Academic journal article Journal of Alcohol & Drug Education

Development of a Measure of Hepatitis C-Alcohol Knowledge

Academic journal article Journal of Alcohol & Drug Education

Development of a Measure of Hepatitis C-Alcohol Knowledge

Article excerpt

Dear Editor:

Hepatitis C (HCV) is the most common blood-borne virus in the United States (US), infecting an estimated 1.6% of the US population, corresponding to 4.1 million people (Armstrong et al., 2006). Alcohol use in patients with HCV has been shown to increase the risk of progression to cirrhosis, as well as the development of hepatocellular carcinoma (Poynard et al., 1997). Despite these health implications, studies have shown that adults with HCV are eight times more likely to consume three or more drinks daily, compared with adults who do not have HCV (Armstrong et al., 2006). Thus, it is essential that persons with HCV infection understand the need to abstain from alcohol use and then get the support to do so.

Interventionists designing alcohol treatment programs for HCV-infected individuals may choose to incorporate education on the relationship between alcohol use and liver health. Research suggests that persons with dual disease states are more motivated to make behavioral changes, when the behavior directly affects one or more of their diseases (Weisner et al., 2001). Because alcohol use directly impacts HCV-related health outcomes, people with HCV should be especially motivated to decrease their alcohol consumption, when provided with education.

Researchers studying alcohol treatment outcomes for HCV-infected individuals could benefit from measures of whether participants understand the HCV-related reasons to decrease alcohol use. Such a measure may be helpful for interventionists to use mid-intervention to assess what essential HCV-alcohol information participants do and do not yet understand. The measure could also be used as an indicator of an individual's ultimate alcohol outcome.

We were unable to find any existing measures of HCV knowledge that include a substantial alcohol component. Of general HCV knowledge measures, the Brief HCV Knowledge Scale devotes only 1 out of 19 items to alcohol use (Balfour et al., 2009). A measure by Strauss and colleagues (2006) consisting of 20 items on HCV knowledge has only one item that references alcohol (Strauss et ah, 2006). Finally, a measure used by Surjadi and colleagues includes 31 HCV knowledge questions, but none of the items reference alcohol (2011). Thus, HCV knowledge measures that include alcohol-related content are needed, especially given the impact of alcohol use on HCV-related health outcomes.

We developed a measure of knowledge of the relationship between HCV and alcohol. Two of us wrote HCV-alcohol items and then shared them with three HCV medical providers and one addictions therapist. The providers suggested wording changes to make the items optimally clear from a patient perspective. The authors incorporated this feedback and finalized seven items for inclusion in interviews with HCV-infected patients reporting alcohol use.

We conducted a study with three aims. The first aim was to assess the ability of this HCV-alcohol knowledge measure, called the HCV-alcohol Knowledge Scale, to identify changes in HCV-alcohol knowledge after exposure to HCV-alcohol education. This is important because to be useful for both research and clinical purposes, any knowledge measure needs to be sensitive to changes in knowledge. The second aim was to determine any demographic characteristics related to HCV-alcohol knowledge, to inform targeting HCV-alcohol knowledge interventions to specific sub-groups. The third aim was to determine if changes in HCV-alcohol knowledge as assessed by this measure predict changes in alcohol use, because decreased alcohol use is the ultimate goal of providing HCV-alcohol education in the context of alcohol treatment.

As part of the Hepatitis C-Alcohol Reduction Team (Hep ART) study (Proeschold-Bell et al., 2012), we screened patients presenting with HCV at the Duke Liver Clinic for risky alcohol use using the 10-item Alcohol Use Disorders Identification Test (AUDIT). …

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