Self-Management Intervention for Reducing Stroke Burden Among Ugandans With Epilepsy

SMART-U will consist of 2 main components: a 12-week "intensive" group format stage and a 12-week remotely accessed telephone follow-up stage. SMART-U will be assessed for acceptability and fidelity, as well as efficacy in comparison to eTAU for improving QOL, reducing seizure frequency and in improving other health outcomes including depression, functional status and health resource use. Stage 1 consists of 8 group-format, 45-60-minute in-person sessions (up to 10 PWE participants per group), which will be collaboratively delivered by a nurse and the PED. PWE will be encouraged to have a family member who is important in their epilepsy self-management attend the groups with them. Following the Stage 1 group sessions, participants will have 3 brief (no more than 15 minutes) monthly web-based or telephone maintenance sessions conducted by the SMART-U nurse. Telephone sessions will address on-going issues of epilepsy self-management, including medication adherence. Additionally, the nurse will serve as a facilitator of linkage between the individual's epilepsy care clinicians, by providing SMART-U program status updates to providers.

To control for the same number of patient contacts as SMART-U, the nurse in eTAU will then follow-up with participants with a series of 8 brief phone calls spaced out over the course of 6 months (approximately every 2 weeks during months 1 and 2, then approximately monthly thereafter). Content will reinforce materials provided in the orientation visit and the nurse will be available to answer questions that may arise. Different nursing personnel will deliver the SMART-U and eTAU interventions to minimize chance of contamination across study arms.

Each research participant will be assessed 3 times: at screening, at baseline, at 13 weeks (after completion of the SMART-U group sessions), and at 24-week follow-up (end of efficacy RCT). The first one-quarter of enrolled participants will be followed post-RCT for an additional 18 months with assessments done at 52-weeks/12-months; 76 weeks (18-months) and 104 weeks (24-months) follow-up. For this sample the total follow-up will be 24 months. In addition to demographic and clinical information (age, sex, self-reported cumulative medical illness).

The investigators will use In-depth interviews on perceived benefits vs. burdens as well as barriers/facilitators to SMART-U and eTAU implementation will be conducted at each of the 2 sites. Given the corrosive and persistent nature of stigma on QOL among PWE, input and recommendations on specific strategies regarding ways to potentially mitigate stigma in families and communities will be assessed. Informants will include 20 PWE from SMART-U and 20 PWE from eTAU (total N=40). The investigators will conduct qualitative interviews to elicit participant perceptions of the intervention at 13-weeks (when SMART-U groups are completed) and again at 24 weeks. For qualitative interviews, this sample size is within the range of recommended sample sizes (i.e., 20-50 individuals).

The investigators recognize the need for careful, expert external data and safety oversight to ensure the well-being of the participants in this study and the scientific integrity of the project. These experts, who are not members of the study team, will review and evaluate the accumulated data for participant safety, AEs, study conduct and progress, at minimum, every 12 months. Ad-hoc meetings might be called to evaluate unanticipated serious adverse events or any other urgent issues that are relevant and which might occur during the course of the study. The DSMB will be comprised of two clinicians with epilepsy expertise at the Uganda site; a faculty member/clinician with epilepsy expertise at the US site, and a biostatistician at the US site who are all not part of the study team, but have extensive experience with federally funded research. The DSMB communication and oversight will be accomplished via videoconference call or email communication for issues that need more immediate attention.