Perceived stigma and adherence in epilepsy: Evidence for a link and mediating processes

Abstract

ObjectiveThis study tested whether perceived epilepsy-related stigma is associated with adherence in people living with epilepsy and if information, motivation, and behavioral skills are potential pathways underlying the stigma–adherence link. MethodsWe surveyed persons living with epilepsy between the ages of 18 and 65 (N=140) using an online questionnaire to assess medication adherence and perceived epilepsy-related stigma. In addition, participants reported their level of information, motivation, and behavioral skills. ResultsHigher perceived epilepsy-related stigma was associated with lower medication adherence (r=−0.18, p<.05). Higher perceived stigma was associated with lower levels of information (r=−0.28, p<.05), motivation (r=−0.55, p<.05), and behavioral skills (r=−0.41, p<.05), and the link between stigma and adherence was fully explained by information, motivation, and behavioral skills, i.e., the effect of stigma on adherence was fully mediated (c=−0.18, p<.05 reduced to c′=0.06, p=.48). ConclusionPerceived epilepsy-related stigma is problematic for maintaining the prescribed medication regimen in people living with epilepsy. The information–motivation–behavioral skills model is a useful framework for understanding the pathways linking perceived stigma and adherence in this population.