title: Perceived stigma and adherence in epilepsy: evidence for a link and mediating processes.
abstract: OBJECTIVE
  This study tested whether perceived epilepsy-related stigma is associated with adherence in people living with epilepsy and if information, motivation, and behavioral skills are potential pathways underlying the stigma-adherence link.
  
  
  METHODS
  We surveyed persons living with epilepsy between the ages of 18 and 65 (N = 140) using an online questionnaire to assess medication adherence and perceived epilepsy-related stigma. In addition, participants reported their level of information, motivation, and behavioral skills.
  
  
  RESULTS
  Higher perceived epilepsy-related stigma was associated with lower medication adherence (r = -0.18, p < .05). Higher perceived stigma was associated with lower levels of information (r = -0.28, p < .05), motivation (r = -0.55, p < .05), and behavioral skills (r = -0.41, p < .05), and the link between stigma and adherence was fully explained by information, motivation, and behavioral skills, i.e., the effect of stigma on adherence was fully mediated (c = -0.18, p < .05 reduced to c' = 0.06, p = .48).
  
  
  CONCLUSIONS
  Perceived epilepsy-related stigma is problematic for maintaining the prescribed medication regimen in people living with epilepsy. The information-motivation-behavioral skills model is a useful framework for understanding the pathways linking perceived stigma and adherence in this population.
authors.affiliation: Columbia University, USA. Electronic address: mchesa2@uic.edu.
authors.forename: Marie
authors.initials: M
authors.lastname: Chesaniuk
authors.affiliation: Columbia University, USA.
authors.forename: Hyunmi
authors.initials: H
authors.lastname: Choi
authors.affiliation: PatientsLikeMe.com, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Wicks
authors.affiliation: Columbia University, USA.
authors.forename: Gertraud
authors.initials: G
authors.lastname: Stadler
mesh_terms: D000328:Adult; D004827:Epilepsy / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation; D057545:Social Stigma; D055815:Young Adult
keywords: Epilepsy; Medication adherence; Stigma