Analysis Of Focus Group Discussions Research Articles

Barriers to Poverty Reduction in Russia: Participatory Qualitative Assessment. Oxfam GB Case Study

This article provides a participatory poverty analyses based on experience gained from EU-Oxfam GB project “Empowering Municipalities to Effectively Address Poverty” carried out in five small towns, including Ostashkov town in Tver oblast, in Central Russia. Research on participatory assessment was carried out through focus group discussions (FGDs) among the people living in poverty, namely: single mothers; people with disabilities; families with many children; families with disabled children; and pensioners. In this article, the participatory results are given on the example of the qualitative analyses of FGDs in Ostashkov town. One of the results of cluster qualitative analyses is identification of institutional and behavioral barriers as structural factors for better life that could be considered for policy decisions. For example, better information channels on health services or an awareness campaign on social benefits for the elderly or people with disabilities may reduce behavior barriers, while improved doctor’s appointment system at health clinic may reduce institutional barriers in access to public services for those vulnerable groups of population. Official figures may simply omit those living in poverty as they may just not be seen in the public eyes and their needs remain unmet at policy level. We argue that a participatory understanding of community barriers can help local municipalities to develop more targeted community programs on poverty reduction.

How MOOCs can empower learners: a comparison of provider goals and user experiences

The collective aims of the three biggest providers of Massive Open Online Courses (MOOCs) are to promote anywhere, anytime learning; to increase access to world-class higher education; and to connect and empower learners. Through analysis of focus group discussions between MOOC participants at the Australian National University, this study shows that MOOCs do appear to empower some users, but perhaps not in the ways – or for the people – that providers had expected. Rather than simply producing a new means for disadvantaged groups to access higher education – which can, in turn, empower them to have more opportunities in social, political and economic avenues of life – even people who are already enrolled at university can be empowered, psychologically, by MOOCs to feel confident in their abilities and to try learning new things without fear of failure. The types of people most likely to be psychologically empowered by MOOCs are those who are intrinsically motivated to learn for learning’s sake and who are anxious about the prospect of failure with regards to academic credit and course fees. Conversely, those who are more driven by extrinsic rewards may be more suited to a formally-graded learning environment, where fear of failure and financial investment in learning are regarded as motivating rather than de-motivating forces. These findings suggest that, while they may not have the same impact on all participants, MOOCs can still be a beneficial education resource with an ability to empower even already well-educated members of society.

Consumer Engagement in Value Co-Creation: what Kind of Value it creates for Company?

Introduction of the concept value co-creation (Prahalad and Ramaswamy, 2000) called for a new wave of research, emphasizing the need for creation, development and consolidation of mutually beneficial relationships between the consumer and the company. This in turn raised the interest in consumer engagement, which was described as a psychological state that occurs by virtue of interactive customer experiences with a company or a brand (Brodie at al., 2011). Recent research in marketing highlights the importance of the role of consumer engagement into value co-creation, providing a considerable number of studies, exploring the drivers, types, dimensions of consumer engagement as well as its outcomes, as expressed by consumer perceived value, loyalty, etc. However, as yet there is a lack of understanding how consumer engagement contributes to value co-creation and what benefits it brings to the company as well as to consumer. Therefore, the purpose of this article is to explore the role of consumer engagement in value co-creation from the company’s perspective, identifying the value company gets as an outcome of co-creation process. The focus on the value for company in this article is explained by the fact that it is traditionally analysed mainly through economic perspective, meanwhile consumer perceived value is agreed being multidimensional. The authors of this article suggest that value for company, as generated through co-creation process, should also be viewed as multidimensional and propose three-dimensional structure: economic, social and functional value. The study contributes to the domain of consumer engagement and value co-creation research by revealing the techniques of consumer engagement, with an emphasis on gamification as one of them, and diverse benefits the co-creation processes bring to company through the analysis of focus group discussion with representatives of companies in Lithuania that engage consumers in value co-creation.DOI: http://dx.doi.org/10.5755/j01.ee.26.4.12502

Converging approaches to understanding early onset familial Alzheimer disease: A First Nation study.

Objectives:In 2007, a novel pathogenic genetic mutation associated with early onset familial Alzheimer disease was identified in a large First Nation family living in communities across British Columbia, Canada. Building on a community-based participatory study with members of the Nation, we sought to explore the impact and interplay of medicalization with the Nation’s knowledge and approaches to wellness in relation to early onset familial Alzheimer disease.Methods:We performed a secondary content analysis of focus group discussions and interviews with 48 members of the Nation between 2012 and 2013. The analysis focused specifically on geneticization, medicalization, and traditional knowledge of early onset familial Alzheimer disease, as these themes were prominent in the primary analysis.Results:We found that while biomedical explanations of disease permeate the knowledge and understanding of early onset familial Alzheimer disease, traditional concepts about wellness are upheld simultaneously.Conclusion:The analysis brings the theoretical framework of “two-eyed seeing” to the case of early onset familial Alzheimer disease for which the contributions of different ways of knowing are embraced, and in which traditional and western ways complement each other on the path of maintaining wellness in the face of progressive neurologic disease.

Client perceptions of the mental health engagement network: a qualitative analysis of an electronic personal health record

BackgroundInformation technologies such as websites, mobile phone applications, and virtual reality programs have been shown to deliver innovative and effective treatments for mental illness. Much of the research studying electronic mental health interventions focuses on symptom reduction; however, to facilitate the implementation of electronic interventions in usual mental health care, it is also important to investigate the perceptions of clients who will be using the technologies. To this end, a qualitative analysis of focus group discussions regarding the Mental Health Engagement Network, a web-based personal health record and smartphone intervention, is presented here.MethodsIndividuals living in the community with a mood or psychotic disorder (n = 394) were provided with a smartphone and access to an electronic personal health record, the Lawson SMART Record, for 12 to 18 months to manage their mental health. This study employed a delayed-implementation design and obtained both quantitative and qualitative data through individual interviews and focus group sessions. Participants had the opportunity to participate in voluntary focus group sessions at three points throughout the study to discuss their perceptions of the technologies. Qualitative data from 95 focus group participants were analysed using a thematic analysis.ResultsFour overarching themes emerged from focus group discussions: 1) Versatile functionality of the Lawson SMART Record and smartphone facilitated use; 2) Aspects of the technologies as barriers to use; 3) Use of the Mental health Engagement Network technologies resulted in perceived positive outcomes; 4) Future enhancement of the Lawson SMART Record and intervention is recommended.DiscussionThese qualitative data provide a valuable contribution to the understanding of how smarttechnologies can be integrated into usual mental health care. Smartphones are extremely portable andcommonplace in society. Therefore, clients can use these devices to manage and track mental health issuesin any place at almost any time without feeling stigmatized.ConclusionsAssessing clients’ perspectives regarding the use of smart technologies in mental health care provides an invaluable addition to the current literature. Qualitative findings support the feasibility of implementing a smartphone and electronic personal health record intervention with individuals who are living in the community and experiencing a mental illness, and provide considerations for future development and implementation.

“Only Image I Ever See”

Previous scholarship has demonstrated that Orientalist stereotypes pervade US and European photojournalism of the Middle East in general, and specifically of coverage of conflict, yet little work has investigated whether such ideology has been transmitted to audiences and incorporated into their personal worldviews. Therefore, this project investigates how media consumers negotiate Orientalist depictions of Iraqis. This qualitative analysis of focus group discussions between US college students at a large urban university sheds light on how media visuals shape consumers’ perceptions about these groups. Understanding if and how Orientalist stereotypes are transmitted to audiences is an essential first step in trying to eliminate them from photography and from US society.

'Through my eyes': health-promoting factors described by photographs taken by children with experience of cancer treatment.

Health promotion for children with cancer should be based on the children's own needs and desires. Because there is a lack of knowledge in this area, the aim of this study was to explore what promotes health from the perspective of children with experience of cancer treatment. Fifteen children between 8 and 12 years of age participated in focus groups with three children in each group. The children were given a camera and instructions to photograph subjects that promote their health. Focus group discussions were based on the photographs and the children's own description of those photographs. The analysis of focus group discussions and photographs was conducted using inductive content analysis. According to the children, health-promoting factors are defined as meaningful relationships, recreational activities and a trustful environment. Meaningful relationships include togetherness within the family, affection for pets and friendship with peers. Recreational activities include engagement in play and leisure, withdrawal for relaxation and feeling enjoyment. Trustful environment includes confidence in significant others and feeling safe. Knowledge from this study can contribute to health promotion interventions and quality improvements in the health care of children with experience of cancer treatment. Children's experiences with what promotes health in their everyday lives provide a better understanding of the type of support children prefer when promoting their own health.

Village Voices: Lessons about Processes for Disease Prevention from a Qualitative Study of Family Health Leaders in a Community in Northeastern Thailand.

Cancer is a primary source of concern in Thailand and other countries around the world, including the Asian-Pacific region. Evidence supports that an important contributing cause of cancer and other chronic illnesses such as stroke, diabetes, and hypertension is excessive alcohol consumption. Studies conducted in Thailand reveal a worrisome rise in the number of new and regular drinkers in communities. Therefore, actions for primary, secondary and tertiary prevention of problem drinking are necessary. In recent years nurses in North East Thailand have been developing and implementing the Khon Kaen Family Health Nursing model to embed disease prevention in communities through the actions of family health nurses and local family health leaders. The aim of this qualitative research was to better understand the experiences of the local family health leaders using this model and to synthesize lessons learned. As part of a participatory action research approach involving analysis of focus group discussions and individual interviews, the experiences of 45 family health leaders were synthesized. Four main themes were identified, namely: i) Family first: role modeling beginning at the personal and family level. ii) Local leverage: using village community forums to reduce alcohol drinking. iii) Gentle growth: making the first step and treading gently; and iv) Respect, Redemption, Rehabilitation: valuing the person to re-integrate them in the village society. As alcohol consumption in the village declined significantly following the prevention program, these findings illuminate how low-tech integrated prevention approaches may be very useful, particularly in rural communities. The lessons learned may have relevance not only in Thailand but in other countries seeking to prevent and mitigate behavior that conduces to diseases such as cancer.

Development and validation of a cross-cultural knowledge, attitudes, and practices survey instrument for chronic kidney disease in a Swahili-speaking population.

IntroductionNon-communicable diseases are a growing global burden, and structured surveys can identify critical gaps to address this epidemic. In sub-Saharan Africa, there are very few well-tested survey instruments measuring population attributes related to non-communicable diseases. To meet this need, we have developed and validated the first instrument evaluating knowledge, attitudes and practices pertaining to chronic kidney disease in a Swahili-speaking population.Methods and ResultsBetween December 2013 and June 2014, we conducted a four-stage, mixed-methods study among adults from the general population of northern Tanzania. In stage 1, the survey instrument was constructed in English by a group of cross-cultural experts from multiple disciplines and through content analysis of focus group discussions to ensure local significance. Following translation, in stage 2, we piloted the survey through cognitive and structured interviews, and in stage 3, in order to obtain initial evidence of reliability and construct validity, we recruited and then administered the instrument to a random sample of 606 adults. In stage 4, we conducted analyses to establish test-retest reliability and known-groups validity which was informed by thematic analysis of the qualitative data in stages 1 and 2. The final version consisted of 25 items divided into three conceptual domains: knowledge, attitudes and practices. Each item demonstrated excellent test-retest reliability with established content and construct validity.ConclusionsWe have developed a reliable and valid cross-cultural survey instrument designed to measure knowledge, attitudes and practices of chronic kidney disease in a Swahili-speaking population of Northern Tanzania. This instrument may be valuable for addressing gaps in non-communicable diseases care by understanding preferences regarding healthcare, formulating educational initiatives, and directing development of chronic disease management programs that incorporate chronic kidney disease across sub-Saharan Africa.

General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system: a qualitative focus-group study.

BackgroundMany physicians in Sweden, as well as in other countries, find the matter of certification of sickness absence (COSA) particularly burdensome. The issuing of COSAs has also been perceived as a work-environment problem among physicians. Among general practitioners (GPs) are the highest proportion of physicians in Sweden who experience difficulties with COSA. Swedish authorities have created several initiatives, by changing the social security system, to improve the rehabilitation of people who are ill and decrease the number of days of sick leave used. The aim of this study was to describe how GPs in Sweden perceive their work with COSA after these changes.MethodsA descriptive design with a qualitative, inductive focus-group discussion (FGD) approach was used.ResultsFour categories emerged from the analysis of FGDs with GPs in Sweden: 1) Physicians’ difficulties in their professional role; 2) Collaboration with other professionals facilitates the COSA; 3) Physicians’ approach in relation to the patient; 4) An easier COSA process.ConclusionsSwedish GPs still perceived COSA to be a burdensome task. However, system changes in recent years have facilitated work related to COSA. Cooperation with other professionals on COSA was perceived positively.

Strengthening Nepal's Female Community Health Volunteer network: a qualitative study of experiences at two years.

BackgroundNepal’s Female Community Health Volunteer (FCHV) program has been described as an exemplary public-sector community health worker program. However, despite its merits, the program still struggles to provide high-quality, accessible services nation-wide. Both in Nepal and globally, best practices for community health worker program implementation are not yet known: there is a dearth of empiric research, and the research that has been done has shown inconsistent results.MethodsHere we evaluate a pilot program designed to strengthen the Nepali government’s FCHV network. The program was structured with five core components: 1) improve local FCHV leadership; 2) facilitate structured weekly FCHV meetings and 3) weekly FCHV trainings at the village level; 4) implement a monitoring and evaluation system for FCHV patient encounters; and 5) provide financial compensation for FCHV work. Following twenty-four months of program implementation, a retrospective programmatic evaluation was conducted, including qualitative analysis of focus group discussions and semi-structured interviews.ResultsQualitative data analysis demonstrated that the program was well-received by program participants and community members, and suggests that the five core components of this program were valuable additions to the pre-existing FCHV network. Analysis also revealed key challenges to program implementation including geographic limitations, literacy limitations, and limitations of professional respect from healthcare workers to FCHVs. Descriptive statistics are presented for programmatic process metrics and costs throughout the first twenty four months of implementation.ConclusionsThe five components of this pilot program were well-received as a mechanism for strengthening Nepal’s FCHV program. To our knowledge, this is the first study to present such data, specifically informing programmatic design and management of the FCHV program. Despite limitations in its scope, this study offers tangible steps forward for further research and community health worker program improvement, both within Nepal and globally.

Uniting Postcolonial, Discourse, and Linguistic Theory to Explore Participation of African Americans in Cancer Research as an Effect of Social and Historical Race Relationships

This article uses a historical framework of postcolonialism; discourse analytic concepts (significance, identity, and relationships); and 5 social and cultural linguistic principles of emergence, positionality, indexicality, relationality, and partialness as a theoretical and methodological triangulation approach to data analysis of focus group discussion. Exemplars of focus group data from a study exploring African American participation in research demonstrate the application of this combined framework as a useful tool for analysis. This approach allows for examination of identity and interaction and generates a more rigorous and complete understanding of how individuals use language to construct identity as participants or nonparticipants in research.

‘Oh my god, we're not doing nothing’: Young people's experiences of spatial regulation

Social psychologists have become increasingly concerned with examining the ways in which social practices are interrelated with their location. Critical perspectives have highlighted the traditional lack of attention given to both the collective aspects of spatial identities, together with the discursive practices that construct the relationships between people and places. In this article, we draw together the developing discursive work on place with work on children's geographies, in order to examine young people's accounts of spatial regulation. Adopting a discursive approach to the analysis of focus group discussion, we illustrate a variety of concerns managed in relation to spatial practices by 41 young people living in a large city in the South of England. Our findings suggest that everyday use of public space by young people is constructed at a nexus of competing concerns around childhood/adulthood, freedom, and citizenship, and illustrate the dynamic nature of place, and its regulation, as a resource for constructing identities.

Patient Perceptions Of Treatments In SCD: Implications For Gene Transfer Therapy

Sickle cell disease (SCD) is a chronic genetic disease with high morbidity and early mortality affecting approximately 100,000 individuals in the US.Treatment of SCD has primarily focused on symptom management and infection prevention; however, there are two targeted therapeutic options: bone marrow transplant (BMT) and hydroxyurea (HU). BMT is curative, but limited by matched donor siblings and immunological risks. Barriers to acceptance of BMT from a matched donor are not well understood. HU if taken on a long term basis, reactivates fetal hemoglobin (HbF), reduces sickling, and prolongs survival but may be associated with side-effects related to marrow suppression. Additionally, adherence is a major compliance barrier to daily life-long HU use. Gene transfer therapy (GTT) is a novel, potential treatment for SCD. GTT is a one-time treatment that transfers an anti-sickling gene (e.g. gamma globin/HbF producing gene) into bone marrow hematopoietic stem cells. These cells can then produce sickling resistant RBCs. Little is known about the knowledge, beliefs, and acceptance of GTT and other SCD treatments in adults with SCD. If we are to improve outcomes in SCD, it is essential that we provide developmentally and culturally appropriate disease education that integrates patients' values and supports informed decision-making.The aims of the current study were to assess: 1) perceptions and knowledge about treatments in adults with SCD, and 2) the effectiveness of GTT educational materials. To the best of our knowledge, this is the first study to examine the perceptions of GTT in SCD. MethodsParticipants from two cohorts (ages 18-30 and ages 30-45) participated in focus groups and completed measures including a demographics survey (e.g. age, gender, medical history), the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health-Related Quality of Life survey (HRQOL), and a focus group questionnaire (e.g. disease knowledge /perceptions, evaluation of education materials). The HRQOL survey assessed both physical and mental health status. Qualitative data was analyzed using evidence-based methods, organizing responses into broad conceptual categories. Descriptive analyses and a linear regression were used to analyze quantitative data. ResultsTwenty-six adults with HbSS (88%), HbSC (4%), or HbSB+Thal (8%) participated in one of two focus groups. Cohort 1 (N= 14, 50% male) had a mean age of 21.7 (SD= 2.7) and Cohort 2 (N= 12, 45.5% male) had a mean age of 42.8 (SD= 12.2). With respect to disease severity (mild, moderate, or severe), 40% of Cohort 1 reported mild severity and 55% of Cohort 2 reported severe severity. The groups did not differ on their HRQOL scores. HU was the most recognized treatment (Cohort 1= 89%; Cohort 2= 91%). Participants were less aware of BMT (Cohort 1= 56%; Cohort 2= 70%) and least aware of GTT (Cohort 1= 38%; Cohort 2= 56%). Participants were asked their perception of treatments on a scale of 0-negative to 10-positive. HU was rated most favorably (Cohort 1, M=6.5, SD= 3.0; Cohort 2, M= 8.8, SD= 1.7). BMT was rated less favorably (Cohort 1, M= 4.1, SD= 3.4; Cohort 2, M= 5.8, SD= 4.3). Impressions of GTT were least favorable (Cohort 1, M= 2.8, SD= 2.3; Cohort 2, M= 5.4, SD= 4.0). A linear regression was used determine if treatment knowledge predicted treatment perception; a significant relationship was present only for BMT (ß= 5.1, p< .05). Clarity of educational materials was rated on a scale of 0-not at all to 10-very much. Cohort 2 rated the explanation of GTT (M=10, SD= 0) more positively than Cohort 1 (M=7.7, SD= 2.2). A thematic analysis of focus group discussions highlighted barriers to HU, BMT, and GTT and recommendations for improving educational materials. ConclusionsThis study provides insight regarding SCD patients' knowledge and perceptions about GTT and other treatments. Knowledge of BMT was associated with more positive perceptions of this treatment. Since this relationship was not present for HU, it may be that this association is important for more complex treatments, such as BMT and GTT. Study results highlight the importance of ensuring that GTT educational materials are clear, particularly for younger adults, and inform the development of educational and recruitment materials for SCD treatment research studies.This study was supported in part by NIH CTSA Grant #: 8 UL1 TR000077-04, and the Cincinnati Comprehensive Sickle Cell Center. Disclosures:No relevant conflicts of interest to declare.

Abstracts

In recent months there have been suggestions that TPTD is poorlydiagnosed. Inconsistency in assessment protocols has been postulatedas being a contributing factor. To further explore this hypothesis, amodified Delphi technique was employed to gather multidisciplinaryexpert opinion in the areas of assessment and diagnosis of TPTD. Thelevel of agreement among the participants was analyzed using Kendall’scoefficient of concordance on the ratings for the closed questionsand percent agreement for the open-ended responses. The initialquestionnaire analysis revealed that for some areas there was a lackof agreement among health care practitioners. Thematic analysis offocus group discussions showed that lack of concordance was partlydue to a varied scope of practice between professional groups. Thesedifferences in practice could be well justified, for example some practitionersmay not conduct a detailed weight-bearing assessment andmay decide that onward referral to a foot and ankle specialist is indicated.Others, however, would carry out such an assessment andmake a clinical diagnosis based on their findings. Another example isdiagnostic imaging. For surgical assessment imaging is often a prerequisitewhereas this may not be the case for non-surgical management,and therefore a lack of concordance would be expected.

The changing cultural and economic dynamics of polygyny and concurrent sexual partnerships in Iringa, Tanzania

Polygyny has been identified both as a ‘benign’ form of concurrency and as the cultural basis of concurrent partnerships that are considered important drivers of the HIV epidemic in sub-Saharan Africa. This paper investigates the changing cultural and economic dynamics of polygyny in concurrency in Iringa, Tanzania, a region with traditions of polygyny and high prevalence of HIV. Our analysis of focus group discussions, in-depth interviews and key informant interviews indicate that contemporary concurrent partnerships differ from regional traditions of polygyny. Whereas in the past, polygyny reflected men's and their kin group's wealth and garnered additional prestige, polygyny today is increasingly seen as a threat to health, and as leading to poverty. Nevertheless, participants evoked the social prestige of polygyny to explain men's present-day concurrency, even outside the bounds of marriage, and despite continued social prohibitions against extramarital affairs. Difficult economic conditions, combined with this prestige, made it easier for men to engage in concurrency without the considerable obligations to wives and children in polygyny. Local economic conditions also compelled women to seek concurrent partners to meet basic needs and to access consumer goods, but risked greater moral judgement than men, especially if deemed to have excessive ‘desire’ for money.

Knowledge of psychiatric terms and concepts among Kenyan youth: Analysis of focus group discussions

Psychiatric disorders and symptoms are common worldwide. However, cultural differences in symptom manifestation and knowledge of psychiatric terms and concepts represent a challenge to accurate clinical assessment. Our previous youth surveys revealed higher rates of psychotic experiences in Kenya compared to several other countries, suggesting culture may influence psychosis risk assessment survey results. The goal of the present investigation is to evaluate understanding of general mental health related terms and concepts and specific items from the Structured Interview for Psychosis-Risk Symptoms (SIPS), a commonly used psychosis risk assessment instrument. Six focus groups were conducted in Nairobi, Kenya and surrounding areas with young adults from the community, university and secondary school students, and mental health professionals. Analysis of the information obtained from participants indicated that adolescents and young adults in Kenya were aware of mental illness in their communities, but had very limited knowledge of the meaning of specific psychiatric disorders and symptoms. Many believed that the cause of mental illness was spiritual in nature. These results suggest that in order to obtain accurate reported rates of psychiatric symptoms, assessment of Kenyan adolescents and young adults requires elaboration of assessment questions and use of simplified terms.

Shaping medicinal product information: a before and after study exploring physicians’ perspectives on the summary of product characteristics

ObjectiveTo establish, in the context of the revised European Pharmacovigilance Directive and based on physicians’ perspectives, how Summaries of Product Characteristics (SmPCs) could be more user friendly and better support...

P3.165 Establishing Second Generation HIV/STI-surveillance For Migrants from Sub-Saharan Africa in Germany - A Participatory Process

BackgroundMigrants from sub-Saharan Africa (MisSA) are a relevant sub-group for HIV-transmission in Germany. 10–15% of all newly diagnosed cases are MisSA, and approximately one third acquired HIV in Germany. Diagnosis...

Perceptions of drug users regarding Hepatitis C screening and care: a qualitative study

BackgroundIllicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher HCV-related mortality. Factors contributing to poor engagement in care are incompletely understood.MethodsFourteen mixed-gender focus groups of either African American or Latino/a drug users (N = 95) discussed barriers to HCV testing and treatment. Themes were identified through content analysis of focus group discussions.ResultsMany drug users were tested for HCV in settings where they were receiving care. Outside of these settings, most were unaware of voluntary test sites. After testing HCV positive, drug users reported not receiving clear messages regarding the meaning of a positive HCV test, the impact of HCV infection, or appropriate next steps including HCV clinical evaluations. Many drug users perceived treatment as unimportant because they lacked symptoms, healthcare providers minimized the severity of the diagnosis, or providers did not recommend treatment. Mistrust of the motivations of healthcare providers was cited as a barrier to pursuing treatment. Social networks or social interactions were a source of HCV-related information and were influential in shaping drug users perceptions of treatment and its utility.ConclusionDrug users perceived a paucity of settings for self-initiated HCV testing and poor provider-patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations and monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed.