Abstract
Background
Helicobacter pylori eradication is associated with reduced gastric cancer and peptic ulcer disease incidence and mortality. Factors influencing patients’ experiences surrounding H. pylori diagnosis and management are not well-described. Current patient perceptions can influence adherence to treatment, and also their anxieties related to this potentially carcinogenic condition. The objective of this study was to understand the patient experience surrounding H. pylori management and to qualitatively construct a contextual framework to inform and guide providers who manage patients with H. pylori infection.
Methods
We conducted a qualitative analysis using a focus group and one-on-one telephone interviews. An iterative inductive/deductive approach was applied to recorded transcripts to identify and hierarchically order themes. Patient experience was defined according to major themes within a structured health behavior framework.
Results
Theme saturation was achieved with thirteen participants (mean age 50.4 years; 62% female; 38% non-Hispanic white). Qualitative analysis yielded a total of 987 codes that resulted in five major themes related to the patient H. pylori experience: context of decision-making; health beliefs; barriers experienced; cues to action; and impact of new knowledge. These themes aligned with the Health Behavior Model framework. Participants were motivated to treat H. pylori. However, the experience was more often perceived negatively versus positively. The perceived patient-provider interaction contributed most prominently to the negative experience compared to other patient experiences, including treatment-related side effects. Internal cues, including symptoms and fear of cancer, modified participants’ perceptions and motivation to accept treatment.
Conclusions
Patient experiences related to H. pylori management are predominantly negative. Increasing providers’ awareness about patients’ values, beliefs, anxieties, and expectations surrounding H. pylori diagnosis/treatment may improve provider-patient communication and, ideally, related outcomes.
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Availability of Data and Materials
The data generated and analyzed during the current study are not publicly available due to some personal provider information being verbalized within transcript documents. The de-identified data are available in included in this published article and supplementary material.
References
Hooi JKY, Lai WY, Ng WK et al. Global prevalence of helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology 2017;153:420–429.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394–424.
Sonnenberg A, Turner KO, Genta RM. Low prevalence of helicobacter pylori-positive peptic ulcers in private outpatient endoscopy centers in the United States. Am J Gastroenterol 2020;115:244–250.
Sonnenberg A, Wasserman IH. Associations of peptic ulcer and gastric cancer with other diseases in US veterans. Am J Public Health 1995;85:1252–1255.
Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2017;112:212–239.
Shah SC, Iyer P, Moss S. AGA Clinical Practice Update on the Management of Refractory Helicobacter pylori Infection: Expert Review. Gastroenterology 2021;160(5):1831–1841.
Readability Test Results. https://www.webfx.com/tools/read-able/check.php (accessed Aug 17, 2020).
O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med 2014;89:1245–1251.
Azungah T. Qualitative research: deductive and inductive approaches to data analysis. Qual Res J 2018;18:383–400.
Tjora A. Qualitative Research as Stepwise-Deductive Induction. Abingdon, Oxon; New York, NY : Routledge, 2018. | Series: Routledge advances in research methods ; 26: Routledge, 2018 DOI:https://doi.org/10.4324/9780203730072.
Fereday J, Muir-Cochrane E. Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods 2006;5:80–92.
Jones CL, Jensen JD, Scherr CL, Brown NR, Christy K, Weaver J. The Health Belief Model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation. Health Commun 2015;30:566–576.
Glanz K, Rimer BK, Viswanath K, eds. Health Behavior and Health Education: Theory, Research, and Practice, 4th edn. Hoboken: Wiley; 2008.
Reesor L, Vaughan EM, Hernandez DC, Johnston CA. Addressing outcomes expectancies in behavior change. Am J Lifestyle Med 2017;11:430–432.
Shah SC, Nunez H, Chiu S et al. Low baseline awareness of gastric cancer risk factors amongst at-risk multiracial/ethnic populations in New York City: results of a targeted, culturally sensitive pilot gastric cancer community outreach program. Ethn Health 2020;25:189–205.
Lee M, Kemp JA, Canning A, Egan C, Tataronis G, Farraye FA. A randomized controlled trial of an enhanced patient compliance program for Helicobacter pylori therapy. Arch Intern Med 1999;159:2312–2316.
Acknowledgments
Contributors: Other than the authors listed, there are no additional contributors. Funders: SCS and this work was supported by the Agency for Healthcare Research (AHRQ) and Quality and Patient-Centered Outcomes Research Institute (PCORI) K12 HS026395, American Gastroenterological Association Research Scholar Award, and Veterans Affairs Career Development Award ICX002027A. Additional funding support for co-authors include DK R0158587, CA R01 77955, CA P01 116087 (RP). The content is solely the responsibility of the listed authors and does not necessarily represent the official views of the funding agencies. Prior presentations: This work has not been previously presented.
Funding
SCS and this work was supported by the Agency for Healthcare Research (AHRQ) and Quality and Patient-Centered Outcomes Research Institute (PCORI) K12 HS026395, American Gastroenterological Association Research Scholar Award, and Veterans Affairs Career Development Award ICX002027A-01. Additional funding support for co-authors include DK R0158587, CA R01 77955, CA P01 116087 (RP). The content is solely the responsibility of the listed authors and does not necessarily represent the official views of the funding agencies.
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Conceptualization: Shah; Design: Shah, Roumie, Bonnet, Schlundt; Conduct interviews/data collection: Bonnet, Schulte; Analysis: Bonnet, Schulte, Shah; Drafting manuscript: Shah; Critical revision of manuscript: Shah, Bonnet, Peek, Schlundt, Roumie; Funding and Administrative Oversight: Shah, Roumie.
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All participants included in this study provided both verbal and written voluntary consent and were allowed to withdraw their participation at any time. This study was approved by the Vanderbilt University Medical Center Institutional Review Board.
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Shah, S.C., Bonnet, K., Schulte, R. et al. Helicobacter pylori Management Is Associated with Predominantly Negative Patient Experiences: Results from a Focused Qualitative Analysis. Dig Dis Sci 67, 4387–4394 (2022). https://doi.org/10.1007/s10620-021-07320-8
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DOI: https://doi.org/10.1007/s10620-021-07320-8