الفهرس 
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Abstract
Summary
Hepatitis C virus (HCV) is a major causative agent of chronic liver diseases. chronic HCV infection defined as the persistence of HCV genome in the blood for at least six months after the onset of acute infection. Patients with chronic HCV infection are at high risk of developing liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC), which are the most common indications for liver transplantation (Kitab et al., 2021).
Until 2011, the standard-of-care therapy for HCV infection consisted on pegylated-interferon alpha (IFNα) in combination with the nucleotide analogue ribavirin (RBV) (peg-IFNα/RBV) leading to sustained virologic response (SVR) in 54–63% of patients with substantial side effects. The great advances in HCV research allowed the development of direct-acting antivirals (DAAs) which have dramatically improved the standard-of-care for HCV-infected patients (Kitab et al., 2021).
Enrichment of patients with nursing intervention and knowledge about chronic hepatitis C, seemed to have positive effects on improving patients’ knowledge about diseases and managing their symptoms and self-care modalities that reflected by improvement of patients complains to therapeutic regimen (Besely et al., 2022).
Aim of the Study:
The aim of this study was to evaluate the effect of educational guidelines on adherence of patients with viral hepatitis C toward new oral therapeutic regimenThrough the following:
1. Assessment of adherence of patients with viral hepatitis C regarding oral therapeutic regimen before implementing educational guidelines.
2. Develop and implement the educational guidelines.
3. Evaluate the effect of educational guidelines on adherence of patients with viral hepatitis C regarding oral therapeutic regimen.
Study design:
A quasi experimental design (one group pretest/ posttest) was used to achieve the aim of the present study.
Setting:
This study was conducted in hepatitis C treatment clinic at Beni Suef general hospital.
Subjects:
A purposive sample of 94 patients with viral hepatitis C based on power analysis according to certain inclusion criteria as follow: adult patients from both sexes diagnosed with chronic hepatitis C, at beginning of treatment and willing to participate in the study.
Tools for data collection:
Two tools for data collection were used as follow:
1- Patients assessment tool: (Appendix I)
This tool was developed by the researcher based on the extensive review of relevant and recent literatures Jones & Bartlett (2019); EASL (2018); Ignatavicius et al. (2018); Hinkle & Cheever (2018); AASLD (2018); Ali (2015). Included three parts as following:
Part 1: Socio-demographic characteristics of patients: This part composed of (10) questions used to assess the patient’s socio-demographic characteristics as gender, age, level of education, marital status, occupation, work type, monthly income, residence, smoking status, health care provider at home.
Part 2: Clinical data: this part was used to assess current and past medical history for patient. It composed of (5) questions, (2) of them used to assess the present history which includes: chief complain, other drugs used with hepatitis C treatment and (3) questions to assess past medical history which includes: onset of diseases, previous diseases, previous HCV treatment.
Part 3: Patients’ Knowledge regarding hepatitis C and its new oral medication. It was used to assess patients’ level of knowledge regarding hepatitis C and its new oral therapeutic regimen, pre and post implementation of educational guideline. It composed of 7 categories which included (38) closed end questions.
2. Patient’s adherence assessment tool: (Appendix II)
This tool was used to assess the level of patients’ adherence to therapeutic regimen. It consisted of 2 parts.
Part I: Morisky Medication Adherence Scale (MMAS): This scale was adopted from Morisky, (2010) and it was translated into an Arabic language and back translated into English. It composed of (8) closed ended questions used to assess adherence of patient with viral hepatitis C to medication therapy.
Part II: patients’ adherence tool: IT was developed by the researcher based on reviewing the related literature Chirch & Ivanaviciene (2019), Kwo et al., (2018), Preziotti (2018), Wohl et al., (2017), Forde et al., (2017), John & Sandt (2008). It composed of (17) closed ended questions designed to assess patient s’ adherence to diet, activities and follow up.
Tools Validity and Reliability :( Appendix III)
Testing validity of the proposed tools by inspecting the items to determine whether the tools measure what supposed to measure. The data collection tools were examined by a jury of seven experts; five of them from medical –surgical nursing department, faculty of nursing of Ain Shams University (2 professors and 3 assistant professors). Other two members were hepatologist consultants, working at liver and endoscopy department, Beni Suef general hospital. The expertise reviewed the tools for clarity, relevance, comprehensiveness, simplicity and minor modifications was done.
Testing reliability:
The tool was assessed by Cronbach’s alpha to check the internal consistency and it was as follow, tool I entitled Patients knowledge regarding hepatitis C and its new oral medication was 0.91, which mean highly reliable.Tool II entitled Patients adherence tool was 0.89.
Pilot Study:
A pilot study was carried out on 10% of the studied subjects (10 patients). It was carried out in the hepatitis C treatment clinic at Beni Suef general hospital to assess the clarity of the designed tools, applicability of the tools, and the time needed for filling data collection tools. The subjects who included in the pilot study were excluded from the main study subjects.
Field Work:
• Field work included 4 phases: assessment phase, planning phase, implementation phase and evaluation phase.
• The study was carried out in the waiting areas of hepatitis C treatment clinic.
• The study was carried out in the form of four cycles where, 23 patients were taken in each cycle except last cycle was 25 patients. Each cycle lasted three months and included 4 phases, the assessment phase and planning phase in the first month, the implementation phase in the second month and the evaluation phase in the third month.
• Data collection and teaching session were conducted in the morning shift 3-5 days per week according to patients’ schedule, started from the beginning of September 2019 until the end of August 2020.
Results:
The result of the present study showed that:
• More than half of the studied patients was females (55.3%), and 54.3% of patients their age range between 26 - < 41 years old with mean age 33.7 ± 11.4, as regard to educational level, two fifths (41.5%) of patients can’t read and write. Moreover three quarters of subjects (74.4%) were married.
• There was a statistically significant difference in patients’ total knowledge in all aspects of HCV and its therapeutic regimen pre and post implementation of educational guidelines as p value = 0.000.
• The result revealed that 72.3% of studied patients were adhered to therapeutic regimen post implementation of educational guidelines compared to 54.3% pre implementation of educational guidelines.
• There was statistical significant relation between total level of patients’ knowledge and their gender, age group, educational level and marital status as p value > 0.05.
• There was statistical significant relation between total levels of patients’ adherence and their educational level, work type, residence and home care provider as p value > 0.05.
• The result clarified that there was positive significant correlation between total adherence and total knowledge post implementation of educational guidelines.
• Also, there was positive significant correlation between total knowledge and adherence to medication, diet, daily activity post implementation of educational guideline where p value > 0.05.
The result of this study concluded that:
- Implementation of educational guideline, for patients with hepatitis C under new oral treatment has statistically significant positive effect on improving patients’ adherence to medication, diet, daily activity, and fallow up and this support research hypothesis.
The study recommended that:
1- For patients:
- Design Arabic educational material (colored booklet) about HCV and management needed during treatment. It should be given to every patient.
- Close involvement of the individuals and their families in decision making about disease management, to improve patient’s adherence.
- Continuing counseling training programs for all patients with HCV under new oral treatment therapy.
2- In Services:
- Establishment of ahot line contact on whats’APP support group for urgent and non–urgent consultation to overcome non adherence to new oral hepatitis C virus therapeutic regimen.
- Publishing posters containing mangment needed during new oral hepatitis C virus treatment in all different health care settings.
3- In research:
- Replication of the research study on a large probability sample is recommended to achieve generalization of the results.
- Further researches are recommended to study factor affecting patients’ adherence to new oral hepatitis C virus therapeutic regimen.