title: "It gives me a sense of belonging": providing integrated health care and treatment to people with HCV engaged in a psycho-educational support group.
abstract: BACKGROUND
  Injection drug use (IDU) increases the risk of contracting hepatitis C virus (HCV) yet very few people living with HCV access effective, and potentially curative, treatments. The East Toronto Hepatitis C Program (ETHCP) was developed in 2006 and provides health care, treatment and support to people living with HCV who have complex mental health, physical health and psychosocial needs. The program is anchored in a 16-18 week psychosocial support group located within one of the 3 participating community-based health clinics. The objective of this study was to explore the experiences of individuals engaged in the ETHCP psycho-educational group.
  
  
  METHODS
  This phenomenological qualitative study consisted of semi-structured in-depth interviews with twenty randomly selected program participants.
  
  
  RESULTS
  The three dominant themes that emerged from the analysis were program structure, group cohesion and group as agent for change. The ETHCP "one-stop shopping" model provided a stable foundation allowing for the development of group cohesion. Group cohesion was marked by the formation of intense relationships creating a safe and non-judgmental environment where participants could self-reflect, make social connections and feel cared for and accepted. Three types of relationships characterized group cohesion: relationship to self, relationships with individual group members and relationship to group as a whole. Within the nurturing group environment, participants could challenge themselves and others, ultimately enabling change.
  
  
  CONCLUSIONS
  The results of our qualitative study suggest that it is the formation of strong group cohesion that facilitated participants' behavioural change, regardless of their level of substance use. The structure of the group provided stability and was characterized by consistent weekly meetings, knowledge exchange and the provision of multiple services in one location. The support from peers and staff allowed participants to develop personal goals. Participants began to see themselves in a new and changed way; expressing this change in a variety of positive behaviours.
authors.affiliation: South Riverdale Community Health Centre, Toronto, ON, Canada; Department of Family Medicine, The Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Electronic address: swoolhouse@srchc.com.
authors.forename: Susan
authors.initials: S
authors.lastname: Woolhouse
authors.affiliation: South Riverdale Community Health Centre, Toronto, ON, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Cooper
authors.affiliation: Division of Social and Behavioural Health Science, Dalla Lana School of Public Health, University of Toronto, ON, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Pickard
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D019033:Delivery of Health Care, Integrated; D055030:Drug Users / Q000523:psychology*; D005260:Female; D006126:Group Processes; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006526:Hepatitis C / Q000175:diagnosis / Q000523:psychology / Q000628:therapy* / Q000635:transmission; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D007600:Judgment; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010353:Patient Education as Topic; D015397:Program Evaluation; D012929:Psychological Distance; D036301:Qualitative Research; D012657:Self-Help Groups; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Group cohesion; Hepatitis C virus; Interprofessional care; Psycho-educational group; Qualitative research; Substance abuse