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Adherence During Antiviral Treatment Regimens for Chronic Hepatitis C: A Qualitative Study of Patient-reported Facilitators and Barriers

Evon, Donna M. PhD*; Golin, Carol E. MD†,‡; Bonner, Jason E. PhD*; Grodensky, Catherine MPH; Velloza, Jennifer MPH

Journal of Clinical Gastroenterology: May/June 2015 - Volume 49 - Issue 5 - p e41–e50
doi: 10.1097/MCG.0000000000000151
ONLINE ARTICLE: Original Article

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:

Received December 18, 2013

Accepted April 8, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.