Publish date: Jun 2017

'Not just methadone Tracy': Transformations in service-user identity following the introduction of hepatitis C treatment into Australian opiate substitution settings

Jake Rance, Carla Treloar, and on behalf of the ETHOS study group. Addiction, 109: 452–459. doi:10.1111/add.12392

 

Members of the Qualitative Methods Journal Club (QMJC) enjoyed reading the paper which explored identity transformations of service users since the introduction of hepatitis C care and treatment within opiate substitution treatment (OST) clinics. Our discussions focussed on what we thought about the paper, and highlighted many strengths:

We liked how the authors use a quotation from one of the study participants in the paper’s title. This makes it immediately clear that the article reports a qualitative study. The choice of quotation reflects the authors key finding - how the introduction of care and treatment for hepatitis C in OST clinics may help OST service users to develop a 'non-addict' identity. The full quotation appears in the findings, linking in with the title.


The introduction is clear, concise, and sets the scene well - it positions the international nature of hepatitis C and provides the Australian context by giving up-to-date figures regarding those in receipt of OST and those living with HCV. The authors have considered the international readership of Addiction, as this positioning is useful for non-Australian readers; QJC members with less knowledge about opiate substitution treatment and hepatitis C welcomed the inclusion of this information.


The aim of the paper is clear and the position of it - at the end of the introduction, before the methods - is well located.


The methods are well described. We learn that the study is part of a larger prospective observational cohort. We liked this use and application of qualitative research, and discussed how it shows how qualitative and quantitative approaches can complement one another to answer different research topics.


The reader is provided with information on the setting, ethical approval, and data collection. We particularly liked the section on the sample. The study includes a range of OST clinic service users, including those assessed for hepatitis C treatment and those who weren’t, as well as staff participants. The authors provide a clear justification for this - to access different viewpoints on the topic to understand their attitudes, experiences, and motivations. The sample (n=76) was large for a qualitative study, although the paper does not justify how the sample was decided upon.


We thought the process of data management, coding and analysis was easy to follow, transparent, and showed good practice by protecting confidentiality during analysis.


The findings are easy to read - broken down into 4 key areas. The first area focuses on the nature of identities in the OST setting, which positions how the later findings link to the aim of the study. The findings show the benefit of interviews with both staff and clients, as the authors distinguish between their views - and draw similarities and differences between the accounts where necessary. We felt that this shows attention to detail in the analytical process, and also in the reporting.


The authors use a range of verbatim quotations from the interviews to highlight and support their findings. They protect the identity of the those interviewed and use pseudonyms to label quotations.


The discussion reminds the reader of the relevance of the findings beyond the Australian setting. It clearly justifies why a qualitative approach was suitable, and provides a gauged overview of the study limitations for readers - warning against making interpretations beyond the data. The discussion draws on wider literature, including Mol's work on 'logic of care' and Fox's work on the 'politics of care' which the authors use to discuss the implications of their findings.

The paper ends with a strong conclusion which reminds the reader of the aim of the paper and summarises the key findings in line with these.

 

Dr Charlotte Tompkins, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London. charlotte.tompkins@kcl.ac.uk

 

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Neale, J. & West, R. (2015) Guidance for reporting qualitative manuscripts. Addiction, 110: 549-550.
Radcliffe P. & Stevens A. (2008) Are drug treatment services only for ‘thieving junkie scumbags’? Drug users and the management of stigmatised identities. Social Science & Medicine, 67: 1065–73.

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The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.