A randomized clinical trial to support adherence regimens in children with epilepsy: Examining potential mechanisms of change
•Family-based problem-solving interventions improve adherence to antiseizure medications.•Epilepsy-specific knowledge, barriers to medication adherence, problem-solving skills, caregiver emotional distress, and family functioning do not mediate these treatment effects.•Families of young children wit...
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| Veröffentlicht in: | Epilepsy & behavior 2023-10, Vol.147, p.109393-109393, Article 109393 |
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| container_title | Epilepsy & behavior |
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| creator | Winning, Adrien M. Mara, Constance A. Williford, Desireé N. Guilfoyle, Shanna M. Buschhaus, Stacy Modi, Avani C. |
| description | •Family-based problem-solving interventions improve adherence to antiseizure medications.•Epilepsy-specific knowledge, barriers to medication adherence, problem-solving skills, caregiver emotional distress, and family functioning do not mediate these treatment effects.•Families of young children with newly diagnosed epilepsy are generally functioning well from a psychosocial perspective.•The examination of other mediators (e.g., epilepsy-specific family conflict or communication) is warranted.
A family-tailored education and problem-solving intervention, Supporting Treatment Adherence Regimens (STAR), was developed to address the adherence challenges common in youth with epilepsy and their families. Randomized clinical trial (RCT) results indicated a 21% adherence improvement in the STAR group compared with an education-only (EO) group 12-months post-intervention. The current study examined group differences (STAR vs. EO) in epilepsy-specific knowledge, barriers to medication adherence, problem-solving skills, caregiver emotional distress, and family functioning over time and whether these factors mediated group differences in adherence at 12-months post-intervention.
Two-hundred children (ages 2–12) with epilepsy and their caregivers were included as RCT participants. Children with new-onset epilepsy and adherence |
| doi_str_mv | 10.1016/j.yebeh.2023.109393 |
| format | Article |
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A family-tailored education and problem-solving intervention, Supporting Treatment Adherence Regimens (STAR), was developed to address the adherence challenges common in youth with epilepsy and their families. Randomized clinical trial (RCT) results indicated a 21% adherence improvement in the STAR group compared with an education-only (EO) group 12-months post-intervention. The current study examined group differences (STAR vs. EO) in epilepsy-specific knowledge, barriers to medication adherence, problem-solving skills, caregiver emotional distress, and family functioning over time and whether these factors mediated group differences in adherence at 12-months post-intervention.
Two-hundred children (ages 2–12) with epilepsy and their caregivers were included as RCT participants. Children with new-onset epilepsy and adherence <95% were randomized to receive either the STAR (n = 27) or EO (n = 29) intervention. Caregivers completed questionnaires assessing outcomes of interest at baseline, midpoint of the intervention, post-intervention, and 3-, 6-, and 12-month follow-ups. Regression-based analyses of covariance and longitudinal mixed effect linear models were conducted.
Results generally revealed no significant group differences across outcomes of interest at post-intervention or over time. However, one significant model did emerge for social problem-solving skills (b = −1.74, p = 0.04), such that these scores were initially higher in the STAR group compared to the EO group, then decreased slightly in the STAR group over time while remaining stable in the EO group. None of these factors mediated group differences in adherence at 12-months post-intervention.
Future research should examine other potential mechanisms of treatment change after adherence interventions, such as STAR. Nonsignificant findings can inform the development of future study designs and intervention efforts.</description><identifier>ISSN: 1525-5050</identifier><identifier>ISSN: 1525-5069</identifier><identifier>EISSN: 1525-5069</identifier><identifier>DOI: 10.1016/j.yebeh.2023.109393</identifier><identifier>PMID: 37619462</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adherence ; Adolescent ; Behavioral intervention ; Child ; Clinical Protocols ; Compliance ; Epilepsy ; Epilepsy - psychology ; Humans ; Mediators ; Medication Adherence - psychology ; Pediatric ; Self-Help Groups ; Surveys and Questionnaires</subject><ispartof>Epilepsy & behavior, 2023-10, Vol.147, p.109393-109393, Article 109393</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-e8646b21a41c22fd7a9ed880181a4e63b9b944161e4a27f6ed79b369d86c51d23</citedby><cites>FETCH-LOGICAL-c415t-e8646b21a41c22fd7a9ed880181a4e63b9b944161e4a27f6ed79b369d86c51d23</cites><orcidid>0000-0002-7580-3751</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1525505023003128$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37619462$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Winning, Adrien M.</creatorcontrib><creatorcontrib>Mara, Constance A.</creatorcontrib><creatorcontrib>Williford, Desireé N.</creatorcontrib><creatorcontrib>Guilfoyle, Shanna M.</creatorcontrib><creatorcontrib>Buschhaus, Stacy</creatorcontrib><creatorcontrib>Modi, Avani C.</creatorcontrib><title>A randomized clinical trial to support adherence regimens in children with epilepsy: Examining potential mechanisms of change</title><title>Epilepsy & behavior</title><addtitle>Epilepsy Behav</addtitle><description>•Family-based problem-solving interventions improve adherence to antiseizure medications.•Epilepsy-specific knowledge, barriers to medication adherence, problem-solving skills, caregiver emotional distress, and family functioning do not mediate these treatment effects.•Families of young children with newly diagnosed epilepsy are generally functioning well from a psychosocial perspective.•The examination of other mediators (e.g., epilepsy-specific family conflict or communication) is warranted.
A family-tailored education and problem-solving intervention, Supporting Treatment Adherence Regimens (STAR), was developed to address the adherence challenges common in youth with epilepsy and their families. Randomized clinical trial (RCT) results indicated a 21% adherence improvement in the STAR group compared with an education-only (EO) group 12-months post-intervention. The current study examined group differences (STAR vs. EO) in epilepsy-specific knowledge, barriers to medication adherence, problem-solving skills, caregiver emotional distress, and family functioning over time and whether these factors mediated group differences in adherence at 12-months post-intervention.
Two-hundred children (ages 2–12) with epilepsy and their caregivers were included as RCT participants. Children with new-onset epilepsy and adherence <95% were randomized to receive either the STAR (n = 27) or EO (n = 29) intervention. Caregivers completed questionnaires assessing outcomes of interest at baseline, midpoint of the intervention, post-intervention, and 3-, 6-, and 12-month follow-ups. Regression-based analyses of covariance and longitudinal mixed effect linear models were conducted.
Results generally revealed no significant group differences across outcomes of interest at post-intervention or over time. However, one significant model did emerge for social problem-solving skills (b = −1.74, p = 0.04), such that these scores were initially higher in the STAR group compared to the EO group, then decreased slightly in the STAR group over time while remaining stable in the EO group. None of these factors mediated group differences in adherence at 12-months post-intervention.
Future research should examine other potential mechanisms of treatment change after adherence interventions, such as STAR. Nonsignificant findings can inform the development of future study designs and intervention efforts.</description><subject>Adherence</subject><subject>Adolescent</subject><subject>Behavioral intervention</subject><subject>Child</subject><subject>Clinical Protocols</subject><subject>Compliance</subject><subject>Epilepsy</subject><subject>Epilepsy - psychology</subject><subject>Humans</subject><subject>Mediators</subject><subject>Medication Adherence - psychology</subject><subject>Pediatric</subject><subject>Self-Help Groups</subject><subject>Surveys and Questionnaires</subject><issn>1525-5050</issn><issn>1525-5069</issn><issn>1525-5069</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFv1DAQhSNERUvhFyAhH7ns4nFiJ0ZCqKpaQKrUSzlbjj3ZeJXYwc4WFon_XoctK3rhYo-e37wZ-SuKN0DXQEG836732GK_ZpSVWZGlLJ8VZ8AZX3Eq5PNjzelp8TKlLaUAvIQXxWlZC5CVYGfF7wsStbdhdL_QEjM474weyBzdcgaSdtMU4ky07TGiN0gibtyIPhHniendYLNMfri5Jzi5Aae0_0CufuoxJ_kNmcKMfl7CRjS99i6NiYSOLPUGXxUnnR4Svn68z4tv11d3l19WN7efv15e3KxMBXxeYSMq0TLQFRjGOltribZpKDRZQlG2spVVBQKw0qzuBNpatqWQthGGg2XlefHpkDvt2hGtyStFPagpulHHvQraqacv3vVqE-4VUC4ZNCInvHtMiOH7DtOsRpcMDoP2GHZJsYbXTcU41NlaHqwmhpQidsc5QNVCTm3VH3JqIacO5HLX239XPPb8RZUNHw8GzB917zCqZNxCxLqIZlY2uP8OeAC33a4a</recordid><startdate>20231001</startdate><enddate>20231001</enddate><creator>Winning, Adrien M.</creator><creator>Mara, Constance A.</creator><creator>Williford, Desireé N.</creator><creator>Guilfoyle, Shanna M.</creator><creator>Buschhaus, Stacy</creator><creator>Modi, Avani C.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7580-3751</orcidid></search><sort><creationdate>20231001</creationdate><title>A randomized clinical trial to support adherence regimens in children with epilepsy: Examining potential mechanisms of change</title><author>Winning, Adrien M. ; Mara, Constance A. ; Williford, Desireé N. ; Guilfoyle, Shanna M. ; Buschhaus, Stacy ; Modi, Avani C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-e8646b21a41c22fd7a9ed880181a4e63b9b944161e4a27f6ed79b369d86c51d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adherence</topic><topic>Adolescent</topic><topic>Behavioral intervention</topic><topic>Child</topic><topic>Clinical Protocols</topic><topic>Compliance</topic><topic>Epilepsy</topic><topic>Epilepsy - psychology</topic><topic>Humans</topic><topic>Mediators</topic><topic>Medication Adherence - psychology</topic><topic>Pediatric</topic><topic>Self-Help Groups</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Winning, Adrien M.</creatorcontrib><creatorcontrib>Mara, Constance A.</creatorcontrib><creatorcontrib>Williford, Desireé N.</creatorcontrib><creatorcontrib>Guilfoyle, Shanna M.</creatorcontrib><creatorcontrib>Buschhaus, Stacy</creatorcontrib><creatorcontrib>Modi, Avani C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Epilepsy & behavior</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Winning, Adrien M.</au><au>Mara, Constance A.</au><au>Williford, Desireé N.</au><au>Guilfoyle, Shanna M.</au><au>Buschhaus, Stacy</au><au>Modi, Avani C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A randomized clinical trial to support adherence regimens in children with epilepsy: Examining potential mechanisms of change</atitle><jtitle>Epilepsy & behavior</jtitle><addtitle>Epilepsy Behav</addtitle><date>2023-10-01</date><risdate>2023</risdate><volume>147</volume><spage>109393</spage><epage>109393</epage><pages>109393-109393</pages><artnum>109393</artnum><issn>1525-5050</issn><issn>1525-5069</issn><eissn>1525-5069</eissn><abstract>•Family-based problem-solving interventions improve adherence to antiseizure medications.•Epilepsy-specific knowledge, barriers to medication adherence, problem-solving skills, caregiver emotional distress, and family functioning do not mediate these treatment effects.•Families of young children with newly diagnosed epilepsy are generally functioning well from a psychosocial perspective.•The examination of other mediators (e.g., epilepsy-specific family conflict or communication) is warranted.
A family-tailored education and problem-solving intervention, Supporting Treatment Adherence Regimens (STAR), was developed to address the adherence challenges common in youth with epilepsy and their families. Randomized clinical trial (RCT) results indicated a 21% adherence improvement in the STAR group compared with an education-only (EO) group 12-months post-intervention. The current study examined group differences (STAR vs. EO) in epilepsy-specific knowledge, barriers to medication adherence, problem-solving skills, caregiver emotional distress, and family functioning over time and whether these factors mediated group differences in adherence at 12-months post-intervention.
Two-hundred children (ages 2–12) with epilepsy and their caregivers were included as RCT participants. Children with new-onset epilepsy and adherence <95% were randomized to receive either the STAR (n = 27) or EO (n = 29) intervention. Caregivers completed questionnaires assessing outcomes of interest at baseline, midpoint of the intervention, post-intervention, and 3-, 6-, and 12-month follow-ups. Regression-based analyses of covariance and longitudinal mixed effect linear models were conducted.
Results generally revealed no significant group differences across outcomes of interest at post-intervention or over time. However, one significant model did emerge for social problem-solving skills (b = −1.74, p = 0.04), such that these scores were initially higher in the STAR group compared to the EO group, then decreased slightly in the STAR group over time while remaining stable in the EO group. None of these factors mediated group differences in adherence at 12-months post-intervention.
Future research should examine other potential mechanisms of treatment change after adherence interventions, such as STAR. Nonsignificant findings can inform the development of future study designs and intervention efforts.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37619462</pmid><doi>10.1016/j.yebeh.2023.109393</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-7580-3751</orcidid></addata></record> |
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| subjects | Adherence Adolescent Behavioral intervention Child Clinical Protocols Compliance Epilepsy Epilepsy - psychology Humans Mediators Medication Adherence - psychology Pediatric Self-Help Groups Surveys and Questionnaires |
| title | A randomized clinical trial to support adherence regimens in children with epilepsy: Examining potential mechanisms of change |
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