Help-seeking and coping with the psychosocial burden of chronic hepatitis C: A qualitative study of patient, hepatologist, and counsellor perspectives Benjamin J. Stewart a, *, Antonina A. Mikocka-Walus a,b , Hugh Harley c,d , Jane M. Andrews d,e a School of Psychology, University of Adelaide, Australia b School of Nursing and Midwifery and Sansom Institute for Health Research, University of South Australia, Australia c Clinical Hepatology, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Australia d Discipline of Medicine, University of Adelaide, Australia e IBD Service and Education, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Australia International Journal of Nursing Studies 49 (2012) 560–569 A R T I C L E I N F O Article history: Received 17 May 2011 Received in revised form 3 November 2011 Accepted 7 November 2011 Keywords: Coping Doctor–patient relations Help seeking Hepatitis C Psychosocial Social support A B S T R A C T Background: Chronic hepatitis C affects millions of people worldwide, may have significant physical consequences, and patients are also at increased risk of psychiatric morbidity. However, it is currently unknown how patients cope with, and seek help for the psychosocial issues which contribute to this psychiatric morbidity. Objectives: This study aimed to qualitatively explore the biopsychosocial burden of chronic hepatitis C, patients’ subsequent coping and help-seeking, and the patient–health professional relationship from the different perspectives of patients, hepatologists, and counsellors. Methods: Thirteen patients, five hepatologists, and two hepatitis C specific counsellors from South Australia participated in semi-structured interviews, which were audio- recorded, transcribed verbatim, and analysed thematically. Results: All groups perceived chronic hepatitis C as a severe disease involving inextricably intertwined biological, psychological, and social impacts. Negative factors included the impact of diagnosis, stigmatisation, and often unwarranted fears regarding transmission and disease progression. The key positive influences reported across the groups involved information provision and access to informal and formal support. However, a number of barriers were noted to accessing this support, particularly stigmatisation. All respondents highlighted the importance of the patient–health professional relationship. This relationship was perceived to be enhanced by empathetic, compassionate professionals who provided comprehensive information in a sensitive and timely manner. Key negative influences on this relationship included discrimination or inappropriate treatment from mainstream health professionals, time constraints of doctors, patient non-attendance, and discordant views regarding treatment decisions. Conclusions: Reducing the psychosocial impact of chronic hepatitis C requires targeted information provision for patients, the general public, and mainstream health services. This may increase patient education, reduce the extent and impact of stigmatisation, remove barriers to help-seeking, and improve the patient–health professional relationship. ß 2011 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +61 08 8303 3136; fax: +61 08 8303 3770. E-mail address: benjamin.j.stewart@adelaide.edu.au (B.J. Stewart). Contents lists available at SciVerse ScienceDirect International Journal of Nursing Studies journal homepage: www.elsevier.com/ijns 0020-7489/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijnurstu.2011.11.004