SynthesisBMJ paediatrics open2026
Barriers and enablers to antiseizure medication adherence in children with epilepsy: a systematic review using the theoretical domains framework (TDF).
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Abstract
backgroundAntiseizure medications (ASMs) are the primary treatment for controlling seizures in children with epilepsy (CWE). Despite their proven effectiveness, non-adherence to ASMs remains a major challenge. The aim of this study is to synthesise qualitative data using the theoretical domains framework (TDF) to identify the behavioural mechanisms associated with ASM adherence in CWE. This will then inform the development of a theory-informed ASM adherence intervention.
methodsThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in CINAHL, PubMed, SCOPUS, EMBASE and PsycINFO databases. The Critical Appraisal Skills Programme was used to assess the quality of the included studies. Qualitative findings relating to barriers and enablers of ASMs were extracted, analysed and synthesised using NVivo V.14 and mapped to the TDF. Behaviour change techniques (BCTs) associated with identified TDF domains were identified using the Theory and Techniques Tool.
results19 studies were included: 17 qualitative and two mixed-methods studies. A total of 83 factors were identified comprising 51 barriers and 32 enablers. Key factors included poor communication between prescribers and parents (
conclusionThese findings provide broad descriptions of the determinants of non-adherence enabling direct linkage to evidence-based BCTs and therefore ultimate creation of theory-informed interventions. PROSPERO REGISTRATION NUMBER: CRD42024600476.
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