# Effects of a Transtheoretical Model–Based mHealth Intervention on Transition Readiness in Adolescents With Epilepsy: Quasi-Experimental Study

## TL;DR

A mobile health program based on the transtheoretical model improved transition readiness and self-management in adolescents with epilepsy over six months.

## Contribution

This study introduces a TTM-based mHealth intervention to enhance transition readiness in adolescents with epilepsy.

## Key findings

- The intervention group showed significantly better self-management behavior stages compared to the control group.
- Participants in the intervention group achieved higher scores in medication management, healthcare engagement, and transition readiness.
- The program had high acceptability with satisfaction scores of 4.43 for patients and 4.16 for healthcare providers.

## Abstract

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 provides a framework for reducing intervention costs while personalizing care.

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

A total of 98 adolescent patients with epilepsy aged 12-18 years were recruited. Using a nonrandomized 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 mHealth management program, which included phase-specific group sessions led by a multidisciplinary team and conducted via Tencent Meeting every 2 weeks or monthly (biweekly for the precontemplation, 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 6 months for both groups. Outcomes were assessed after 6 months using the self-management stage, Self-Management and Transition to Adulthood with Rx=Treatment questionnaire, and a self-developed program acceptability questionnaire.

Postintervention, the intervention group demonstrated significantly better self-management behavior stages compared with controls. At the end of 6 months of intervention, the majority of participants in the intervention group reached the action stage (16/49, 32.65%) and maintenance stage (14/49, 28.57%), whereas most controls remained in precontemplation (12/49, 24.49%) and contemplation stages (13/49, 26.53%). Both groups showed significant improvements from baseline in medication management, health care participation, disease knowledge, doctor-patient communication, and transition readiness total scores at 6-month follow-up (all P<.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 d] ranged from 0.527 to 0.864, indicating moderate-to-large clinical effects). The overall satisfaction scores were 4.43 (SD 0.50) for patients and 4.16 (SD 0.82) for health care providers.

The TTM-based mHealth 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 health care. 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.