Predictors of objective treatment adherence in adolescents with epilepsy: The important role of motivation

Epilepsy Behav. 2023 May:142:109192. doi: 10.1016/j.yebeh.2023.109192. Epub 2023 Apr 15.

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 AdhereTechTM pill bottle or the Vaica SimpleMedTM 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.

Keywords: Anti-seizure medications; Compliance; Insurance; Motivation; Seizure.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Anticonvulsants / therapeutic use
  • COVID-19*
  • Child
  • Cross-Sectional Studies
  • Epilepsy* / drug therapy
  • Epilepsy* / epidemiology
  • Epilepsy* / psychology
  • Humans
  • Medication Adherence / psychology
  • Motivation
  • Pandemics

Substances

  • Anticonvulsants