Predictors of Objective Treatment Adherence in Adolescents with Epilepsy: The Important Role of Motivation

Overview

Journal Epilepsy Behav

Specialties Neurology
Psychology
Social Sciences

Date 2023 Apr 17

PMID 37068420

Authors

Amy C Lang

Jack Stevens

Constance A Mara

Anup D Patel

Matthew Schmidt

Jeffrey R Tenney

Avani C Modi

Affiliations

Soon will be listed here.

Abstract

Objective: Adolescents with epilepsy are at heightened risk for suboptimal anti-seizure medication (ASM) adherence; however, there is a paucity of adherence interventions for this age group. The current study aimed to identify a comprehensive and novel set of predictors of objective, electronically-monitored ASM adherence in adolescents with epilepsy.

Methods: Participants included 104 adolescents (13-17 years old; M = 15.36 ± 1.40), diagnosed with epilepsy and their caregivers. Cross-sectional data were collected from adolescents, caregivers, healthcare providers, and medical chart reviews, including demographics (i.e., age, race/ethnicity, sex, insurance status), the COVID-19 pandemic (i.e., participation before versus during), seizure characteristics (i.e., presence and severity), ASM side effects (Pediatric Epilepsy Side Effects Questionnaire), adherence motivation (1-item 6-point Likert scale item), and adherence barriers (Pediatric Epilepsy Medication Self-Management Questionnaire). Electronically-monitored adherence data was collected via the AdhereTech pill bottle or the Vaica SimpleMed pillbox over 30 days.

Results: Adolescents demonstrated suboptimal adherence at 78 ± 31.6%, despite high ASM adherence motivation (M = 4.43 ± .94) and minimal adherence barriers (M = 35.64 ± 3.78). Hierarchical multiple regression, which included non-modifiable sociodemographic and medical variables (Block 1) and behaviorally modifiable psychosocial variables (Block 2) was significant, F(12,87) = 3.69, p < .001. Specifically, having private insurance (versus Medicaid or public insurance; t = -2.11, p = .038) and higher adherence motivation (t = 2.91, p = .005) predicted higher objective ASM adherence.

Conclusion: Routine assessment of adherence predictors is vital for the promotion of adherence among adolescents with epilepsy. Adolescent adherence motivation may be an important element of multi-component interventions focused on improving ASM adherence in adolescents with epilepsy.

Citing Articles

Promoting medication compliance in epileptic children: a cross sectional survey.

Zhang L, Li P, He J, Qian J, Liu Y BMC Pediatr. 2024; 24(1):583.

PMID: 39277767 PMC: 11401307. DOI: 10.1186/s12887-024-05011-7.

A 6-month, prospective, randomized controlled trial of customized adherence enhancement versus a bipolar-specific educational control in poorly adherent adolescents and young adults living with bipolar disorder.

Levin J, DelBello M, Modi A, Briggs F, Forthun L, McVoy M Bipolar Disord. 2024; 26(7):696-707.

PMID: 39231780 PMC: 11560489. DOI: 10.1111/bdi.13489.

Medication compliance of children with epilepsy: a cross-sectional survey.

Wang S, Zhang X, Wang Y, Zhou J Ital J Pediatr. 2023; 49(1):153.

PMID: 37974267 PMC: 10655363. DOI: 10.1186/s13052-023-01525-5.

References

Wagner J, Modi A, Guilfoyle S, Junger K, Weyand C, Smith G . Current behavioral health and cognitive screening practices in pediatric epilepsy. Epilepsy Behav. 2019; 101(Pt A):106214. DOI: 10.1016/j.yebeh.2019.03.019. View

Modi A, Pai A, Hommel K, Hood K, Cortina S, Hilliard M . Pediatric self-management: a framework for research, practice, and policy. Pediatrics. 2012; 129(2):e473-85. PMC: 9923567. DOI: 10.1542/peds.2011-1635. View

McGrady M, Prosser L, Thompson A, Pai A . Application of a Discrete Choice Experiment to Assess Adherence-Related Motivation Among Adolescents and Young Adults With Cancer. J Pediatr Psychol. 2017; 43(2):172-184. PMC: 5896606. DOI: 10.1093/jpepsy/jsx104. View

Modi A, Patel A, Mara C, Schmidt M, Tenney J, Stevens J . Pilot randomized controlled clinical trial of an adherence social norms intervention for adolescents with epilepsy. Epilepsy Behav. 2023; 140:109082. PMC: 9998352. DOI: 10.1016/j.yebeh.2022.109082. View

Menon S, Sander J . Effects of the COVID-19 pandemic on medication adherence: In the case of antiseizure medications, A scoping review. Seizure. 2021; 93:81-87. PMC: 8526436. DOI: 10.1016/j.seizure.2021.10.009. View

Smith A, Mara C, Modi A . Adherence to antiepileptic drugs in adolescents with epilepsy. Epilepsy Behav. 2018; 80:307-311. DOI: 10.1016/j.yebeh.2017.12.013. View

Modi A, Wu Y, Guilfoyle S, Glauser T . Uninformed clinical decisions resulting from lack of adherence assessment in children with new-onset epilepsy. Epilepsy Behav. 2012; 25(4):481-4. PMC: 3513760. DOI: 10.1016/j.yebeh.2012.09.008. View

Wagner J, Modi A, Johnson E, Shegog R, Escoffery C, Bamps Y . Self-management interventions in pediatric epilepsy: What is the level of evidence?. Epilepsia. 2017; 58(5):743-754. DOI: 10.1111/epi.13711. View

Plevinsky J, Young M, Carmody J, Durkin L, Gamwell K, Klages K . The Impact of COVID-19 on Pediatric Adherence and Self-Management. J Pediatr Psychol. 2020; 45(9):977-982. PMC: 7522296. DOI: 10.1093/jpepsy/jsaa079. View

10.

Yang C, Hao Z, Yu D, Xu Q, Zhang L . The prevalence rates of medication adherence and factors influencing adherence to antiepileptic drugs in children with epilepsy: A systematic review and meta analysis. Epilepsy Res. 2018; 142:88-99. DOI: 10.1016/j.eplepsyres.2018.03.018. View

11.

Anghel L, Farcas A, Oprean R . An overview of the common methods used to measure treatment adherence. Med Pharm Rep. 2019; 92(2):117-122. PMC: 6510353. DOI: 10.15386/mpr-1201. View

12.

Wu Y, Follansbee-Junger K, Rausch J, Modi A . Parent and family stress factors predict health-related quality in pediatric patients with new-onset epilepsy. Epilepsia. 2014; 55(6):866-77. PMC: 4057964. DOI: 10.1111/epi.12586. View

13.

Kyngas H . Compliance with health regimens of adolescents with epilepsy. Seizure. 2001; 9(8):598-604. DOI: 10.1053/seiz.2000.0470. View

14.

Cushing C, Jensen C, Miller M, Leffingwell T . Meta-analysis of motivational interviewing for adolescent health behavior: efficacy beyond substance use. J Consult Clin Psychol. 2014; 82(6):1212-8. DOI: 10.1037/a0036912. View

15.

Gutierrez-Colina A, Smith A, Mara C, Modi A . Adherence barriers in pediatric epilepsy: From toddlers to young adults. Epilepsy Behav. 2018; 80:229-234. PMC: 6816538. DOI: 10.1016/j.yebeh.2018.01.031. View

16.

Buck D, Jacoby A, Baker G, Chadwick D . Factors influencing compliance with antiepileptic drug regimes. Seizure. 1997; 6(2):87-93. DOI: 10.1016/s1059-1311(97)80060-x. View

17.

Modi A, Monahan S, Daniels D, Glauser T . Development and validation of the Pediatric Epilepsy Medication Self-Management Questionnaire. Epilepsy Behav. 2010; 18(1-2):94-9. PMC: 2904867. DOI: 10.1016/j.yebeh.2010.03.009. View

18.

Ingerski L, Hente E, Modi A, Hommel K . Electronic measurement of medication adherence in pediatric chronic illness: a review of measures. J Pediatr. 2011; 159(4):528-34. PMC: 3176987. DOI: 10.1016/j.jpeds.2011.05.018. View

19.

Ellis J, Struble C, Fodor M, Cairncross M, Lundahl L, Ledgerwood D . Contingency management for individuals with chronic health conditions: A systematic review and meta-analysis of randomized controlled trials. Behav Res Ther. 2020; 136:103781. DOI: 10.1016/j.brat.2020.103781. View

20.

Chan C, Zou G, Wiebe S, Speechley K . Global assessment of the severity of epilepsy (GASE) Scale in children: Validity, reliability, responsiveness. Epilepsia. 2015; 56(12):1950-6. DOI: 10.1111/epi.13216. View