Medication Adherence in Individuals With Epilepsy

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.