title: Applying a perceptions and practicalities approach to understanding nonadherence to antiepileptic drugs.
abstract: OBJECTIVE
  Nonadherence to antiepileptic drugs (AEDs) is a common cause of poor seizure control. This study examines whether reported adherence to AEDs is related to variables identified in the National Institute for Health and Clinical Excellence (NICE) Medicines Adherence Guidelines as being important to adherence: perceptual factors (AED necessity beliefs and concerns), practical factors (limitations in capability and resources), and perceptions of involvement in treatment decisions.
  
  
  METHODS
  This was a cross-sectional study of people with epilepsy receiving AEDs. Participants completed an online survey hosted by the Epilepsy Society (n = 1,010), or as an audit during inpatient admission (n = 118). Validated questionnaires, adapted for epilepsy, assessed reported adherence to AEDs (Medication Adherence Report Scale [MARS]), perceptions of AEDs (Beliefs about Medicines Questionnaire [BMQ]), and patient perceptions of involvement in treatment decisions (Treatment Empowerment Scale [TES]).
  
  
  RESULTS
  Low adherence was related to AED beliefs (doubts about necessity: t(577) = 3.90, p < 0.001; and concerns: t(995) = 3.45, p = 0.001), reported limitations in capability and resources (t(589) = 7.78, p < 0.001), and to perceptions of a lack of involvement in treatment decisions (t(623) = 4.48, p < 0.001). In multiple logistic regression analyses, these factors significantly (p < 0.001) increased variance in reported adherence, above that which could be explained by age and clinical variables (seizure frequency, type, epilepsy duration, number of AEDs prescribed).
  
  
  CONCLUSIONS
  Variables identified in the NICE Medicines Adherence Guidelines as potentially important factors for adherence were found to be related to adherence to AEDs. These factors are potentially modifiable. Interventions to support optimal adherence to AEDs should be tailored to address doubts about AED necessity and concerns about harm, and to overcome practical difficulties, while engaging patients in treatment decisions.
authors.affiliation: Centre for Behavioural Medicine, UCL School of Pharmacy, London, United Kingdom.
authors.forename: Sarah C E
authors.initials: SC
authors.lastname: Chapman
authors.affiliation: Centre for Behavioural Medicine, UCL School of Pharmacy, London, United Kingdom.
authors.forename: Rob
authors.initials: R
authors.lastname: Horne
authors.affiliation: Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom.
authors.forename: Rona
authors.initials: R
authors.lastname: Eade
authors.affiliation: Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom.|Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom.|Neuroscience Department, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Balestrini
authors.affiliation: Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rush
authors.affiliation: Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom.|Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom.
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Sisodiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000097:blood / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; 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; D011209:Power, Psychological; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drugs; Beliefs about medicine; Epilepsy; Medication adherence; Treatment decisions