A qualitative service evaluation of a multimodal pilot service for earlier detection of liver disease in high-risk groups: ‘Alright My Liver?’

Archer, Ann, May, Tom, Bowers, Hannah, Kesten, Joanna, Tilden, Sally, Abeysekera, Kushala W.M., Gordon, Fiona H., Hickman, Matthew and Yardley, Lucy (2024) A qualitative service evaluation of a multimodal pilot service for earlier detection of liver disease in high-risk groups: ‘Alright My Liver?’. Gut, 73 (3), A57-A58, [P74]. (doi:10.1136/gutjnl-2024-basl.81).

Abstract

Background and aims: in 2022, NHS England funded the Bristol and Severn hepatitis C operational delivery network to deliver a community-based proactive screening pilot to identify chronic liver disease in high-risk groups. Liver health screening events were co-located with existing services that serve vulnerable and high risk groups, for instance at addiction services and homeless hostels. This study aimed to evaluate the acceptability and feasibility of the Alright My Liver? service using qualitative semi-structured interviews with service users and service providers.

Method: between December 2022 and May 2023, 20 interviews were conducted with service users (n=14) and service providers (n=6). The median age of service users was 48.2 (range 32-65), who were predominantly white British (n=7) followed by Black African (n=4). 12 of the 14 service users reported either previous or current problematic substance use, including alcohol (n=10) and heroin/crack (n=2). Transcripts were imported to NVivo software for thematic analysis utilising a data-driven inductive approach was used to scrutinise the data in order to identify and analyse themes of particular salience across the dataset.

Results: the thematic analysis identified three main themes, including: (1) Motivations for Engagement, (2) Experience of service, and (3) Health Impacts. Most participants were motivated to attend a liver screening event in response to immediate health concerns or specific events but the novelty, accessibility and convenience of the intervention also prompted uptake among those lesser perceived risk of liver damage. The service was considered acceptable to most participants, who valued the information they received and engagement with liver screening specialist nurses. Positive impacts cited in response to screening results included increased risk awareness and knowledge of liver disease, reassurance around health and the reconsideration of health and lifestyle factors. Appreciation of direct access to a healthcare professional and referral into services was also frequently cited.

Conclusions: this study has demonstrated acceptability of a novel pilot service to a representative group of service users and providers. It has identified a number facilitators to engagement with such a service, which may be useful in the future roll out of similar screening strategies for liver disease. Acceptability among those with lower risk perceptions of liver damage suggests the service may have further utility in health promotion.

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Contributors

Author: Hannah Bowers

Author: Lucy Yardley

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