Barriers and Facilitators of Antiepileptic Drug Adherence: A Qualitative Study Among People Living With Epilepsy in Pakistan
Author(s)
Bushra B. Zahra, MPhil.
Department of Pharmacy, Riphah International University, Islamabad, Pakistan.
Department of Pharmacy, Riphah International University, Islamabad, Pakistan.
OBJECTIVES: Medication adherence is crucial to achieving optimal health outcomes in people living with epilepsy (PLWE). Approximately 52.1% of PLWE are sub-optimally adherent to antiepileptic drugs (AEDs) in Pakistan, leading to an increased risk of drug resistance. Achieving adherence in Pakistan is challenging because of socioeconomic, psychological, and cultural factors. In this qualitative study, we identified the factors that hinder or support adherence to medication regimens and explored the experiences of PLWE regarding adherence to AEDs.
METHODS: Twenty-eight qualitative interviews were conducted with PLWE, who visited the largest hospital in Islamabad, Pakistan Institute of Medical Sciences (PIMS), from March to June 2024. Clinically diagnosed PLWE with their caregivers (CGs) were invited to participate in this study. Recruitment persisted until saturation was achieved. Interviews averaged 30 minutes in length and were conducted using a semi-structured guide. Interview questions were open-ended. All interviews were audio-recorded in Urdu and transcribed into English. The qualitative responses were evaluated using a thematic analysis technique emphasizing the dominant themes.
RESULTS: Three themes emerged surrounding issues of PLWE and their CGs in adhering to AEDs, which include the non-availability of AEDs in pharmacies, the financial instability of PWE, religious beliefs, forgetfulness, lack of counseling about medication doses and side effects, poor psychological care, and prevalence of comorbidities. At the same time, facilitators such as access to free medications, family support, effective monotherapy prescription, and a sense of responsibility were identified.
CONCLUSIONS: To improve medication adherence, there is a need for attention and practical measures in the field of identified issues. Removing barriers such as providing educational and counseling services to PLWE and their CGs, providing free-of-cost treatment facilities, and the availability of AEDs in poor-resourced areas will improve health outcomes and ensure the continuum of epilepsy care among PLWE residing in Pakistan.
METHODS: Twenty-eight qualitative interviews were conducted with PLWE, who visited the largest hospital in Islamabad, Pakistan Institute of Medical Sciences (PIMS), from March to June 2024. Clinically diagnosed PLWE with their caregivers (CGs) were invited to participate in this study. Recruitment persisted until saturation was achieved. Interviews averaged 30 minutes in length and were conducted using a semi-structured guide. Interview questions were open-ended. All interviews were audio-recorded in Urdu and transcribed into English. The qualitative responses were evaluated using a thematic analysis technique emphasizing the dominant themes.
RESULTS: Three themes emerged surrounding issues of PLWE and their CGs in adhering to AEDs, which include the non-availability of AEDs in pharmacies, the financial instability of PWE, religious beliefs, forgetfulness, lack of counseling about medication doses and side effects, poor psychological care, and prevalence of comorbidities. At the same time, facilitators such as access to free medications, family support, effective monotherapy prescription, and a sense of responsibility were identified.
CONCLUSIONS: To improve medication adherence, there is a need for attention and practical measures in the field of identified issues. Removing barriers such as providing educational and counseling services to PLWE and their CGs, providing free-of-cost treatment facilities, and the availability of AEDs in poor-resourced areas will improve health outcomes and ensure the continuum of epilepsy care among PLWE residing in Pakistan.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PCR28
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas