Barriers and facilitators to implementation of epilepsy self-management programs: a systematic review using qualitative evidence synthesis methods.
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2020-04-25
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Abstract
Background
Epilepsy affects nearly 50 million people worldwide. Self-management is critical for individuals with epilepsy in order to maintain optimal physical, cognitive, and emotional health. Implementing and adopting a self-management program requires considering many factors at the person, program, and systems levels. We conducted a systematic review of qualitative and mixed-methods studies to identify facilitators and barriers that impact implementation and adoption of self-management programs for adults with epilepsy.Methods
We used established systematic review methodologies for qualitative and mixed-methods studies. We included studies addressing facilitators (i.e., factors that aided) or barriers (i.e., factors that impeded) to implementation and adoption of self-management interventions for adults with epilepsy. We conducted a narrative thematic synthesis to identify facilitators and barriers.Results
The literature search identified 2700 citations; 13 studies met eligibility criteria. Our synthesis identified five themes that categorize facilitators and barriers to successful implementation epilepsy self-management: (1) relevance, intervention content that facilitates acquisition of self-management skills; (2) personalization, intervention components that account for the individual's social, physical, and environmental characteristics; (3) intervention components, components and dosing of the intervention; (4) technology considerations, considerations that account for individual's use, familiarity with, and ownership of technology; and (5) clinician interventionist, role and preparation of the individual who leads intervention. We identified facilitators in 11 of the 13 studies and barriers in 11 of the 13 studies and classified these by social-ecological level (i.e., patient/caregiver, program, site/system).Conclusion
Identification of facilitators and barriers at multiple levels provides insight into disease-specific factors that influence implementation and adoption of self-management programs for individuals with epilepsy. Our findings indicate that involving individuals with epilepsy and their caregivers in intervention development, and then tailoring intervention content during the intervention, can help ensure the content is relevant to intervention participants. Our findings also indicate the role of the clinician (i.e., the individual who provides self-management education) is important to intervention implementation, and key issues with clinicians were identified as barriers and opportunities for improvement. Overall, our findings have practical value for those seeking to implement and adopt self-management interventions for epilepsy and other chronic illnesses.Systematic review registration
PROSPERO registration number is CRD42018098604.Type
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Publication Info
Lewinski, Allison A, Abigail Shapiro, Jennifer M Gierisch, Karen M Goldstein, Dan V Blalock, Matthew W Luedke, Adelaide M Gordon, Hayden B Bosworth, et al. (2020). Barriers and facilitators to implementation of epilepsy self-management programs: a systematic review using qualitative evidence synthesis methods. Systematic reviews, 9(1). p. 92. 10.1186/s13643-020-01322-9 Retrieved from https://hdl.handle.net/10161/22412.
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Scholars@Duke
Karen M. Goldstein
Dr. Goldstein's research interests include women's health, cardiovascular risk reduction, evidence synthesis methodology and peer support.
Daniel Blalock
I am a research scientist and Licensed Clinical Psychologist with a background in health services research, clinical psychology, and experimental psychology. My research interests include 1) the evaluation of current integrated behavioral health settings in health care systems to optimize future implementation efforts, 2) the development of novel integrated behavioral health strategies tailored to specific populations and healthcare system needs, 3) broad processes of behavior change and self-regulation, and 4) psychometric measurement of patient reported outcomes and research methods/statistics.
These interests have taken the form of specific research endeavors involving: a) large nonrandomized investigations of electronic health records data, b) development and evaluation of telehealth interventions to improve self-management of mental and physical health behaviors, and c) evaluation of patient-reported outcomes through telehealth modalities and in primary care, specialty care, and higher level of care settings.
To date, the content domains of most of my research have involved substance use (specifically alcohol, opioids, and tobacco), health behaviors (specifically medication adherence), mental health (specifically anxiety, depression, PTSD, and eating disorders), and health services utilization.
Matthew William Luedke
I have diverse research interests and collaborations. Clinical research interests include epilepsy quality-of-life interventions and therapeutics and acute care neurological issues like post-cardiac arrest management and quality-of-care issues. I work with the Duke hyperbaric chamber team on clinical neurophysiological monitoring of ketone-related research.
Connor David Drake
Connor Drake is a health services researcher and implementation scientist. His research interests are at the intersection of primary care, population health management, social determinants of health, chronic illness care redesign, and health equity. He has experience with policy analysis, electronic health record data, mixed and multi methods, community engaged research, and implementation and dissemination methods.
Dr. Drake's current research projects include leveraging telemedicine and other clinical informatics to improve chronic illness care and population health management; developing and implementing behavioral interventions and 'whole-person' care models for patients with cardiovascular disease and metabolic disorders; and studying social care interventions to respond to social risk factors including food insecurity, housing instability, and social isolation to improve health outcomes and equity.
Tung T Tran
John Wiley Williams
John Williams, MD, MHS, is a Professor of Medicine at Duke University Medical Center and a past recipient of VA Health Services Career Development and a Robert Wood Johnson Foundation Generalist Faculty Scholar Awards. He received his bachelor and MD degrees from the University of North Carolina. Dr. Williams completed residency training at the University of Iowa and a research fellowship at Duke University. He is a primary care internist who is trained in epidemiology, biostatistics, and literature synthesis. Dr. Williams’ topical interests include depression, mental health services, dementia and implementation of best practices. He is a medical editor for the Patient Centered Outcomes Research Institute and the Evidence-base Practice Program. Dr. Williams is Senior Science Advisor to the Durham VA Evidence Synthesis Program and has led numerous systematic reviews, many focusing on mental health services. Dr. Williams is board certified in Internal Medicine and active in clinical practice and resident physician education at the Durham VAMC.
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