A randomized controlled multimodal behavioral intervention trial for improving antiepileptic drug adherence
Open accessAbstract
Purpose Medication nonadherence is one of the most important reasons for treatment failure in patients with epilepsy. The present study investigated the effectiveness of a multicomponent intervention to improve adherence to antiepileptic drug (AED) medication in patients with epilepsy.Methods In a prospective, randomized multicenter trial, three sessions of face-to-face motivational interviewing (MI) in combination with complementary behavior change techniques were compared with standard care. Motivational interviewing prompted change talk and self-motivated statements from the patients, planning their own medication intake regimen and also identifying and overcoming barriers that may prevent adherence. Participants were provided with calendars to self-monitor their medication taking behavior. A family member and the health-care team were invited to attend the last session of MI in order to improve the collaboration and communication between patients, their caregiver or family member, and their health-care provider. At baseline and 6-month follow-up, psychosocial variables and medical adherence were assessed.Results In total, 275 participants were included in the study. Compared with the active control group, patients in the intervention group reported significantly higher medication adherence, as well as stronger intention and perceptions of control for taking medication regularly. The intervention group also reported higher levels of action planning, coping planning, self-monitoring, and lower medication concerns.Conclusions This study shows that MI can be effective in clinical practice to improve medication adherence in patients with epilepsy. It also provides evidence that combining volitional interventions, including action planning, coping planning, and self-monitoring with motivational interviewing can promote the effectiveness of the medical treatments for epilepsy by improving adherence.
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There was only 1 study (4%) that investigated an adherence intervention using MI aiming to improve medication adherence, medication-taking behaviors, seizure severity, and HRQoL.
“There was only 1 study (4%) that investigated an adherence intervention using MI aiming to improve medication adherence, medication-taking behaviors, seizure severity, and HRQoL. 48”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [48]
The remaining 7 studies (29%) employed a usual care (UC)/treatment as usual (TAU) control group.
“The remaining 7 studies (29%) employed a usual care (UC)/treatment as usual (TAU) control group. 26,27,31,41,44,48 -50”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [48]
Six interventions (25%) were delivered through individual sessions.
“6 interventions (25%) were delivered through individual sessions, 9,15,26,27,43,44,48”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [48]
Eight studies (33%) were rated as low risk for attrition bias as there was only a small number of missing data, which were balanced across the groups with justifiable reasons.
“Eight studies (33%) 27,29,36,38,39,44,48,49 were rated as low risk as there was only a small number of missing data, which were balanced across the groups with justifiable reasons.”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [48]
The risk of infidelity to the intervention protocol was considered to be relatively low whenever the therapist delivering the intervention coincided with the developer of the intervention protocol (n = 6, 25%).
“Furthermore, the risk of infidelity to the intervention protocol was considered to be relatively low whenever the therapist delivering the intervention coincided with the developer of the intervention protocol (n = 6, 25%) 25 -27,34,46,48,49”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [48]
In the QOLIE-31 study Pakpour 48, the intervention group had a mean postintervention score of 62.14 (SD 13.21) versus control 56.01 (SD 12.12), P<0.001.
“Pakpour 48 | 62.14 | 13.21 | 56.01 | 12.12 | < .001”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [48]
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- Authors
- Pakpour, A. H., Gholami, M., Esmaeili, R., Naghibi, S. A., Updegraff, J. A., Molloy, G. J., & Dombrowski, S. U.
- Affiliations
- Qazvin University of Medical Sciences (IR)
- Freie Universität Berlin (DE)
- Mazandaran University of Medical Sciences (IR)
- Kent State University (US)
- Ollscoil na Gaillimhe – University of Galway (IE)
- University of Stirling (GB)
- Corresponding author
- Pakpour, Amir H.
- ORCID
- Venue
- Epilepsy & Behavior
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 52
- Issue
- Pt A
- Pages
- 133-142
- ISSN
- 1525-5050 (ISSN-L)
- OpenAlex
- W1777038357
- Cited by
- 55
- References
- 44
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 5 · 2022: 5 · 2021: 6 · 2020: 3 · 2019: 9 · 2018: 3 · 2017: 7 · 2016: 10 · 2012: 1
- FWCI
- 7.78
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- Epilepsy & Behavior (publishedVersion)
- PubMed (publishedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc-nd)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc)
- Research Repository UCD (University College Dublin) (cc-by-nc)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Keywords
- antiepileptic drug adherence, medication non-adherence, epilepsy, motivational interviewing, behaviour change techniques, self-monitoring, action planning, coping planning, patient-family communication, medication concerns, treatment failure
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Anticonvulsants, Behavior Therapy, Double-Blind Method, Epilepsy, Family, Female, Follow-Up Studies, Humans, Male, Middle Aged, Motivation, Patient Education as Topic, Prospective Studies, Socioeconomic Factors, Caregivers, Medication Adherence, Young Adult, Self Report, Motivational Interviewing
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