Environmental factors affecting self-management of chronic hepatitis B from the patients' perspective

Development and Pilot Testing of a Smartphone-Based Self-Care Program for Patients with Chronic Hepatitis B

The purpose of this study is to develop a smartphone-based self-care program (Hep B Care^®) for patients with the chronic hepatitis B virus (HBV). To pilot test the feasibility of Hep B Care^®, 63 participants with chronic HBV were recruited from an outpatient clinic at S hospital, Seoul, South Korea (experimental group [EG]: n = 30, control group [CG]: n = 33) between February and July 2016. Hep B Care^® was developed based on the theory of self-care whilst having a chronic illness. During the 12-week intervention period, the application: (1) provided information about the disease, medication, nutrition, and exercise; (2) encouraged taking medication and exercise using alarms; and (3) enabled the exchange of messages between healthcare providers and patients. Salivary cortisol, fatigue, depression, anxiety, knowledge of the HBV, quality of life, and medication adherence were all measured as outcomes. Cortisol levels were significantly increased, knowledge of the HBV was improved, and the mean anxiety score was significantly decreased in the EG. Thus, Hep B Care ^® partially improved health outcomes in the EG. We recommend that large trials be conducted among patients with the HBV. The smartphone-based self-care program for providing education and coaching is effective for improving knowledge and reducing anxiety among patients with the HBV.

A qualitative exploration of enablers for hepatitis B clinical management among ethnic Chinese in Australia

An estimated 18% of people living with chronic hepatitis B (CHB) in Australia were born in China. While guideline-based care, including regular clinical monitoring and timely treatment, prevent CHB-related cirrhosis, cancer and deaths, over three-quarters of people with CHB do not receive guideline-based care in Australia. This qualitative study aimed to identify enablers to engagement in CHB clinical management among ethnic Chinese people attending specialist care. Participants self-identified as of Chinese ethnicity and who attended specialist care for CHB clinical management were interviewed in Melbourne in 2019 (n = 30). Semi-structured interviews covered experiences of diagnosis and engagement in clinical management services, and advice for people living with CHB. Interviews were recorded with consent; data were transcribed verbatim and thematically analysed. Receiving clear information about the availability of treatment and/or the necessity of long-term clinical management were the main enablers for participants to engage in CHB clinical management. Additional enablers identified to maintain regular clinical monitoring included understanding CHB increases risks of cirrhosis and liver cancer, using viral load indicators to visualize disease status in patient-doctor communication; expectations from family, peer group and medical professionals; use of a patient recall system; availability of interpreters or multilingual doctors; and largely subsidized healthcare services. In conclusion, to support people attending clinical management for CHB, a holistic response from community, healthcare providers and the public health sector is required. There are needs for public health programmes directed to communicate (i) CHB-related complications; (ii) availability of effective and cheap treatment; and that (iii) long-term engagement with clinical management and its benefits.

Psychological distress and self-management behaviours among patients with chronic hepatitis B receiving oral antiviral therapy

AIMS

To assess the prevalence and associated factors of psychological distress among patients with chronic hepatitis B receiving oral antiviral therapy and explore the association between psychological distress and self-management behaviours among this population.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of 188 patients with chronic hepatitis B receiving oral antiviral therapy was recruited from March-October 2018 to complete a self-report questionnaire including the Chinese version of Depression Anxiety Stress Scale-21 and Chronic Hepatitis B Self-Management Scale. Logistic regression analysis and hierarchical multiple regression analysis were used to determine the factors associated with psychological distress and the association between psychological distress and self-management behaviours respectively.

RESULTS

The prevalence of depression, anxiety, and stress symptoms were 33.0%, 38.3% and 17.6% respectively. Depression was associated with older age, female gender, lower education level and longer treatment duration; anxiety was associated with female gender and longer treatment duration; and stress was associated with age of 31-40 years, female gender and unmarried status. There were significant associations between depression and anxiety symptoms and self-management behaviours.

CONCLUSION

Psychological distress was prevalent among patients with chronic hepatitis B receiving oral antiviral therapy and had a negative impact on self-management. Interventions targeting depression and anxiety symptoms may be beneficial to improve self-management behaviours for this population.

IMPACT

This study explored the factors associated with psychological distress in patients with chronic hepatitis B receiving oral antiviral therapy. The findings showed psychological distress was more common in patients who were with older age, female, less educated, unmarried and receiving longer duration of treatment and psychological distress was significantly associated with self-management behaviours. Nurses and other healthcare providers should provide interventions to reduce the risk of psychological distress and improve self-management behaviours for this population.