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.
*Division of Gastroenterology and Hepatology
†Department of Health Behavior, Gillings School of Public Health
‡Division of General Medicine and Clinical Epidemiology, University of North Carolina, NC
Present address: Jason E. Bonner, PhD, Pope Army Air Field, Fort Bragg, NC.
Present address: Jennifer Velloza, MPH, Global Health Institute, Duke University Medical Center, Durham, NC.
Supported, in part, by National Institutes of Health: K23DK089004-02 (D.M.E.); UL1RR025747 (J.E.B.); and P30-AI50410 (C.E.G., C.G.). Golin's salary was partly supported by K24HD06920.
The authors declare that they have nothing to disclose.
Reprints: Donna M. Evon, PhD, Division of Gastroenterology and Hepatology, CB#7584, 8010 Burnett-Womack, University of North Carolina, Chapel Hill, NC 27599 (e-mail: email@example.com).
Received December 18, 2013
Accepted April 8, 2014