Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.
Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, NC, USA.
Syst Rev. 2020 Apr 25;9(1):92. doi: 10.1186/s13643-020-01322-9.
Epilepsy affects nearly 50 million people worldwide. Self-management is critical for individuals with epilepsy in order to maintain optimal physical, cognitive, and emotional health. Implementing and adopting a self-management program requires considering many factors at the person, program, and systems levels. We conducted a systematic review of qualitative and mixed-methods studies to identify facilitators and barriers that impact implementation and adoption of self-management programs for adults with epilepsy.
We used established systematic review methodologies for qualitative and mixed-methods studies. We included studies addressing facilitators (i.e., factors that aided) or barriers (i.e., factors that impeded) to implementation and adoption of self-management interventions for adults with epilepsy. We conducted a narrative thematic synthesis to identify facilitators and barriers.
The literature search identified 2700 citations; 13 studies met eligibility criteria. Our synthesis identified five themes that categorize facilitators and barriers to successful implementation epilepsy self-management: (1) relevance, intervention content that facilitates acquisition of self-management skills; (2) personalization, intervention components that account for the individual's social, physical, and environmental characteristics; (3) intervention components, components and dosing of the intervention; (4) technology considerations, considerations that account for individual's use, familiarity with, and ownership of technology; and (5) clinician interventionist, role and preparation of the individual who leads intervention. We identified facilitators in 11 of the 13 studies and barriers in 11 of the 13 studies and classified these by social-ecological level (i.e., patient/caregiver, program, site/system).
Identification of facilitators and barriers at multiple levels provides insight into disease-specific factors that influence implementation and adoption of self-management programs for individuals with epilepsy. Our findings indicate that involving individuals with epilepsy and their caregivers in intervention development, and then tailoring intervention content during the intervention, can help ensure the content is relevant to intervention participants. Our findings also indicate the role of the clinician (i.e., the individual who provides self-management education) is important to intervention implementation, and key issues with clinicians were identified as barriers and opportunities for improvement. Overall, our findings have practical value for those seeking to implement and adopt self-management interventions for epilepsy and other chronic illnesses.
PROSPERO registration number is CRD42018098604.
癫痫影响着全球近 5000 万人。为了保持最佳的身体、认知和情绪健康，癫痫患者的自我管理至关重要。实施和采用自我管理计划需要考虑个人、计划和系统层面的许多因素。我们对定性和混合方法研究进行了系统综述，以确定影响成年癫痫患者自我管理计划实施和采用的促进因素和障碍因素。
我们使用已建立的定性和混合方法研究的系统综述方法。我们纳入了针对促进因素（即有助于实施的因素）或障碍因素（即阻碍实施的因素）的研究，这些因素涉及成年癫痫患者自我管理干预措施的实施和采用。我们进行了叙述性主题综合分析，以确定促进因素和障碍因素。
文献检索确定了 2700 条引文；13 项研究符合入选标准。我们的综合分析确定了五个主题，这些主题将成功实施癫痫自我管理的促进因素和障碍因素进行了分类：（1）相关性，促进自我管理技能获取的干预内容；（2）个性化，考虑到个人的社会、身体和环境特征的干预组成部分；（3）干预组成部分，干预的组成部分和剂量；（4）技术考虑因素，考虑到个人使用、对技术的熟悉程度和拥有技术的情况；以及（5）临床医生干预者，负责领导干预的个人的角色和准备情况。我们在 13 项研究中的 11 项研究中确定了促进因素，在 13 项研究中的 11 项研究中确定了障碍因素，并按社会生态水平（即患者/照顾者、计划、地点/系统）对其进行了分类。
在多个层面上确定促进因素和障碍因素，可以深入了解影响癫痫患者自我管理计划实施和采用的特定疾病因素。我们的研究结果表明，让癫痫患者及其照顾者参与干预措施的制定，然后在干预过程中调整干预内容，可以帮助确保内容与干预参与者相关。我们的研究结果还表明，临床医生的角色（即提供自我管理教育的个人）对干预实施很重要，并且确定了临床医生的关键问题，这些问题既是障碍，也是改进的机会。总的来说，我们的研究结果对于那些寻求实施和采用癫痫和其他慢性病自我管理干预措施的人具有实际价值。
PROSPERO 注册号为 CRD42018098604。
