Adherence during antiviral treatment regimens for chronic hepatitis C: a qualitative study of patient-reported facilitators and barriers.
OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Donna M
DM
Evon
Carol E
CE
Golin
Jason E
JE
Bonner
Catherine
C
Grodensky
Jennifer
J
Velloza
D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001007:Anxiety / Q000209:etiology; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006184:Habits; D007722:Health Knowledge, Attitudes, Practice; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation; D011092:Polyethylene Glycols / Q000627:therapeutic use; D036301:Qualitative Research; D012254:Ribavirin / Q000627:therapeutic use; D013997:Time Factors
D000998:Antiviral Agents; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D012254:Ribavirin