Efficacy of a self-management program in patients with chronic viral hepatitis in China

Ying’Ai Cui,Md Moshiur Rahman,Kazuaki Chayama,Basilua Andre Muzembo,Yanhui Liu,Chunmei Ya,Michiko Moriyama

doi:10.1186/s12912-019-0366-7

Abstract

BackgroundChronic hepatitis, mainly B or C, increases the risk of hepatocellular carcinoma and remains an emerging issue in the globe. China has high rates of liver cancer incidence and mortality in the world. To address such challenges, adequate management of chronic hepatitis is required. Self-management education is one alternative for improving the hepatitis patients’ knowledge of the disease, mental health, and clinical management.This study aimed to examine the quality of life (QOL), psychological effects, and behavioral changes of a self-management program which allows continuity of care for chronic hepatitis B and C patients.MethodIn a six-month, randomized controlled trial, we invited 73 chronic hepatitis B/C inpatients to receive (i) two face-to-face education sessions provided by a nurse during hospitalization, and monthly telephone counseling at home after discharge; (ii) or usual care treatment (control group). The primary endpoint (patients’ QOL) and secondary outcomes (including self-efficacy, depression symptoms, perceived cognition of illness and behavioral changes) were assessed. In addition, we conducted qualitative data analysis to facilitate the evaluation of the interventions.ResultsSixty (82.2%) out of 73 eligible patients with chronic hepatitis B/C (aged 34.9 ± 8.9 years) participated in the study. The intervention group (n = 30) significantly improved on outcomes including QOL, self-efficacy, perceived cognition of illness, and behavioral changes, whereas the control group significantly decreased their healthy behaviors. In terms of behavioral changes, alcohol avoidance, dietary adherence, and stress management also improved in the intervention group. However, there were no significant improvements in symptoms of depression. Most participants (80%) in the intervention group stated that they benefited from the program.ConclusionsThis program contributed to patients’ acquisition of self-management skills to cope with their illnesses, and significantly improved their QOL. This program serves as a reminder for nurses who care for patients with chronic viral hepatitis to acquire these skills as it would help them address the daily needs of their patients.Trial registrationUMIN000025378. Registered December 23, 2016.

Highlights

Chronic hepatitis, mainly B or C, increases the risk of hepatocellular carcinoma and remains an emerging issue in the globe
This program contributed to patients’ acquisition of self-management skills to cope with their illnesses, and significantly improved their quality of life (QOL). This program serves as a reminder for nurses who care for patients with chronic viral hepatitis to acquire these skills as it would help them address the daily needs of their patients
We hypothesized that after providing chronic hepatitis self-management education to the patients, cognition would be corrected, lifestyle behavior would change, and self-efficacy would improve as monthly goals for them to attain

Summary

Results

A total of 86.7% (52/60) of the participants had hepatitis B, whereas hepatitis C was found in 13.3% (8/60) of the participants (Table 1) Efficacy of this program QOL There were significant differences in QOL scores between the intervention and UC group (p < 0.001). CLDQ Chronic Liver Disease questionnaires, CES-D the Center for Epidemiologic Depression scale, GSES General Self Efficacy Scale, IV Intervention group, SD Standard Deviation, I – J = Difference in average value, SE Standard Error, ANOVA Analysis of variance, ANCOVA Analysis of covariance, UC Usual care group, BL Base line, M month *Analysis of covariance was carried out using gender as a covariate **p values comparing the intervention group with the control group were obtained by multiple comparisons (Bonferroni’s correction). After adjusting for confounding factors, ANCOVA results showed that there was a significant difference between the two groups in perceived dietary habit (p = 0.034), alcohol avoidance (p < 0.001), and stress management (p = 0.037) (Table 5).

Conclusions

Background

Methods

Discussion

Conclusion