Adapting Evidence-Based Epilepsy Self-Management Programs for Blacks in Georgia

Project UPLIFT is a manualized intervention that includes a script for use by the telephone facilitators in leading activities and discussions; use of a script is possible because the delivery is not face-to-face. Activities and discussions are designed to increase knowledge about epilepsy and mental health; monitoring, challenging, and changing of thoughts; coping and relaxing; attention and mindfulness; focusing on pleasure; the importance of reinforcement; and preventing relapse. Sessions are designed to last one hour by telephone, and are comprised of a check-in period, teaching on the topic of that week's session, group discussion, a skill-building exercise, and a recommended practice for the week. They are co-facilitated by a research staff and an UPLIFT trained adult with epilepsy. The same facilitators lead all eight sessions of a particular group. Facilitators will receive training in delivery of the program, including delivery of a practice session, from the Co-PI, a Georgia-licensed clinical psychologist. She will also supervise the facilitators throughout the program delivery. As noted above, spiritualism and religion; oral, interpersonal communication; and appreciation of intuition and experience are commonly held values in the African American community. This suggests that Project UPLIFT, with its activities based in experiential, meditative exercises, and oral, group discussion over the telephone may be a good fit.

Design. The outcome evaluation of the efficacy of the Project UPLIFT telephone intervention groups will be assessed using a cross-over design.

Participants/Procedure. A total of 60 participants will be recruited. Participants must self-identify as black or African American. All participants must be English-speaking, age 18 or older, mentally stable as assessed by the T-MMSE, have been diagnosed with epilepsy for at least three months, and screen positive for depression or anxiety on the Patient Health Questionnaire for Depression and Anxiety (PHQ-4). They must also have access to a telephone, be willing to attend eight hour-long telephone groups, and be willing to be audio-recorded. Individuals who are on antidepressant medication will not be excluded from this study, since CBT has been demonstrated to have a greater effect on relapse prevention than antidepressant medication. Once recruited, participants will be randomly assigned to one of two strata, each comprised of five 6-person groups. After each 12-participant cohort is recruited, they will be randomly assigned to Stratum 1 (intervention) or Stratum 2 (treatment-as-usual waitlist). During weeks 1-4, all participants will be pre-tested. During weeks 5-10, participants in Stratum 1 will receive Project UPLIFT, while participants in Stratum 2 are called weekly for a brief check-in. During weeks 11-14, all participants will receive interim testing. During weeks 15-22, participants in Stratum 2 will receive Project UPLIFT. During weeks 23-26, all participants will be post-tested. Five months after the completion of their final UPLIFT session, participants will be contacted for a follow-up assessment.

During the intervention in stratum 1, stratum 2 will serve as a control. In addition, the design allows a replication of the results in the initial intervention group (stratum 1) by the delayed intervention group (stratum 2). By the end of the intervention, all 10 6-person groups will have received the intervention.

Research Strategy Conferencing Methods. In order for the participants to communicate with one another as well as the facilitators, the telecommunicated group intervention sessions will use GoToMeeting. This conferencing method allows the moderator to not only record the call but also to screening participants waiting to join the call with the option to accept or reject those waiting, dismiss in-meeting participants, lock the meeting as well as dial out to participants. Use of this service is free of charge to MSM faculty.