Epilepsy misconceptions and stigma reduction: Current status in Western countries

Clinical correlates of perceived stigma among people living with epilepsy enrolled in a self-management clinical trial

BACKGROUND AND PURPOSE

Stigma is a pervasive barrier for people living with epilepsy (PLWE) and can have substantial negative effects. This study evaluated clinical correlates of perceived stigma in a research sample of PLWE considered to be at high risk due to frequent seizures or other negative health events.

METHODS

Analyses were derived from baseline data from an ongoing Centers for Disease Control and Prevention (CDC)-funded randomized controlled trial (RCT) testing an epilepsy self-management approach. Standardized measures assessed socio-demographics, perceived epilepsy stigma, epilepsy-related self-efficacy, epilepsy self-management competency, health literacy, depressive symptom severity, functional status, social support and epilepsy-related quality of life.

RESULTS

There were 160 individuals, mean age of 39.4, (Standard deviation/SD=12.2) enrolled in the RCT, 107 (66.9 %) women, with a mean age of epilepsy onset of 23.9 (SD 14.0) years. The mean seizure frequency in the prior 30 days was 6.4 (SD 21.2). Individual factors correlated with worse perceived stigma were not being married or cohabiting with someone (p = 0.016), lower social support (p < 0.0001), lower self-efficacy (p < 0.0001), and lower functional status for both physical health (p = 0.018) and mental health (p < 0.0001). Perceived stigma was associated with worse depressive symptom severity (p < 0.0001). Multivariable linear regression found significant independent associations between stigma and lower self-efficacy (β -0.05; p = 0.0096), lower social support (β -0.27; p = 2.4x10-5, and greater depression severity (β 0.6; p = 5.8x10-5).

CONCLUSIONS

Perceived epilepsy stigma was positively correlated with depression severity and negatively correlated with social support and self-efficacy. Providers caring for PLWE may help reduce epilepsy stigma by screening for and treating depression, encouraging supportive social relationships, and providing epilepsy self-management support. Awareness of epilepsy stigma and associated factors may help reduce some of the hidden burden borne by PLWE.

Validation of the Japanese version of the scales of the attitudes toward people with epilepsy (SAPE-J)

OBJECTIVE

The aims of this study were to translate the SAPE questionnaire (Scales of the Attitudes toward People with Epilepsy) questionnaire developed in Germany that assesses attitudes toward people with epilepsy (PWE) into Japanese and to examine its reliability and validity.

METHODS

We crafted the Japanese version of SAPE (SAPE-J) by drawing upon the original German version. On May 22nd and 23rd, 2023, we surveyed the general public registered with an online research survey service (Cross Marketing Group Inc., Tokyo, Japan) using an online questionnaire. Inclusion criteria were an age of ≥18 years, sufficient reading and speaking skills in Japanese, and the ability to comprehend the Japanese questionnaires. In addition to the translated SAPE-J, we asked about knowledge of epilepsy, personal experience with epilepsy, and gathered information about age, gender, employment status, education level, marital status, and household income in accordance with the validation of the German version of the SAPE.

RESULTS

400 adults from the general public who had heard or read about epilepsy were asked to participate, granted informed consent, and completed the study questionnaire. The SAPE-J questionnaire has 6 scales: 1. Social Distance; 2. Stereotypes; 3. Concerns when encountering a person with epilepsy (PWE) and emotional reactions differentiated by 4.1 Fear, 4.2. Anger, and 4.3 Pity; with a total of 26 items. The reliability of these scales ranged between acceptable to high (Cronbach's alpha 0.74-0.92) and confirmatory factor analyses (CFA) confirmed the presumed six-factor structure of the SAPE (factorial validity). Multivariate generalized linear models (GLM) were used to investigate the construct validity and showed that, depending on subscale, different variables such as age, gender, education level, personal contact to PWE, and epilepsy specific knowledge were significant predictors of attitudes.

SIGNIFICANCE

The Japanese version of the SAPE proved reliable and valid for assessing attitudes toward PWE in the Japanese public. Increasing understanding about how to deal with and accept persons with epilepsy may help reduce negative attitudes and fears about the condition.

PLAIN LANGUAGE SUMMARY

The study translated the German SAPE questionnaire, which measures attitudes toward people with epilepsy (PWE), into Japanese and tested its reliability and validity. The Japanese version (SAPE-J) was created and surveyed online among 400 adults in Japan. The SAPE-J has 6 scales covering social distance, stereotypes, and emotional reactions like fear, anger, and pity. Reliability was high (Cronbach's alpha 0.74-0.92), and factor analyses confirmed its structure. The study found age, gender, education, and personal contact with PWE influenced attitudes. The SAPE-J is reliable and valid for assessing attitudes toward PWE in Japan, potentially reducing negative views and fears about epilepsy.

Four questions to assess attitudes toward epilepsy, the caveness questions: Analytical study to verify the usefulness of the Japanese version

Objective

This study sought to translate the Caveness questions (CQs), initially formulated in the United States for assessing attitudes toward people with epilepsy (PWE), into Japanese. Concurrently, the study examined the translated instrument's psychometric properties, specifically the usefulness within Japan's cultural and linguistic context.

Methods

We crafted the Japanese version of CQs-J by drawing upon the original English and German versions. Subsequently, On May 22nd and 23rd, 2023, we administered an online questionnaire survey to the general public registered with the online research survey service (Cross Marketing Group Inc., Tokyo, Japan). Inclusion criteria comprised an age of ≥18 years, processing proficient reading and speaking skills in Japanese, and demonstrating the ability to comprehend the Japanese questionnaires. In addition, we included questions about age, gender, education levels, employment status, and any experiences with epilepsy.

Results

A cohort comprising 400 ordinary people processing prior exposure to information regarding epilepsy participated in the study. Participants provided informed consent before proceeding to complete the study questionnaire. The CQs-J, encompassing following four items.CQ1) Would you object to having any of your children in school or at play associate with persons who sometimes had seizures (fits)?CQ2) Do you think epilepsy is a form of insanity or not?CQ3) Do you think epileptics should or should not be employed in jobs like other people?CQ4) Would you object to having a son or daughter of yours marry a person who sometimes has seizures (fits)?We compared CQs-J groups with negative or positive attitudes towards epilepsy, taking into account age, gender, employment status, education levels, and knowledge and experiences of the condition. Those who responded to the CQ1 question that they would object to their child's occasional association with someone at school or at play who has seizures (fits) were significantly more negative in their experiences with epilepsy: they did not understand what to do during seizures (Ex3, p < 0.01), and they did not believe in the effectiveness of epilepsy treatment (Ex4, p < 0.01). In addition, males were significantly more likely to respond that epilepsy is insanity when asked the CQ2 question (p < 0.001). Additionally, in CQ3, do you think people with epilepsy should have the same access to jobs as other people with epilepsy? Significant differences were found for younger age, a lower overall Epilepsy Knowledge Scale score (p < 0.001), being employed (p = 0.028), Ex3 (p = 0.041), and Ex4 (p < 0.01). Finally, older people were significantly more opposed to marrying someone who has seizures in CQ4 (p < 0.001) or is not working, and others were also significantly more opposed (p = 0.030).

Significance

We evaluated the utility of the Japanese version of the CQs, demonstrating its effectiveness for assessing treatment strategies in stigma reduction and enabling cross-cultural comparisons of attitudes towards epilepsy. In large-scale social surveys, the CQs-J scale effectively captures broad attitudes toward epilepsy with a limited number of items and offers the advantage of ease of use for longitudinal studies, such as tracking changes in attitudes over time. Furthermore, we expect the CQs-J results to facilitate in-depth cross-cultural comparisons of attitudes toward epilepsy by comparing them across different cultures.

Historical roots of the stigma of epilepsy: A review of the classic Iranian literature

BACKGROUND

The stigma toward epilepsy is a daily challenge for people with epilepsy (PWE) and can influence the well-being and prognosis of these individuals. However, the cultural origins of such stigma have sparsely been examined. In this study, we aimed to investigate the classic Persian literature to gain insight into the historical and cultural beliefs and opinions regarding epilepsy as a determinant in developing stigma towards PWE.

METHODS

In this narrative review of the classic Persian literature, we investigated the opinions and beliefs regarding epilepsy and PWE. In February 2023, we searched https://ganjoor.net (an open-access database of Iranian literature) for the relevant literary materials (poem and prose) using the Persian translation of the terms epilepsy (Sar'e) and epileptic (Masroo'e). Two clinical researchers went through the results and extracted the related materials under the supervision of two experts in Persian literature. A bilingual academic translated the included literary materials from Persian to English.

RESULTS

Our search yielded 57 literature materials by 31 poets and writers from the 4th to 14th Hijri centuries, roughly coinciding with the past Gregorian millennium (1000-2000 AC). We classified the literary concepts related to epilepsy stigma into five subgroups: (i) a simile for pain and suffering; (ii) an atonement for blasphemous beliefs or a disease caused by supernatural power; (iii) a sign of madness, insanity, and lack of wisdom; (iv) a celestial observation; and (v) a subject for jokes.

CONCLUSIONS

Classic Persian literature considered epilepsy as a simile for suffering and a sign of insanity that is caused by blasphemous beliefs or celestial objects, with PWE classified as insane and unwise. While such depictions became less prevalent after the 14th century CE, they can give rise to misconceptions and negative stigma toward PWE and should be addressed in modern culture. Each society should critically investigate its socio-cultural origins of stigma and rectify such misbeliefs.

Epilepsy knowledge and attitudes: A large observational study among the Palestinian general public

Background

Epileptic seizures are often misunderstood as supernatural power or satanic possession in different cultures around the world. Therefore, people with epilepsy (PWE) suffer discrimination, prejudice, and stigma. The epilepsy knowledge and attitude (EKA) of the Palestinian general public were not assessed before. Therefore, this study assessed the EKA of the Palestinian general public. In addition, the study identified the characteristics that were associated with EKA.

Methods

This was a large cross-sectional study that was conducted using a self-administered instrument. The study participants were invited and recruited from the Palestinian general public. The EKA were assessed using 16 knowledge items and 13 attitude items.

Results

In this study, responses were collected from 746 participants. Knowledge scores were significantly associated with having a university degree, satisfaction with household income, adequate knowledge about epilepsy, having acquaintances with epilepsy, and having witnessed someone experiencing epileptic seizures. Attitude scores were significantly associated with living in urban areas, being married, having a university degree, satisfaction with household income, adequate knowledge about epilepsy, having acquaintances with epilepsy, and having witnessed someone experiencing epileptic seizures.

Conclusion

Large knowledge gaps and negative attitudes toward PWE were identified among the Palestinian general public. These findings might be considered a call to increase knowledge and correct negative attitudes toward PWE. Decision-makers need to design and implement effective measures to increase knowledge and correct negative attitudes toward PWE. Further studies are still needed to assess the effectiveness of these measures in increasing knowledge and positive attitudes toward PWE.

A community-based awareness program improves knowledge and attitudes toward epilepsy: An interventional study

OBJECTIVE

Little interventional studies were conducted to improve knowledge, improve attitude, and eliminate stigma against patients with epilepsy. This study was conducted to investigate the effect of a community-based epilepsy awareness program (CBEAP) on knowledge, attitude, and stigma against patients with epilepsy among the Palestinian general public.

METHODS

This interventional study used a pre-post design. Knowledge and attitudes were assessed using a reliable and internally consistent questionnaire before and 1 month after receiving a CBEAP. Knowledge was assessed using a 16-item and attitudes were assessed using 13 items.

RESULTS

A total of 150 participants completed the questionnaire before the CBEAP. Of those, 136 (90.7 %) completed the CBEAP, and 129 (86.0 %) completed the questionnaire 1 month after receiving the CBEAP. The CBEAP significantly (p-value < 0.05) increased knowledge about the nature of epilepsy and seizures, triggers and treatment options, and patients with epilepsy. Similarly, the CBEAP significantly (p-value < 0.001) improved the attitudes of the participants toward epilepsy or having epilepsy, patients with epilepsy, relationships with patients with epilepsy, and working or staying with patients with epilepsy. Greater changes in knowledge and attitude scores were predicted by younger age and having a close friend or family member with epilepsy.

CONCLUSION

The CBEAP developed and implemented in this interventional study significantly increased the knowledge of the participants about epilepsy and improved their attitudes toward epilepsy and patients with epilepsy. Large-scale implementation of such interventional programs is still needed to increase knowledge and improve attitudes toward epilepsy and patients with epilepsy.

Unfavorable public attitude toward people with epilepsy in Ethiopia: A systematic review and meta-analysis study

OBJECTIVE

This systematic review and meta-analysis aims to show the pooled prevalence of unfavorable public attitude toward people with epilepsy (UPATPWE) as well as the effect estimates of associated factors in Ethiopia.

METHODS

Between December 1 and 31, 2022, we searched for the English version of published research reports on public attitude toward epilepsy in Ethiopia in PubMed/Medline, Science Direct, Cochrane Library, Google Scholar, and PsycINFO. The research reports' quality was assessed using the Newcastle-Ottawa Scale. We extracted the relevant information from the searched papers in a Microsoft Excel format and imported it to STATA version 15.0, for analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reports guideline was used. A random-effects meta-analysis model was used to estimate the Der Simonian and Laird's pooled prevalence of unfavorable public attitude and its associated factors.

RESULTS

Nine out of the accessed 104 research papers meeting the pre-specified criteria were included in this study. The overall pooled prevalence of UPATPWE in Ethiopia is 52.06 (95% CI: 37.54, 66.59), resulting in excommunication, physical punishments, and assaults against people with epilepsy as well as frequent lack of diagnosis and proper treatment. The pooled effect estimates for witnessing a seizure episode were done and it was (AOR = 2.70 [95% CI: 1.13, 6.46]).

SIGNIFICANCE

As interventions and new strategies to change attitudes and facilitate a supportive, positive, and socially inclusive environment for PWE may root in education and scientific research outputs, our result hopefully evokes the policy makers' attention for building a well-designed and comprehensive health education and campaign strategy.

A knowledge-based simple education program for patients with epilepsy in Japan: Effects sustained after the program implementation

PURPOSE

To investigate the effects of an original education program on patients with epilepsy (PWE). The effects on knowledge about epilepsy, attitude to epilepsy, depression scales, and quality of life were investigated.

METHOD

Thirty-five PWE participated in a lecture-style educational program using an original knowledge-oriented textbook. All patients were administered a total of four rating scales: the Knowledge about Epilepsy Scale (KES), the Attitude toward Epilepsy Scale (AES), and the Japanese version of the Quality of Life in Epilepsy Inventory (QOLIE-31-P), the Beck Depression Inventory (BDI). The KES and AES of patients (pKES and pAES) were compared to those of medical students (St) and residents (Rd).

RESULTS

After education, pKES improved and showed significant differences among pre-and post-education and six months later. Before education, pKES was inferior to St and Rd. However, after education, pKES changed and became superior to St and Rd. Six months later, the advantage was lost, but not significantly. PAES also improved after education, with significant differences before, after, and six months later after education. PAES was statistically inferior to St and Rd before education, but the difference disappeared after education, and the effect persisted after six months. The non-depressed (BDI < 20) and depressed groups (BDI ≧ 20) improved in the KES after education. About the AES, the non-depressive group has a statistical tendency, but not the depressive group. At six months, the depressed group's AES is significantly lower than the non-depressed group.

CONCLUSION

While correct knowledge about epilepsy can improve attitudes and perceptions of epilepsy in PWE, special measures are needed for PWE with depression.

Health-related quality of life and associated factors among adult patients with epilepsy in public hospitals of Wolaita zone, southern Ethiopia. An embedded mixed method study

BACKGROUND

The socioeconomic and overall quality of life of patients with epilepsy are significantly impacted by the disease, which is one of the most prevalent chronic noncommunicable brain disorders. Less consideration has, however, been given to research in Ethiopia generally and the study setting in particular. Consequently, the purpose of this study was to assess the health-related quality of life and associated factors among adult patients with epilepsy in public hospitals in the Wolaita zone of southern Ethiopia.

METHODS

A facility-based embedded mixed method with cross-sectional and phenomenological study designs was carried out on 423 adult patients with epilepsy from August 1 to August 30, 2022. Systematic and criterion-purposive sampling was employed for the cross-sectional and phenomenological designs, respectively, to select study participants. Quantitative data were entered into Kobo Toolbox and then exported to SPSS Version 25 for analysis. The frequency, percentage, and cross-tabulation of the different variables were then determined. Finally, the magnitude and associated factors were first analyzed using binary logistic regression and then multivariate logistic regression. P < 0.05 was chosen as the level of statistical significance. An inductive thematic approach was used for qualitative data analysis.

RESULTS

A total of 423 patients with epilepsy were included in the study, making the response rate 100%. The overall prevalence of poor quality of life among patients with epilepsy in the study area was 53 percent (95% CI: 48.24-57.76). Being single (AOR = 4.457, 95% CI: 1.149, 17.282), having poor social support (AOR = 3.741, 95% CI: 2.107, 6.643), having uncontrolled seizures (AOR = 2.154, 95% CI: 1.234, 3.759), and having a high frequency of seizures (AOR = 5.192, 95% CI: 1.574, 17.126) were significantly associated factors with quality of life. Lack of social support, a fear of drug side effects, and worry about their disease were findings from the qualitative perspective added to the perspective of the quantitative findings.

CONCLUSION

One in every two patients with epilepsy in this study had a poor quality of life. Being single, the frequency of seizures, and a lack of social support all have a significant association. Public health initiatives should continue to strive to create positive awareness of epilepsy in society in addition to managing the clinical aspect of the disease.

Psychosocial Basis of Human Sufferings and Poverty in Patients with Neurological and Psychiatric Disorders

Neurological disorders and psychiatric ailments often lead to cognitive disabilities and low attainment of education, pivoting misconceptions, myths, and misbeliefs. Poverty and low educational attainment are intriguingly associated with poor awareness and perception of these diseases that add to the suffering. Poverty goes parallel with a low level of education and is intricately associated with neuropsychiatric ailments, which have the potential to spread transgenerationally. Robust education policies, proper government rules and regulations against the spread of disease-related myths and misconceptions, uplifting medical education in its true sense, voices against consanguinity, and programs to raise scientific perception about diseases can help to throw light at the end of this dark tunnel. In this article, the authors intend to 1) decipher the potential psychosocial basis of human suffering and poverty in patients with neurological and psychiatric disorders, and 2) discuss the apropos way-outs that would potentially mitigate suffering, and alleviate the economic burden and cognitive disabilities of families with neuropsychiatric diseases.

Knowledge and misconceptions about epilepsy among people with epilepsy and their caregivers attending mental health clinics: A qualitative study in Taenia solium endemic pig-keeping communities in Tanzania

OBJECTIVE

Taenia solium (T. solium) neurocysticercosis (NCC) affects the central nervous system and is associated with 30% of acquired epilepsy in some endemic areas. Epilepsy is a stigmatizing disease in many societies and people with epilepsy (PWE) and their families experience discrimination. This study aimed to explore the knowledge, perceptions, and experiences of epilepsy among PWE and their caregivers attending mental health clinics.

METHODS

In T. solium endemic areas of Tanzania, PWE and their caregivers attending mental health clinics were identified and their informed consent was sought prior to study participation. In-depth interviews were conducted in Swahili language and analyzed thematically. The coding was undertaken by two independent researchers using NVivo (Version 12, QSR International).

RESULTS

Thirty-eight participants were interviewed. Three themes were identified during the analysis, namely, knowledge about epilepsy; perception of epilepsy; and experience with epilepsy among PWE and their caregivers. Participants commonly defined epilepsy as a "falling disease," perceived to be caused by witchcraft, and were unaware of the association between T. solium and epilepsy. Stigmatization of epilepsy was reported as a problem. Reported treatment patterns after the initial onset of epilepsy varied widely; however, patients usually began treatment with traditional healing methods, and only later opted for biomedical treatment. Patients had generally poor adherence to antiseizure medication, which could be caused by inadequate knowledge or irregular supply.

SIGNIFICANCE

Level of knowledge about epilepsy was low, and NCC was not mentioned as a cause of epilepsy among participants. Epilepsy was generally perceived to be the result of witchcraft, evil spirits, or curses. Health education is needed, including an explanation of the model of T. solium transmission and the insistence on hygiene measures. This could reduce the number of new infections with T. solium, improve access to prompt biomedical treatment, and improve the lives of PWE.

On epilepsy perception: Unravelling gaps and issues

Epilepsy is one of the most common neurological diseases, but it can sometimes be under-reported or have a time delay in diagnosis. This data is not surprising if we consider that a person often seeks medical attention only after presenting a generalized tonic-clonic seizure. Epilepsy diagnostic delay is caused by several factors: under-reporting by patients, under-diagnosed epileptic manifestations by inexperienced clinicians, and lack of time in the emergency setting. The consequences of this delay are increased accidents, a high rate of premature mortality, and economic expanses for the healthcare system. Moreover, people with epilepsy have a higher probability of comorbidities than the general population, such as mood disorders or cognitive problems. Along with recurrent seizures, these comorbid diseases promote isolation and stigmatization of people with epilepsy, who suffer from discrimination at school, in the workplace, and even in social relationships. Public awareness of epilepsy and its comorbidities is necessary to prevent diagnostic delays and overcome social and professional iniquities for people with epilepsy.

Epilepsy and stigma in Africa: Viewpoint of healthcare professionals and combat strategies

Epilepsy is a major public health problem in developing countries where eighty percent (80%) of people with epilepsy (PWE) live. Stigma has psychological consequences as well as serious repercussions on patients' quality of life. This study assesses the perception of health professionals in Africa regarding the stigmatization of PWE.

METHODOLOGY

This is a multicenter descriptive, cross-sectional study, from 1st August 2020 to 1st September 2021. Medical practitioners from African countries involved in the management of epilepsy and who agreed to fill out forms were included in the study. Sampling was nonrandom and based on respondent choice. The data were analyzed using the EPI INFO 7 software.

RESULTS

A total of two hundred and twenty-nine (229) health workers from twenty-six (26) African countries participated in this survey. 24.89% of the respondents were specialists and 46.72% were neurologists. Ninety-one percent (91%) of practitioners felt that PWE were stigmatised. The main forms of stigma were isolation (68.56%), celibacy (60.70%), unemployment (53.28%), divorce (44.54%) and exclusion (37.99%)%). Community, school and family were recognized as the main places of stigmatization. The fight against this stigma was carried out mainly in hospitals and in isolation in 58.4% and 55.8% of cases, respectively. Only 0.4% of practitioners opted for mass awareness.

CONCLUSION

PWE are victims of various forms of stigmatization, particularly in community settings. Measures aimed at raising awareness of the public are essential to reduce this stigma and improve patients' quality of life.

Epilepsy life skill education guidelines for primary school teachers and learners in Limpopo and Mpumalanga Provinces, South Africa: Multiphase mixed methods protocol

Epilepsy is a disorder in which nerve cell activity in the brain is disturbed, causing seizures. It may result from a genetic condition and occurs mainly in children, especially at a primary level. Most people living with Epilepsy suffer from stigma and discrimination because of a lack of knowledge regarding Epilepsy. This study aims to develop life skills education guidelines for primary school learners of Limpopo and Mpumalanga provinces to educate learners about Epilepsy, thus decreasing stigma and discrimination. A multimethod research approach will be used in this study to fulfil its purpose. Both stages 1 and 2 of the empirical phase (phase 1) will employ an exploratory-descriptive study design focusing on the primary school teachers, life skills educational advisors and learners to obtain their perceptions or views regarding the need to include Epilepsy in life skills education. Data will be collected using individual interviews for life skill educational advisors and focus group discussions for teachers and learners at the sampled primary schools in Limpopo and Mpumalanga provinces. Phase two will conceptualise the phase 1 findings into the conceptual framework, and phase 3 will develop and validate the life skills guideline. This study will adhere to both internal and external ethical considerations. Recommendations will be made based on the findings of the study.

Attitudes toward epilepsy assessed by the SAPE questionnaire in Germany - Comparison of its psychometric properties and results in a web-based vs. face-to-face survey

OBJECTIVE

The aims of this study were (1) to investigate psychometric properties of a new questionnaire (SAPE, Scales of the Attitudes toward People with Epilepsy) that assesses attitudes toward people with epilepsy (PWE) (2) to compare the effects of mode of survey administration (web-based vs. face-to-face) on attitudes, and (3) to identify predictors of attitudes.

METHODS

A face-to-face and a web-based survey were performed in Germany. Weighting factors were used to achieve representative samples of the German population. Reliability and validity of the 6 scales of the SAPE (social distance, stereotypes, personal concerns, and emotional reactions differentiated by fear, anger, and pity) were evaluated and compared for both surveys. Epilepsy knowledge was also assessed. General linear models were performed to investigate predictors of attitudes toward PWE including the type of survey.

RESULTS

In total, 1001 participants of the web-based survey and 1026 participants of face-to-face survey were included. Psychometric analyses indicated satisfactory reliability and validity of the scales and differed only slightly between modes of survey. In both surveys, fears and concerns were more pronounced than stereotypes and social distance. However, mean values of two scales were slightly or moderately higher in the face-to-face survey indicating more negative attitudes toward PWE (p < 0.001). Fewer participants of the face-to-face survey reported personal experience with PWE, claiming to know what to do in case of a seizure and claiming to know that seizures can be treated successfully (p < 0.001). These variables proved to be important predictors of positive attitudes toward PWE, besides demographic factors (e.g. age < 65, female gender). When controlling for them, the differences remained significant only for the scales Social Distance (moderately) and Fear (slightly).

SIGNIFICANCE

In total, psychometric analyses show that web-based surveys using the SAPE may be an alternative to face-to-face surveys to assess attitudes toward PWE. This applies also to the scales Social Distance and Emotional Reactions that allow comparisons with other diseases, e.g. psychiatric disorders. Most scales differ only slightly between survey modes, except social distance. This indicates that single components of attitudes toward PWE may be dependent on the mode of survey or different characteristics of respondents.

What is the community's knowledge and understanding regarding epilepsy? Epilepsy knowledge and its determinants among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia, 2019: a cross-sectional study

OBJECTIVE

Epilepsy is a neurological condition marked by recurring seizures. People with epilepsy, particularly in low-income and middle-income countries, are stigmatised due to a lack of understanding and a negative attitude towards the disease. Increased public awareness of epilepsy will aid in the search for therapy and the quality of life of the patients. The study aimed to assess knowledge about epilepsy and the associated factors among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia in 2020.

SETTING

This community-based, cross-sectional study triangulated with qualitative method was conducted from 25 April 2020 to 20 May 2020. Multistage sampling technique was used to select 601 participants. A structured and interviewer-administered questionnaire was used to collect data. Data were entered in EpiData Manager V.4.0.2.101 and exported to SPSS V.23 for analyses. Multivariable logistic regression was carried out to identify the factors associated with knowledge of epilepsy. A p value of <0.05 was taken to indicate statistical significance.

RESULTS

A total of 601 respondents participated, of whom 340 (56.6%) were male. The mean age of the respondents was 34.84±11.42 years. The proportion with good knowledge of epilepsy was 55.1%. Factors associated with good knowledge of epilepsy were attending primary education (adjusted OR (AOR)=2.06, 95% CI 1.27 to 3.34), secondary education (AOR=5.01, 95% CI 2.62 to 9.58), above secondary education (AOR=5.67, 95% CI 2.35 to 13.69), being in high wealth index (AOR=1.74, 95% CI 1.09 to 2.78), being a government employee (AOR=3.69, 95% CI 1.39 to 9.83), being a merchant (AOR=3.16, 95% CI 1.80 to 5.54) and being an urban resident (AOR=2.15, 95% CI 1.36 to 3.42).

CONCLUSION

Only 55% of the residents have sufficient knowledge about epilepsy. Factors associated with knowledge of epilepsy were educational status, wealth index, occupation and residence.

An exploration of the experiences of self-disgust in people with epilepsy

AIM

To explore the experiences of self-disgust in people with epilepsy and their understandings about this.

DESIGN

A qualitative study informed by thematic analysis.

METHOD

Ten adults (out of 43 individuals initially interested in taking part, with 38 of those with levels of self-disgust categorised as high) with epilepsy and uncontrolled seizures were recruited online and participated in a telephone semi-structured interview.

RESULTS

Three themes illustrated the development and experiences of self-disgust in adults with epilepsy and uncontrolled seizures, and how participants attempted to manage this. The first theme described the development of self-disgust as a result of the physical manifestations of seizures but also the experiences of others' disgust reactions to seizures and an expectation of rejection. The second theme described the enduring and often unescapable experiences of self-disgust, with the final theme illustrating how participants attempted to manage experiences of self-disgust, particularly through avoidance.

DISCUSSION

This study was the first to explore qualitatively the experiences of self-disgust in people with epilepsy. People with epilepsy experience disgust in reaction to the physical symptoms of seizures and these disgust-based feelings appeared to become internalized following others' disgust reactions. Avoidance as a strategy to manage self-disgust could be protective but might have inadvertently maintained feelings of self-disgust.

Knowledge and attitudes of physical educators toward epilepsy and students with epilepsy: A cross-sectional study from Palestine

OBJECTIVE

The study aimed to test knowledge and attitudes of physical educators in Palestine toward epilepsy and students with epilepsy. The study also aimed to identify the variables that were associated with adequate knowledge and positive attitudes toward epilepsy and students with epilepsy.

METHODS

This study was done in a cross-sectional design among physical educators in Palestinian schools. The questionnaire tested knowledge and attitudes of physical educators using 18-item and 12-statement tests, respectively.

RESULTS

Complete questionnaires were returned by 226 physical educators (response rate = 75.3%). The median knowledge score of the physical educators on the 18-item knowledge test was 50% [33.0%, 61.0] and the median attitudes score of the physical educators on the 12-statemtns was 50.0% [42.0, 58.0]. Higher knowledge scores were associated with age, teaching experience, educational level, having known/interacted with people with epilepsy, and receiving education about epilepsy. Higher attitude scores were associated with gender, age, educational level, place of residence, type of school, having known/interacted with people with epilepsy, and receiving education about epilepsy.

CONCLUSION

Knowledge gaps and negative attitudes toward epilepsy and students with epilepsy were identified among physical educators in Palestine. Appropriately designed interventions are still needed to improve knowledge and correct attitudes of physical educators about epilepsy and students with epilepsy.

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.

Public awareness and attitudes toward epilepsy in Saudi Arabia: A systematic review and meta-analysis

INTRODUCTION

Public awareness of epilepsy and attitudes toward people with epilepsy (PWE) largely affect patients' perceived stigma and their quality of life. Educational interventions to increase public awareness of the disease need to target areas of lowest awareness levels to achieve best results. The aim of this review was to identify these areas in Saudi Arabia.

METHODS

This review was based on PRISMA guidelines. Medline, PsychInfo, Embase, Ovid Evidence-Based Medicine Reviews, and Web of Science databases were searched for relevant literature. Inclusion criteria was cross-sectional studies that are done in Saudi Arabia, assess any aspect of epilepsy awareness or attitudes toward PWE, and report outcomes in proportions. Meta-analysis was done on outcomes reported in ≥5 studies utilizing random-effects model. Quality assessment was done using AXIS tool.

RESULTS

Twenty-seven studies were included in this review. A total of 48 questions' outcomes were reported in ≥3 studies, and 26 of them were included in the meta-analysis. The meta-analysis estimated that 6.4% (CI 4.2-9.7%) of the population think epilepsy is a contagious disease; 90.7% (CI 85.5-94.1%) have heard/read about epilepsy; 53.1% (CI 47.7-58.3%) have witnessed a seizure; 38.6% (CI 24.7-54.7%) think epilepsy is a psychological disorder; 25.2% (CI 16.5-36.7%) think it is caused by spirit possession; 35.1% (CI 22.0-50.8%) were estimated to think it is caused by evil eye (envy); 37.9% (CI 21.9-57.0%) would try to put something inside a seizing patient's mouth to prevent tongue biting; 34.6% (CI 26.9-43.1%) would approve their offspring marrying someone with epilepsy.

CONCLUSION

Areas of unsatisfactory awareness levels included etiology of epilepsy and appropriate seizure responses. Attitudes were more negative regarding marriage, children, and employment. These areas need to be properly addressed in future educational interventions.

A journey into the unknown: An ethnographic examination of drug-resistant epilepsy treatment and management in the United States

Patients often recognize unmet needs that can improve patient-provider experiences in disease treatment management. These needs are rarely captured and may be hard to quantify in difficult-to-treat disease states such as drug-resistant epilepsy (DRE). To further understand challenges living with and managing DRE, a team of medical anthropologists conducted ethnographic field assessments with patients to qualitatively understand their experience with DRE across the United States. In addition, healthcare provider assessments were conducted in community clinics and Comprehensive Epilepsy Centers to further uncover patient-provider treatment gaps. We identified four distinct stages of the treatment and management journey defined by patients' perceived control over their epilepsy: Gripped in the Panic Zone, Diligently Tracking to Plan, Riding a Rollercoaster in the Dark, and Reframing Priorities to Redefine Treatment Success. We found that patients sought resources to streamline communication with their care team, enhanced education on treatment options beyond medications, and long-term resources to protect against a decline in control over managing their epilepsy once drug-resistant. Likewise, treatment management optimization strategies are provided to improve current DRE standard of care with respect to identified patient-provider gaps. These include the use of digital disease management tools, standardizing neuropsychiatrists into patients' initial care team, and introducing surgical and non-pharmacological treatment options upon epilepsy and DRE diagnoses, respectively. This ethnographic study uncovers numerous patient-provider gaps, thereby presenting a conceptual framework to advance DRE treatment. Further Incentivization from professional societies and healthcare systems to support standardization of the treatment optimization strategies provided herein into clinical practice is needed.

Effects of an educational comic book on epilepsy-related knowledge, attitudes and practices among schoolchildren in Madagascar

INTRODUCTION

Epilepsy is a chronic disease of the brain that affects approximately 50 million people globally, with over 80 % of them living in low- and middle-income countries (LMICs). In Madagascar, as in most LMICs, one of the main obstacles to treatment is the stigma and discrimination experienced by patients. Beliefs and prejudices regarding this disease are common, especially among children. "Ao Tsara" is an educational comic book regarding epilepsy, which has been translated in Malagasy from a French version, and which objective is to raise awareness and fight epilepsy related stigma and discrimination. Comic books have indeed been used successfully to raise awareness and change behaviors in several areas of public health.

METHODS

We conducted a study to evaluate the effect of a single reading of this comic book on epilepsy related knowledge, attitudes and practices (KAP) in schoolchildren in Madagascar. This quasi-experimental study compared data collected before and immediately after reading "Ao Tsara". It was conducted both in a school in an urban area and in a school in a rural area.

RESULTS

We recruited 244 children with a mean age of 11.4 (±1.5) in this study. We noted a significant improvement in the global KAP score after reading the comic book, overall as well as both in the urban school and the rural school. Out of a maximum score of twenty, the global KAP score increased from 9.4 to 11.2 (p < 0.001). Although the increase in knowledge was reasonable (from 10.2 to 12.9, p < 0.001) and the corresponding subscore after reading the comic book was at a satisfactory level, that was not the case for attitudes & practices, where the sub-score despite a significant increase remained low (from 8.7 to 9.5 out of a maximum score of twenty, p < 0.001). The comic book was much appreciated by the children with more than 50.0 % giving it the top rating, and 66.4 % stating they had learned a lot from it.

CONCLUSION

A single reading of the comic book has demonstrated a positive effect on the knowledge, attitudes and practices of primary school children in Madagascar. This educational tool, which was much enjoyed by the children, could be of great value to raise awareness about epilepsy in Madagascar. By targeting a slightly older age group and adjusting the reading approach, the outcomes could be optimized especially in terms of attitudes and practices.

Attitudes of individuals in Eastern Turkey toward epilepsy and the factors associated with these attitudes

AIM

This study was performed to analyze the attitudes of individuals in eastern Turkey toward epilepsy and the factors associated with these attitudes.

METHODS

Designed as a cross-sectional descriptive study, this study was performed from January 28 to February 8, 2021. A snowball sampling technique was used to select the study sample, and a survey was sent online to individuals aged 18 or above. A total of 617 individuals who filled in this online survey form were included in this research. Data were collected via a personal information form and the Public Attitudes Toward Epilepsy (PATE) scale.

RESULTS

The results showed that the mean scores of the participants on the PATE scale, on its general domain, and on its personal domain were 1.79±0.63, 1.70±0.63, and 1.96±0.77, respectively. Comparing the participants' mean PATE scale scores on the basis of their descriptive characteristics revealed statistically significant differences in the mean scores on the scale and its two domains in terms of age, place of residence, educational level, knowing anyone who had epilepsy or experienced epileptic seizures, and witnessing a person having an epileptic seizure (p < 0.05).

CONCLUSION

Individuals living in eastern Turkey have positive attitudes toward epilepsy. Moreover, it was found that, among all the participants, those who were relatively young, those who lived in a provincial center, those who had a relatively high educational level, those who knew an individual with epilepsy, and those who had witnessed an epileptic seizure have more positive attitudes toward epilepsy than their counterparts.

IMPLICATIONS

It is recommended to design educational programs focusing on raising the level of public awareness and knowledge regarding epilepsy.

Epilepsy - from mysticism to science

The understanding of epilepsy has been in progressive evolution since Antiquity, with scientific advances culminating in the last few decades. Throughout history, epilepsy was plagued by mystical misconceptions involving either demonic possessions, witchcraft, or divine interventions. This has frequently altered or even halted any real progress in its scientific understanding or its social perception. This metaphysical context is also at the core of the stigma revolving around this condition, some of which still lingering today. This review explores the origins of these mystical beliefs, and describes the chronological evolution of epilepsy from mysticism to science across different civilizations and eras.

Underutilization of epilepsy surgery: Part II: Strategies to overcome barriers

Interventions focused on utilization of epilepsy surgery can be divided into groups: those that improve patients' access to surgical evaluation and those that facilitate completion of the surgical evaluation and treatment. Educational intervention, technological innovation, and effective coordination and communication can significantly improve patients' access to surgery. Patient and public facing, individualized (analog and/or digital) communication can raise awareness and acceptance of epilepsy surgery. Educational interventions aimed at providers may mitigate knowledge gaps using practical and concise consensus statements and guidelines, while specific training can improve awareness around implicit bias. Innovative technology, such as clinical decision-making toolkits within the electronic medical record (EMR), machine learning techniques, online decision-support tools, nomograms, and scoring algorithms can facilitate timely identification of appropriate candidates for epilepsy surgery with individualized guidance regarding referral appropriateness, postoperative seizure freedom rate, and risks of complication after surgery. There are specific strategies applicable for epilepsy centers' success: building a multidisciplinary setup, maintaining/tracking volume and complexity of cases, collaborating with other centers, improving surgical outcome with reduced complications, utilizing advanced diagnostics tools, and considering minimally invasive surgical techniques. Established centers may use other strategies, such as multi-stage procedures for multifocal epilepsy, advanced functional mapping with tailored surgery for epilepsy involving the eloquent cortex, and generation of fresh hypotheses in cases of surgical failure. Finally, improved access to epilepsy surgery can be accomplished with policy changes (e.g., anti-discrimination policy, exemption in transportation cost, telehealth reimbursement policy, patient-centered epilepsy care models, pay-per-performance models, affordability and access to insurance, and increased funding for research). Every intervention should receive regular evaluation and feedback-driven modification to ensure appropriate utilization of epilepsy surgery.

Stigma and associated factors among people with epilepsy in Ethiopia: A systematic review and meta-analysis

This systematic review and meta-analysis was aimed to summarize the pooled prevalence of stigma and associated factors among people with epilepsy in Ethiopia. A systematic search of articles was conducted in PubMed, SCOPUS, African Journals Online (AJOL), and Journal Storage (JSTOR). A standardized data extraction format was used to extract data. The analysis was conducted using STATA version 11 software. Cochrane Q statistic was used to assess the presence of significant between-study heterogeneity. I² was used to quantify between-study heterogeneity. A leave-one-out sensitivity analysis was done. Subgroup analysis was conducted. Funnel plot, Begg's test, and Egger's regression tests were used to measure the presence of publication bias. Since the studies showed heterogeneity, the pooled estimated prevalence of stigma of people with epilepsy was conducted using DerSimonian-Laird's random-effects model. The estimated pooled prevalence of stigma was 44.65(95%CI; 29.37-59.94). Begg's rank correlation test (Z = 0.15, P = 0.881) and Egger's linear regression test (t = 0.14, P = 0.894) showed the absence of publication bias. Factors associated with an increased likelihood of stigma were 6-10 years of duration of illness (p = 0.003), ≥11 years of duration of illness (p = 0.008), and ≥1/month of seizure frequency (p = 0.01). Comprehensive care that involves psychological, social, and medical components is required. Health education on effective coping mechanisms is recommended.

Insights into the real-life experiences of people living with epilepsy: A qualitative netnographic study

A qualitative netnographic study of epilepsy conversations posted on public social media sites over a 12-month period was conducted in order to identify key themes and issues for people living with epilepsy (PWE). A total of 264,706 conversations posted online between 03 November 2018 and 03 November 2019, which had originated in the UK, Spain, France, Italy, and Germany, were identified using pre-defined and piloted search terms. A random sample of these posts was then analyzed using natural language processing, and qualitative in-depth and contextual analysis. Key themes that emerged related to: disease awareness among the general public; the psychological and physical impact of seizures; the importance of ensuring proper sleep; understanding disease burden through time; finding treatment and managing side effects; and dealing with depression and anxiety. People living with epilepsy highlighted that seizures have a significant impact on mental as well as physical health and can cause limitations to all aspects of life. Fear of having a seizure in public is a major concern for PWE and the anticipation of seizures can worsen anxiety, causing patients to limit social interaction and often leading to social isolation, which may further exacerbate anxiety and depression. People living with epilepsy therefore advocate that greater attention be paid to the mental health impact of epilepsy. Treatment and its side effects were also a major aspect of the online conversation of PWE. Some PWE believe there is a lack of awareness or sensitivity among healthcare professionals, who may underestimate their concerns or not take sufficient time to discuss their needs. These findings therefore help sign-post issues of importance to PWE and areas in which their care may be improved.

Knowledge, Skills, and Attitudes Towards Children with Epilepsy Among Egyptian Parents: A Comparative Cross-Sectional Study

INTRODUCTION

Epilepsy is one of the most common neurological disorders affecting children. As a chronic disease, it affects not only the child but also the entire family. The attitudes towards the children suffering from epilepsy and the skills required to deal with acute seizures are influenced by the level of knowledge the parents have about that disease.

AIM

To evaluate the knowledge, attitudes, and skills toward epilepsy among parents of children diagnosed with epilepsy in comparison to parents of children without epilepsy.

METHOD

Data collected through a structured questionnaire that was designed, translated into Arabic, and analyzed statistically in a cross-sectional study for a total of 534 Egyptian parents as two groups, group I (n = 223) consist of parents with children with epilepsy and group II (n = 311) of parents with children without epilepsy. Parents with children with epilepsy were recruited from the Paediatric Neurology Outpatient Clinic of Alexandria University Children's Hospital (AUCH). Parents with children without epilepsy were recruited from other outpatient clinics or wards of AUCH.

RESULTS

This study showed a poor knowledge score percentage of (89.7 %) among parents with children with epilepsy and (83.3 %) among parents with children without epilepsy. The difference between both groups was statistically significant with fewer knowledge scores among parents of children with epilepsy. Parents of both groups showed a negative attitude score percentage; (69.5 %) of group I and (62.7 %) of group II. The difference between both groups was statistically significant with a more negative attitude score percentage among parents with children without epilepsy. Parents of both groups had poor practice score percentage of (66.8 %) of group I and (74.3 %) of group II having poor practice skills needed for emergency management of acute seizures. A high level of education was significantly associated with fair knowledge score percentage and positive attitude score percentage.

CONCLUSIONS

Poor knowledge, negative attitudes, and poor skills required for the management of acute seizures were found among both parents of children with epilepsy and those with children without epilepsy. Educational programs are needed to eliminate all the misconceptions and myths and to change attitudes of the Egyptian parents towards epilepsy.

Educational interventions improving knowledge about epilepsy in preschool children

OBJECTIVE

Sufficient public knowledge about epilepsy is a starting point for reducing epilepsy-related stigma and improving quality of life of people with this condition. Thus, interventions aimed at improving such knowledge are greatly needed. However, there is a significant lack of such interventions and none have been applied to preschool children. We aimed to develop effective interventions using the educational board game Action Zone! and a technique known as educational story, and by focusing on the acquisition of knowledge about epilepsy in children aged 5-6 years with no previous knowledge of epilepsy.

METHODS

Knowledge about epilepsy was measured using a 20-item test consisting of questions selected from educational game and an 11-item test used successfully in our previous intervention study focused on children aged 9-11 years. Both measures exhibited acceptable internal consistency with Cronbach's alpha of 0.72 and 0.67. In total, 296 children participated in three intervention studies (educational game, educational story, and a revised version of educational story). Level of knowledge was assessed immediately after each intervention and again one month later.

RESULTS

We found that all interventions were effective (p = 0.001) in comparison of retest results with baseline of zero level of knowledge based on the statements of children before intervention. Intervention based on educational game resulted in a higher percentage of correct responses in comparison with educational story (p = 0.020). However, the revised version of educational story developed using participatory action research was superior in comparison with the original version (p < 0.001) and fully comparable with educational game (p = 0.864).

CONCLUSIONS

The results showed the aforesaid interventions were significant and effective ways to establish basic knowledge about epilepsy in the given age group.

Knowledge about epilepsy and factors associated with attitudes toward marrying, employing, and driving people with epilepsy: A cross-sectional survey of Asokore Mampong community dwellers in Ghana

BACKGROUND

Due to lack of information and illiteracy, epilepsy remains a stigmatized disease in sub-Saharan Africa.

OBJECTIVES

The main aim of the study was to determine, among community dwellers in Asokore Mampong Municipality (Ghana): (i) the knowledge on risk factors, signs and symptoms, management of epilepsy, and (ii) factors associated with attitudes toward marrying, employing, or driving people with epilepsy (PWE).

METHODS

A cross-sectional study of 100 randomly selected individuals aged 18 years and older in Asokore Mampong Municipality was conducted in February 2019. A self-administered questionnaire was used to assess the knowledge about epilepsy and attitudes toward marrying, employing, and driving people with epilepsy. Frequencies and corresponding percentages were used to describe the study participants, their knowledge regarding epilepsy and attitudes toward marrying, employing, or driving people with epilepsy. Univariate and multivariate logistic regression analyses were used to determine the factors associated with attitudes toward marrying, employing, or driving people with epilepsy.

RESULTS

Majority (33%) of the respondents indicated that epilepsy is caused by possession of evil spirits or witchcraft. More than 60% of the respondents correctly identified all signs and symptoms presented in the survey. Almost half (45%) of the respondents selected orthodox/medical treatment as the treatment for epilepsy. The odds of marrying PWE among Akans and Ewe/Ga Adangbe were 90% [adjusted Odds ratio (aOR) = 0.10, 95% CI: 0.01-0.67] and 84% lower [aOR = 0.16, 95% CI: 0.04-0.62] compared to odds of marrying PWE among Northerners, respectively. Compared to respondents with no formal education, the odds of employing PWE were 88% lower [aOR = 0.12, 95% CI: 0.03-0.40] among those with tertiary education. In addition, the odds of driving a person with an epileptic attack among Muslims/Traditionalists were 81% lower [aOR = 0.19, 95% CI: 0.05-0.68] than Christians. Respondents between 18 and 30 years old had more than 5 times higher odds of driving a person with an epileptic attack [aOR 5.28, 95% CI: 1.15-24.84] compared to respondents above 30 years.

CONCLUSIONS

Individuals in Asokore Mampong have less knowledge about the risk factors and treatment of epilepsy. Generally, they have negative attitudes toward marrying, employing, and driving PWE. Findings from this study highlight the need to increase education to reduce the stigma associated with epilepsy. We recommend that a massive educational campaign should be organized by the Ghana Health Service to address deficiencies in knowledge as well as the negative attitudes toward PWE.

Fish soup for the falling sickness: Tracing epilepsy through Hmong and Western beliefs

Hmong communities originated in China but today are located across the globe. Salvation, health, and well-being in Hmong tradition are contingent upon pleasing spirits and ancestors. While most diseases are believed to reflect the displeasure of spirits and ancestors, epilepsy is unique in that it portends a heightened capacity for achieving an elevated level of spirituality, which has led it to be deemed honorable by Hmong society members. This stands in stark contrast to some contexts within which epilepsy has been historically understood in the West in which the disease was believed to originate from sin and evil. If and how societal response toward persons with epilepsy (PWE) in Hmong communities differ from that in other Western communities in a way that parallels these differences in beliefs regarding the etiology and significance of the seizures is unknown. Understanding this may have implications that guide efforts in combatting stigma affecting PWE.

Knowledge of and familiarity with epilepsy in U.S. adults: Results from the 2017 ConsumerStyles Online Panel Survey

Examining and improving knowledge and attitudes about epilepsy has been a public health priority because of stigma around the disorder. This study had three goals: (1) to update estimates describing U.S. adults' perceived knowledge about epilepsy, seizure first aid, and confidence in providing seizure first aid; (2) to examine U.S. adults' recognition of common signs and symptoms of generalized and focal seizures to inform public awareness efforts; and (3) to provide baseline estimates of exposure to an Epilepsy Foundation public awareness campaign, #ShareMySeizure, launched in November, 2016. Four sets of epilepsy questions were included on the 2017 Porter Novelli ConsumerStyles survey, an online panel survey of the U.S. adult population. We examined differences in study outcomes by sociodemographic factors and familiarity with someone with epilepsy. Small percentages of U.S. adults felt knowledgeable about epilepsy (16%), knew seizure first aid (25%), or reported having confidence in being able to help someone having a seizure with appropriate seizure first aid (20%). Fewer adults were familiar with signs of focal seizures compared to generalized seizures. About 1% of U.S. adults had heard of the #ShareMySeizure campaign. Television and family and friends emerged as the most common sources of information for those who reported hearing something about epilepsy. About 33% of U.S. adults wanted to learn more about epilepsy. Knowledge about epilepsy among the U.S. public is suboptimal, though generally on par with that of more common conditions such as heart disease, eye conditions, and ovarian cancer. U.S. adults need and want more information about epilepsy, appropriate seizure first aid training, and recognition of seizure symptoms.

Predictors of high school dropout, anxiety, and depression in genetic generalized epilepsy

Affective disorders are overrepresented in epilepsy, and people with epilepsy may be at risk of dropping out from school. The aim of the present study was to assess factors influencing high school dropout, anxiety, and depression in genetic generalized epilepsy (GGE). One hundred and ten people with GGE aged 19-40 years underwent a clinical interview, including the Hospital Anxiety and Depression Scale (HADS) questionnaire. Potential predictors of high school dropout were analyzed with logistic regression, and factors influencing total HADS score were analyzed with linear regression. Having felt excluded because of epilepsy was significantly associated with high school dropout (odds ratio 7.80, P = .009), as was total HADS score (odds ratio 1.22, P = .005). If a participant was currently employed or undergoing education, previous high school dropout was less likely (odds ratio 0.07, P = .005). High school dropout was associated with increased current anxiety and depression (β = 0.32, P = .005). Epilepsy severity (current drug resistance, current polytherapy, and active generalized tonic-clonic seizures) was not associated with high school dropout, nor with total HADS score. The issue of stigma in epilepsy must be thoroughly addressed in comprehensive care and may be as important as seizure control when it comes to education and quality of life.

Examining the impacts of the COVID-19 pandemic on the well-being and virtual care of patients with epilepsy

OBJECTIVE

The emergence of SARS-CoV-2 (COVID-19) as a novel coronavirus resulted in a global pandemic that necessitated the implementation of social distancing measures. These public health measures may have affected the provision of care for patients with epilepsy. Social isolation may have also adversely affected well-being and quality of life due to informal and formal support networks becoming less accessible. The purpose of this qualitative study was to examine the lived experiences of patients with epilepsy and to see how their quality of life and healthcare has been affected by the COVID-19 pandemic.

METHODS

From April 27 to May 15, 2020 we performed remote interviews with 18 participants who had virtual appointments with their healthcare providers and were enrolled in the Calgary Comprehensive Epilepsy Program registry. Interviews were recorded and transcribed, after which transcripts were analyzed and coded into relevant themes using NVivo 12.

RESULTS

Three broad themes emerged throughout the interviews:1) impact of pandemic on informal and formal support systems; 2) impact of pandemic on healthcare provision; and 3) concerns about the impact of the pandemic on personal situations and society in the future. Participants reported anxiety and stress about decreased social engagement and activity cessations. Although face-to-face appointments were preferred, virtual care was well-received. Common concerns about the future included securing employment and burnout from balancing family responsibilities. Some patients also feared they would be stigmatized as society adapted to the situation.

SIGNIFICANCE

This study highlights the need for additional research in anticipation of the implementation of remote medicine in the management and treatment of epilepsy. It also highlights the tenacity of those living with epilepsy during difficult periods despite social and familial pressures. Raising awareness during this time about the lives and experiences of epilepsy patients can help challenge misconceptions and stigma in the workplace and wider society.

Quality of life, fatigue and seizure severity in people living with epilepsy in a selected Nigerian population

BACKGROUND

Epilepsy, a chronic seizure disorder, can cause elevated fatigue and reduced quality of life (QOL) of the sufferers. Hence, improving QOL, seizure severity (SS) and fatigue are important areas of therapeutic interventions for people living with epilepsy (PLWE). Therefore, there is need to ascertain the levels and interrelationships among these constructs in PLWE.

OBJECTIVE

This study compared fatigue and QOL of PLWE with those of apparently healthy individuals (AHIs) and also determined the interrelationships between fatigue, QOL and SS in PLWE.

METHOD

This cross-sectional survey involved 91 PLWE and 101 AHIs consecutively recruited from purposively selected hospitals and hosting communities. The Short-form Health Survey (SF-36) questionnaire, the Fatigue Severity Scale, the Modified Fatigue Impact Scale and the Seizure Severity Questionnaire were used to evaluate QOL, fatigue severity (FS), fatigue impact (FI) and SS respectively. Data was analyzed using frequency count, proportions, mean and standard deviation, range, Chi-square test, Mann-Whitney U test and Spearman-rank order correlation. Alpha level was set at 0.05.

RESULTS

PLWE had significantly lower QOL compared to AHIs (U = 3057.00;p < 0.01). The two groups however experienced similar fatigue severity, but PWE suffered greater fatigue impact (U = 2798.00;p < 0.01). Significant relationships existed among FI, FS, SS and QOL in PLWE (p < 0.01).

CONCLUSION

Compared with AHIs, PLWE had poorer QOL, similar FS, and higher FI. QOL of PLWE was negatively associated with SS, FI and FS. Clinical interventions geared towards minimizing seizure, severity and impact of fatigue may improve the QOL of PLWE.

Community integration, self-esteem, and perceived stigma in a Nigerian sample with epilepsy

OBJECTIVE

The objective of the study was to investigate the levels, interrelationships, and associated factors of community integration (CI), perceived stigma (PS), and self-esteem in people living with epilepsy (PWE) in Anambra and Enugu States of south-east Nigeria.

METHODS

This was a cross-sectional survey involving 70 consenting adults living with epilepsy consecutively recruited from three purposively sampled specialized clinics in Anambra State. The Reintegration to Normal Living Index, the Epilepsy Stigma Scale, and the Rosenberg Self-Esteem Scale were used to estimate CI, PS, and self-esteem, respectively among the participants. Data were analyzed at 0.05 level of significance.

RESULTS

The mean age of the participants (28.6% females) was 34.91 ± 16.21 years. The participants had moderate PS score (43.54 ± 14.20), poor self-esteem score (17.63 ± 6.12), and mild-to-moderately restricted CI score (67.83 ± 24.72). Participants' PS, CI, and self-esteem significantly correlated with one another (p < 0.05) with PS and self-esteem being significant predictors of CI. Participants' PS had a significant correlation with their age at onset of epilepsy, while their self-esteem and CI significantly correlated with their seizure episodes (p < 0.05). Participants' PS and CI were significantly different across different categories of their occupational and educational statuses. Perceived stigma also varied across participants' marital status with divorced participants having the worst score (p < 0.05).

CONCLUSION

People living with epilepsy had moderate PS, poor self-esteem, and mild-to-moderate CI, which correlated significantly with one another. Results suggest the possibility of using CI as an outcome for assessing the effectiveness of stigma and self-esteem interventions during epilepsy rehabilitation.

Stigma in psychogenic nonepileptic seizures

OBJECTIVE

There is scarce literature on stigma in families living with psychogenic nonepileptic seizures (PNES). Using a cohort of patients with epileptic seizures (ES) and their caregivers as controls, we aimed to quantify the level of patient and caregiver stigma in PNES and identify associations of patient and caregiver characteristics with it.

METHODS

Patients with PNES and ES and their caregivers completed surveys about demographic, clinical, and psychosocial characteristics. Multivariate regression analysis was used to identify correlates of patient and caregiver stigma.

RESULTS

Forty-three patients with PNES and 165 patients with ES were recruited. Compared with patients with ES, patients with PNES had shorter disease duration, higher seizure frequency, normal diagnostic data, poorer psychosocial health, and fewer antiseizure medications (ASMs). A total of 76.5% of patients with PNES and 59.5% of patients with ES felt stigmatized. Patient stigma level was higher in patients with PNES compared with those with ES, and it was negatively associated with patient quality of life (QOL). Additionally, 28 caregivers of patients with PNES and 99 caregivers of patients with ES were recruited. There were no significant demographic, caregiving, or psychosocial differences between the two caregiver cohorts. Seventy-two percent of caregivers of patients with PNES and 47% of caregivers of patients with ES felt stigmatized. Caregiver stigma level was also higher in caregivers of patients with PNES compared with caregivers of patients with ES, and it was negatively associated with patient QOL and positively associated with patient and caregiver anxiety.

CONCLUSION

Compared with those with ES, patients and caregivers living with PNES experience stigma more frequently and to a higher extent. Patient QOL emerges as a consistent correlate of that stigma.

New-onset epilepsy in pregnant women: clinical features and delivery outcomes

INTRODUCTION

Most seizures during pregnancy occur in women who already have epilepsy. Rarely, some women may have their first seizure during pregnancy. The purpose of this study was to investigate the clinical features and pregnancy outcomes in women with new-onset epilepsy during pregnancy.

METHODS

112 pregnant women with epilepsy were prospectively evaluated at the Education - Therapeutic Clinic of the Azerbaijan Medical University, in the neurological and maternity departments of the Clinical Medical Center in Baku over a six-year period. Women were regularly followed by a neurologist and obstetrician till the end of pregnancy. To determine the recurrence of seizures during the pregnancy and after delivery, the women were followed up at least once per three months for a one year period after delivery. Delivery and perinatal outcomes were compared with those of 277 healthy women in the control group (without epilepsy and without registering chronic diseases).

RESULTS

Of the 112 pregnant women with epilepsy, 12 (10.7%) had their first seizures during the pregnancy: 6 in the 1^st, 4 in the 2^nd, 2 in the 3^rd trimester. Women with new-onset epilepsy had increased risk of cesarean section and perinatal hypoxia in offspring, compared with controls (Odds ratio [OR]: 13.57; 95% confidence interval (CI):2.86-64.31 and OR: 3.61; 95 % CI: 1.06-12.27, respectively). The risks of cesarean section and perinatal hypoxia were not increased in women with new-onset epilepsy compared to women with epilepsy before pregnancy (OR 2.64; 95 % CI 0.54-12.93 and OR 2.18, 95% CI 0.61-7.76, respectively).

CONCLUSION

In our cohort, women with new-onset epilepsy may have an increased risk of delivery by cesarean section and perinatal hypoxia compared to pregnant controls. The risks were not increased compared to women with epilepsy before pregnancy. Neonatal hypoxia was associated with delivery by cesarean section.

Agreement of Palestinian nursing students with recommendations to eliminate epilepsy stigma and change perception of the general public about epilepsy: A cross-sectional study

OBJECTIVE

This study was conducted to assess the degree of agreement of Palestinian nursing students with recommendations and key messages to eliminate/reduce epilepsy stigma and change perception of the general public about epilepsy and people with epilepsy (PWE).

METHODS

A cross-sectional observational study was conducted among undergraduate nursing students. The study tool was a questionnaire with 24 items which collected the sociodemographic and academic characteristics of the participants (6 items) and agreements with 18 recommendations and key messages to eliminate/reduce epilepsy stigma.

RESULTS

A total of 342 nursing students completed the questionnaire with a response rate of 68.4%. The participants agreed with the 6 recommendations to inform media, improve awareness, and educate the general public on epilepsy (agreement rates: 87.7% to 92.4%), 4 recommendations to coordinate efforts to improve awareness and educate the general public on epilepsy and PWE (agreement rates: 89.8% to 93.0%), and 8 key messages to eliminate/reduce epilepsy stigma (agreement rates: 70.2% to 93.9%). In general, female students tended to express significantly higher levels of agreement with the recommendations and key messages (p-value < 0.05).

CONCLUSION

Results of the present study highlighted the importance of involving nurses and future nurses in eliminating/reducing epilepsy stigma and changing perception of the general public about epilepsy and PWE. Further studies are to be conducted to investigate if these recommendations and messages can eliminate or significantly reduce epilepsy stigma and change perception of the general public about epilepsy and PWE.

Standing up to stigma in epilepsy

This article explores the nature of stigma and discusses how stigma negatively affects both adults and children with epilepsy.

Digital conversations about suicide among teenagers and adults with epilepsy: A big-data, machine learning analysis

Objective

Digital media conversations can provide important insight into the concerns and struggles of people with epilepsy (PWE) outside of formal clinical settings and help generate useful information for treatment planning. Our study aimed to explore the big data from open‐source digital conversations among PWE with regard to suicidality, specifically comparing teenagers and adults, using machine learning technology.

Methods

Advanced machine‐learning empowered methodology was used to mine and structure open‐source digital conversations of self‐identifying teenagers and adults who endorsed suffering from epilepsy and engaged in conversation about suicide. The search was limited to 12 months and included only conversations originating from US internet protocol (IP) addresses. Natural language processing and text analytics were employed to develop a thematic analysis.

Results

A total of 222 000 unique conversations about epilepsy, including 9000 (4%) related to suicide, were posted during the study period. The suicide‐related conversations were posted by 7.8% of teenagers and 3.2% of adults in the study. Several critical differences were noted between teenagers and adults. A higher percentage of teenagers are: fearful of “the unknown” due to seizures (63% vs 12% adults), concerned about social consequences of seizures (30% vs 21%), and seek emotional support (29% vs 19%). In contrast, a significantly higher percentage of adults show a defeatist (“given up”) attitude compared to teenagers (42% vs 4%). There were important differences in the author's determined sentiments behind the conversations among teenagers and adults.

Significance

In this first of its kind big data analysis of nearly a quarter‐million digital conversations about epilepsy using machine learning, we found that teenagers engage in an online conversation about suicide more often than adults. There are some key differences in the attitudes and concerns, which may have implications for the treatment of younger patients with epilepsy.

Correlates of Stigma in People with Epilepsy

Background and Purpose

Epilepsy is often associated with substantial stigma. This study evaluated clinical correlates of stigma in a sample of people living with epilepsy (PLWE) considered high risk due to frequent seizures or other negative health events.

Methods

Data were derived from an epilepsy self-management clinical trial. Standardized measures assessed socio-demographics, epilepsy stigma, epilepsy severity, self-efficacy, self-management competency, health literacy, depressive symptoms severity, functional status, social support and quality of life.

Results

There were 120 individuals, mean age of 41.73 (SD=17.08), 81 men (66.9%), and 79 (65.3%) African-American. Individual factors correlated with worse stigma w ere indicative of more severe or poorly controlled seizures (frequent seizures, worse seizure severity scores, more antiepileptic drugs), mental health comorbidity (worse depression severity, other comorbidities) and factors related to individual functioning and perceived competency in managing their health (health literacy, health functioning, self-efficacy, quality of life). Multivariable linear regression found that worse quality of life, and having a mental condition were associated with more stigma (β=6.4 and 6.8, respectively), while higher self-efficacy, health literacy and social support were associated with less stigma (β=−0.06, −2.1, and −0.3, respectively). These five variables explained 50% of stigma variation.

Conclusions

Stigma burden can be substantial among PLWE and may vary depending on contextual factors such as mental health comorbidity. Care approaches that screen for psychiatric comorbidities, address low health literacy, institute promising self-management programs, and employ effective health communication strategies about epilepsy misconceptions, may reduce epilepsy related burden.

Assessing knowledge and attitudes of Palestinian undergraduate nursing students toward epilepsy and patients with epilepsy: A cross-sectional study

OBJECTIVE

This study assessed knowledge and attitudes of undergraduate nursing students toward epilepsy and patients with epilepsy (PWEs). Associations between different sociodemographic and academic variables and knowledge and attitude scores were also assessed.

METHODS

The present study was conducted in a cross-sectional observational design among Palestinian undergraduate nursing students using a prevalidated and reliable questionnaire of 38 items. After collecting sociodemographic and academic characteristics, students answered a knowledge test (16 items) and attitude test (13 items).

RESULTS

The questionnaire was completed by 342 nursing students. The median knowledge score was 65.6 with an interquartile range (IQR) of 31.3, and the median attitude score was 81.5 with an IQR of 20.0. Multiple linear regression analyses showed that higher knowledge scores were predicted by being female in gender (p-value <0.05), had a course/studied about epilepsy (p-value <0.001), self-rated knowledge about epilepsy as high (p-value <0.05), and ever witnessing a PWE experiencing seizures (p-value <0.001). Higher attitude scores were predicted by self-rated knowledge about epilepsy as high (p-value <0.001), had a course/studied about epilepsy (p-value <0.05), and ever witnessed a PWE experiencing seizures (p-value <0.05).

CONCLUSION

Nursing students had moderate knowledge of epilepsy and had generally positive attitudes toward PWEs. Findings of this study highlighted knowledge gaps and areas for improvement. As knowledge scores were positively correlated with attitudes, probably, findings of this study might suggest that educational/training interventions can improve knowledge as well as positive attitudes of nursing students with regard to epilepsy and PWEs.

Social functions and socioeconomic vulnerability in epilepsy

Social functions are commonly impaired in people with epilepsy who are at increased risk of experiencing altered social cognition, communication problems, and interpersonal difficulties. Several factors are implicated, including developmental delay, seizure-related factors, somatic and psychiatric comorbidities, antiepileptic drugs (AEDs), and - not least - the effects of stigma. The variable interaction of all these factors can explain the differing pictures observed in the various epilepsy phenotypes but is also a source of interindividual variability depending on the strength of the effects of each factor on social cognition. This article is part of the Special Issue "Epilepsy and social cognition across the lifespan.

Disclosure strategies in adults with epilepsy when telling, "I have epilepsy": The How2tell study

OBJECTIVE

To generate evidence-based knowledge about the strategies that adult people with epilepsy (PWEs) use in the process of telling others about their epilepsy.

METHODS

In-depth, one-to-one interviews explored PWEs' first-hand experiences of self-disclosure (or not), and grounded theory methods of inductive-deductive analysis were used to identify strategies used in disclosing. Interviews were audio-recorded, transcribed, coded, and independently recoded by two researchers using a coding framework specifically developed in this study. To account for maximum variation, PWEs (aged 18+ years) with different life experiences and situations relating to (1) gender, (2) age, (3) employment status, (4) personal relationships, (5) family relationship, (6) support group involvement, and (7) seizure frequency were included. Given the many variables and psychosocial issues associated with epilepsy, demographic details and validated measures including Quality of Life in Epilepsy-10-P, Coping Inventory of Stressful Situations-Adult, and Patient Health Questionnaire-9 were used to describe the characteristics of participants and to contextualize the results.

RESULTS

Forty-nine adults with epilepsy participated. Data analysis revealed six interrelated categories (with subcategories) of the strategies that PWEs reported using in the process of disclosure: (1) concerns about disclosing; (2) weighing up who and when to tell; (3) opportunities for telling; (4) moment of disclosure-how to construct the message; (5) tailoring the message to audience needs-altering the message when telling family members, partner, friends, children, or employer and workplace colleagues; and (6) managing reactions by making it ordinary.

SIGNIFICANCE

People with epilepsy use a range of different strategies during the process of disclosing their epilepsy. These strategies were used to inform the development of the How2tell multimedia self-management resource for PWEs on self-disclosure in everyday social and life situations. How2tell is designed to benefit PWEs by empowering them with practical information about the process of telling another person, "I have epilepsy."

Epilepsy-associated stigma from the perspective of people with epilepsy and the community in Italy

OBJECTIVE

The objective of this study was to assess the stigma related to epilepsy from the perspective of people with epilepsy (PWE) and from the Italian community (Rome and central Italy); moreover, the impact of the perceived stigma on the mood and quality of life of patients was also evaluated.

MATERIALS AND METHODS

We consecutively enrolled 100 PWE and 202 nonepileptic subjects (NES). Both PWE and NES completed an Italian version of the Stigma Scale of Epilepsy (SSE), a 24-items questionnaire that has been demonstrated to allow the quantification of the stigma perception by patients and people from the community. Moreover, the PWE fulfilled a 3-item Jacoby's Stigma Scale, the Quality of Life in Epilepsy-31 (QOLIE-31 [Q3])), and Beck Depression Inventory II (BDI-II) questionnaires for the evaluation of the quality of life and depressive symptoms. The results of the SSE were correlated with clinical and demographic details of PWE and NES, as well as the Q31 and BDI-II scores in PWE.

RESULTS

The SSE scores were significantly higher in NES with respect to PWE (respectively 47.1 vs 39.5, p < .001). Forty-two percent of PWE reported feeling stigmatized, with 5% reporting feeling highly stigmatized. In PWE, the perceived stigma was not correlated with seizure frequency but was significantly associated with worse quality of life, more severe depressive symptoms, and higher number of AEDs. The multiple regression analysis showed that the quality-of-life overall score and Q31 subscale exploring "social function" are the most significant predictors of stigma.

CONCLUSIONS

By using an Italian translation of the SSE questionnaire, even if we cannot consider our sample representative of the whole Italian community our study evidenced higher rates of stigma related to epilepsy in NES than in PWE. The PWE still experience feelings of stigmatization strongly correlated with higher depressive symptoms and worse quality of life that has proven to be the most significant predictor of stigma. Finally, seizure frequency does not affect the perceived stigma, which is instead significantly influenced by antiepileptic therapy.

Epilepsy stigma in Saudi Arabia: The roles of mind-body dualism, supernatural beliefs, and religiosity

INTRODUCTION

The stigma of epilepsy continues to negatively impact people with epilepsy (PWE) in many Arab Middle Eastern countries, including Saudi Arabia. Socioreligious, cultural, and philosophical ideas prevalent in the region may contribute to the underpinnings of stigma toward PWE, but this has not been sufficiently studied.

MATERIALS AND METHODS

This study recruited a convenience sample of people without epilepsy from clinic waiting rooms and through social media. Participants completed a questionnaire with questions about demographics, mind-body dualism (MBD), supernatural beliefs (SB), attitudes toward epilepsy (ATE), and religiosity.

RESULTS

A total of 210 participants were recruited. Analysis of variance (ANOVA) showed a significant difference in the mean total ATE scores, indicating better ATE with higher education (p < 0.001). Despite the relatively high level of education and a high proportion of participants with medical training, only slightly more than half rejected the possibility that demonic possession may be a cause of epilepsy. Attitudes toward epilepsy were correlated with MDB and SB but not with religiosity. Mind-body dualism and religiosity correlated significantly with negative attitudes toward PWE (p < 0.05). A linear regression model using ATE as the dependent variable and MDB, SB, and educational level as independent variables significantly predicted ATE (F = 15.6, p < 0.001, R2 = 0.24), although SB dropped out as a predictor of ATE in that model. Another regression used SB as the dependent variable, and MBD, religiosity, and educational level as independent variables were also significant with all three variables predicting SB (F = 64.0, p < 0.001).

CONCLUSIONS

Mind-body dualism was related to the cognitive process leading to supernatural misconceptions about epilepsy and negative attitudes toward PWE in Saudi Arabia. Although misconceptions that supernatural possession was the cause of epilepsy (justifying treatment by religious healing) and was likely derived from prevalent religious beliefs of the region, religiosity was not associated with negative attitudes toward PWE. The merits and efficacy of an intervention focused on reducing the negative effects of MBD and SB on ATE warrants further investigation.

A qualitative study on the stigma experienced by people with mental health problems and epilepsy in the Philippines

BACKGROUND

Stigma towards people with mental health problems (PMHP) is known to have substantial negative impacts on their lives. More in-depth exploration of the stigma and discrimination experienced by PMHP in low- and middle-income countries is needed. Previous research suggests that negative attitudes towards PMHP are widespread among the Filipino general public. However, no study has investigated PMHP's own experiences of being stigmatised in the Philippines.

METHODS

A qualitative study was conducted on the stigma experienced by PMHP (including people with epilepsy) and its related factors in the Philippines, employing the constructivist grounded theory approach. We analysed data on 39 PMHP collected through interviews with PMHP, their carers, and community health volunteers who know them well.

RESULTS

The findings highlight the culturally and socio-economically specific contexts, consequences, and impact modifiers of experiences of stigma. Participants emphasised that PMHP face stigma because of the cultural traits such as the perception of mental health problem as a disease of the family and the tendency to be overly optimistic about the severity of the mental health problem and its impact on their life. Further, stigma was experienced under conditions where mental health care was not readily available and people in the local community could not resolve the PMHP's mental health crisis. Stigma experiences reduced social networks and opportunities for PMHP, threatened the economic survival of their entire family, and exacerbated their mental health problems. An individual's reaction to negative experiences can be fatalistic in nature (e.g. believing in it is God's will). This fatalism can help PMHP to remain hopeful. In addition, traditional communal unity alleviated some of the social exclusion associated with stigma.

CONCLUSIONS

The study indicates that existing stigma-reduction strategies might have limitations in their effectiveness across cultural settings. Therefore, we propose context-specific practical implications (e.g. emphasis on environmental factors as a cause of mental health problems, messages to increase understanding not only of the possibility of recovery but also of challenges PMHP face) for the Philippines.

Epilepsy misconceptions and stigma reduction interventions in sub-Saharan Africa, a systematic review

OBJECTIVE

This systematic review identified papers that described epilepsy misconceptions or stigma in sub-Saharan Africa (SSA) and research interventions focused on reducing these misconceptions.

MATERIALS AND METHODS

Publications in the English language from January 2000 to October 2017 that described original research conducted in SSA on misconceptions about epilepsy were utilized.

RESULTS

Twenty-three publications were identified. Studies were from Nigeria (N = 4), Cameroon (N = 4), Uganda (N = 3), Zambia (N = 2), Ethiopia (N = 2), Tanzania (N = 2), Kenya (N = 2), Ghana, Zimbabwe, Benin, and Mali (N = 1 each). The studies included assessments of misconceptions among healthcare providers and medical students (N = 3), high school students (N = 2), teachers (N = 2), the general public (N = 10), people with epilepsy (N = 7), and traditional healers (N = 1). Only two studies had stigma-focused interventions. Majority of the studies reported limitations to socialization with people with epilepsy and various beliefs associated with epilepsy.

CONCLUSIONS

Epilepsy misconceptions, stigmatizing cultural beliefs, and perceptions were widely prevalent in SSA, and there are a few studies targeting epilepsy stigma. Existing stigma-reduction educational approaches may be impractical for general population implementation. Scalable approaches to reduce stigma are urgently needed within SSA.