Clinic-Based Mobile Health Decision Support to Enhance Adult Epilepsy Self-Management: An Intervention Mapping Approach

Abstract

IntroductionEpilepsy is a neurological disorder involving recurrent seizures. It affects approximately 5 million people in the U.S. To optimize their quality of life people with epilepsy are encouraged to engage in self-management (S-M) behaviors. These include managing their treatment (e.g., adhering to anti-seizure medication and clinical visit schedules), managing their seizures (e.g., responding to seizure episodes), managing their safety (e.g., monitoring and avoiding environmental seizure triggers), and managing their co-morbid conditions (e.g., anxiety, depression). The clinic-based Management Information Decision Support Epilepsy Tool (MINDSET) is a decision-support system founded on theory and empirical evidence. It is designed to increase awareness by adult patients (≥18 years) and their health-care provider regarding the patient’s epilepsy S-M behaviors, facilitate communication during the clinic visit to prioritize S-M goals and strategies commensurate with the patient’s needs, and increase the patient’s self-efficacy to achieve those goals.MethodsThe purpose of this paper is to describe the application of intervention mapping (IM) to develop, implement, and formatively evaluate the clinic-based MINDSET prototype and in developing implementation and evaluation plans. Deliverables comprised a logic model of the problem (IM Step 1); matrices of program objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); a functional MINDSET program prototype (IM Step 4); plans for implementation (IM Step 5); and evaluation (IM Step 6). IM provided a logical and systematic approach to developing and evaluating clinic-based decision support toward epilepsy S-M.

Intervention Mapping: Theory- and Evidence-Based Health Promotion Program Planning: Perspective and Examples

“…There are several examples of the use of IM for the development of eHealth interventions. Shegog and Begley (40), using IM, involved both a diverse planning group and a patient provider advisory group to develop a decision support tool (DST) to increase self-management among epilepsy patients and their care providers. The tool is used to increase awareness and efficacy of self-management behaviors among epilepsy patients and their healthcare providers and to improve communication during clinic visits.…”

“…The tool is used to increase awareness and efficacy of self-management behaviors among epilepsy patients and their healthcare providers and to improve communication during clinic visits. The Shegog and Begley (40) paper includes a table that illustrates the identification of methods, organized by determinants, and how these were operationalized, using practical applications of the DST. The authors demonstrate how the online decision-support system in this case can include multiple methods and practical applications to address users' determinants of self-management.…”

“…The intervention materials included an interactive tablet-based application, print materials, an action plan, with a follow-up phone call to determine and address remaining barriers. As in the Shegog and Begley (40) and Rodriguez et al (42) examples, IM helped to identify determinants, and the interactive tailoring features of the intervention provided specific messages for users that depended on their beliefs, knowledge, and identified barriers. Targeting health care providers directly was not possible, but a patient activation element (patient-mediated prompts) was added to the intervention to increase provider recommendations and referrals for CRCS.…”

Optimising epilepsy management with a smartphone application: a randomised controlled trial

“…Supporting self‐management by people with chronic diseases facilitates expanding the provision of health care from doctors to the patients themselves . Clinic‐based mobile health decision support for enhancing self‐management by adults with epilepsy and WebEase, an online epilepsy self‐management program that assists people with medications, managing stress, and improving sleep quality, have been described in the literature; an internet‐based psychosocial intervention was reported to have improved self‐management and self‐efficacy in American veterans with epilepsy . Our findings suggest that a mobile phone app can have a substantial effect on epilepsy self‐management and may reduce seizure frequency.…”

Recommendations for development of acute seizure action plans (ASAPs) from an expert panel

“…Use of an ASAP can reinforce appropriate and timely care in seizure emergencies, such as the use of rescue medication, and offer increased control and decreased vulnerability to patients and caregivers by providing consistent guidance regarding epilepsy management that is specific to patients regardless of setting. Use of an ASAP may provide clarification on patient and caregiver concerns, such as understanding what to do during a seizure, when watchful waiting is appropriate, when to call 911 or go to the hospital, geographic issues, and age-related differences in treatment [11,12].…”