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Abstract
Background. Attitude plays a critical role in determining patient medication adherence. Medication adherence is an integral aspect of treatment and affects the effectiveness of managing epilepsy. Approximately 50 million people worldwide supper from epilepsy, with 80% of these cases in low- and middle-income countries. It is described as the most common and problematic neurological disorder. Epileptic seizures can be controlled by taking antiepileptic medication as prescribed.
Objectives. To determine the influence of attitudes on medication adherence among patients with epilepsy at the Kilifi Neurology Clinic, Kenya.
Methods. A descriptive cross-sectional study design was used. Patients with epilepsy attending the Kilifi Neurology Clinic who fulfilled the inclusion criteria were recruited to participate in the study. Attitude and adherence to treatment were evaluated using a researcher-administered questionnaire and the Morisky Medication Adherence Scale-4 (MMAS).
Results. A total of 89 patients with epilepsy participated in the study. The largest age group was <18 years, comprising 37 participants (41.6%), of whom the youngest was 7 years old and the oldest 17. Forty-seven of the patients (52.8%) were male and 42 (47.2%) were female. Perceptions of social stigma regarding their condition and its effect on medication adherence were reported as extreme by 33 of the 89 participants (37.1%). Societal misconceptions also affected medication adherence, with 46 individuals (51.7%) reporting a significant impact. The impact of personal beliefs and values on medication adherence varied among participants. The majority (n=85; 95.5%) had a low level of adherence, reflected in total MMAS scores of 3 or 4. Three participants (3.4%) had a moderate adherence level, with total scores of 1 or 2. Only one participant (1.1%) showed a high level of adherence.
Conclusion. The stigma associated with epilepsy produces shame or embarrassment, which can result in reduced health-seeking behaviour. The fear that brews from stigma can further lead patients to skip doses or stop medication completely. The role of attitude in shaping medication adherence cannot be over-emphasised. The study concluded that attitudes influence adherence to epileptic medication in this population group.
References
1. Ghuloum S, Mahfoud ZR, Al-Amin H, Marji T, Kehyayan V. Healthcare professionals’ attitudes toward patients with mental illness: A cross-sectional study in Qatar. Front Psychiatry 2022;13:884947. https://doi. org/10.3389/fpsyt.2022.884947
2. Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: The case for developing innovative drug delivery systems. Nat Rev Drug Discov 2023;22(5):387-409. https://doi. orgj/10.1038/s41573-023-00670-0
3. De las Cuevas C, de Leon J. Reviving research on medication attitudes for improving pharmacotherapy: Focusing on adherence. Psychother Psychosom 2017;86(2):73-79. https://doi.org/10.1159/000450830
4. World Health Organization. Adherence to long-term therapies: Evidence for action. Geneva: WHO, 2003. https://iris.who.int/bitstream/handle/10665/42682/9241545992.pdf (accessed 14 November 2024).
5. Kardas P. From non-adherence to adherence: Can innovative solutions resolve a longstanding problem? Eur J Intern Med 2024;119:6-12. https://doi.org/10.1016/j.ejim.2023.10.012
6. SaleemF,HassaliMA,ShafieAA,AtifM.Drugattitudeandadherence:Aqualitativeinsightofpatientswith hypertension. J Young Pharm 2012;4(2):101-107. https://doi.org/10.4103/0975-1483.96624
7. Rosa AR, Marco M, Fachel JMG, Kapczinski F, Stein AT, Barros HMT. Correlation between drug treatment adherence and lithium treatment attitudes and knowledge by bipolar patients. Prog Neuropsychopharmacol Biol Psychiatry 2007;31(1):217-224. https://doi.org/10.1016/j.pnpbp.2006.08.007
8. Chapman SCE, Horne R, Chater A, Hukins D, Smithson WH. Patients’ perspectives on antiepileptic medication: Relationships between beliefs about medicines and adherence among patients with epilepsy in UK primary care. Epilepsy Behav 2014;31:312-320. https://doi.org/10.1016/j.yebeh.2013.10.016
9. Bożek M, Kurkowska-Jastrzebska I, Krzystanek E, Bienkowski P, Konopko M, Sienkiewicz-Jarosz H. Attitudes towards the switching of anti-epileptic medications in pharmacies: The patients’ perspective. Adv Psychiatry Neurol 2023;32(1):12-17. https://doi.org/10.5114/ppn.2023.126329
10. Olsson P, Pearson K, Reimers A, Källén K. Widespread skeptic attitudes among people with epilepsy toward generic antiseizure drugs – a Swedish survey study. Epilepsy Behav 2021;114(Pt A):107554. https://doi. org/10.1016/j.yebeh.2020.107554
11. Sabouri F, Rambod M, Khademian Z. The effect of positive thinking training on hope and adherence to treatment in hemodialysis patients: A randomised controlled trial. BMC Psychol 2023;11(1):6. https://doi. org/10.1186/s40359-023-01036-2
12. Kassie GM, Kebede TM, Duguma BK. Knowledge, attitude, and practice of epileptic patients towards their illness and treatment in Jimma University Specialised Hospital, Southwest Ethiopia. North Am J Med Sci 2014;6(8):383-390. https://doi.org/10.4103/1947-2714.139288
13. Musekwa OP, Makhado L, Maphula A. Caregivers’ and family members’ knowledge attitudes and practices (KAP) towards epilepsy in rural Limpopo and Mpumalanga, South Africa. Int J Environ Res Public Health 2023;20(6):5222. https://doi.org/10.3390/ijerph20065222
14. Elsayed M, El-Sayed N, Badi S, Ahmed M. Factors affecting adherence to antiepileptic medications among Sudanese individuals with epilepsy: A cross-sectional survey. J Fam Med Prim Care 2019;8(7):2312-2317. https://doi.org/10.4103/jfmpc.jfmpc_405_19
15. Solomon Y, Teshome Y, Ejigu S, Bezabih M. Prevalence of anti-seizure medication nonadherence and its associated factors, among people with epilepsy in North Shewa, Ethiopia, 2021. Epilepsy Behav 2023;145:109301. https://doi.org/10.1016/j.yebeh.2023.109301
16. Mushi VP, Kidima W, Massawe IS, et al. Attitudes and perceptions towards epilepsy in an onchocerciasis- endemic region of Tanzania: A mixed approach to determine the magnitude and driving factors. BMC Public Health 2024;24(1):2608. https://doi.org/10.1186/s12889-024-20108-5
17. HasisoTY,DesseTA.AdherencetotreatmentandfactorsaffectingadherenceofepilepticpatientsatYirgalem General Hospital, Southern Ethiopia: A prospective cross-sectional study. PLoS ONE 2016;11(9):e0163040. https://doi.org/10.1371/journal.pone.0163040
18. YangC,HaoZ,YuD,XuQ,ZhangL.Theprevalenceratesofmedicationadherenceandfactorsinfluencing adherence to antiepileptic drugs in children with epilepsy: A systematic review and meta analysis. Epilepsy Res 2018;142:88-99. https://doi.org/10.1016/j.eplepsyres.2018.03.018
19. Yeni K. Stigma and psychosocial problems in patients with epilepsy. Explor Neurosci 2023;2:251-263.
https://doi.org/10.37349/en.2023.00026
20. Chesaniuk M, Choi H, Wicks P, Stadler G. Perceived stigma and adherence in epilepsy: Evidence for a link and mediating processes. Epilepsy Behav 2014;41:227-231. https://doi.org/10.1016/j.yebeh.2014.10.004
21. Osungbade KO, Siyanbade SL. Myths, misconceptions, and misunderstandings about epilepsy in a Nigerian rural community: Implications for community health interventions. Epilepsy Behav 2011;21(4):425-429. https://doi.org/10.1016/j.yebeh.2011.05.014
22. Rani A, Thomas PT. Parental knowledge, attitude, and perception about epilepsy and sociocultural barriers to treatment. J Epilepsy Res 2019;9(1):65-75. https://doi.org/10.14581/jer.19007
23. Tomlins J, Pearson S. Barriers and facilitators to accessing care and adhering to medications in people with epilepsy in India: Healthcare workers’ perspectives. Cureus 2024;16(10):e72393. https://doi.org/10.7759/ cureus.72393
24. Niriayo YL, Mamo A, Gidey K, Demoz GT. Medication belief and adherence among patients with epilepsy. Behav Neurol 2019;2019:2806341. https://doi.org/10.1155/2019/2806341
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