Abstracts

Rationale: Adolescents and young adults with epilepsy (AYAWE) are poorly prepared for the responsibility of managing their health and healthcare needs. The traditional education strategies employed in settings with parents and adults with epilepsy are often rejected by adolescents as they prioritize their social/developmental goals ahead of epilepsy self-management. YESS seeks to develop strategies to engage AYAWE in self-management education a youth-centered approach grounded in positive youth development and Self-Determination Theory. Methods: Data come from the YESS Youth survey of adolescents and young adults (ages 13-24 years) with epilepsy recruited through clinical and community-based efforts. Participants were assessed for eligibility and provided assent and consent through a central study center. Questionnaires were completed primarily online, telephone interviews and paper versions were offered. The YESS youth survey collected information directly from AYAWE to inform the YESS self-management intervention (forthcoming) and test the intervention model and measures. For this analysis, we adapted versions of validated measures of motivations (Work Motivation Scale; Gagne 2015) and measures of self-management self-efficacy (SMSE; Lorig) and behaviors SMB. Analysis began with confirmatory factor analysis (CFA) in a structural equation measurement framework of the 13 items and the four motivational factors (amotivation, extrinsic, introjected and identified/autonomous motivations). Next, we tested associations between motivational factors and SMSE & SMB in linear and logistic regression models. Finally, we tested the theoretically derived hypothesis that youth expressing the most self-determined motivation (high autonomous and low extrinsic motivation) would report the highest level of SMSE and SMB. Results: A total of 153 AYAWE responses (of anticipated 200) were analyzed, mean age (19.8 years), female (64%) and 14% non-white. CFA of the four factor model demonstrated good fit statistics (RMSEA 0.044; CFI 0.975; SRMR 0.048; CD 0.991) after excluding one item which cross-loaded on several factors). Each factor demonstrated acceptable internal consistency (alpha: amotivation 0.70; extrinsic 0.64; introjected 0.70; identified/autonomous 0.84). Extrinsic motivation was negatively correlated with SMSE (-0.25, p.05) and Autonomous motivation were positively correlated (0.60, p.01). These results remained significant after controlling for age, sex and race/ethnicity. Finally, after categorizing Extrinsic and Autonomous motivations to low, medium and high (by tertile), we tested each of the nine combinations. As hypothesized, the combination of high Autonomous/low Controlled was associated with significantly higher SMSE and SMB than all other combinations including high Autonomous/high Controlled and low Autonomous/high Controlled before and after controlling for demographic characteristics. Conclusions: Developing a testable self-management support and education program for AYAWE is a national priority. The YESS model is grounded in the experience of adolescents and young adults and the Self-Determination Theory model of motivation for behaviors and the adapted measures. This analysis confirms the SDT model and its applicability to self-management during the transition to adulthood. The YESS intervention, informed by these findings, is being prepared for testing in late 2017. Funding: Centers for Disease Control and Prevention (CDC) and is supported byspecial interest project  SIP 14–007 CooperativeAgreement 1U48DP005022