"In Vino Veritas, in Aqua Sanitas": A Mixed-method Study to Explore the Factors of Alcohol Relapse Using Q-Methodology.

Three million deaths worldwide are attributed to alcohol use each year. Primarily, the liver is most impacted. Chronic liver disease patients have a significant relapse risk. Seven out of 10 start drinking again, a process that appears to be influenced by multiple factors. The aim of this study was to explore the factors of alcohol relapse in chronic liver disease patients. The study was conducted in a tertiary hospital using Q-methodology, a mixed-method that aids statistically rigorous examination of subjective expressions. Forty consenting participants matching the eligibility criteria purposively were enrolled. Data was gathered by sorting 25-statements (CVI 0.98-1; r = 0.88) about alcohol relapse on a Q-grid, developed after two Delphi rounds. Principal component analysis and varimax rotation were performed in PQ software. Post-interviews validated the Q-sorting. Three-factor analysis explained 43% of variance with 30 significant sorts (13 for factor 1, 7 for factor 2, 10 for factor 3), 0 confounded, and 10 non-significant. Factors were labeled as alcohol craving and dependence, intrapersonal and interpersonal influences, and ineffective coping strategies in high-risk situations. Knowledge of the factors of relapse among cirrhotic patients can inform nurses to render targeted interventions to the individual needs of the patients while supporting them through their recovery.