JMIR Publications

ABSTRACT

Background:

Enhancing self-management and transition readiness in adolescents with epilepsy is essential for successful transition to adult care. The combination of the Transtheoretical Model (TTM) and mobile health (mHealth) management offers a framework to reduce intervention costs while personalizing care.

Objective:

This quasi-experimental study evaluates the feasibility of TTM-based mHealth management for improving transition services in adolescents with epilepsy.

Methods:

A total of 98 adolescent epilepsy patients aged 12-18 years were recruited. Using a non-randomized design based on treatment locations, they were allocated into either the intervention group (n=49) or the control group (n=49). The intervention group received a TTM-based mobile health management program, which included phase-specific group sessions led by a multidisciplinary team and conducted via Tencent Meeting every two weeks or monthly (biweekly for the pre-contemplation, contemplation, and preparation, and monthly for the action and maintenance). The sessions involved lectures, discussions, and a mini-program that provided disease management support, motivational strategies, and digital reminders tailored to each stage. The control group received conventional remote extended care, consisting of biweekly group lectures and discussions for all patients and their families via Tencent Meeting, supplemented by regular health education materials delivered through a WeChat group. Telephone follow-ups were conducted at the third and sixth months. The total intervention duration was six months for both groups. Outcomes were assessed after six months using the Self-management Stage, STARx, and a self-developed program acceptability questionnaire.

Results:

Post-intervention, the intervention group demonstrated significantly better self-management behavior stages compared to controls. At the end of 6 months of intervention, the majority of participants in the intervention group reached the action stage (n=16, 32.65%) and maintenance stage (n=14, 28.57%), whereas most controls remained in pre-contemplation (n=12, 24.49%) and contemplation stages (n=13, 26.53%). Both groups showed significant improvements from baseline in medication management, healthcare participation, disease knowledge, doctor-patient communication, and transition readiness total scores at 6-month follow-up (all P<0.05). Notably, the intervention group achieved additional incremental benefits versus controls: Medication management: 3.81 (95% CI=1.26-6.36), Health-care engagement: 2.77 (95% CI=0.52-5.02), Disease knowledge: 1.30 (95% CI=0.28-2.31), Provider communication: 3.42 (95% CI=1.62-5.22), Transition readiness: 11.30 (95% CI=5.70-6.89), Effect sizes (Cohen's d) ranged from 0.527 to 0.864, indicating moderate-to-large clinical effects. The Overall satisfaction scores were 4.43 ± 0.50 for patients and 4.16 ± 0.82 for healthcare providers.

Conclusions:

The TTM-based mobile health management program may effectively improve self-management behavior changes and enhance readiness for transition among adolescents with epilepsy, thereby facilitating a smooth transition to adult healthcare. The program demonstrated high acceptability, providing a reference for establishing clinical transition service protocols. However, this study was a single-center, quasi-experimental trial with a small sample size and short intervention duration. The findings need to be confirmed by larger-scale randomized controlled trials to verify efficacy.