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. 2019 Mar 1;8(1):103-113.
doi: 10.1556/2006.7.2018.137. Epub 2019 Jan 20.

Giving room to subjectivity in understanding and assessing problem gambling: A patient-centered approach focused on quality of life

Nicolas A Bonfils  1   2   3   4 , Marie Grall-Bronnec  5   6 , Julie Caillon  5   6 , Frédéric Limosin  2   3   4 , Amine Benyamina  1   7   8 , Henri-Jean Aubin  1   7   8 , Amandine Luquiens  1   7   8
Affiliations

Giving room to subjectivity in understanding and assessing problem gambling: A patient-centered approach focused on quality of life

Nicolas A Bonfils et al. J Behav Addict. .

Abstract

Background and aims: Problem gambling is characterized by high stigma and self-stigma, making relevant measurement of the burden of the disorder complex. The aim of our qualitative study was to describe health-related quality of life (HRQOL) impacted by problem gambling from the patients' perspective.

Methods: We conducted 6 focus groups with 25 current or lifetime at-risk problem gamblers to identify key domains of quality of life impacted by problem gambling. A content analysis from the focus groups data was conducted using Alceste© software, using descendant hierarchical classification analysis, to obtain stable classes and the significant presences of reduced forms. The class of interest, detailing the core of impacted quality of life, was described using a cluster analysis.

Results: Thematic content analysis identified three stable classes. Class 1 contained the interviewers' speech. Class 3 was composed of the vocabulary related to gambling practice, games and gambling venues (casino, horse betting, etc.). Class 2 described the core of impact of gambling on quality of life and corresponded to 43% of the analyzed elementary context units. This analysis revealed seven key domains of impact of problem gambling: loneliness, financial pressure, relationships deterioration, feeling of incomprehension, preoccupation with gambling, negative emotions, and avoidance of helping relationships.

Conclusions: We identified, beyond objective damage, the subjective distress felt by problem gamblers over the course of the disorder and in the helping process, marked in particular by stigma and self-stigma. Four impacted HRQOL areas were new and gambling-specific: loneliness, feeling of incomprehension, avoidance of helping relationships, and preoccupation with gambling. These results support the relevance of developing, in a next step, a specific HRQOL scale in the context of gambling.

Keywords: focus groups; health-related quality of life; patient-reported outcome; problem gambling; qualitative research; quality of life.

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Figures

Figure 1.
Figure 1.
The dendrogram (from top-down hierarchical classification analysis) and the major associated words (χ2 ≥ 12) on the corpus [form (χ2/Φ/frequency)]. Note. Theses major associated words were translated from French to English
Figure 2.
Figure 2.
Cluster analysis of Class 2 (French corpus) (cosines similarity). Translation from French to English of the associated words of each cluster cited in proximity order: cluster 1 loneliness: indebtedness, file, to keep busy, full, to make, buddies, to try, to give, family, alone, to fill somebody in, people, to love, contact, action, to keep in, work, to meet up with, need, retirement, and home; cluster 2 financial pressure: small, flat, sold, to pay, loan, debt, to reimburse, judge, danger, car, to see, to eat, ongoing, desire, worry, sense, problem, to help, to go out, group, and friend; cluster 3 relationships deterioration: hobby, year, child, shame, son, daughter, mummy, to realize; cluster 4 avoidance of helping relation: situation, to treat (invisible from this screenshot), to get here, psychologist; cluster 5 preoccupation with gambling: phone, to concentrate, rendez-vous, mind; cluster 6 relationships deterioration: to admit, woman, credit; cluster 7 feeling of incomprehension: to understand, alcohol, to search for, sport; cluster 8 preoccupation with gambling: mad, midday, in the end; cluster 9 avoidance of helping relationships: to answer, to ask, mother; cluster 10 negative emotions: myself, serious. Note. To understand the content of clusters, it is necessary to locate back the significant words of each cluster in the context of its significant ECUs. We cannot provide all the significant ECU’s links to the significant words because of their large number. However, we provided a sufficient number of quotes to allow the reader to understand the meaning of clusters in-text and in-table
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