Abstracts

Rationale: Epilepsy is a common chronic neurological disorder that disproportionately affects individuals within minority groups, those in rural areas, and those living in low-income communities. Patients with epilepsy within these communities are most likely to experience a high gap in accessibility to specialized care and lower adherence to medication regimens. Community health workers (CHWs) are trained and certified public health workers linking health and social services in the community with the people who need them, often share lived experiences with the population served, and often work in conjunction with nurses, physicians, and other professionals. CHWs are increasingly being incorporated within healthcare teams, including those in epilepsy clinics, to provide health education and promotion, healthcare navigation, and care coordination. There is a need to understand the factors contributing to successful onboarding, implementation, efficacy, and retention for CHWs in epilepsy clinical care.To describe facilitators and barriers to a successful implementation of a CHW intervention using MINDSET 2.0 within clinics managed by the Epilepsy Foundation Texas (EFTx).

Methods: A Manual of Procedures (MoP) was developed to mitigate implementation barriers and to enhance the efficacy of an innovative intervention for people with epilepsy. The intervention provides CHW navigators with tablet-based decision support to enable assessment of patient self-management behaviors and the provision of a tailored self-management action plan. An expert panel, comprising EF administration, neurologists, clinic coordinators, program managers, a CHW certification specialist, and behavioral scientists experienced in epilepsy treatment and research, provided consensus on facilitators and barriers to successfully implement the intervention through a series of planning meetings. An MoP was then developed that outlined the strategies to mitigate individual and organizational barriers to implementing the CHW intervention.

Results: The resultant MoP described the steps for implementing the CHW intervention into EFTx clinics including onboarding, training and evaluation, and intervention quality, fidelity, and accountability to enhance patient care. Strategies included trainings and organizational capacity building. These addressed identified facilitators and barriers including (1) individual level factors for CHWs (knowledge and skills in assessment, intervention, and support linkage) for epilepsy self-management, co-morbidities (depression, cognitive deficit), and social determinants; (2) individual level factors for clinic coordinators; (3) organizational capacity factors for EFTx; and (4) motivational factors related to the intervention (i.e. relative advantage, compatibility, etc.).

Conclusions: A MoP that addresses individual, organizational, and intervention level implementation facilitators and barriers and guided by implementation models can aid in advanced planning for implementation of an innovative CHW intervention in Epilepsy Foundation clinics. An evaluation of the feasibility and efficacy of implementing the MoP strategies is indicated.

Funding: Please list any funding that was received in support of this abstract.: CDC SIP 20-006.