Abstracts

This is a Late Breaking abstract

Rationale: Telehealth delivery of epilepsy self-management (ESM) programs as an adjunct to clinic based care continues to expand through dissemination and implementation in clinic and community settings. Evidence-based ESM programs have shown benefits in quality of life (QOL), comorbid cognitive dysfunction and mental illness, and seizure frequency for people with epilepsy (PWE). The HOBSCOTCH (HOme Based Self-Management and COgnitive Training CHanges Lives) program has demonstrated improved QOL and cognitive function in two randomized controlled trials. In order for application of ESM programs to be maximally effective it is critical to understand drivers of patient satisfaction as experienced through real world implementation of the interventions.

Methods: A post-program REDCap satisfaction survey was sent to US based telehealth participants (n=131) who received the 8-week HOBSCOTCH intervention via a centralized HOBSCOTCH Institute Coaching team (MD, APRN, Psychologist). The survey included Likert-scale satisfaction ratings and free-text open response questions (response rate 60%, n=78). Surveys with a response to at least one of five free-text questions were de-identified for qualitative analysis (96% of respondents, n=75). Researchers (3) performed independent coding of free text data to develop and finalize a codebook and identify major themes. The final codebook was applied to individual free-text responses. Codes were analyzed across researchers (3) for frequency, and a comparative analysis completed.

Results: Demographic data (n=75, 61% female; mean age 46; 65% White; 80% HS education or above; 40% employed; 30% rural) presented in Table 1. Qualitative analysis of open text responses revealed eight major themes: (1) HOBSCOTCH Coach impact on participant experience; (2) acquired ESM skills; (3) subjective memory improvement; (4) knowledge acquired; (5) stress/anxiety reduction; (6) telehealth delivery; (7) adaptability for individual needs; (8) confidence in cognitive abilities. A summary of qualitative data (code frequencies, n=1394) is in Figure 1A and Likert-scale satisfaction ratings are shown in Figure 1B. 88% of participants (n=66) responded  HOBSCOTCH provided benefit (some benefit to very beneficial) and 97% indicated they strongly/mostly agreed they enjoyed working with a Coach. 25% highlighted in free-text the positive impact (knowledge, delivery skill, empathy, support) experienced via individual Coaching. Additional drivers of satisfaction included use of taught compensatory memory strategies, ESM skills acquired, increased self-awareness, memory improvement, stress/anxiety reduction, among others (Figure 1A).

Conclusions: Assessment of real-word application of ESM in our ongoing efforts to translate science to service delivery reveals key drivers of patient satisfaction related to participation in HOBSCOTCH. These data are important in asserting and maintaining standards for Coach training and maintenance of skills, and for utilizing implementation models that support fidelity of program delivery. Further, valuable insights are shared for future development of ESM programming targeting the comorbidity of cognitive dysfunction in epilepsy.

Funding: HOBSCOTCH Institute, Dartmouth-Health