Perception of epilepsy among public workers: perspectives from a developing country

Experiences of stigma in people with epilepsy: A meta-synthesis of qualitative evidence

OBJECTIVE

Stigma is reported to cause as much distress and effect on quality of life for individuals with epilepsy as the physical symptoms of seizures. Existing quantitative reviews have focused on describing levels of stigma in epilepsy, but no qualitative review has been undertaken despite the increasing number of relevant studies. We provide a qualitative synthesis to aid the understanding of stigma experiences in adults with epilepsy across different sociocultural contexts.

METHODS

A systematic database search yielded an initial set of 3,032 relevant papers, of which 28 were included. A meta-synthesis was conducted according to a meta-ethnographic approach which has been adapted for health research.

RESULTS

Five themes were generated: 1) Societal negative perceptions of epilepsy result in discrimination and rejection; 2) Internal attributions of blame lead to negative self-perception and shame; 3) Stigma impacts everyday life and contributes to reliance on others; 4) Stigma is managed through concealment and avoidance; 5) Support from others is beneficial but dependant on own and others' understandings of epilepsy. These themes highlighted the key individual experiences of epilepsy stigma, which appeared to some degree culture-specific. Culturally-informed misconceptions of epilepsy were readily internalised, resulting in emotional challenges and affecting participants' lives. Strategies for coping with this were also described.

SIGNIFICANCE

This synthesis characterised the experiences of stigma among adults with epilepsy and highlighted key similarities and differences in these experiences across sociocultural contexts. Educational programmes to inform communities about epilepsy hold importance going forward.

Knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy: A systematic scoping review

BACKGROUND

In today's healthcare systems, physiotherapists are one of the most important providers of care services to patients with disabilities including those with epilepsy. The aims of this systematic scoping review were to identify, summarize, and present narrative synthesis of qualitative evidence on knowledge, attitudes, and practices of physiotherapists toward epilepsy and patients with epilepsy.

METHODS

Primary studies were searched in Medline/PubMed, Embase, Science Direct, SpringerLink, CInAHL/EBSCO, Cochrane library, and Scopus as late as July 02, 2021. Appraisal of the methodological quality was conducted for the studies included in this systematic scoping review. Due to the heterogenous nature of the collected data, results of this study are presented as narrative synthesis.

RESULTS

A total of 11 were finally included in the qualitative synthesis. The selected studies were published in the period between 2016 and 2020. The studies included in this review had acceptable methodological quality in many of the 11 domains of the quality assessment tool. Contents of the included studies were grouped into the 11 themes and 8 subthemes. The major themes were related education/access to information, interaction with patients, witnessing seizures, barriers and promoters of adequate knowledge and attitudes, and interventions to improve knowledge and attitudes.

CONCLUSION

Currently, high-quality interventional studies are needed to improve knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy. Future studies are still needed to investigate if improving knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy can improve health-related outcomes of the patients.

Stigmatizing Diagnoses in Neurosurgery: A Narrative Review

Stigma is defined as a social process resulting in labeling, stereotyping, and separation that cause status loss, disapproval, rejection, exclusion, and discrimination of the labeled individuals. Stigma can be experienced by individuals or groups, can be real or perceived, and can include a wide array of characteristics (e.g., race/ethnicity, gender, and health conditions). It is well documented that stigma for health conditions is a barrier to treatment and leads to worse outcomes for vulnerable people. The purpose of this study is to examine the increasingly mature field of stigma theory and research, and how this relates to the practice of neurosurgery. This review provides an overview of stigma and its application in a neurosurgical setting, including diagnoses treated by neurosurgeons as well as diagnoses with impact on neurosurgical outcomes. Examples of stigmatizing diagnoses of relevance to neurosurgical practice include epilepsy, pain, smoking, obesity, and substance use disorder. This information is useful for the practicing neurosurgeon to understand the origins and higher-order effects of societal perceptions surrounding certain diagnoses, and the subsequent effects on health that those perceptions can create on a systemic level.

A Study on Childhood Epilepsy among Traders in Benin City Nigeria

BACKGROUND

Epilepsy is a serious childhood disease associated with stigmatization in the community. Despite the deleterious effect of the disease on childhood brain growth and development, the disease is treatable.

OBJECTIVE

The aim of this study is to document the knowledge of childhood epilepsy by community members using traders (market women and men in a popular market in Benin City, Nigeria) as a case study.

METHODOLOGY

This was a descriptive cross-sectional study carried out in April 2018. Data collection was by researcher-administered questionnaire. The respondents were traders (women and men) in Edaiken market Benin City Nigeria who were recruited consecutively during the period of the study. The analysis was performed using the Statistical Package for the Social Sciences version 21, and the level of statistical significance of variables was set at 95% confidence level and P < 0.05.

RESULTS

Of the 500 respondents, 47 (9.4%) males and 453 (90.6%) females; mean age (standard deviation) was 35.3 ± 9.4 years. Total knowledge score of childhood epilepsy in this study was 27.6%. Only 116 (23.2%) study participants gave correctly a description of epileptic fits in a child. Although majority 71.0% said that epilepsy has the medical cure, none was able to mention any known drugs for the treatment of epilepsy and 72.6% said that they would use traditional remedies.

CONCLUSION

The overall observed knowledge score of childhood epilepsy was low. Although most respondents stated that epilepsy has medical cure, majority preferred the traditional options for treatment. These findings, therefore, highlighted the need to enlighten the public about childhood epilepsy and its medical treatment options.

Marriage in epilepsy: The impact of the question in knowledge, attitude, and practice surveys

BACKGROUND

Knowledge, attitudes, and practice (KAP) questionnaire-based surveys have captured negative attitudes towards marriage involving people with epilepsy (PWE). The attitudes may vary according to the nature of the question posed, whether personal or generic, in addition to many other covariates.

METHODS

We carried out meta-proportion and -regression analyses of epilepsy-related KAP surveys published between 1970 and 2016 in the medical literature analysis retrieval system online (MEDLINE) database.

RESULTS

The pooled estimate of the proportion of those responding positively to the marriage question was 0.45 (95% confidence interval (_95%CI): 0.35 to 0.54; I²_res = 99.89%). The pooled proportion of positive responders to a personal question (0.40; _95%CI: 0.35 to 0.46) was significantly lower than those responding positively to a generic question (0.64; _95%CI: 0.57 to 0.70) (P = 0.001). When modeled individually in regression analyses, only the continent of origin of the survey (P = 0.001; tau²: 0.06; I²_res: 99.8%; adjusted R²: 11.4%) and subject population type (P = 0.02; tau²: 0.07; I²_res: 99.9%; adjusted R²: 4.2%) were associated with the pooled estimate of positive responders to the question on marriage.

CONCLUSIONS

Personal questions probing the possibility of marriage of self or family members to someone with epilepsy bring about negative attitudes more often than generic questions inquiring the marriage-worthiness of PWE.

Knowledge, attitudes, and first-aid measures about epilepsy among primary school teachers in northern Iran

OBJECTIVE

To assess knowledge, attitudes, and first-aid measures about epilepsy among primary school teachers.

METHOD

This cross-sectional study was conducted with participation of 342 primary school teachers during September 2016 to January 2017 in cities of Babol and Qaem-Shahr in Mazandaran Province in northern Iran. Primary schools were selected using simple random sampling. Data were collected through interviews using a structured questionnaire. The knowledge section included general knowledge, causes, symptoms, seizure triggers, first-aid measures, and recommended treatments. The Likert scale was used for the attitudes section. Answers about first-aid measures were categorized as helpful or harmful.

RESULTS

The level of total knowledge score of 25 (7.7%) teachers was very high, 140 (43.3%) high, 141 (43.8%) moderate, and 17 (5.2%) low. The mean score about general knowledge was as follows: 6.1 (1.9), range = 0-9; causes 6.3 (1.9), range = 0-10; symptoms of seizures 8.5 (2.5), range = 0-12; and first-aid measures 6.8 (2.0), range = 0-11. Some 83% knew not taking anticonvulsants regularly could trigger seizures, and all teachers said a person with epilepsy should go see a physician. Attitudes were generally positive except for marriage and having children. The level of first-aid measures score of 8 (7.2) teachers was very high, 79 (70.5) high, 25 (22.3) low. Teachers with teaching experience at special schools took more helpful measures CONCLUSIONS: The knowledge of teachers about epilepsy was insufficient, attitudes toward people with epilepsy were generally positive, and first-aid measures at the last witnessed seizure were fairly helpful. Having teaching experience in special schools had a positive influence over knowledge and taking appropriate first-aid measure at time of the last witnessed seizure.

Knowledge, attitudes and practices regarding epilepsy in the Kingdom of Bhutan

OBJECTIVE

To assess the knowledge, attitudes and practices of epilepsy among healthcare workers (HCWs) and people with epilepsy (PWE) living in Bhutan.

METHODS

A survey with similar questions was distributed to HCWs and PWE (2014-2015). Responses were compared between the two groups. A Stigma Scale in Epilepsy Score was tested for an independent association with patient age, sex, years of education and presence of seizure freedom using regression models.

RESULTS

PWE (n=177), when compared to HCWs (n=75), were more likely to believe that epilepsy is contagious; epilepsy results from karma or past actions; PWE need help in school; and people with epilepsy have spiritual powers (p<0.05 for each comparison). Among people with epilepsy, a higher stigma score was independently associated with lower educational attainment (p=0.006) and presence of a seizure in the prior year (p=0.013), but not age, sex or anti-epileptic drug side effects.

CONCLUSIONS

While knowledge of epilepsy was overall fairly high, PWE more often held certain stigmatizing beliefs, including theories of contagion and a relationship between seizures and spiritual powers. Higher educational level and seizure freedom were associated with lower stigma, underscoring their importance in stigma reduction.

Perception of, attitudes toward, and knowledge of epilepsy among teachers and high school and college students in Sicily

The study was aimed at investigating perception of, attitudes toward, and knowledge of epilepsy among college students of the University of Messina in Sicily (Italy), high school students, and teachers from Sicily in order to structure health educational programs to remediate inadequate knowledge and stigma about epilepsy. Participants in this study consisted of 932 subjects (571 males, 361 females) aged between 13 and 63 years old (M 21.75 ± 8.7): 571 college students aged between 18 and 35 years old (M 21.54 ± 2.59), 62 teachers aged between 38 and 63 years old (M 51.18 ± 6.27), and 299 high school students aged between 13 and 19 years old (M 16.05 ± 1.67). Measures were two anonymous questionnaires to collect sociodemographic information and to assess knowledge of, attitudes toward, and perception of epilepsy. Analyses were performed with descriptive statistical analysis (mean, standard deviation, frequency counts, and percentages) and Mann-Whitney U-test nonparametric for two independent samples. This study provides general information about psychosocial aspects of epilepsy in Sicily which provides the basis for further studies and the development of interventions to eliminate prejudices against persons with epilepsy and related myths.

Knowledge and attitudes towards epilepsy in Zambia: a questionnaire survey

Misconception and stigma towards epilepsy have a profound impact on this disease in Africa. An unselected sample of Zambian people was interviewed to investigate their knowledge and attitudes towards epilepsy. Proper/improper answers were scored, and a composite score was developed with negative values for unsatisfactory awareness and high stigma levels. The sample comprised 231 people residing in urban (107) or in rural (124) areas. The median and interquartile range of scores for epilepsy awareness and stigma were, respectively, -1 (-3; +1) and +1 (-1; +6). Poor education was the only significant predictor of unsatisfactory awareness (p=0.0131), while education and residency were significantly associated with stigma (p<0.0001 and p=0.0004). Rural people were mostly in the highest stigma level (44.2%) and urban people in the lowest stigma level (60.4%). Misconception and negative attitudes towards epilepsy among Zambian people reflect poor education and rural residency.

A lay carer's story about epilepsy in an urban South African context: they call it an illness of falling or an illness of fitting because a person shakes and eventually falls

In South Africa, epilepsy is poorly understood and managed. The different cultural understandings and terms used to explain the condition across the diverse population groups exacerbate this problem. In this article, we describe the findings from a single story about epilepsy which we elicited through a semistructured interview guide in the respondents' natural setting. We used Kleinman and Benson's mini-ethnographic questions to explore the lay carer's explanatory models about epilepsy. Our respondent had different descriptors for epilepsy which include 'an illness of falling', 'an illness of fitting', and 'a thing'. His explanatory models concerning epilepsy were predominantly sociocultural, psychological, economical, and political in nature and were supported by personal examples from his past and present experiences. Key to this man's story is the reality of a strong cultural base of understanding epilepsy, with the added reality of an urbanized world in which people feel alienated from one another and do not necessarily share the same cultural beliefs and practices. Instead of viewing understandings of epilepsy as either 'traditional' or 'western', community-based health promotion interventions must therefore recognize both cultural issues and urban realities and should also incorporate approaches that foster a common ground for patients and carers with very diverse views. The findings of this one interview cannot be generalized but have implications for managing epilepsy in an urban African context.