J Clin Psychol Med Settings (2013) 20:156–163
DOI 10.1007/s10880-012-9332-1
A Comparison of Enrollees Versus Non-enrollees in a Patient/
Family HCV Psychoeducation Study
David E. Pollio • Carol S. North • Ashley M. Hudson
Barry A. Hong
Published online: 19 September 2012
 Springer Science+Business Media, LLC 2012
Abstract Despite the seriousness of Hepatitis C (HCV),
many patients do not receive treatment. One promising
means of addressing these issues for medically ill patients
is through participation in support group services. This
study examined individual-, treatment- and system-level
factors associated with enrolling in a support group inter-
vention (psychoeducation) for persons with HCV. A total
of 235 research participants were recruited as part of a
NIAAA-funded randomized clinical trial for patients with
HCV and their family members, with 172 (73.2 %)
agreeing to enroll in the psychoeducation trial and 63
(26.8 %) declining. Factors leading to enrollment indicated
that individuals without employment, with certain person-
ality structures (low cooperativeness and self-directed-
ness), and traveling greater distance to their group were
more likely to agree to participate. Populations being seen
in public settings demonstrate a desire for additional sup-
port and education, but at the same time these potential
participants are faced with challenges to following through
and enrolling in the desired services.
D. E. Pollio (&)
A. M. Hudson
School of Social Work, University of Alabama, Box 870314,
Tuscaloosa, AL 35487-0314, USA
e-mail: depollio@sw.ua.edu
C. S. North
The VA North Texas Health Care System, Departments
of Psychiatry and Surgery/Division of Emergency Medicine,
University of Texas Southwestern Medical Center,
Dallas, TX, USA
B. A. Hong
Department of Psychiatry, Washington University School
of Medicine, St. Louis, MO, USA
123
•
Keywords HCV
Enrollment
Addiction

Psychoeducation
Group
Introduction
It is estimated that nearly 4 million individuals (1.8 % of
the population) in the United States are infected with the
hepatitis C virus (HCV) and that perhaps as many as 2.7
million people have chronic HCV infections (Ho et al.,
2008). Without treatment, many of these patients will
progress to cirrhosis, end-stage liver disease, and death
(Alter et al., 1999). Despite the medical seriousness
of HCV, many patients do not receive treatment because of
limited access to specialized healthcare services, lack of
motivation for treatment, inadequate family support, and/or
pre-existing or current psychiatric problems (National
Institutes of Health, 2002).
One promising means of addressing these issues for
HCV patients is through participation in support group
services, which have been shown in other populations to
improve mood, coping skills, overall physical functioning,
and knowledge about the illness (Cameron et al., 2005;
Sherman et al., 2008). In general, support groups for
medical conditions tend to attract patients who are dis-
proportionately white, female, middle-class and employed,
better-educated, and relatively young (Bauman, Gervey, &
Siegel, 1992; Cameron et al., 2005; Katz et al., 2002;
Sherman et al., 2008; Taylor, Falke, Shoptaw, & Lichtman,
1986). Characteristics of those who join and do not join
support groups are likely to vary, however, according to the
type of support group offered and the particular health
issue it addresses (Walch, Roetzer, & Minnett, 2006). In
addition to these demographic correlates, research con-
ducted by Bauman et al. (1992) found that support group
J Clin Psychol Med Settings (2013) 20:156–163
participation appeared to be more appealing to those who
have unhealthy or maladaptive personality traits, who in
general have been found to lack emotional support and/or
social networks (Josefsson et al., 2011; Cloninger & Zohar,
2011; Beadle, Brown, Keady, Tranel, & Paradiso, 2012;
Williams & Wingate, 2012). Fassino and colleagues found
that lower scores on specific temperament and character
traits of cooperativeness and self-directedness were asso-
ciated with dropout from groups and other type treatments
in several different populations (Fassino, Abbate-Daga,
Piero, Leombruni, & Rovera, 2003; Mongini et al., 2005;
Leombruni, Fassino, Picardi, & Morosini, 2005).
Involvement in a support group may further be affected
by various treatment- and system-level factors. Examining
the illness-related perceptions of patients with other kinds
of chronic illness, both Cameron et al. (2005) and Sherman
et al. (2008) found that support group participation
reflected patients’ perceptions of illness severity, disease-
related distress, and perceived benefits of participation.
These findings suggest that problem-specific support group
services may not be utilized by patients who have greater
concerns over a second unrelated but overriding medical
issue (i.e., psychiatric or substance abuse issues). Finally,
lack of reliable transportation and/or living in distant or
rural areas where fewer group services are readily available
or accessible is the most commonly cited barrier (Bauman
et al., 1992; Sherman et al., 2009; Voerman et al., 2007).
Further support for this finding emerged from research by
Voerman et al. (2007) indicating that level of interest in
support group participation was positively associated with
patients’ perceived control—especially control involving
the physical distance they were willing and able to travel to
participate in the groups. Another cited hindrance to sup-
port group participation is lack of physician recommen-
dation (Cameron et al., 2005; Sherman et al., 2009; Taylor,
Falke, Shoptaw, & Lichtman, 1986).
Understanding the individual-, treatment-, and system-
level factors associated with participating in support group
services is vital for maximizing recruitment of HCV
patients to this intervention. Therefore, the purpose of this
study was to examine factors associated with enrolling in a
study to participate in a support group intervention (psy-
choeducation) for persons with HCV. The two specific
research questions addressed in this study were: (1) which
individual-level (demographic, risk behavior, recent life
events, and temperament and character), treatment-level
(other medical conditions, treatment involvement), and
system-level (residential location) factors contribute to
likelihood of enrollment into a randomized clinical trial of
a group psychoeducation intervention for HCV patients and
their families, and (2) considered together, how do these
factors predict likelihood of enrollment into a clinical trial
of a multifamily group psychoeducation program? It
157
was hypothesized that enrollees would differ on demo-
graphic factors (more likely to be white, female, employed,
better-educated, relatively younger) and temperament and
character indicators of disordered personality (likely to
have higher scores on these characteristics); treatment-
related factors (higher levels of treatment satisfaction,
greater length of time in treatment, and lack of additional
medical conditions and negative life events); and residen-
tial location (easier spatial access to groups).
Methods
Psychoeducation Trial
The data collected for this article were collected as part of a
NIAAA-funded randomized psychoeducation trial for
patients with HCV and their family members. The proposed
project enrolled HCV patients in various stages of illness
and disease progression for randomization into either a
multifamily group psychoeducation program (described
subsequently) or to an education only group control con-
dition of equal service intensity. The study was approved in
advance of recruitment by the Institutional Review Board of
the Washington University School of Medicine.
HCV-PERF and Comparison Condition
The PsychoEducation Responsive to Families for patients
with HCV and their family members (HCV-PERF) pro-
gram is an adaptation of a PERF model developed spe-
cifically for families with a member with a severe mental
illness (North et al., 1998; Pollio, North, & Osborne, 2002;
Pollio et al., 2012). HCV-PERF is a six-month-long mul-
tiple family group program of HCV patients and any of
their family members who would like to participate. The
family groups meet for 90 min twice a month. The sessions
are semi-structured and problem-oriented, focusing on
providing information, support, and sharing. HCV-PERF
provides illness education and a forum to discuss problems
in daily living and coping with the illness within a sup-
portive, proactive, and problem-focused agenda. Topics
covered in the psychoeducation groups are systematically
generated by the group members themselves. This format
permits discussions to be participant-specific, emphasizing,
and reinforcing personalized solutions to the problems of
living with a chronic illness and its complicated treatment
regimen. The groups are led by two professionals, one with
HCV medical knowledge and the other with a mental
health background.
The control group provides patient education in a group
format with the same time commitment as the active HCV-
PERF family psychoeducation groups, with opportunities
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158
for interactive question-and-answer periods with the group
leader. The didactic curriculum covered in these groups do
not focus on HCV or any particular disease, instead pro-
moting general health and wellbeing, such as the impor-
tance of dental care (e.g., instruction on correct brushing
and flossing and the importance of regular dental visits),
first aid, nutrition, and effective time management.
Recruitment and Assessment of Research Participants
Study participants were recruited from the hepatitis service
of a large Midwestern university medical center. All study-
eligible patients attending this service were invited to par-
ticipate in the research by the study’s hepatitis nurse coor-
dinator or physician assistant. Written informed consent to
participate in the study was obtained from all participants
after the research was explained to them, prior to study
enrollment. As part of this process, the full requirements for
study participation were detailed. Participants were
informed that the groups would be held at a time convenient
to them, usually on the day of their HCV medical
appointment. Inclusion criteria were a diagnosis of HCV
confirmed by serology and documented viral load, and age
18 years or above. Exclusion criteria include inability to
provide informed consent, current homicidality of suici-
dality, or active psychosis. None of the patients in this study
were in active HCV antiviral treatment at the time of study
recruitment. Patients who provided permission to contact
them and agreed to complete research assessments but who
declined to enroll in the psychoeducation trial were asked to
complete a brief instrument providing data on key variables
obtained from baseline interviews of psychoeducation en-
rollees. A total of 235 research participants were recruited
to the study between November 2007 and May 2010, with
172 (73.2 %) agreeing to enroll in the psychoeducation trial
and 63 (26.8 %) declining the intervention. Study partici-
pants were given assessments to collect data for the study
variables described below, with 173 (73.6 %) providing
data. The analyses for this study are based on the 140 par-
ticipants with complete data.
Variables in the Analysis
Dependent Variable
The dichotomous dependent variable in the study was
whether patients with HCV recruited into the clinical trial
elected to enroll or not.
Individual-Level Variables
Demographic variables in the analysis included race
(categorically representing Caucasian, African-American,
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J Clin Psychol Med Settings (2013) 20:156–163
Asian, and other races), age in years, gender, marital status
(married, divorced/separated, widowed, or never married),
and specific medical illnesses and number of medical ill-
nesses. Additionally, participants were asked to identify
risk behaviors (dichotomous variables representing specific
risky sexual activities, needle use, and substance use, and
total number of these risk behaviors) (Partnership Steering
Committee, Special Projects of National Significance
Program, 2000). Negative recent life events in the last
6 months were identified by the patient from a checklist of
13 events: loss of job or income, moving, breakup of a
romantic partner or good friend, long separation from a
loved one, major car trouble, house robbery or break-in,
being assaulted, bad debts, serious illness or injury, arrest
or other legal problems, death of a relative or close friend,
and pressure to shelter an undesired house guest (Wachtel
et al., 1992). A dichotomous variable was created from this
list to reflect the occurrence of any recent negative life
event. Temperament and character were assessed using the
Temperament and Character Inventory (TCI), a self-
administered self-report questionnaire of 240 items scored
on a 5-point Likert scale (Cloninger, 1987; Cloninger,
Svrakic, & Przybeck, 1993; Svrakic, Whitehead, Przybeck,
& Cloninger, 1993). The TCI has been described in greater
detail previously; inter-rater reliability and validity in
relation to structured interview diagnoses of personality
disorder have been demonstrated. The TCI measures three
dimensions of character (self-directedness, cooperative-
ness, and self-transcendence) and four dimensions of
temperament (harm avoidance, novelty seeking, reward
dependence, and persistence). The combination of low
cooperativeness and low self-directedness is conceptual-
ized by Cloninger and colleagues as representing an
unhealthy personality structure that is characteristic of
personality disorders.
Treatment-Level Variables
To assess the presence of medical conditions, individuals
completed a checklist of 10 individual types of chronic
illnesses experienced in their lifetime, including heart dis-
ease, cancer, stroke, arthritis, asthma, diabetes, tuberculosis,
ulcer, epilepsy, and other illness; a variable reflecting a
count of the number of medical conditions was created.
Treatment satisfaction was assessed through a scale con-
sisting of 12 items on a 5-point Likert scale. Because the
individual treatment satisfaction variables collectively
demonstrated strong intercorrelations (alpha = .95), an
aggregate measure representing the sum of the satisfaction
variables was created. Length of time in HCV treatment by
self-report since first episode of treatment was coded as
number of months.
J Clin Psychol Med Settings (2013) 20:156–163 159

System-Level Variables structure measured by TCI scale scores reflecting the

To examine the contribution of residential location, home
addresses were coded by zip code. Individuals residing
within the city of St. Louis and with zip codes directly
contiguous to the city were coded as nearby residents.
(Because the HCV clinic and location of the group were in
the far western part of the city, inclusion of the residential
zip codes contiguous to the city was considered to repre-
sent approximately the same range of travel.) Patients
residing more than 60 miles away were not included in the
study as part of the recruitment exclusion criteria.
Non-enrollee Data
Psychoeducation non-enrollees were asked to indicate from
a checklist their reasons for choosing to not participate in
the intervention.
Data Analysis
Data analysis was conducted in two stages, bivariate and
multivariate analyses based on the hypothesis. The
bivariate analyses commenced with v2 tests and t tests
based on the operationalization of the variable. Psycho-
education enrollees and non-enrollees were compared for
demographic variables (age in years, gender, race, marital
status, employment status) and disordered personality
combination of low cooperativeness and low self-direct-
edness, treatment-level variables (treatment satisfaction,
individual medical illnesses and number of medical ill-
nesses reported, negative life events and total number of
recent life events reported in the last 6 months), and resi-
dential location. Variables significant in bivariate equations
were included in a logistic regression model predict-
ing psychoeducation trial enrollee versus non-enrollee
groups.
Results
Individual-Level Findings
Demographics
Table 1 presents demographics of the psychoeducation trial
enrollees and non-enrollees. The sample was about one-
half male and nearly two-thirds (57.6 %) were of ethnic
minority groups (predominantly black, 54.7 %). The mean
age was 51.7 ± 8.9 years. Enrollees and non-enrollees
were equivalent in sex ratios and age. Only 25.7 % were
currently married. More than one-fourth were unemployed
(27.7 %) and nearly one-half (47.4 %) were disabled. Non-
enrollees were significantly more likely than enrollees to be
non-minorities and employed.

Table 1 Comparisons between

Enrollees (%) Non-enrollees (%) Significance
psychoeducation enrollees
(n = 113)* (n = 59)*
and non-enrollees
Male gender 49.6 50.4 NS
Race
Caucasian 32.7 61.0 v2 = 13.00,
df = 1, p \ .001
Black 63.7 37.3 v2 = 10.49,
df = 1, p = .001
Asian 0.9 1.7 NS
Other 2.7 0.0 NS
Marital status
Married 29.2 36.2 NS
Divorced/separated 46.0 31.0 NS
Widowed 7.1 3.5 NS
Never married 26.6 29.3 NS
Current employment
status
Employed 18.4 37.3 v2 = 7.41,
df = 1, p = .007
Unemployed 30.7 22.0 NS
*n varies across variables based Disabled 50.9 40.7 NS
on sporadic missing data (\1 % Residing in city or 50.5 28.8 v2 = 7.32,
for all but one variable, which is adjacent zip code areas df = 1, p = .007
missing \5 %)

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Risk Behaviors
High lifetime rates of multiple risk behaviors were found
across the sample, including cocaine use (49.4 %), heroin
use (83.5 %), other hard drug use (71.8 %), injection drug
use (52.7 %), sharing needles (41.4 %), prostitution
(20.4 %), and smoking (74.8 %). Compared to non-enrol-
lees, a higher proportion of enrollees reported having
engaged in prostitution (25.5 vs. 10.5 %; v2 = 5.16,
df = 1, p = .023, n = 167). The two groups did not differ
in lifetime history of the other risk behaviors.
Recent Life Events
The majority (81.4 %) had at least one recent negative life
event, with a mean (SD) of 2.4 (2.0) events. The most
frequent negative life events involved a serious illness or
injury (36.6 %), death of a relative or close friend
(33.7 %), long separation from a loved one (18.6 %), and
job loss or substantial loss of income (20.4 %). The only
specific type of life event related to the likelihood of not
enrolling in the psychoeducation trial was bad debts
(28.8 % of non-enrollees vs. 15.9 % of enrollees; v2 = 3.9,
7df = 1, p = .046, n = 172). The total number of life
events was not associated with enrollment in the psycho-
education trial.
Temperament and Character
One-third of the sample (35.3 %) had a disordered per-
sonality structure (i.e., low cooperativeness and low self-
directedness as measured by the TCI). Fewer non-enrollees
(23/63, 36.5 %) than enrollees (101/172, 58.7 %) had this
personality structure (v2 = 9.13, df = 1, p = .003).
Treatment-Level Findings
Medical Conditions
Besides HCV, a medical condition experienced by all study
participants, two-thirds (69.4 %) of the sample reported
having experienced one or more of the lifetime medical
illness from the list of specific conditions (heart disease,
cancer, stroke, arthritis, asthma, diabetes, tuberculosis,
ulcer, or epilepsy), and 26.0 % reported a lifetime history
of some other medical illness. The mean (SD) number of
lifetime major medical illnesses reported from the list for
the entire sample was 1.2 (1.1). The most prevalent lifetime
medical conditions were arthritis (37.6 %), diabetes
(20.3 %), asthma (16.8 %), heart disease (15.6 %), and
cancer (9.3 %). Psychoeducation enrollees were more
likely than non-enrollees to report a lifetime history of
asthma (21.1 vs. 8.5 %; v2 = 4.41, df = 1, p = .036). The
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J Clin Psychol Med Settings (2013) 20:156–163
two groups did not differ in the proportions with any
lifetime medical illness or in the total number of lifetime
medical illnesses.
Treatment Satisfaction
The treatment satisfaction summary variable was not sig-
nificantly different between the two groups (mean = 47.5,
SD = 9.1, n = 143, p [ .05). No individual satisfaction
item significantly differentiated enrollees and non-
enrollees.
System-Level Findings/Residential Location
More than one-half of the sample (57.1 %) resided within
the city or immediately adjacent suburbs, near the medical
center. Enrollees were more than twice as likely to be
residents of the city or contiguous neighborhoods (see
Table 1).
Reasons for Psychoeducation Non-enrollment
For the 54 non-enrollees who provided data on reasons for
non-enrollment, the two most common reasons provided
for choosing not to participate in the psychoeducation
program were transportation issues (44.4 %) and the
amount of time required for participation (40.7 %). Other
responses were that the individual had prioritized another
health condition (9.3 %) or family concerns (9.3 %) ahead
of psychoeducation. Lack of interest was reported by
5.6 %, feeling too upset to participate by 5.6 %, perception
that it wasn’t worth the effort by 3.7 %, and concerns about
privacy by 1.9 % as reasons for non-enrollment.
Multivariate Modeling
A final model was created using only variables that
significantly predicted enrollment group in the bivariate
analyses (see Table 2). Variables entered into the final
model included African American race, current employ-
ment status, residing within the city or immediately
adjacent zip code area, and disordered personality struc-
ture (low cooperativeness and low self-directedness).
The model as a whole was significant (model likelihood
ratio v2 = 29.88, df = 4, p \ .001, n = 168). Individuals
residing in the city or adjacent areas were almost two
and a half times as likely to enroll as those residing in
non-adjacent areas (Wald v2 = 5.07, df = 1, p = .024,
CI 1.12–5.22), individuals who were employed were less
than half as likely to enroll as those not employed (Wald
v2 = 4.99, df = 1, p = .026, CI 0.19–0.90), and indi-
viduals with disordered personality structure were more
than three times as likely to enroll as those with healthy
J Clin Psychol Med Settings (2013) 20:156–163
Table 2 Multiple logistic regression model predicting psychoeducation enrollee status
df Estimate Standard error
Parameter
Intercept 1 -0.68 0.22
Residing in city or adjacent suburbs 1 0.44 0.20
Black 1 0.31 0.19
Employed 1 -0.44 0.20
Low cooperativeness/low self-directedness 1 0.57 0.20
personality structure (Wald v2 = 8.13, df = 1, p = .004,
CI 1.43–6.93).
Discussion
The results of this investigation of factors leading to
enrollment into a clinical trial of a multifamily psychoed-
ucation group for patients with HCV indicates that, taken
as a whole, individuals with greater access to the groups,
lack of employment, and less adaptive personality char-
acteristics (low cooperativeness and self-directedness)
were more likely to agree to participate in the clinical trial.
Recruitment primarily through the university hepatology
service led to a patient sample with significant lifetime risk
behaviors, including a high proportion with a history of
substance use and abuse, as well as multiple medical and
life challenges. In characterizing those who enrolled in the
psychoeducation trial relative to those who chose not to,
enrollees had fewer external resources and were in greater
need of an intervention to help provide support and edu-
cation about HCV.
The findings from the hypothesis on individual-, treat-
ment- and system-level factors’ impact on enrollment in
psychoeducation are both similar and different from pre-
vious research on support groups. Unlike previous studies
of individual-level characteristics for support group par-
ticipation for persons with HIV (Walch et al., 2006) and
other medical conditions (Bauman et al., 1992; Cameron
et al., 2005; Katz et al., 2002; Sherman et al., 2008; Taylor,
Falke, Shoptaw, & Lichtman, 1986), and as opposed to the
hypothesized direction, participants were less likely to be
Caucasian and demonstrated lower functioning. In terms of
treatment-level variables, no significant relationships were
found in the analyses. It may be the case that treatment-
level variables are more important predictors of treatment
engagement. Finally, in terms of system-level variables, the
findings very much echo those found by Voerman et al.
(2007) in that distance to the treatment location appears to
serve as a major barrier to enrollment.
In examining results from the multivariate analysis,
psychoeducation trial enrollees are more likely to be lower
161
Wald v2 p Odds ratio point 95 % Wald confidence
estimate limits
9.31 .002
5.07 .024 2.42 1.12 5.22
2.60 .107 1.86 0.88 3.97
4.99 .026 0.41 0.19 0.90
8.13 .004 3.15 1.43 6.93
functioning (with disordered personality structure) and
unemployed and to reside in geographical proximity to the
trial site. The primary concerns of transportation issues and
time commitment required to attend the psychoeducation
groups suggest that those choosing not to enroll in the
psychoeducation trial are concerned with the difficulties of
both time and travel, rather than reasons previously
reported in the literature around prioritizing other health
conditions or family (Cameron et al., 2005; Sherman et al.,
2009). It appears that individuals who are busy, have other
existing support networks, and experience systemic issues
around attending the groups are less likely to enroll in the
clinical trial. It may also have been the case that the dis-
cussion of the burden revealed in the consenting process
influenced the decision whether or not to enroll in the
study.
The findings on the relationship between race/ethnicity
and residential proximity to the medical center bear further
discussion. In individual-level analyses, the finding that
racial/ethnic minorities were more likely to enroll in the
study was exactly opposite the general conclusion from
previous research (Walch et al., 2006; Bauman et al.,
1992). However, in the final model, this difference disap-
peared. The most likely explanation for this change in
significance when multiple variables were included in the
model has to do with the neighborhood characteristics
surrounding the recruitment and treatment site, where the
areas in close proximity were more likely to dispropor-
tionately consist of racial minority groups than those of
areas further away. It appears possible that structural
issues, such as location of treatment, may be explanatory of
some of the racial/ethnic differences noted in the literature.
Minimally, this finding affirms the need to conceptualize
racial/ethnic composition more thoroughly, and to endea-
vor to examine other factors for which individual minority
membership may be serving as a proxy—and vice versa,
where other factors may be serving as proxies for race/
ethnicity.
The methods of this study are not without significant
limitations. Individuals who chose not to enroll in the
psychoeducation trial were asked to complete brief
assessments. A small proportion of those approached
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elected not to complete this assessment, providing an
unknown bias. Additionally, although the comparison was
between individuals choosing to enroll in the trial and those
electing not to, it is beyond the scope of the current
exploration to examine the actual participation of those
enrolling in the study. The sample is also limited in that it
is drawn from a hepatology service associated with a uni-
versity medical service. Although attempts were made by
the research team to outreach to private practice settings,
virtually none of the participants in the current trial were
recruited from locations other than the primary site. It is
also likely that the current study over-recruited individuals
with limited resources and treatment options, not uncom-
mon for university medical centers. This suggests that the
current sample may over-represent those with addiction, as
well as those for whom proximity might represent a greater
perceived barrier. Finally, the variable for distance served
as a proxy for amount of effort required to participate in the
study. Details of travel time, transportation method, and
burden of travel were not available in the data collected.
Findings from this exploration of psychoeducation trial
enrollment have some broader implications for HCV
treatment and psychoeducation and support groups. In
terms of HCV treatment, populations being seen in public
settings demonstrate a clear need for additional support and
education, but at the same time these potential participants
are faced with some challenges to following through and
enrolling in the desired education and support services.
Specifically, the limitations imposed by a population in
which those most likely to enroll in treatment are those
with the fewest resources indicates the need for ‘‘wrap
around services’’ such as transportation and case manage-
ment. Potentially this could be by providing resources for
transportation, or by adding a case management component
to assure that participants have made adequate plans for
attending individual sessions. The findings also suggest
that potentially locating psychoeducation groups in closer
proximity to other HCV-infected populations (for example,
within larger, suburban private medical practices) or
holding groups during evenings or on weekends may result
in different populations being able and willing to access
psychoeducation groups. As HCV-PERF allows for a
flexible curriculum that is tailored to the specific mem-
bership, it would appear likely that this particular model
could be moved to different locations and populations with
little effort.
The findings presented here point out directions for
future research. Within the current trial, as pointed out in
the discussion of study limitations, a subsequent explora-
tion of enrollees who chose to attend groups within the trial
would allow valuable information on which individuals
would be most likely to participate in interventions. This
exploration could include those who attended no sessions
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J Clin Psychol Med Settings (2013) 20:156–163
versus those who attended at least one session, as well as
those who attended one session versus those who attended
consistently. Taking these three comparisons together
(enrollee/non-enrollee, attender/non-attender, attender/
active participant) would allow a deeper understanding of
different types of barriers facing participants in this par-
ticular type of clinical trial. Further, similar comparisons
with recruitment in other, similar trials would allow
researchers to assess whether the barriers detected gener-
alize broadly, or are specific to certain types of clinical
intervention trials.
Acknowledgments This research was supported by the National
Institute on Alcohol Abuse and Alcoholism, grant RO1-015201 to
Dr. North. Points of view in this document are those of the authors
and do not necessarily represent the official position of NIAAA, the
Department of Veterans Affairs, or the U.S. Government.
Disclosures Dr. North discloses employment by VA North Texas
Health Care System, Dallas, TX, USA. Dr. North also discloses
research support from NIAAA, NIDDK, the Department of Veterans
Affairs, the American Psychiatric Association, and the Orthopaedic
Trauma Association, consultant fees from the University of Okla-
homa Health Sciences Center and from the Tarrant County, TX
Department of Health, and speaker’s fees from the Pueblo City/
County, CO Department of Health.
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