The hepatitis C self-management programme: a randomized controlled trial

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http://www3.interscience.wiley.com/journal/123485151/abstract

Journal of Viral Hepatitis

Early View (Articles online in advance of print)

Published Online: 31 May 2010

© 2010 Blackwell Publishing Ltd

The hepatitis C self-management programme: a randomized controlled trial

E. J. Groessl 1,2 , K. R. Weingart 1 , C. J. Stepnowsky 1,2 , A. L. Gifford 3,4

, S. M. Asch 5,6 and S. B. Ho 1,2

1 VA San Diego Healthcare System ; 2 University of California San Diego, CA

; 3 Edith Nourse Memorial Veterans Hospital, Bedford ; 4 Boston

University School of Public Health, Boston, MA ; 5 VA Greater Los Angeles

Healthcare System ; and 6 Geffen School of Medicine at the University of

California, Los Angeles, CA, USA

Correspondence to J. Groessl, PhD, Health Services Research and

Development, VA San Diego Healthcare System, 3350 La Jolla Village Dr. 111 N-1,

San Diego, CA 92161, USA.

E-mail: egroessl@...

Blackwell Publishing Ltd

KEYWORDS

behavioural interventions • health-related quality of life • hepatitis C •

self-management • US veterans

ABSTRACT

Summary. Chronic hepatitis C (HCV) infection afflicts millions of people

worldwide. While antiviral treatments are effective for some patients, many

either cannot or choose not to receive antiviral treatment. Education about

behavioural changes like alcohol avoidance and symptom management, in contrast,

is universally recommended, particularly in HCV-infected persons from

disadvantaged groups where liver risk factors are most prevalent.

Self-management interventions are one option for fostering improved HCV

knowledge and health-related quality of life (HRQOL). One hundred and thirty-two

patients with VA with HCV (mean age of 54.6, 95% men, 41% ethnic minority, 83%

unmarried, 72% unemployed/disabled, 48% homeless in last 5 years) were

randomized to either a 6-week self-management workshop or an information-only

intervention. The weekly 2-h self-management sessions were based on

cognitive-behavioural principles and were adapted from an existing

self-management programme that has been efficacious with other chronic diseases.

HCV-specific modules were added. Outcomes including HRQOL, HCV knowledge,

self-efficacy, depression, energy and health distress were measured at baseline

and 6 weeks later. Data were analysed using ANOVA. When compared to the

information-only group, participants attending the self-management workshop

improved more on HCV knowledge (P < 0.001), HCV self-efficacy (P = 0.011), and

SF-36 energy/vitality (P = 0.040). Similar trends were found for SF-36 physical

functioning (P = 0.055) and health distress (P = 0.055). Attending the

self-management programme improved disease knowledge and HRQOL 6 weeks later in

this disadvantaged population. The intervention can improve the health of people

with hepatitis C, independent of antiviral therapy. Future research will study

longer-term outcomes, effects on antiviral treatment and costs.

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Received February 2010; accepted for publication March 2010

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1365-2893.2010.01328

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