Authors :
Presenting Author: Anaum Showkat, MS – Dartmouth Hitchcock Medical Center
Kathryn Giordano, MPH – Dartmouth Health
Meredith Olenec, BA, CHW – Dartmouth Health
Suzanne Lenz, MA, CCRP – Dartmouth Health
Elaine Kiriakopoulos, MD, MPH, MSc – Dartmouth Health
Rationale:
Strong evidence supports the effectiveness of telehealth interventions in improving health outcomes for chronic conditions. However, rural populations continue to face significant barriers to epilepsy care. Geographic isolation leads to delayed diagnosis, suboptimal management, and increased ED utilization. While 70-80% of people with epilepsy (PWE) experience cognitive impairments, rural patients have minimal access to comprehensive interventions addressing disease management and related cognitive dysfunction. Despite interest in telehealth solutions, research examining rural patients' experiences with epilepsy-specific telehealth programs remains limited. This study explores rural patients' experiences accessing epilepsy care and evaluates the utility of a telehealth program for epilepsy self-management (ESM).
Methods:
Semi-structured interviews were conducted to explore the experiences of rural residing epilepsy patients (n=10; ages 25-65+) who completed the Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) program from 8 states (GA, WI, CA, MI, NH, ME, OH, VT). Semi-structured key informant interviews examined rural care access barriers, ESM challenges, and detailed program experiences. Transcripts were analyzed (NVivo software) using a mixed inductive and deductive thematic approach with inter-rater reliability established across three researchers.
Results:
Themes which emerged include: (1) rural healthcare access barriers with travel distances of 30 minutes to 3+ hours to specialists and diagnostic delays extending up to 12 years; (2) HOBSCOTCH program components (8-week individual coaching, structured workbooks, longitudinal group sessions) provided epilepsy education/expertise not available locally; (3) universal knowledge and strategy gains with 100% of participants reporting sustained self-management techniques, particularly distinguishing epilepsy effects from medication side effects; (4) meaningful quality of life improvements including reduced social isolation and enhanced sense of normalcy; (5) transformation in epilepsy management from passive care recipients to active healthcare partners; (6) rural-specific challenges including unreliable internet connectivity, transportation dependencies, and weather-related barriers requiring program adaptations; (7) sustained program benefits with participants continuing to utilize learned ESM strategies.
Conclusions:
Despite significant geographic and infrastructure barriers, rural epilepsy patients demonstrated meaningful engagement with telehealth interventions and achieved sustained improvements in self-management capabilities and quality of life. Participants emphasized the critical value of specialized epilepsy education and peer connection previously unavailable in their communities. With healthcare systems increasingly recognizing rural health disparities, telehealth ESM programs represent essential support for bridging critical care gaps in rural settings and addressing broader chronic disease challenges.
Funding: None