Barriers and enablers to antiseizure medication adherence in children with Epilepsy: A systematic review using meta-ethnography

Adherence to antiseizure medications (ASMs) is essential for seizure control in children with epilepsy. However, multiple factors influence adherence, leading to varied treatment outcomes. The aim of this study is to explore the barriers and enablers to antiseizure medication adherence in children with epilepsy by synthesising qualitative studies. This systematic review and qualitative synthesis followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. The critical appraisal skills programme (CASP) was used to assess the quality of the included studies. A comprehensive search was conducted in CINAHL, PubMed, SCOPUS, EMBASE, PsycINFO databases. Qualitative studies were extracted, analysed, and synthesised using meta-ethnography approach. Of the 20 studies identified, 18 were qualitative and remaining 2 were mixed method studies. Barriers included unpleasant medication taste, difficulty in swallowing, adverse effects, poor communication with healthcare providers, and stigma. Enablers included suitable taste of medication, easy to swallow, equity to healthcare, trust in ASMs, and access to mobile technology. Findings indicate that adherence barriers differ by age group. Younger children primarily face challenges related to medication formulation, while older children and adolescents experience barriers linked to stigma. This study provides deeper insight into the complex factors affecting ASM adherence in children with epilepsy. Addressing these barriers through individualized treatment approaches, caregiver education, improved healthcare communication, and accessible healthcare services could enhance adherence and improve health outcomes.