Barriers and Facilitators to Accessing Care and Adhering to Medications in People With Epilepsy in India: Healthcare Workers' Perspectives.

Introduction Exploring the barriers and facilitators that people with epilepsy face in accessing care and adhering to medications could enable a better understanding of how India's epilepsy treatment gap could be addressed. Furthermore, there is a paucity of research on the topic, and we could not find any studies exploring these barriers from the perspective of healthcare workers. Aim The study aimed to explore the barriers and facilitators to accessing care and adhering to medications faced by people with epilepsy in India. Methodology Purposive sampling was used to recruit healthcare workers at a private hospital and a non-governmental organization in Pune, India. A total of 13 participants were interviewed, with all of these interviews being audio-recorded. Findings were transcribed and then analyzed by thematic analysis. Findings Several barriers to accessing care were identified, with misconceptions surrounding epilepsy being the most frequently mentioned barrier. Facilitators to accessing care mentioned by participants included higher symptom severity and a higher level of education. Several barriers to medication adherence were discussed, with misconceptions and finances being key themes in participants' responses. Finally, four key themes arose from exploring facilitators to adherence, namely the low cost of medicines, counselling, a good doctor-patient relationship, and a higher education level. Discussion The barriers and facilitators in this study were similar to the barriers and facilitators identified in similar studies. However, some key differences were seen too. For example, this study found financial difficulties to be a key barrier to adherence, but a similar study in South India did not find financial difficulties to be a barrier. Several recommendations can be made based on the findings of this study on how to address India's epilepsy treatment gap. Conclusion People with epilepsy in India face several barriers and facilitators to accessing care and adhering to medications. India's epilepsy treatment gap is a complex and multifactorial issue and will therefore be challenging to address.
Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Leeds Institute of Health Sciences Research Ethics Sub-Committee (FMHREC-18-2.1) issued approval N/A. Ethical approval was obtained on May 9, 2019, by the Leeds Institute of Health Sciences Research Ethics Sub-Committee (FMHREC-18-2.1). The approval included the consent form, information sheet, and draft question guide. Participants received an information sheet detailing the research and were given 24 hours before deciding whether to consent to the study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
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