Evaluation of the efficiency of the web-based epilepsy education program (WEEP) for youth with epilepsy and parents: A randomized controlled trial

Effects of self-management education on quality of life in patients with epilepsy: A systematic review and meta-analysis

BACKGROUND

Self-management education, as a non-pharmacological intervention, aims to help epilepsy patients better control their condition and improve their quality of life. While some studies have shown that self-management education is beneficial for epilepsy patients, its specific effects still require systematic evaluation.

OBJECTIVE

This study aims to comprehensively assess the impact of self-management education on the quality of life and recurrence frequency of epilepsy patients through a systematic review and meta-analysis.

METHODS

This study systematically reviewed literature on self-management education for epilepsy patients from 2014 to 2024. Computer searches were conducted in PubMed, Wiley Library, EMBASE, Web of Science, Cochrane Central, and CNKI databases, covering the period from January 1, 2014, to August 31, 2024, to identify relevant randomized controlled trials (RCTs). Two independent reviewers screened the literature, extracted data, and assessed the risk of bias according to predefined criteria. The primary outcome measures included scores from the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression, the Epilepsy Self-Efficacy Scale (ESES), the Quality of Life in Epilepsy Inventory (QOLIE-31), the Medication Event Monitoring System (MEMS), the Patient Health Questionnaire (PHQ-9), and the Epilepsy Knowledge Questionnaire (EKP).

RESULTS

A total of 9 RCTs involving 1094 patients were included after searching six databases. The results showed that self-management education significantly improved the quality of life of epilepsy patients (SMD = 0.56, 95 % CI [-0.05; 0.18]) and significantly reduced anxiety (SMD = -0.41, 95 % CI [-0.58; -0.23]) and depression symptoms (SMD = -0.40, 95 % CI [-0.76; -0.05]). Additionally, self-management education significantly enhanced patients' self-efficacy in managing seizures (SMD = 0.32, 95 % CI [0.12; 0.52]).

CONCLUSION

Self-management education can effectively improve the quality of life and mental health of epilepsy patients, enhancing their ability to cope with the disease, and provides strong evidence for clinical practice. However, due to the high heterogeneity among studies, more high-quality RCTs are needed to further validate these findings.

Improving the health literacy of persons with epilepsy

Improving health literacy can improve health. This essay reviews the resources available to help improve epilepsy health literacy, including websites, drug inserts/labels/information leaflets, patient educators, handouts, plain language, lay summaries, and other efforts to close the gaps between research and epilepsy health literacy.

Meeting Parents' Health Literacy Needs-Designing and Feasibility Testing of a Three-Step Intervention in the Childhood Epilepsy Context

AIMS

(1) To codesign a health literacy intervention within a specialist healthcare setting to help the parents of children with epilepsy access, comprehend, use and communicate information and (2) to assess the intervention's feasibility by exploring stakeholders' perspectives on its usefulness, ease of use of trial methods and contextual factors impacting its execution.

DESIGN

A codesign participatory approach followed by a feasibility approach inspired by the OPtimising HEalth LIteracy and Access to Health Services (Ophelia) process for health literacy intervention development.

METHODS

(1) The codesign approach included workshops with (a) multidisciplinary personnel (n = 9) and (b) parents (n = 12), along with (c) an interview with one regional epilepsy specialist nurse (n = 1). The participants discussed parents' health literacy needs on the basis of vignettes and brainstormed service improvements. A three-step intervention was subsequently designed. (2) The intervention's feasibility was assessed via interviews with six parents (n = 6), a focus group interview with study nurses, a short doctors survey and a log of time spent testing the intervention.

RESULTS

(1) The parents of first-time admitted children to a specialist epilepsy hospital were targeted for the intervention. Nurse-parent consultations were central to the intervention, activating parents in codeveloping and executing a tailored education plan. (2) Feasibility: parents (n = 6) experienced consultations and education plans that were beneficial for enhancing their self-efficacy in managing the child's condition. The study nurses (n = 3) acknowledged positive outcomes in streamlining patient education but felt that their training on the intervention methods was insufficient. Both parents and nurses identified limited personnel resources as a significant barrier to executing the intervention.

CONCLUSION

The codesigned intervention engaged nurses and parents in HL development despite system barriers. The parents experience enhanced self-efficacy in managing their child's condition. However, needs refinements and further feasibility tests are needed before future implementation.

REPORTING METHOD

The Consort Statement 2010 extension for reporting non-randomised pilot and feasibility studies was used to ensure the methodological quality of the study. A Consort Statement 2010 checklist is provided as an additional file.

PATIENT OR PUBLIC CONTRIBUTION

The collaboration of parents within the target group, the providers involved and the project's steering committee was crucial in codesigning and evaluating this three-step intervention. Parents and multidisciplinary providers actively contributed through workshops, interviews and in discussion meetings. The study nurses testing the intervention played a key role in defining the documentation process for the codeveloped education plan.

IMPLICATIONS FOR PROFESSIONAL CARE

This three-step health literacy intervention can positively impact parents' self-efficacy in managing their child's condition. Enhancing nurses' communication skills is essential for improving parents' health literacy, making it crucial to allocate resources for such training. The intervention content and strategies to meet parents' health literacy needs require refinement, with more provider involvement to better adapt it to the context. Future studies should focus on further feasibility testing by considering a more flexible time frame.

TRIAL REGISTRATION

Open Science Framework: https://osf.io/fg9c7/.

Effectiveness of eHealth literacy interventions: a systematic review and meta-analysis of experimental studies

BACKGROUND

eHealth Literacy (eHL) is a set of competencies and skills encompassing the knowledge, comfort and perceived ability to identify, evaluate and apply electronic health information to health problems. Given its role in the appropriate use of health technologies, ensuring equitable access to health information and improving patient outcomes, this study aims to systematically retrieve, qualitatively and quantitative pool and critically appraise available experimental evidence on the effectiveness of eHL interventions across different population groups.

METHODS

Following the PRISMA guidelines, we conducted a systematic review in PubMed/Medline, Scopus, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov, including original experimental studies quantifying the effectiveness of interventions aimed at increasing eHL, as assessed by the eHealth Literacy Scale (eHEALS) or other validated scales. We performed a random-effects model meta-analysis comparing changes in eHL levels before and after the interventions, and between the intervention and control groups. Heterogeneity was assessed using I2 statistics.

RESULTS

Out of the 504 studies retrieved, 15 studies conducted between 2011 and 2023 met the inclusion criteria. Target populations of eHL interventions included adults in 7 studies, older people in 5 and young people in 4. The meta-analysis included 10 studies that used the eHEALS. Participants showed a mean increase in eHEALS scores of 5.81 points (95% CI = 3.36-8.26, N = 1025) following the eHL interventions compared to the pre-intervention period. In the analysis between the intervention and control groups, we found a statistically significant difference in eHL improvement in favour of the intervention group, with mean eHEALS scores 3.62 points (95% CI = 1.63-5.60, N = 1258) higher in the intervention group than in the control groups. Subgroup analyses by intervention type, stratified by Collaborative Learning (CL) or Individualistic Learning (IL) showed significant increases in eHealth Literacy in the pre-post intervention analysis (CL: UMD = 5.19, CI = 0.01-10.38, N = 402; IL: UMD = 6.05; CI = 3.14-8.97, N = 623) and in the intervention vs. control analysis in the IL group (DMD = 4.98; CI = 1.77-8.12, N = 540).

CONCLUSIONS

Our findings support the effectiveness of tailored interventions in significantly enhancing eHL, providing key insights for evidence-based intervention design targeted to different population groups.

A systematic review of the effectiveness of community-based interventions aimed at improving health literacy of parents/carers of children

AIM

The aim of this systematic review was to examine the effectiveness of community-based health literacy interventions in improving the health literacy of parents.

METHODS

A systematic review of six databases - MEDLINE, PsycINFO, CINAHL, Cochrane Library, Embase, and Education Source - was conducted to identify relevant articles. Risk of bias was assessed using version two of the Cochrane risk of bias tool for randomised controlled trials or the Cochrane collaboration risk of bias in non-randomised studies of interventions. The study findings were grouped and synthesised following the synthesis without meta-analysis framework.

RESULTS

Eleven community-based health literacy interventions for parents were identified. Study design included randomised controlled trials (n = 4), non-randomised studies with comparison group (n = 4), and non-randomised studies without a comparison group (n = 3). Interventions were delivered digitally, in person or a combination of the two. The risk of bias was high in over half the studies (n = 7). The main findings of the studies showed some potential for both in person and digital interventions to increase parental health literacy. Studies were heterogeneous preventing a meta-analysis.

CONCLUSION

Community-based, health literacy interventions have been identified as potential methods for enhancing parental health literacy. Due to the small number of included studies and their potential for bias, these results must be interpreted with caution. This study emphasises the need for additional theory and evidence-based research on the long-term effects of community interventions.

Efficacy of Health Literacy Interventions for Caregivers of Individuals with Neurodevelopmental and Chronic Conditions: A Rapid Review

BACKGROUND/OBJECTIVES

Caregivers of individuals with neurodevelopmental and chronic health conditions require health literacy (HL) skills for the long-term management of these conditions. The aim of this rapid review was to investigate the efficacy of HL interventions for these caregivers.

METHODS

Five databases (Cochrane Central, PubMed, Embase, CINAHL, and PsycINFO) were searched. Studies were eligible for inclusion if they reported the efficacy of any intervention aimed at improving the HL of caregivers of individuals with a neurodevelopmental disorder or chronic condition and assessed caregiver HL. All original intervention study designs were eligible, as were systematic reviews. Studies had to be published in English since 2000; grey literature was excluded. The review was registered before commencement with PROSPERO (CRD42023471833).

RESULTS

There were 3389 unique records, of which 28 papers (reporting 26 studies) were included. In these studies, 2232 caregivers received interventions through a wide range of media (online, group, written materials, one-to-one, video, phone, and text messages). Research designs were classified as Levels I (n = 8), II (n = 5), III (n = 2), and IV (n = 11), and the quality of evidence ranged from high to very low. Half (n = 7) of the trials with moderate to high evidence levels reported significant between-group differences in caregiver HL outcomes and/or individuals' health-related outcomes. Effective interventions occurred across a wide range of conditions, ages, and carer education levels and using a diversity of intervention media.

CONCLUSIONS

HL interventions for caregivers of individuals with neurodevelopmental and chronic conditions can improve health-related outcomes and caregivers' HL. Longer and more intensive HL programs may be more likely to be effective, but attention must be paid to participant retention.

The effectiveness of an individual and family self-management theory-based education program given for adolescents with epilepsy and parents: Randomized controlled trial

BACKGROUND

This study focused on an online education program based on Individual and Family Self-Management Theory.

PURPOSE

The study investigated whether the education program affected adolescents' attitudes toward epilepsy, seizure self-efficacy, quality of life, and their parents' perceived nurse-support levels.

METHODS

The study is a single-blind, randomized, controlled trial. The study was conducted in the pediatric neurology outpatient clinic of a medical hospital between January 2021 and April 2022 in Konya. The sample consisted of adolescents with epilepsy (n = 36) and their parents (n = 36). The intervention group attended the education program in three main sessions, two weeks apart. The control group received routine education. Data were collected using a Child Demographics Form (CDF), a Parent Demographics Form (PDF), the Child Attitude Toward Illness Scale (CATIS), the Self-Efficacy Scale for Children with Epilepsy (SSES-C), the Pediatric Quality of Life Inventory (PedsQL), and the Nurse Parents Support Tool (NPST). The data were analyzed using descriptive statistics, Pearson's chi-square test, Fisher's Exact test, independent samples t-test, Mann-Whitney U test, Mixed design ANOVA analysis, Cohen's d, and 95 % confidence interval. This study adhered to CONSORT research guidelines.

RESULTS

The intervention group adolescents had a significantly higher mean of all scale scores than the control group adolescents. The intervention group parents had a significantly higher mean NPST score than the control group parents.

CONCLUSION

Healthcare professionals should organize theory-based online education programs for adolescents and their parents at regular intervals for the self-management of epilepsy in special situations, such as pandemics, where face-to-face education is impossible.

PRACTICE IMPLICATIONS

The study revealed that, unlike existing cues that highlight the effectiveness of face-to-face education, online interventions will strengthen epilepsy self-management of children with epilepsy and their parents. In extreme situations where face-to-face education has to be postponed for a long time and in routine education interventions, it is recommended to plan and implement online education so that children with chronic diseases can maintain their self-management.

CLINICALTRIALS

The paper is registered in the Clinical Trials database (NCT04822662).

Evaluation of a Seizure Action Plan in an Adult Epilepsy Center

Background

Seizure action plans (SAPs) provide valuable information for patients to manage seizure emergencies, but are underutilized in adult epilepsy centers. The purpose of this project was to implement a structured SAP for adult patients with epilepsy.

Methods

A pre/postimplementation design was used. Provider SAP utilization rates were analyzed over a 16-week period. A pre and postimplementation survey assessed participant perceived impact of the SAP on knowledge and comfort associated with managing seizure emergencies. Provider barriers and facilitators were also assessed.

Results

Average provider SAP utilization rate was 51.45%. A total of 204 participants completed the surveys, which showed a significant increase in knowledge and comfort for all items, p < 0.001. At postsurvey analysis, 98% of participants felt that all patients with epilepsy should have a SAP regardless of seizure burden.

Discussion

Implementing a structured SAP increased provider utilization and patient and care partner knowledge and comfort of managing seizure emergencies.

The Parent Health Literacy Questionnaire (HLQ-Parent). Adaptation and validity testing with parents of children with epilepsy

AIMS

The aim of this study was to adapt the Health Literacy Questionnaire (HLQ) in English and Norwegian for use with parents.

METHODS

The research group evaluated all HLQ items and, where relevant, modified them to refocus the attribution of care to that of a child by a parent. Five cognitive interviews with parents were undertaken to gain a detailed depiction of the meanings and processes they used to respond to the HLQ items. Assessment of the psychometric properties of the revised HLQ was undertaken using data from a cross-sectional survey of 254 parents of children with epilepsy. Analysis included internal consistency (Cronbach's alpha) and confirmatory factor analysis (CFA).

RESULTS

Some 22 out of 44 items and the names of three domains were modified (e.g. attribution changed from 'me' to 'my child'). Cognitive interviews indicated that parents interpreted the HLQ-Parent items in the way intended. All but three factor loadings were high to acceptable. All nine HLQ scales showed satisfactory to good internal consistency (Cronbach's alpha 0.70 to 0.87). When fitting one-factor CFA models, correlated residuals were required for four scales to generate an acceptable fit. One scale, '8. Ability to find good health information', required inclusion of two correlated residuals to generate an acceptable CFA model fit, indicating that further work on this scale is warranted.

CONCLUSIONS

The results from both the adaptation process and the CFA analysis supported the relevance, understanding and theoretical structure of the instrument in a parental context.

The effectiveness of epilepsy educational intervention using computer game-based epilepsy educational program (Epigame) among Malaysian children with epilepsy: A prospective cohort study

BACKGROUND

A computer game-based epilepsy educational programme (Epigame) can potentially improve the awareness, knowledge and attitude (AKA) and quality of life (QOL) of children with epilepsy (CWE). Our study among Malaysian CWE aimed to assess the: i) baseline level of epilepsy AKA and potential characteristics associated with poor levels of AKA, ii) effectiveness of Epigame in improving AKA and QOL of CWE.

METHOD

Prospective cohort study on CWE age 7-18 years old with no comorbidities. Epilepsy education was delivered using Epigame. CWE completed AKA questionnaire before (time point 1 [TP1]), immediately after (TP2), 3 months (TP3) after provision of Epigame. Child self-report Health-Related Quality of Life Measurement for Children with Epilepsy (CHEQOL-25) questionnaire was completed at TP1 and TP3.

RESULTS

Total of 106 CWE participated in this study (mean age of 13.3 years). Baseline (TP1) AKA was rated "very low to moderate" for awareness domain in 95.3 %, "very low to moderate" for knowledge domain in 67 %, "negative to indifferent" for attitude domain in 54.7 %, and "very poor to moderate' for total AKA score domain in 84 %. "Positive to very positive" for child attitude domain was significantly associated with parents with "positive to very positive" for attitude domain (OR 10.6, 95 % CI 3.23-34.66). "Good to excellent" for total child AKA domain was significantly associated with parents with "Good to excellent" for total AKA domain (OR 5.2, 95 % CI 1.16-15.02) and with < 2 antiseizure medication (OR 5.0, 95 % CI 1.34-18.98). The scores in the knowledge, attitude and total AKA score domains improved significantly after the introduction of Epigame at TP3. There were no significant improvements in the CHEQOL-25 scores over time except for the "Quest for Normality" subscale score (mean of score difference between TP1 and TP3 = 1.0, 95 % CI 0.19-1.81).

CONCLUSION

Majority of Malaysian CWE had low levels of epilepsy AKA, particularly among parents with "negative to indifferent" for attitude domain, parents with "very poor to moderate" for total AKA domain and on polytherapy. Introduction of Epigame was effective in improving scores of the knowledge, attitude and total AKA domains, and the QOL "Quest for Normality" domain of the CHEQOL-25.

Self-management education for children with epilepsy and their caregivers. A scoping review

Self-management education programs have been highly successful in preparing people to manage medical conditions with recurring events. A detailed curriculum for epilepsy patients, and their caretakers, is lacking. Here we assess what is available for patients who have disorders with recurring events and offer an approach to developing a potential self-care curriculum for patients with seizures and their caregivers. Among the anticipated components are a baseline efficacy assessment and training tailored to increasing self-efficacy, medication compliance, and stress management. Those at risk of status epilepticus will also need guidance in preparing a personalized seizure action plan and training in how to decide when rescue medication is appropriate and how to administer the therapy. Peers, as well as professionals, could teach and provide support. To our knowledge, no such programs are currently available in English. We encourage their creation, dissemination, and widespread use.

Web-based training for future healthcare professionals who will care for elderly individuals with epilepsy receiving home care: A quasi-experimental study

OBJECTIVE

The need for home care for elderly people with epilepsy is increasing. This study aims to determine the knowledge and attitudes of the students and examine the effect of the web-based epilepsy education program given to health students who will care for elderly individuals with epilepsy receiving home care.

METHODS

This quasi-experimental study with a control group pre-post-test research design was conducted with 112 students (intervention: 32/control: 80) studying in the Department of Health Care Services (home care, elderly care) in Turkey. The sociodemographic information form, Epilepsy Knowledge Scale, and Epilepsy Attitude Scale were used for data collection. Web-based training in three two-hour sessions focusing on the medical and social aspects of epilepsy was applied to the intervention group in this study.

RESULTS

It was found that the epilepsy knowledge scale score of the intervention group increased from 5.56 (±4.96) to 13.15 (±2.56), and the epilepsy attitude scale score increased from 54.12 (±9.73) to 62.31 (±7.07) after the training. After the training; there was a significant difference in all items except the 5th item in the knowledge scale and the 14th item in the attitude scale (p < 0.05).

SIGNIFICANCE

In the study; it has been found that the web-based epilepsy education program provided increases students' knowledge and develops positive attitudes. This study will provide evidence for strategies to be developed to improve the quality of care for elderly patients with epilepsy who are cared for at home.

The experiences of caregivers of children with epilepsy: A meta-synthesis of qualitative research studies

Objective

Epilepsy is one of the most common chronic neurological disorders in children. The caregivers of these children bear heavy burden of care in the process of taking care of them. The objective of this metasynthesis was to explore the experiences and needs of caregivers of children with epilepsy.

Methods and data sources

Eight databases (PubMed, CINAHL, EMBASE, Web of Science, CNKI, Wanfang Data, VIP database, and CBM) were searched for qualitative studies from each database's inception to 31 June 2021. Studies were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Qualitative data were extracted, summarized, and meta-synthesized.

Results

13 studies were included, covering the data of 316 participants. 36 research results were extracted from these studies, which were combined into 11 categories, and finally formed 4 themes: (a) heavy burden of care; (b) emotional experience; (c) coping strategies; (d) care needs.

Conclusion

Caregivers beared a heavy burden of care and psychological burden. Despite the adoption of different coping strategies, their emotional distress was still very serious. Caregivers had unmet care needs. In order to improve caregivers' care capacity, the society and healthcare workers need to provide them with information support, psychological support, and take measures to create a friendly medical and living environment for them.

Impact

Understanding the experiences of caregivers of children with epilepsy will inform future research and practice. Healthcare workers could develop interventions to reduce caregiver burden and improve the level of caregivers' mental health. On the other hand, effective programs should be designed to improve caregivers' knowledge of the disease and enhance their ability to care. Society needs to take steps to improve the medical environment and the social stigma that is not friendly to epilepsy.

Persistent knowledge gaps between 2005 and 2020 in women with epilepsy: Comparison of multicenter studies from Germany

OBJECTIVE

Epilepsy is a chronic condition that can affect patients of all ages. Women with epilepsy (WWE) require access to specific counseling and information regarding issues related to contraception, pregnancy, and hormonal effects on seizure control and bone mineral density. This study investigated the knowledge among WWE regarding their condition, and whether epilepsy-specific knowledge has improved over the last 15 years.

METHODS

A total of 280 WWE aged 18 to 82 years participated in this multicenter, questionnaire-based study. The study was conducted at four epilepsy centers in Germany, between October 2020 and December 2020. Sociodemographic and epilepsy-specific data for participating women were analyzed and compared with the results of a similar survey performed in 2003-2005 among 365 WWE in Germany.

RESULTS

The questionnaire-based survey revealed considerable knowledge deficits without significant improvements over the last 15 years, particularly among those with less education and with regards to information on the more pronounced effects of epilepsy in older WWE (>50 years), including interactions with menopause and osteoporosis. In WWE ≤29 years, a significant increase in the knowledge score was observed in 2020 compared with this age group in 2005 (mean 7.42 vs. 6.5, p = .036). Mothers frequently reported epilepsy-related concerns regarding childrearing, particularly of seizures scaring their child and the need to rely on other people.

CONCLUSION

WWE continue to demonstrate inadequate epilepsy-related knowledge. Despite increasing information availability and the aspiration toward better awareness among medical professionals, overall knowledge has not increased sufficiently compared with the levels observed in recent studies.

Effectiveness of technological interventions to improve healthcare communication with children with long-term conditions: A systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effectiveness of technological interventions used to improve communication between healthcare professionals (HCPs) and children with long-term conditions (LTCs).

METHODS

PROSPERO: CRD42020221977. Five electronic databases were searched from inception to May 2021 for randomised controlled trials. Study characteristics were described and random-effects meta-analysis was conducted.

RESULTS

Nineteen studies were included, involving 1995 participants. Technological interventions were found to significantly improve participants' knowledge of their condition (standardised mean difference [SMD] 0.39; 95% CI 0.07-0.71; p = 0.02) and lead to a more internal health locus of control (SMD 0.50; 95% CI 0.25-0.76; p < 0.0001). There was no statistically significant improvement in physiological measures or emergency healthcare use.

CONCLUSION

This systematic review showed some benefits of using technology to improve communication between HCPs and children with LTCs. Future primary research should use rigorous methods for subsequent reviews to draw conclusions with greater confidence in the evidence. Establishing a core outcome set within this field of study would enable consistent measurement of outcomes.

PRACTICE IMPLICATIONS

Our findings indicate value in integrating communication technologies in the child health setting, aiming to establish greater continuity of care and maintain patient-clinician relationships between healthcare visits.

Parents of children with epilepsy: Characteristics associated with high and low levels of health literacy

Parents of children with epilepsy play a key role in the management of their child's condition. Their level of health literacy (HL), which refers to their ability to seek, understand, assess, remember, and utilize health information, is essential for handling the child optimally. The aim of this study was to investigate characteristics associated with high and low levels of different dimensions of HL in parents. HL was assessed with the multidimensional Health Literacy Questionnaire (parents' version) and the electronic Health Literacy Scale, using data from a cohort of 254 parents of children <12 years. Bivariate correlation and multiple hierarchal linear regression (STATA version 16 SE) were used to investigate variables associated with HL. Self-efficacy (St. β = 0.14-0.34) was the only variable that predicted higher scores on every HL scale. Being older than 35 years (St. β = 0.18-0.21), level of education (St. β = 0.16-0.27), and the child having a coordinator of services (St. β = 0.16-0.28) were associated with higher scores, while sick leave due to the child's epilepsy (St. β = -0.13 to -0.16), child comorbidities (St. β = -0.15 to -0.19), and higher levels of mental distress (St. β = -0.13 to -0.19) were associated with lower scores in several of the different HL dimensions. A total of 44.8% of the parents scored over the cutoff (≥1.85) predicting a mental disorder on the Hopkins symptom checklist. This is the first study to investigate multidimensional parental HL in a childhood epilepsy context. Our results highlight the need to investigate multiple variables, especially mental distress, to determine characteristics that may predict low parental HL. Further qualitative studies are needed to explore the underlying reasons for the parents' HL scores and to develop inventions tailored to meet different HL needs.

A qualitative study of epilepsy self-management barriers and facilitators in Black children and caregivers in Arkansas

OBJECTIVES

To identify facilitators and barriers of epilepsy self-management practices among Black children and caregivers.

METHODS

Qualitative semi-structured in-depth interviews were conducted with 11 child-caregiver dyads (11 children with epilepsy and 11 caregivers). A deductive-inductive analysis was undertaken to describe the range of barriers and facilitators significant to participants.

RESULTS

The barriers and facilitators were classified into 3 management themes: epilepsy-specific knowledge and information, treatment, and lifestyle. Within these themes, several important subthemes were identified. Two subthemes related to knowledge barriers emerged: children and caregivers' limited understanding and retention of complex written and spoken information and variable training and confidence in seizure first-aid. In contrast, facilitators for introducing and encouraging access to epilepsy self-management concepts were participants' eagerness to learn about this topic and a keen interest in using educational materials enriched with visual aids on a phone platform as an adjunct to in-person education. The second theme revealed various practical barriers to optimum treatment adherence, including mistrust of the healthcare system. In comparison, caregivers' collaborative approach and innovative strategies were identified as facilitators for treatment adherence. Finally, the lifestyle management barriers included a lack of defined processes to adopt healthy behaviors and challenges with disclosing epilepsy. Facilitators of this theme were comprised of building a team around the child to foster wellbeing and making healthy habits a fun and joyful experience for children.

DISCUSSION

Qualitative evidence in this study highlights caregivers' mistrust in the healthcare system and the lack of community support. Culturally competent interventions may improve access to and quality and utilization of self-management programs in Black children and families while reducing disparities.

A Comprehensive Analysis of E-Health Literacy Research Focuses and Trends

Objective: To sort out the research focuses in the field of e-health literacy, analyze its research topics and development trends, and provide a reference for relevant research in this field in the future. Methods: The literature search yielded a total of 431 articles retrieved from the core dataset of Web of Science using the keywords “ehealth literacy”, “E-health literacy” and “electronic health literacy”. A bibliometric analysis was performed by using CiteSpace to explore the development history, hot themes, and trends of future research in the field of e-health literacy. Results: The thematic evolution path in e-health literacy was divided into three stages. The research focuses were inspected from four aspects: evaluation, correlation with health-promotion behaviors, influencing factors, and intervention measures for improvement. Conclusion: E-health literacy research faces challenges such as the development of the connotation of the term, the objectivity of evaluation methods, and the long-term impact of interventions. Future research themes in e-health literacy will include the standardization of evaluation instruments and the individualization of therapeutic strategies.

Disease awareness and dietary habits of patients with epilepsy in western China: a cross-sectional study

Background

The optimal management of epilepsy includes engaging patients through education on knowledge of the disease, its treatment and diet control.

Methods

This was a cross-sectional survey-based cohort study, aimed to investigate the awareness of epilepsy in Chinese patients and to understand their dietary habits. Participants were consecutively enrolled from epileptic patients treated in a single epilepsy center from October 1, 2019 to February 29, 2020. A self-reported questionnaire (Cronbach’s α = 0.758) consisting of 3 parts was sent to 407 patients with epilepsy. The questionnaire included items on demographic information, epilepsy features, awareness of epilepsy treatment and dietary habits.

Results

About half of the patients (53.8%, 219/407) thought epilepsy was curable and only 80% knew that the first choice of treatment is medication. While 58.6% of the patients with low educational level preferred the use of antiepileptic drugs (p = 0.014), 52.7% believed that the medication should not be stopped immediately after seizure control (p = 0.026), especially after surgery (40.5%, p = 0.011). Patients with lower household monthly incomes had less awareness of the use of antiepileptic drugs than patients with higher incomes: only 39.2 and 49.8% of patients with lower incomes thought that the drugs could be stopped after epilepsy surgery or seizure control, respectively, compared to 51.6 and 66.1% with higher incomes. Alcohol (86.2%), caffeine (56.8%) and strong tea (49.1%) were top three foods considered by the patients to be avoided to prevent seizures. Approximately 30.2% of patients identified at least one food that made them susceptible to seizures.

Conclusions

Patient education on epilepsy, antiepileptic drugs and diet for management of seizures should be provided especially to patients with less education, lower income or inaccurate beliefs of epilepsy in Western China.

Digital Interventions to Improve Health Literacy Among Parents of Children Aged 0 to 12 Years With a Health Condition: Systematic Review

Background

Parental health literacy is associated with child health outcomes. Parents are increasingly turning to the internet to obtain health information. In response, health care providers are using digital interventions to communicate information to assist parents in managing their child’s health conditions. Despite the emergence of interventions to improve parental health literacy, to date, no systematic evaluation of the effectiveness of the interventions has been undertaken.

Objective

The aim of this review is to examine the effect of digital health interventions on health literacy among parents of children aged 0-12 years with a health condition. This includes evaluating parents’ engagement (use and satisfaction) with digital health interventions, the effect of these interventions on parental health knowledge and health behavior, and the subsequent impact on child health outcomes.

Methods

This systematic review was registered a priori on PROSPERO (International Prospective Register of Systematic Reviews) and developed according to the Joanna Briggs Institute methodology for systematic reviews. The databases CINAHL, MEDLINE, and PsycINFO were searched for relevant literature published between January 2010 and April 2021. Studies were included if they were written in English. A total of 2 authors independently assessed the search results and performed a critical appraisal of the studies.

Results

Following the review of 1351 abstracts, 31 (2.29%) studies were selected for full-text review. Of the 31 studies, 6 (19%) studies met the inclusion criteria. Of the 6 studies, 1 (17%) was excluded following the critical appraisal, and the 5 (83%) remaining studies were quantitative in design and included digital health interventions using web-based portals to improve parents’ health knowledge and health behavior. Owing to heterogeneity in the reported outcomes, meta-analysis was not possible, and the findings were presented in narrative form. Of the 5 studies, satisfaction was measured in 3 (60%) studies, and all the studies reported high satisfaction with the digital intervention. All the studies reported improvement in parental health literacy at postintervention as either increase in disease-specific knowledge or changes in health behavior. Of the 5 studies, only 1 (20%) study included child health outcomes, and this study reported significant improvements related to increased parental health knowledge.

Conclusions

In response to a pandemic such as COVID-19, there is an increased need for evidence-based digital health interventions for families of children living with health conditions. This review has shown the potential of digital health interventions to improve health knowledge and behavior among parents of young children with a health condition. However, few digital health interventions have been developed and evaluated for this population. Future studies with robust research designs are needed and should include the potential benefits of increased parent health literacy for the child.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42020192386; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192386

Factors associated with self-efficacy among patients with epilepsy in Turkey

PURPOSE

This study aimed to determine the self-efficacy levels of individuals with epilepsy and also compare individuals' self-efficacy with sociodemographic and epilepsy-related characteristics.

MATERIAL AND METHODS

The cross-sectional study was carried out with 200 individuals with epilepsy who were suitable for the inclusion criterias. Data were collected using patient information form which includes sociodemographic and clinical characteristics and Epilepsy Self-Efficacy Scale for evaluating epilepsy-related self-efficacy levels of patients.

RESULTS

The self-efficacy levels of the patients were moderate. Education, gender, occupational status, income, seizure frequency, regular use of medication, the number of drugs used, patient behavior following a drug-related problem, family support, the ability to obtain information about the illness, and hiding the illness from other people were significant factors determining scores on the epilepsy self-efficacy scale.

CONCLUSION

This study confirms the findings of previous studies that were conducted to determine factors affecting self-efficacy. In order to increase self-efficacy, the findings show that there is a need for social support, education of epilepsy individuals, and information and awareness in society.