Summary
Waverley Care developed a person-centred, self-management style programme which would enable people living with Hepatitis C to have access to support, information and room to successfully manage their condition and move forward in their lives.
Service users frequently made reference to certain behaviours (often which had led them to contracting Hepatitis C) yet they did not understand why they felt they engaged in these behaviours - nor could they see a way to move forward from them.
The programme’s structured workshops create a group environment in which participants gain new knowledge, learn new skills and explore their lives while discussing a wide range of problems, concerns and experiences.
Some of the areas covered in workshops include: self-identity, confidence and self-esteem, goal setting and problem solving.
Challenge
People living with blood-borne viruses (BBVs) are among the most vulnerable members of society and subject to both health and social inequalities. Whatever their causes, psychological problems complicate the care and clinical management of people living with HCV, by decreasing rates of adherence to medication, reducing the quality of life and leading to poorer physical and mental health outcomes. People often find that their capacity to sustain independent living is substantially compromised – and often this is when they look for, and benefit from, support in a safe setting, both from skilled workers and from their peers so that they are able to learn how to successfully manage living with a long term condition.
Objectives
To work with health, social and voluntary sector partners to identify people living with Hepatitis C and encourage them to take part in the self-management programmes. To support individuals to make informed choices regarding their lifestyles and to affect behaviour change. To give participants better knowledge of their condition, dietary requirements, lifestyle choices, and skills such as setting long-term goals.
Solution
People living with HCV and key professionals were involved in the design of the self- management programmes. Once they were developed, the team engaged broadly with key partners from a variety of different health, social and voluntary sector organisations for its promotion. Taster sessions and open days were offered, which in turn enabled referral pathways to be set up and to encourage referrals to the programmes.
The self-management programmes were modular based, offering flexibility to the course content. Addressing the knowledge and skill gaps on week one enabled the team to provide a programme that was responsive and tailored to the needs of the course participants.
Results
Participants showed a significant increase of satisfaction across all areas: emotional and mental health showed a 49% increase, with a 42% improvement in confidence. Self-esteem also had a 31% increase, implying that participants were feeling much better about themselves. The findings from the life wheel also demonstrated a 24% rise as participants introduced more structure into their lives. This was evident from the amount of references that were requested for volunteer applications, college courses and job applications. Social networks and relationships, knowledge of condition, self-care and self-management all improved, increasing by 19%. Peer support and group discussions were definitely a contributing factor in enabling this. Topics such as healthcare and life skills increased by 16%, which demonstrated that individuals were more satisfied with their relationship with healthcare professionals and felt better able to make informed choices. There was a 14% increase in satisfaction in participants’ physical health, which related to an enhanced understanding of dietary requirement and physical exercise, as well as managing their health better.
Learnings
Having a modular-based programme allows the team to adapt the courses to meet individual needs. Getting referrals into the programme does continue to be a challenge: the perceived stigma surrounding HCV still exists and at times individuals do not want to put themselves forward to attend an ‘HCV’ group as they may feel singled out. For that reason, the team has adapted the programme in some areas to include standalone workshops for those in addiction and who are at risk of contracting HCV. The skills learned apply to all.
Evaluation
The Waverley Care Life Wheel evaluation tool was used, focusing on overall wellbeing. The data was then analysed through the use of frequencies, percentages and means. Participants were asked to complete the Life Wheel at the beginning and end of the programme, rating 10 key areas – such as knowledge of condition, physical health and self-care - on a scale of 1 (very dissatisfied) to 10 (very satisfied). Participants’ pre- and post-intervention scores were then compared and checked for statistical significance. There was also a follow-up health check six weeks after the programme finished and anecdotal evidence from these was very powerful.
