Medication Adherence in Individuals With Epilepsy
Condition: Epilepsy
MeSH terms: Epilepsy
Study type: Observational

Summary: 
      There is an urgent need to understand the psychological and situational factors that
      influence medication adherence in individuals with epilepsy. According to the Center for
      Disease Control (CDC, 2010) about 2.5 million people in the United States have epilepsy and
      one third of them still have seizures despite receiving treatment. With proper medication, an
      estimated 60-70% of individuals with new onset epilepsy become, and remain, seizure free
      (Kwan & Brodie, 2000). Despite the success of medical treatment of epilepsy, many patients do
      not receive these benefits due to inadequate adherence to medication (Meyer et al., 2010).
      And, as with other chronic medical conditions, estimates suggest that between 30% and 60% of
      patients with epilepsy are not adherent with their drug regimens (Green & Simons Morton,
      1988; Leppik, 1990; Jones et al., 2006). Poor adherence may be the most important cause of
      poorly controlled epilepsy (Gomes et al., 1998). Stanaway et al. (1985) found that 31% of
      seizures were precipitated by nonadherence to medication.

      Questions regarding adherence are theoretically informed by Fisher et al. (2006)'s
      Information Motivation Behavioral Skills (IMB) model. While originally developed to describe,
      predict, and inform interventions for antiretroviral treatment for human immunodeficiency
      virus (HIV), this study applies the model to epilepsy for the first time. In addition, this
      study intends to produce an accurate description of how individuals with epilepsy manage
      their medication adherence by identifying current self regulation strategies (immediate
      adherence behaviors, preparatory behaviors, and barrier management strategies) and their
      situational determinants. Situational determinants can explain some of the fluctuations in
      medication adherence. Patients who are motivated to take their medications might still show
      inconsistent medication adherence. For example, patients might miss good opportunities to
      take their medication or fail to anticipate unexpected barriers such as a spontaneous dinner
      with friends or a bout of depression. Therefore, the study will take particular care to
      investigate situational cues such as good opportunities for adherence (e.g., taking
      medication with regular meals or before brushing teeth) and expected and unexpected barriers.
      Preparatory behaviors and their cues are also of interest in this study: Some patients use
      facilitators (such as physical or electronic reminder systems, electronic pill bottles and
      pill boxes) to ensure adequate medication adherence. Social support can serve a similar
      function of reminding patients to take their medication. To address these questions, the
      investigators plan to explore how individual regulation and social support influence
      medication adherence in patients with epilepsy. The specific aims of the proposed research
      are:

        1. To test the hypothesis that there will be a main effect of information, motivation and
           behavioral skills, on adherence behavior, and that a mediation model will show that
           information and motivation effects are partially mediated through behavioral skills.

        2. To identify self regulation strategies and their situational cues (good opportunities,
           facilitators, and barriers) for medication adherence among individuals with epilepsy to
           better describe best practices and challenges.
    


Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        A total of 140 participants between 18 and 65 years old will be recruited with the
        condition that all participants have been diagnosed with epilepsy. The participants will be
        of diverse ethnic background. It is estimated that the participant population will also
        include individuals from a disadvantaged socioeconomic and/or educational background.
      
Keywords: Epilepsy; Medication Adherence