Abstracts

Rationale: HOme Based Self-management and COgnitive Training CHanges Lives (HOBSCOTCH) is a cognitive behavioral intervention that improves quality of life and cognition for people with epilepsy. The HOBSCOTCH Institute (HI) is building capacity for this intervention by creating and supporting the HOBSCOTCH Institute Translational Network (HITN) of 18 epilepsy center clinics (Fig 1) that uses a Hub and Spoke model. To align its training content and implementation support with the HITN clinics’ needs, HI partnered with the Center for Program Design and Evaluation to complete a mixed methods assessment of baseline context (processes, environment, expectations) at HITN clinics.

Methods: We conducted semi-structured interviews (n=15) with HITN site Champions to hear individual perspectives, understand clinic operations, and assess how clinic factors may influence intervention uptake and patient referral to HOBSCOTCH. We recorded, transcribed, and coded interviews using inductive and deductive approaches to identify clinic- and patient-level barriers and facilitators, trainee involvement, and clinic communication methods. We also administered an online survey (n=87) to the 18 HITN clinics with similar question domains. (Fig 2A) Interview data was analyzed using a mixed methods application (Dedoose Version 9.0) and survey data was analyzed in Excel.

Results: Interviewees described a variety of approaches to communication, staffing, and referral, suggesting operational and practice heterogeneity across HITN. Most cited funding and time constraints as barriers to onsite epilepsy self-management (ESM) delivery. Limited engagement with community-based organizations for addressing social determinants of health to remove potential barriers to ESM access was common. Most reported engaging patients in shared decision-making in clinical practice and identified factors affecting patient engagement, like language barriers and limited technology (and patient portal) access. Most survey respondents (95%) were familiar with HOBSCOTCH, and some clinicians (31%) had participated in Cognitive Coach training. Most (80%) see great value in ESM for their patients. They estimated that few patients independently engage in self-management behaviors, making standardized ESM a good option. Many (70%) report clinics provide counseling from nurses and social workers as alternatives to ESM programs. Findings overlap between interview data and survey responses, although interviews yielded more detailed views of clinic processes and provider attitudes. (Fig 2B)

Conclusions: Baseline data collection reveals a variety of perspectives and characteristics across HITN Champions and clinic team members. HI’s plan to align training and education according to each clinic’s unique context will facilitate ESM intervention uptake and build capacity for expanded access to HOBSCOTCH. HI investigators will use these findings for quality improvement that supports ESM implementation.

Funding: CDC Cooperative Agreement Award #1 NU58DP007541-01-00