Beyond Barriers: Contextual Facilitators and Challenges to Epilepsy Care in Rural and Peri-Urban Ghanaian Communities

Background: Epilepsy affects more than 50 million people worldwide, with nearly 80% of them living in resource-poor settings. We explored the contextual facilitators and barriers influencing access to and continuity of care for people with epilepsy in the Shai Osudoku and Ningo Prampram districts of Ghana.

Methods: We employed a qualitative design grounded in Social Support Theory and Health Utilisation Theory, drawing on oral histories from people with epilepsy. We also conducted in-depth interviews with carers, healthcare providers, spiritualists, religious leaders, and traditional healers. Additionally, we conducted focus group discussions with community members. Data were transcribed and analysed using reflexive thematic analysis supported by NVivo software.

Findings: We obtained histories from 50 people, conducted interviews with 10 carers, 10 healthcare providers, 6 spiritualists, 5 religious leaders, and 10 traditional healers, and held 12 focus group discussions. Three key themes emerged. First, health system challenges, such as inadequate epilepsy services, inconsistent medication supply, and limited professional training, disrupted continuity of care. Second, community factors, such as proximity to health facilities, health education, and outreach programs, facilitated treatment adherence and care-seeking behaviour. Third, socioeconomic issues, especially poverty and mobility barriers, hindered engagement with biomedical care and complicated transitions from traditional and spiritual care pathways. These findings demonstrate how structural health system shortcomings intersect with social and community support systems to shape epilepsy care in resource-limited settings.

Interpretation: Epilepsy care in rural and peri-urban Ghana is influenced by a complex interplay of health system, socioeconomic, and community factors. The results emphasise how structural shortcomings in African health systems can disrupt ongoing care for chronic neurological conditions. Improving decentralised epilepsy services, ensuring consistent access to antiseizure medications, enhancing provider training, and increasing community outreach and support may boost treatment adherence and close the epilepsy treatment gap in resource-constrained settings.