The Hepatitis C treatment experience: Patients’ perceptions of the facilitators of and barriers to uptake,adherence and completion

Objective: This study explores the perceptions of patients receiving treatment for Hepatitis C to determine what factors influence their decision to commence treatment, ability to maintain adherence and complete their treatment program.

Design: Semi-structured interview techniques were used in a qualitative study of 20 patients undergoing treatment for Chronic Hepatitis C (CHC).

Main outcome measures: To explore patients’ perceived barriers and facilitators of Hepatitis C treatment adherence and completion.

Results: Analysis of patient interviews identified four key themes: (1) motivations for commencing CHC treatment – fear of death and ridding themselves of stigma and shame; (2) the influential role of provider communication – patients reported that information and feedback that was personalised to their needs and lifestyles was the most effective for improving adherence to treatment; (3) facilitators of treatment adherence and completion – social, emotional and practical support improved adherence and completion, as did temporarily ceasing employment; (4) barriers to treatment adherence and completion – these included side effects, stigma, a complicated dosing schedule and limitations of the public healthcare system.

Conclusion: To increase treatment adherence and completion rates, a patient-centred approach is required that addresses patients’ social, practical, and emotional support needs and adaptive coping strategies.     

The interpretation of change in verbal reports: Implications for health psychology

Abstract

This paper raises a number of issues for health psychology in relation to the interpretation of change in verbal reports. Drawing on a typology of change developed to evaluate organisational interventions, it is suggested that change may occur at an alpha level (e.g. changed health status), beta level (e.g. a recalibration of the respondent's scale for assessing health status) or gamma level (e.g. a reconceptualisation of the meaning attached to health). Given the likely presence of beta and/or gamma change in intervention data in health psychology, researchers may be analysing their change data at an inappropriate level. A number of existing methodologies which attempt to detect beta and gamma change are presented and discussed. The need to develop further methodologies which focus more explicitly on the nature of change is highlighted. Finally, the proposed typology has a number of practical implications for the design of health promotion interventions.     

Parent-adolescent health conversations as action: Theoretical and methodological issues

Abstract

A qualitative research method based on action theory is proposed and illustrated for use in health psychology and health promotion research. Action refers to the goal-directed and intentional behaviors of individual and groups. Action theory has the advantage of using the perspectives provided by manifest behavior, internal processes, and social meaning in the analysis of action. In this article, the actions under consideration are the health-related conversations of parents and their adolescent children. The approach is premised on an understanding of health promotion as a family task constructed through actions such as conversations between family members. Health conversations in two parent-adolescent dyads are used to illustrate the method. The analysis includes the identification of goals, functional steps, and elements and their relation to the family health promotion project. Specific attention is paid to data gathering and analysis issues and their implications for health promotion research.     

Comparing Paper-and-Pencil and Internet Survey Methods Conducted in a Combat-Deployed Environment

The Unit Behavioral Health Needs Assessment Survey (UBHNAS) is a tool used to aid behavioral health providers in assessing the needs of service members of a military unit. Traditionally, the survey has been administered by paper-and-pencil; however, implementing the survey via the Internet may be a faster and easier way to administer the survey. There are, however, potential drawbacks to Internet survey administration, and previous studies comparing the 2 methods have yielded inconsistent findings. Using a between-subjects design with a combat-deployed military sample, the present study compared the 2 survey administration methods. Specifically, we assessed comparability for (a) psychological constructs, (b) auxiliary measures (such as completion time, frequency of missing data, and length of written comments), and (c) ratings and perceptions of the UBHNAS, and preference in methodology. The method of survey administration did not predict differences in the psychological outcome variables. However, participants in the paper-and-pencil condition reported higher rates of comfort answering questions, belief that responses would remain anonymous, and frankness and honesty in answering questions. Nevertheless, participants in both conditions preferred to take the survey via the Internet as opposed to paper-and-pencil in the future. Finally, participants in the Internet condition completed the survey faster and tended to write longer comments, although in terms of the comments being informative, there was no difference between the groups. Based on our findings, we recommend the use of the Internet for administering the UBHNAS; however, we caution that there may be tradeoffs regarding concerns about comfort, honesty, and anonymity.     

The ‘inseparable bond between cure and research’: clinical case study as a method of psychoanalytic inquiry

Abstract

Since Freud's own time, there has been great deal of debate about the most appropriate research methodology for investigating psychoanalytic psychotherapy [Fonagy, Journal of Child Psychotherapy, 29 (2): 129 – 136, 2003 Fonagy, P. 2003. ‘The research agenda: the vital need for empirical research in child psychotherapy’. Journal of Child Psychotherapy, 29(2): 129–136. [Taylor &; Francis Online] , [Google Scholar]; Rustin, Journal of Child Psychotherapy, 29 (2): 137–145, 2003 Rustin, M. 2003. ‘Research in the consulting room’. Journal of Child Psychotherapy, 29(2): 137–145. [Taylor &; Francis Online] , [Google Scholar]]. The single case study, which has a long tradition both within child psychotherapy and the wider research field, has been widely criticised as an approach to research, even while its contribution to clinical practice, the development of new ideas and teaching have been acknowledged. After reviewing the history of case study as a research method, this paper argues that there are a broad range of approaches to the study of the single case, each of which may be appropriate depending on the particular research question. Each of these approaches, however, must respond to the three perceived weaknesses of the clinical case study as a research method: the ‘data problem’, the ‘data analysis problem’ and the ‘generalisability problem’. This paper outlines the nature of these criticisms and, using many examples of actual research projects, suggests various ways in which the criticisms can be addressed, in order for the single case study to re-gain its place at the heart of psychoanalytic research.     

Clinical commentary by David Trevatt,Clinical Manager of ‘Hear and Now’ Adolescent Counselling Service,Redbridge and Manager of Open Door's Parenting Teenagers Project,Haringey

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – can inform therapists of what may be expected from patients with particular patterns of symptoms or behaviours in their clinical practice and how interactions change over time. Using the Child Psychotherapy Q-Set, this study aims to compare the different interaction structures that emerged in the two-year psychotherapy of a six-year-old child conducted, for one year each, by two doctoral-student therapists in a university-based community mental health clinic. The study allows for exploration of the independent role of the therapist in the psychodynamic therapy of a child diagnosed with Asperger's disorder. The results suggest that four distinct interaction structures between child and therapist could be identified in this psychotherapy and that the interaction structures differed between the two therapists and also differed over time within each treatment. The implications of these findings for training and clinical practice are discussed.     

The Impact of Participatory Research on Urban Teens: An Experimental Evaluation

Although there is much practice of community-based participatory research in economically-developing countries and increasingly in North America, there has been little systematic assessment of empowerment effects. Youth-led participatory research holds particular promise for fostering positive development and civic participation among economically disadvantaged urban youth. The present investigation uses a clustered-randomized, within-school experimental design to test the effects of youth-led participatory research on the psychological empowerment of 401 students attending urban public schools. We find that attending a participatory research elective class during the school day was associated with increases in sociopolitical skills, motivation to influence their schools and communities, and participatory behavior. We found no significant effects for perceived control at school. The implications for participatory research and related youth development interventions are discussed.     

Rural Embedded Assistants for Community Health (REACH) Network: First-Person Accounts in a Community–University Partnership

Community research and action projects undertaken by community–university partnerships can lead to contextually appropriate and sustainable community improvements in rural and urban localities. However, effective implementation is challenging and prone to failure when poorly executed. The current paper seeks to inform rural community–university partnership practice through consideration of first-person accounts from five stakeholders in the Rural Embedded Assistants for Community Health (REACH) Network. The REACH Network is a unique community–university partnership aimed at improving rural health services by identifying, implementing, and evaluating innovative health interventions delivered by local caregivers. The first-person accounts provide an insider’s perspective on the nature of collaboration. The unique perspectives identify three critical challenges facing the REACH Network: trust, coordination, and sustainability. Through consideration of the challenges, we identified several strategies for success. We hope readers can learn their own lessons when considering the details of our partnership’s efforts to improve the delivery infrastructure for rural healthcare.     

Youth as Partners, Participants or Passive Recipients: A Review of Children and Adolescents in Community-Based Participatory Research (CBPR)

Community-based participatory research (CBPR) is an orientation to research that places value on equitable collaborations between community members and academic partners, reflecting shared decision making throughout the research process. Although CBPR has become increasingly popular for research with adults, youth are less likely to be included as partners. In our review of the literature, we identified 399 articles described by author or MeSH keyword as CBPR related to youth. We analyzed each study to determine youth engagement. Not including misclassified articles, 27 % of percent of studies were community-placed but lacked a community partnership and/or participatory component. Only 56 (15 %) partnered with youth in some phase of the research process. Although youth were most commonly involved in identifying research questions/priorities and in designing/conducting research, most youth-partnered projects included children or adolescents in several phases of the research process. We outline content, methodology, phases of youth partnership, and age of participating youth in each CBPR with youth project, provide exemplars of CBPR with youth, and discuss the state of the youth-partnered research literature.     

Participatory Action Research

Abstract

Traditionally, mental health research has been conducted exclusively by professionals with little input and participation from individuals with mental illness themselves. Participatory action research (PAR) provides a more dynamic method of research, giving individuals the opportunity to become activists and advocates by influencing the direction of mental health research. This paper outlines important differences between PAR methodology and traditional research, with an emphasis on the differing roles of persons with mental illness in the two models. PAR is consistent with the recovery movement in several ways: both approaches value self-definition, empowerment, and experiential knowledge. As an example, this paper describes one project that incorporates principles of the participatory action research paradigm.