Barriers and enablers to antiseizure medication adherence in children with epilepsy: a systematic review using the theoretical domains framework (TDF)

Background Antiseizure medications (ASMs) are the primary treatment for controlling seizures in children with epilepsy (CWE). Despite their proven effectiveness, non-adherence to ASMs remains a major challenge. The aim of this study is to synthesise qualitative data using the theoretical domains framework (TDF) to identify the behavioural mechanisms associated with ASM adherence in CWE. This will then inform the development of a theory-informed ASM adherence intervention. Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in CINAHL, PubMed, SCOPUS, EMBASE and PsycINFO databases. The Critical Appraisal Skills Programme was used to assess the quality of the included studies. Qualitative findings relating to barriers and enablers of ASMs were extracted, analysed and synthesised using NVivo V.14 and mapped to the TDF. Behaviour change techniques (BCTs) associated with identified TDF domains were identified using the Theory and Techniques Tool. Results 19 studies were included: 17 qualitative and two mixed-methods studies. A total of 83 factors were identified comprising 51 barriers and 32 enablers. Key factors included poor communication between prescribers and parents ( social influences ); unpleasant taste, large tablet size and access to ASMs ( environmental context and resources ); fear of addiction ( beliefs about consequences ); inferiority related to ASM use ( emotion ); parental prompting ( memory, attention and decision processes ); and understanding of treatment purpose ( knowledge ). Across different countries, there was contrasting evidence on belief about consequences. Conclusion These findings provide broad descriptions of the determinants of non-adherence enabling direct linkage to evidence-based BCTs and therefore ultimate creation of theory-informed interventions. PROSPERO registration number CRD42024600476.