Epilepsy and teachers: a survey

'To reveal or to conceal'- Disclosure strategies in parents of children with epilepsy in India

PURPOSE

Disclosure of epilepsy is a relevant but under-researched topic in epilepsy research. This study was done to assess the disclosure strategies in parents of CWE in a developing country with conservative culture. The study also assessed the influence of demographic factors and seizure characteristics on the choice of disclosure. Enablers and barriers behind disclosure and the consequences after disclosure were evaluated.

METHODS

A cross-sectional analytical, self-report survey was done in 284 parents of CWE with the help of a semi-structured questionnaire over a 7-month period in the paediatric epilepsy clinic. Disclosure was considered present if epilepsy was revealed to two or more of the five target groups (extended family, school, friends, neighbours, and peers of children). Separate set of questions was given for reasons behind their choice and consequences after disclosure. For continuous variables, unpaired T test or Mann - Whitney U test between group and for categorized variables, Pearson's Chi square test or Fisher's exact test was used.

RESULTS

92.96 % of 284 subjects disclosed their child's epilepsy while 7.04% concealed. Demographic factors and seizure characteristics did not influence the disclosure choice. Most parents revealed to the extended family followed by teachers. Type of seizure was the commonest information revealed. The main reason behind disclosure was better acceptance of the child followed by safety while main barrier was considering epilepsy as private grief. 92.8% felt their children were better accepted after disclosure.

CONCLUSION

Disclosure practices have improved in parents of CWE in India and well-being and safety of the child has overridden the fear of stigma and discrimination. This could be the first major step to bring epilepsy out of the shadows at national and global levels.

Teachers' knowledge about epilepsy in Greece: Information sources and attitudes towards children with epilepsy during school time

AIM

The aim of this study was to explore the sources of information for the educators in Greek primary and secondary schools with regard to epilepsy, first aid to seizures, and pupils' health conditions.

METHOD

A semistructured anonymous 52-item questionnaire was sent to 100 public primary and secondary Greek schools from all districts. Two thousand thirty-seven teachers were approached; 446 questionnaires returned. The data were analyzed with SPSS20. Also, 70 head teachers were phone-interviewed with an open-ended unstructured questionnaire. The derived data were analyzed using mixed methodology.

RESULTS

Twenty-two percent of the addressed educational community responded to the questionnaire, mostly women (66.6%). More responses came from urban areas (71.5%). The main source for the teachers to obtain information about epilepsy was found to be personal experience (37.75%) and internet (34.93%). Only a small percentage was referred to courses (6.2%). Eighty point three percent of the educators knew what epilepsy is, and 88.1% had the right view about the nature of the illness. However, 92% of the educators replied that they have not had adequate first aid training. Although 80.3% of the teachers believed that the school personnel are aware of the pupils' medical history, 85.48% of the teachers considered that they are informed about the pupils' condition from the parents/carers, and only 5.53% believed that the information came from the family doctor. Ninety-five point seventy percent of the educators declared a wish for further information and training about epilepsy.

CONCLUSION

Knowledge and attitudes of the educators towards epilepsy are improved compared with those reported in previous studies conducted in Greece. However, there are still areas of uncertainty which need improvement. The necessity for more information about epilepsy and pupils' medical history along with appropriate training about seizure incidents seems crucial for the Greek educational community. Educational campaigns about epilepsy could improve teachers' knowledge of epilepsy to develop a well-informed and tolerant community. Further research in the field is necessary to provide teachers with accurate information about the illness and the ways to cope with it.

To tell or not to tell: A systematic review of the disclosure practices of children living with epilepsy and their parents

Disclosing an epilepsy diagnosis to others is complex due to the condition's largely invisible nature and associated stigma. Despite this, little has been documented in terms of what this process involves for children living with epilepsy (CWE) and their parents. A systematic review was conducted to examine and synthesize evidence pertaining to: (i) the disclosure practices of CWE and their parents, (ii) enablers and barriers for disclosure, (iii) the impact of disclosure practices, and (iv) the relationship between disclosure management and other variables. The electronic databases PsycINFO, PubMed, MEDLINE, CINAHL, Scopus, and Web of Science were searched systematically. Any empirical, peer-reviewed journal articles with findings reported regarding the self- or proxy-reported disclosure practices of children aged 0-18years with any type of epilepsy and/or their parents were deemed eligible for inclusion. Two review authors completed all stages of screening, data extraction, and quality assessment independently with two additional review authors resolving any discrepancies. A total of 32 articles were included in the review. Only one dated study examined disclosure as a primary focus; in the remaining studies, disclosure was a subfocus of larger studies or pertinent qualitative themes/subthemes incidentally emerged. The limited evidence suggests that: 1) CWE and parents adopt varying disclosure management strategies - from concealment to voluntary disclosure; 2) disclosure decisions are challenging for CWE and parents; 3) many barriers to disclosure exist (e.g., fear of stigmatization and rejection); 4) only a limited number of factors that enable disclosure are known (e.g., openness by others to engage with and learn about epilepsy); 5) disclosure management is significantly related to a number of variables (e.g., child/maternal perceived stigma and seizure control); and 6) there are varying outcomes for CWE and/or their parents in accordance with the adoption of specific disclosure management strategies (e.g., disclosure resulting in greater acceptance and the receipt of support or evoking anxiety/fear in others; and concealment resulting in misunderstandings, embarrassment, and stigma-coaching), but the evidence remains inconclusive in terms of which disclosure management strategy is optimal. While some preliminary work has been conducted, disclosure of epilepsy is a topic that has been largely neglected to date. This is despite the fact that disclosure is a significant source of concern for CWE and parent populations. Future studies should focus on elucidating the unique contextual factors that inform disclosure decisions in order to develop a theoretical framework that can explain the epilepsy disclosure decision-making process.

Familiarity with, knowledge of, and attitudes toward epilepsy among teachers in Korean elementary schools

We investigated familiarity with, knowledge of, and attitudes toward epilepsy among teachers in elementary schools in Korea, where there is profound prejudice against epilepsy. Most of the teachers thought that epilepsy is a genetic disease. They agreed that children with epilepsy (CWE) should attend regular classes (although with some restriction of school activities) because their academic achievement would be comparable to that of children without epilepsy. However, half of the teachers opposed having CWE in their own classes because they feared a child having a seizure during class and they felt they lacked knowledge of first-aid for seizures. Those teachers who had inaccurate clinical knowledge of epilepsy also demonstrated negative attitudes toward the marriage and employment of persons with epilepsy. We conclude that information about epilepsy should be included in teacher training programs so as to increase their level of knowledge of epilepsy and correct prejudices against epilepsy.

Teachers' perceptions in central Turkey concerning epilepsy and asthma and the short-term effect of a brief education on the perception of epilepsy

This study was aimed at assessing and comparing schoolteachers' perceptions of epilepsy and asthma in central Turkey. Two-hundred seventy-five schoolteachers completed a questionnaire on their knowledge, attitudes, and practice. There were 18 pairs of questions on the questionnaire (one question in each pair pertained to epilepsy, and the other to asthma). One month later, following a brief education program on epilepsy, participants completed the epilepsy section of the questionnaire a second time. Among the teachers, initial rates of acceptance of children with epilepsy were significantly lower than the rates for asthma. Children with epilepsy were less encouraged by teachers to play with others and were perceived as more aggressive. More teachers were worried about other parents objecting to having a child with epilepsy in the class. Following the brief education program, there was a significant positive change in the teachers' perception of epilepsy.

Knowledge and attitude of the Greek educational community toward epilepsy and the epileptic student

The purpose of this study was to investigate primary and secondary school teachers' knowledge of and attitudes toward epilepsy and the epileptic child. A 14-item questionnaire was administered to 300 teachers in three major Greek cities. The focus of interest was the teachers' basic knowledge of epilepsy, their perceptions of the consequences of epilepsy on a student's academic potential and behavior, their tendency to accept or reject the epileptic child, and their ability to help a convulsing child. The majority of teachers have a correct opinion about the nature of epilepsy and its short-term prognosis (control by medication), but are very pessimistic about its long-term prognosis (cure). They believe that although some epileptic children may have mental, learning, or behavioral problems, most of then do not and are therefore capable of academic achievements. The attitude of most teachers is very positive toward the epileptic child, and almost all believe that these children should continue their studies at their regular school. An alarming finding is the reported inability of most teachers to help a convulsing child. Personal knowledge of an epileptic student was a significant factor in determining many of the teachers' responses. Better education of teachers concerning epilepsy and the practical skills involved in first-aid are necessary measures for Greek teachers.