare professionals who treat hepatitis C with those of patients in treatment. Comparative analysis of semi-structured interviews with 20 healthcare professionals and 20 patients undergoing treatment for hepatitis C concluded that patients and healthcare professionals disagreed on the source of communication breakdowns, but both felt that individualised clinical information improved adherence. Stigma was recognised as a barrier to treatment adherence by both patients and healthcare professionals. Limitations of the healthcare system, such as patients receiving inconsistent information and long wait times, negatively impacted both patients and providers.
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Abstract
Stigma is one of the main problems of patients suffering from cirrhosis, and it causes many challenges for the patients and their treatment. The present study aimed to discover and define the perceived stigma by cirrhotic patients. This qualitative study was conducted through a content analysis approach. The participants were 15 patients suffering from cirrhosis. Data were collected via semistructured, in-depth interviews and analyzed on the basis of methods described by Granheme and Landman. During data analysis, stigma was categorized into four categories and 13 subcategories: external representation of social stigma (others' avoidance behaviors, inadmissible tag, discriminative behaviors of treatment personnel, blaming behaviors), internal representation of social stigma (social ostracism, social isolation, curiosity to perceive people's perceptions), external representation of self-stigma (fear of disclosure of illness, threatening situation, difficult emotional relationships), and internal representation of self-stigma (condemned to suffer, self-punishment, self-alienation). Experiencing stigma is common among cirrhotic patients and may affect patients' coping with the illness and treatment. Thus, it is specifically important that treatment personnel know patients' perception, provide comprehensive support for these patients, and plan to enhance public awareness about the disease recommended.
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Valizadeh L, Zamanzadeh V, Negarandeh R, Zamani F, Hamidia A, Zabihi A. Psychological Reactions among Patients with Chronic Hepatitis B: a Qualitative Study. J Caring Sci 2016; 5:57-66. [PMID: 26989666 PMCID: PMC4794545 DOI: 10.15171/jcs.2016.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/02/2015] [Indexed: 01/05/2023] Open
Abstract
Introduction: Hepatitis B is the most prevalent type of
viral hepatitis. Psychological reactions among patients with hepatitis B infection is
considerably different and affects their decision about treating and following up the
disease. The present study aims at explaining the psychological demonstrations experienced
by these patients. Methods: In this qualitative study, a total of 18 patients
with hepatitis B (8 women and 10 men) were selected by purposive sampling method. Data
were collected by unstructured in-depth interviews during 2014-2015 in the medical centers
of three cities in Iran. All interviews were recorded, typed and analyzed by the
conventional content analysis approach. Results: By analyzing the data, the main theme including
psychological instability, with three sub-themes were emerged: grief reaction (stupor,
denial, anger and aggression), emotional challenges (worry and apprehension, contradiction
with beliefs, fear of deprivation, fear of stigma, waiting for death and prognosis
ambiguity) and inferiority complex (social withdrawal, sense of humiliation and
embarrassment and sense of guilt and blame) were acquired. Conclusion: The findings indicate that patients with
hepatitis B experience various psychological reactions that need to be controlled and
managed by themselves or healthcare providers. Thus, implementation of health
interventions with emphasis on psychological care to prevent problems and execution of
educational and consultation programs about hepatitis especially by medical centers and
mass media is seems necessary.
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Affiliation(s)
- Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Angela Hamidia
- Department of Psychiatry, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Ali Zabihi
- Department of Community Health, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Poll R, Allmark P, Tod AM. Reasons for missed appointments with a hepatitis C outreach clinic: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 39:130-137. [PMID: 27939298 DOI: 10.1016/j.drugpo.2015.12.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 11/07/2015] [Accepted: 12/10/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Non-attendance in drug service hepatitis C outreach clinics means clients miss the opportunity of being given lifestyle advice and referral to hospital for assessment and treatment. A similar problem is experienced in other services throughout the UK. A qualitative study was undertaken to investigate the problem. METHODS Clients with a history of not attending the outreach clinic were invited to participate during a routine drug clinic appointment. A contact details sheet with a preferred telephone number was completed by those agreeing to take part. Verbal consent was taken and a telephone interview took place. The participants were remunerated for taking part with a five pounds high street voucher. The 'framework method' was used to analyse the data with key themes identified. RESULTS Twenty-eight telephone interviews were undertaken from April to June 2012. All the clients gave 'prima-facie' reasons for non-attendance including 'not a priority' and 'forgot'. However, the study indicates these are insufficient to explain the various experiences and influences. Underlying reasons that impacted upon attendance were identified. These reasons relate to (i) client characteristics e.g. 'priority' to score drugs and the 'cost of travel' and (ii) clinic service e.g. 'difficult journey' to the clinic and timing of the 'appointment'. The reasons operated within a complex context where other factors had an impact including addiction, welfare policy, stigma and the nature of hepatitis C itself. CONCLUSION The study revealed that beneath apparently simple explanations for non-attendance, such as clients' chaotic lifestyle resulting in them forgetting or not being bothered to attend, there were far more complex and varied underlying reasons. This has important implications for drug policy including the need to better incorporate clients' perspectives. Policy that is based only on the simple, surface reasons is unlikely to be effective.
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Affiliation(s)
- Ray Poll
- Department of Infection and Tropical Medicine, The Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, England, United Kingdom.
| | - Peter Allmark
- Centre for Health and Social Care Research, Montgomery House, 32 Collegiate Crescent, Collegiate Campus, Sheffield S10 2BP, England, United Kingdom
| | - Angela M Tod
- Faculty of Human and Medical Sciences, Room 5.319, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, England, United Kingdom
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Sublette VA, Smith SK, George J, McCaffery K, Douglas MW. Listening to both sides: A qualitative comparison between patients with hepatitis C and their healthcare professionals' perceptions of the facilitators and barriers to hepatitis C treatment adherence and completion. J Health Psychol 2016; 22:1300-1311. [PMID: 26857543 DOI: 10.1177/1359105315626786] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This qualitative study compares and contrasts the perspectives of healthcare professionals who treat hepatitis C with those of patients in treatment. Comparative analysis of semi-structured interviews with 20 healthcare professionals and 20 patients undergoing treatment for hepatitis C concluded that patients and healthcare professionals disagreed on the source of communication breakdowns, but both felt that individualised clinical information improved adherence. Stigma was recognised as a barrier to treatment adherence by both patients and healthcare professionals. Limitations of the healthcare system, such as patients receiving inconsistent information and long wait times, negatively impacted both patients and providers.
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Affiliation(s)
- Victoria A Sublette
- 1 The University of Sydney, Australia.,2 The Westmead Institute for Medical Research, Australia.,3 Westmead Hospital, Australia
| | | | - Jacob George
- 1 The University of Sydney, Australia.,2 The Westmead Institute for Medical Research, Australia.,3 Westmead Hospital, Australia
| | | | - Mark W Douglas
- 1 The University of Sydney, Australia.,2 The Westmead Institute for Medical Research, Australia.,3 Westmead Hospital, Australia
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Returning to work after electrical injuries: workers' perspectives and advice to others. J Burn Care Res 2015; 35:498-507. [PMID: 25100540 DOI: 10.1097/bcr.0000000000000041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study was to gain an understanding of workers' experiences with returning to work, the challenges they experienced, and the supports they found most beneficial when returning to work after a workplace electrical injury. Thirteen semistructured qualitative telephone interviews were conducted with individuals who experienced an electrical injury at the workplace. Participants were recruited from specialized burns rehabilitation programs in Ontario, Canada. Interviews were transcribed verbatim and thematic analysis used to analyze the qualitative interviews. Data regarding workers' demographics, injury events, and occupational categories were also gathered to characterize the sample.Participants identified three distinct categories of challenges: 1) physical, cognitive, and psychosocial impairments and their effects on their work performance; 2) feelings of guilt, blame, and responsibility for the injury; and 3) having to return to the workplace or worksite where the injury took place. The most beneficial supports identified by the injured workers included: 1) support from family, friends, and coworkers; and 2) the receipt of rehabilitation services specialized in electrical injury. The most common advice to others after electrical injuries included: 1) avoiding electrical injury; 2) feeling ready to return to work; 3) filing a Workplace Safety and Insurance Board injury/claims report;4) proactive self-advocacy; and 5) garnering the assistance of individuals who understood electrical injuries to advocate on their behalf. Immediate and persistent physical, cognitive, psychosocial, and support factors can affect individuals' abilities to successfully return to work after an electrical injury. Specialized services and advocacy were viewed as beneficial to successful return to work.
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Stewart BJR, Turnbull D, Mikocka-Walus AA, Harley H, Andrews JM. An Aggravated Trajectory of Depression and Anxiety Co-morbid with Hepatitis C: A Within-groups Study of 61 Australian Outpatients. Clin Pract Epidemiol Ment Health 2015; 11:174-9. [PMID: 26668585 PMCID: PMC4676046 DOI: 10.2174/1745017901511010174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/29/2015] [Accepted: 05/20/2015] [Indexed: 02/07/2023]
Abstract
Background: This study aimed to explore the course of
depression and anxiety in chronic hepatitis C patients. Methods:
Data were combined from two studies: (1) Hospital Anxiety and Depression Scale (HADS)
scores in 395 consecutive Australian outpatients from 2006 to 2010 formed the
baseline measurement; and (2) Depression Anxiety Stress Scales (DASS) scores in
a survey of a sub-sample of these patients in 2011 formed the follow-up
measurement. After converting DASS to HADS scores, changes in symptom scores and
rates of case-ness (≥8), and predictors of follow-up symptoms were assessed. Results: Follow-up data were available for 61 patients (70.5% male)
whose age ranged from 24.5 to 74.6 years (M=45.6). The time to follow-up ranged
from 20.7 to 61.9 months (M=43.8). Baseline rates of depression (32.8%) and
anxiety (44.3%) increased to 62.3% and 67.2%, respectively. These findings were
confirmed, independent of the conversion, by comparing baseline HADS and
follow-up DASS scores with British community norms. Baseline anxiety and younger
age predicted depression, while baseline anxiety, high school non-completion,
and single relationship status predicted anxiety. Conclusion: This
study demonstrated a worsening trajectory of depression and anxiety. Further
controlled and prospective research in a larger sample is required to confirm
these findings.
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Affiliation(s)
| | | | | | - Hugh Harley
- Discipline of Medicine, University of Adelaide, Australia
| | - Jane M Andrews
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Australia; ; Discipline of Medicine, University of Adelaide, Australia
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Mansfield E, Stergiou-Kita M, Cassidy JD, Bayley M, Mantis S, Kristman V, Kirsh B, Gomez M, Jeschke MG, Vartanian O, Moody J, Colantonio A. Return-to-work challenges following a work-related mild TBI: The injured worker perspective. Brain Inj 2015; 29:1362-9. [PMID: 26287754 DOI: 10.3109/02699052.2015.1053524] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To explore how individuals with work-related mild traumatic brain injury (wrMTBI) experience return-to-work (RTW) processes when returning to the workplace where the injury occurred. DESIGN RTW experiences were explored using in-depth interviews and an inductive analytic approach. Qualitative analysis guided by the research question moved through phases of line-by-line and thematic coding through which categories and the interaction between categories emerged. PARTICIPANTS Twelve workers diagnosed with a wrMTBI reported on their RTW experiences following wrMTBIs that occurred 3-5 years prior to the time of the interview. MAIN OUTCOMES AND RESULTS Participants perceived employer and workers' compensation factors as profoundly influencing their RTW experiences. Participants consistently reported that employers and workers' compensation representatives had an inadequate understanding of wrMTBI sequelae. Six of 12 participants were re-injured following their wrMTBI, with three of these injuries occurring at work. CONCLUSION Employers, co-workers and workers' compensation representatives should be aware of wrMTBI sequelae so injured workers can receive appropriate supports and both stigmatization and re-injury can be mitigated. Greater attention to the structural and social elements of workplace and compensation environments could inform strategies to break down barriers to successful return-to-work following a wrMTBI.
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Affiliation(s)
| | - Mary Stergiou-Kita
- a University of Toronto , Toronto , ON , Canada .,b Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada .,c Institute for Work & Health , Toronto , ON , Canada
| | | | - Mark Bayley
- a University of Toronto , Toronto , ON , Canada .,b Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada
| | - Steve Mantis
- e Ontario Network of Injured Workers' Groups , Kaministiquia , ON , Canada
| | - Vicki Kristman
- a University of Toronto , Toronto , ON , Canada .,c Institute for Work & Health , Toronto , ON , Canada .,f Lakehead University , Thunder Bay , ON , Canada
| | | | | | - Mark G Jeschke
- a University of Toronto , Toronto , ON , Canada .,g Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre , Toronto , ON , Canada .,h Sunnybrook Research Institute , Toronto , ON , Canada , and
| | | | - Joel Moody
- i Electrical Safety Authority , Mississauga , ON , Canada
| | - Angela Colantonio
- a University of Toronto , Toronto , ON , Canada .,b Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada
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Stergiou-Kita M, Mansfield E, Sokoloff S, Colantonio A. Gender Influences on Return to Work After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2015; 97:S40-5. [PMID: 25921979 DOI: 10.1016/j.apmr.2015.04.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/28/2015] [Accepted: 04/03/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the influence of gender on the return to work experience of workers who sustained a work-related mild traumatic brain injury (TBI). DESIGN Qualitative study using in-depth telephone interviews. SETTING Community. PARTICIPANTS Purposive sampling was used to recruit participants. Participants were adults (N=12; males, n=6, females, n=6) with a diagnosis of mild TBI sustained through a workplace injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Not applicable. RESULTS Our findings suggest that gender impacts return to work experiences in multiple ways. Occupational and breadwinner roles were significant for both men and women after work-related mild TBI. Women in this study were more proactive than men in seeking and requesting medical and rehabilitation services; however, the workplace culture may contribute to whether and how health issues are discussed. Among our participants, those who worked in supportive, nurturing (eg, feminine) workplaces reported more positive return to work (RTW) experiences than participants employed in traditionally masculine work environments. For all participants, employer and coworker relations were critical elements in RTW outcomes. CONCLUSIONS The application of a gender analysis in this preliminary exploratory study revealed that gender is implicated in the RTW process on many levels for men and women alike. Further examination of the work reintegration processes that takes gender into account is necessary for the development of successful policy and practice for RTW after work-related MTBI.
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Affiliation(s)
- Mary Stergiou-Kita
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Institute of Work and Health, Toronto, ON, Canada
| | - Elizabeth Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Sandra Sokoloff
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Angela Colantonio
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
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Adherence during antiviral treatment regimens for chronic hepatitis C: a qualitative study of patient-reported facilitators and barriers. J Clin Gastroenterol 2015; 49:e41-50. [PMID: 24828358 PMCID: PMC4231022 DOI: 10.1097/mcg.0000000000000151] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOALS To understand patients' perceptions of factors which facilitate and hinder adherence to inform adherence-enhancing interventions. BACKGROUND Adherence to antiviral therapy for hepatitis C viral infection is critical to achieving a sustained virological response. However, persistence with and adherence to antiviral regimens can pose challenges for patients that interfere with sustained virological response. STUDY A qualitative analysis of 21 semistructured patient interviews using open-ended questions and specific follow-up probes was conducted. Interviews were audio-recorded, transcribed, and content-analyzed iteratively to determine frequent and salient themes. RESULTS Three broad themes emerged: (1) missing doses and dose-timing errors; (2) facilitators of adherence; and (3) barriers to adherence. Open-ended questioning revealed few dose-timing deviations, but more specific probes uncovered several more occurrences of delays in dosing. Facilitators of adherence fell into 2 broad categories: (a) patient knowledge and motivation; and (b) practical behavioral strategies and routines. Facilitators were noted post hoc to be consistent with the Information-Motivation-Behavioral Skills Model of Adherence. Barriers to adherence involved changes in daily routine, being preoccupied with family or work responsibilities, and sleeping through dosing times. A few patients reported skipping doses due to side effects. Patients with previous hepatitis C virus treatment experience may have fewer dose-timing errors. Finally, a high level of anxiety among some patients was discovered regarding dosing errors. Emotional and informational support from clinical and research staff was key to assuaging patient fears. CONCLUSION This qualitative study improves our understanding of patients' perspectives regarding adhering to hepatitis C treatment and can lead to the development of adherence-enhancing interventions.
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Rasi M, Künzler-Heule P, Schmid P, Semela D, Bruggmann P, Fehr J, Saxer S, Nicca D. "Fighting an uphill battle": experience with the HCV triple therapy: a qualitative thematic analysis. BMC Infect Dis 2014; 14:507. [PMID: 25231646 PMCID: PMC4174651 DOI: 10.1186/1471-2334-14-507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 09/10/2014] [Indexed: 02/08/2023] Open
Abstract
Background Hepatitis C virus (HCV) infections are a severe burden on public health worldwide, causing mortality rates triple that of the general population. Since 2011, for both therapy-naive and therapy-experienced genotype 1 patients, the first generation of direct acting antivirals (DAAs), i.e., the protease-inhibitors (PI) telaprevir and boceprevir have been added to existing dual therapies. The therapeutic effect of the resulting triple therapy is striking; however, treatment regimens are complex and commonly cause side effects. Little is known of how patients implement therapy in their daily lives, or of how they deal with these effects. This study aims to describe HCV patients' experiences with protease-inhibitor-based triple therapy and their support needs. Methods A qualitative design was used. Patients from three outpatient clinics, with ongoing, completed or discontinued PI treatment experience were recruited using a maximum variation sampling approach. Open-ended interviews were conducted and analyzed using thematic analysis according to Braun & Clarke (Qual Res Psychol 3:77-101, 2006). Results Thirteen patients participated in the interviews. All described themselves as highly motivated to undergo treatment, since they saw the new therapy as a “real chance” for a cure. However, all later described the therapy period as a struggle. The constitutive theme–“Fighting an uphill battle”– describes the common existential experience of and negative consequences of coping with side effects. The processes that fostered this common experience followed three sub-themes: “encountering surprises”, “dealing with disruption” and “reaching the limits of systems”. Conclusion HCV patients undergoing outpatient protease-inhibitor-based triple therapy need systematic support in symptom management. This will require specially trained professionals to advise and support them and their families, and to provide rapid responses to their needs throughout this complex course of therapy. As the generation of DAAs for all genotypes, are expected to have less severe side effects, and many HCV patients require treatment, this knowledge can improve treatment support tremendously, especially for patients who are quite difficult to treat. Furthermore, these findings are helpful to illustrate development in HCV treatment. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-507) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | - Dunja Nicca
- Cantonal Hospital St, Gallen, Division of Infectious Diseases and Hospital Epidemiology, 9007 St, Gallen, Switzerland.
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Stewart BJR, Turnbull D, Mikocka-Walus AA, Harley HAJ, Andrews JM. Acceptability of psychotherapy, pharmacotherapy, and self-directed therapies in Australians living with chronic hepatitis C. J Clin Psychol Med Settings 2014; 20:427-39. [PMID: 23756631 DOI: 10.1007/s10880-012-9339-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite the prevalence of psychiatric co-morbidity in chronic hepatitis C (CHC), treatment is under-researched. Patient preferences are likely to affect treatment uptake, adherence, and success. Thus, the acceptability of psychological supports was explored. A postal survey of Australian CHC outpatients of the Royal Adelaide Hospital and online survey of Australians living with CHC was conducted, assessing demographic and disease-related variables, psychosocial characteristics, past experience with psychological support, and psychological support acceptability. The final sample of 156 patients (58 % male) had significantly worse depression, anxiety, stress, and social support than norms. The most acceptable support type was individual psychotherapy (83 %), followed by bibliotherapy (61 %), pharmacotherapy (56 %), online therapy (45 %), and group psychotherapy (37 %). The most prominent predictor of support acceptability was satisfaction with past use. While individual psychotherapy acceptability was encouragingly high, potentially less costly modalities including group psychotherapy or online therapy may be hampered by low acceptability, the reasons for which need to be further explored.
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Affiliation(s)
- Benjamin J R Stewart
- School of Psychology, University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia,
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Abstract
OBJECTIVE Much of the research to date on barriers to treatment for patients with hepatitis C has approached the problem from either the perspective of the medical provider or the healthcare system. METHODS To better understand these barriers from the patients' perspectives, nine exploratory focus groups of patients with hepatitis C (N=48) were conducted in 2008 and 2009, using a hybrid qualitative analysis. RESULTS Eight content categories emerged. Treatment-related issues, including barriers to care, were most emphasized, representing nearly one-half of the entire content. Need for accurate disease-related information was also extensively discussed. Social factors were important, including considerable focus on stigma. Participants described coping abilities including faith and perseverance. CONCLUSION Areas of concern expressed in these focus groups represent underexplored areas that may warrant additional attention or areas for intervention and investigation, such as exploring differences between perceptions of patients and providers regarding the hepatitis C treatment process and addressing barriers to care.
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Reasons for Nonattendance across the Hepatitis C Disease Course. ISRN NURSING 2013; 2013:579529. [PMID: 24109517 PMCID: PMC3786544 DOI: 10.1155/2013/579529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/02/2013] [Indexed: 02/06/2023]
Abstract
This descriptive qualitative study examined the patient, provider, and institutional factors contributing to nonattendance for hepatitis C (HCV) care throughout the disease course. Eighty-four patients and health and social care providers were interviewed. Thematic analysis of the data yielded 6 interrelated nonattendance themes: self-protection, determining the benefits, competing priorities, knowledge gaps, access to services, and restrictive policies. Factors within the themes varied with the disease course, type of provider/service, and patient context. Nonattendance could span months to years and most frequently began at diagnosis where providers either advised that followup was not necessary or did not recommend any followup. The way services were organized (low barrier access) and delivered (nonjudgmental approach) and higher HCV knowledge levels of patients and providers encouraged attendance. This is the first study to explore the reasons for nonattendance for HCV care throughout the disease course and validate them from multiple perspectives. There are missed opportunities for providers to encourage attendance throughout the disease course beginning at diagnosis. Interventions required include development of integrated health and social service delivery models; mechanisms to improve knowledge dissemination of the disease, its management, and treatment; and implementation of standardized followup protocols for liver disease monitoring in primary care.
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Jiwani NS, Gul RB, Ali A, Salih M, Hanzala M. Experiences and Perceptions of Patients Living With Hepatitis C in Karachi, Pakistan. J Transcult Nurs 2013; 24:297-304. [DOI: 10.1177/1043659613481674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Hepatitis C (HCV) is a chronic disease that affects an individual’s physical, financial, social, and emotional well-being throughout the illness. Although extensive literature is available on experiences of patients with hepatitis C in developed countries, very little exists in developing countries, particularly in Pakistan. This article describes experiences of patients living with HCV in Karachi, Pakistan. Method: Using descriptive exploratory design, data were collected through semistructured interviews from 10 patients with HCV. The interviews were tape recorded and transcribed verbatim. Findings: The three categories—perceptions and misperceptions, challenges and sufferings, support and shortcomings—were subsumed under the theme “deadly, dangerous, and devastating.” Conclusion and implications for practice: Patients with HCV experience profound challenges that are influenced by their level of education, financial capacity, cultural norms, family support, and the sensitivity of health care professionals. Several cultural practices existing in Pakistan identify the need for public awareness. The findings on health care professionals have implications for nursing and allied health continuing education.
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Affiliation(s)
| | | | - Asho Ali
- The Aga Khan University, Karachi, Pakistan
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Hepgul N, Kodate N, Anderson JE, Henderson M, Ranjith G, Hotopf M, Pariante CM. Understanding clinical risk decision making regarding development of depression during interferon-alpha treatment for hepatitis-C: a qualitative interview study. Int J Nurs Stud 2012; 49:1480-8. [PMID: 22889554 DOI: 10.1016/j.ijnurstu.2012.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 07/20/2012] [Accepted: 07/24/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) affects 170 million worldwide. Currently, around 30% of patients receiving interferon-alpha (IFN-α) treatment for HCV experience clinically significant depression. Effective and timely detection of depression is crucial to ensuring appropriate treatment and support. However, little is known about how clinical nurse specialists identify patients at risk of developing interferon-alpha-induced depression, and monitor those receiving antiviral treatment for the occurrence of depression. OBJECTIVE This study aimed to gain an in-depth understanding of staff experience of, and attitudes towards, the identification and monitoring of interferon-alpha-induced-depression and the decision-making process concerning the use of liaison psychiatry and other clinical services. DESIGN A qualitative interview study was conducted among clinical staff involved in the care of patients with hepatitis C, using the perspective of naturalistic decision making. SETTINGS Outpatient liver clinics in three large teaching hospitals in South London, the United Kingdom. PARTICIPANTS All clinical nurse specialists from the three outpatient liver clinics were included. All were involved directly in the care of patients receiving interferon-alpha treatment and had at least one year experience (mean 6.4 years, range 1-11 years) in this field. METHODS Semi-structured face-to-face interviews were conducted between 2010 and 2011. Data collection and analysis were carried out iteratively to ensure the reliability of the analysis using the constant comparison method. RESULTS Staff used verbal and non-verbal cues when assessing risks of patients developing depression before and during IFN-α treatment. Major sources of uncertainty were patient engagement and familiarity, referrals to psychiatrists, language barriers, and distinguishing between psychological and physical symptoms. Good rapport with patients and good communication among multidisciplinary professional groups were key strategies identified to reduce uncertainty. CONCLUSION Current methods of identifying vulnerable patients rely on the availability of clinical experts and good communication within a multidisciplinary team. Detection and management of depression in this population is complex, however, various strategies are employed by nurses to overcome difficulties when making decisions regarding patient welfare. Current clinical practices should be taken into account when developing new tools and methods.
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Affiliation(s)
- Nilay Hepgul
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK
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