Public awareness and attitudes toward epilepsy in different social segments in Brazil

Impact of metacognition on attitudes toward epilepsy in medical students

PURPOSE

This study evaluated medical students' knowledge and attitudes toward epilepsy and the influence of metacognition thereon.

METHOD

Valid questionnaires were administered to medical students including undergraduate, professional postgraduate, and standardized residency training students (N = 503). The questionnaire had 4 parts: demographic information, knowledge of epilepsy, attitudes toward epilepsy, and metacognitive assessment. The Chinese Public Attitudes Toward Epilepsy scale and 30-Item Metacognition Questionnaire were used to assess attitudes and metacognition, respectively.

RESULTS

Almost all participants had heard of epilepsy; 38.8% had witnessed a seizure and 25% were acquainted with a person with epilepsy. The proportion of correct answers to epilepsy-related knowledge ranged from 40.6% (Putting an object into the mouth of a person experiencing an epileptic seizure) to 97% (Convulsion is a symptom of epilepsy). However, knowledge of epilepsy was not able to affect attitudes toward epilepsy. Age, years of clinical experience, having witnessed a seizure, positive belief of worry, and need to control thinking were correlated with the different domains of attitude toward epilepsy. When participants were divided into 2 groups-i.e., those with high and low knowledge of epilepsy, participants in the former group who had a positive belief of worry or had not witnessed any seizures were more likely to have negative attitudes toward epilepsy.

CONCLUSION

Medical students showed good awareness of the etiology and symptoms of epilepsy. Overall, attitudes toward epilepsy were negative. A positive belief of worry was associated with a more negative attitude toward epilepsy among respondents with greater knowledge of epilepsy.

Systematic review of frequency of felt and enacted stigma in epilepsy and determining factors and attitudes toward persons living with epilepsy-Report from the International League Against Epilepsy Task Force on Stigma in Epilepsy

OBJECTIVE

To review the evidence of felt and enacted stigma and attitudes toward persons living with epilepsy, and their determining factors.

METHODS

Thirteen databases were searched (1985-2019). Abstracts were reviewed in duplicate and data were independently extracted using a standardized form. Studies were characterized using descriptive analysis by whether they addressed "felt" or "enacted" stigma and "attitudes" toward persons living with epilepsy.

RESULTS

Of 4234 abstracts, 132 met eligibility criteria and addressed either felt or enacted stigma and 210 attitudes toward epilepsy. Stigma frequency ranged broadly between regions. Factors associated with enacted stigma included low level of knowledge about epilepsy, lower educational level, lower socioeconomic status, rural areas living, and religious grouping. Negative stereotypes were often internalized by persons with epilepsy, who saw themselves as having an "undesirable difference" and so anticipated being treated differently. Felt stigma was associated with increased risk of psychological difficulties and impaired quality of life. Felt stigma was linked to higher seizure frequency, recency of seizures, younger age at epilepsy onset or longer duration, lower educational level, poorer knowledge about epilepsy, and younger age. An important finding was the potential contribution of epilepsy terminology to the production of stigma. Negative attitudes toward those with epilepsy were described in 100% of included studies, and originated in any population group (students, teachers, healthcare professionals, general public, and those living with epilepsy). Better attitudes were generally noted in those of younger age or higher educational status.

SIGNIFICANCE

Whatever the specific beliefs about epilepsy, implications for felt and enacted stigma show considerable commonality worldwide. Although some studies show improvement in attitudes toward those living with epilepsy over time, much work remains to be done to improve attitudes and understand the true occurrence of discrimination against persons with epilepsy.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Attitudes towards people with epilepsy in Moscow

PURPOSE

To assess the knowledge and attitudes in Moscow towards people with epilepsy (PWE).

METHODS

Data were collected from 1167 adults, permanent residents of Moscow, who were interviewed. A 10-item questionnaire was used addressing three major domains: familiarity with epilepsy (2 questions), understanding of epilepsy (5 questions), and attitude towards the PWE (3 questions). Results were standardized to the Moscow population.

RESULTS

The study population was generally well informed about epilepsy. About 80% "has heard" of epilepsy; however, personal acquaintance with PWE was reported by less than half of the study participants. The level of understanding of the disease and its etiology was quite low. About 60% of the survey participants believed that epilepsy was a type of mental retardation. One-third (34%) of respondents were afraid to stay in the proximity of PWE. Only 38% of the survey participants considered epilepsy to be curable; men significantly less frequently than women. Overall, the level of understanding of epilepsy was proportional to the level of education of respondents. Negative attitudes towards PWE were demonstrated in a significant part of the population. Almost half of the respondents would object to their child playing or studying with a child who has epilepsy and more than half (57%) were against the marriage of their daughter or son to a person with epilepsy. Two-fifths of the respondents ranked epilepsy as the "least preferred" of the six chronic diseases for a colleague.

CONCLUSION

This is the first study on awareness and attitudes to PWE in the adult population of Moscow. The study demonstrated that the general public is familiar with epilepsy, but has a rather low level of understanding of essential aspects of the disease. There is an overall high level of negative attitudes towards PWE in Russia, creating a need for targeted interventions. These results reinforced the importance of public education in reducing the stigma of epilepsy.

Development and validation of a public attitudes toward epilepsy (PATE) scale

INTRODUCTION

A quantitative scale of public attitudes toward epilepsy is essential to determine the magnitude of social stigma against epilepsy. This study aims to develop and validate a cross-culturally applicable scale of public attitudes toward epilepsy.

METHODS

A set of questions was selected from questionnaires identified from a literature review, following which a panel review determined the final version, consisting of 18 items. A 1-5 Likert scale was used for scoring. Additional questions, related to perception of the productivity of people with epilepsy and of a modified epilepsy stigma scale, were added as part of construct validation. One hundred and thirty heterogeneous respondents were collected, consisting of various age groups, ethnicity and occupation status levels.

RESULTS

After item and factor analyses, the final version consisted of 14 items. Psychometric properties of the scale were first determined using factor analysis, which revealed a general and a personal domain, with good internal consistency (Cronbach's coefficient 0.868 and 0.633, respectively). Construct validation was demonstrated. The mean score for the personal domain was higher than that for the general domain (2.72±0.56 and 2.09±0.59, respectively). The mean scores of those with tertiary education were significantly lower for the general domain, but not for the personal domain. Age was positively correlated with the mean scores in the personal domain, but not in the general domain.

CONCLUSION

This scale is a reliable and valid scale to assess public attitudes toward epilepsy, in both the general and personal domains.

Knowledge, practice and attitude toward epilepsy among primary and secondary school teachers in South Gezira locality, Gezira State, Sudan

Objective:

The attitudes toward school pupils with epilepsy are influenced by the degree of school teachers’ knowledge of the disorder. Teachers usually do not receive any formal instructions on epilepsy during their training. This study aims to assess school teachers’ knowledge, attitude and practice when dealing with epilepsy in school children.

Materials and Methods:

This study was part of a series mandated by the Gezira Epilepsy Care Programme (GECP), to obtain baseline data for a community-adapted epilepsy education program. A pretested, semi-structured, 35-items questionnaire was the investigational tool. It was used to evaluate the knowledge of the basic facts about epilepsy among school teachers in this cross-sectional study. The questionnaire allowed teachers to express their opinions by means of free answers. The schools were chosen at random but not in a systematic equiprobability design. Two hundred teachers from public primary (100) and secondary (100) schools in the rural area of south Gezira Locality, Gezira State, Central Sudan, were recruited.

Results:

In this study, the majority of respondents had never been informed about epilepsy and therefore gave evasive answers to many questions. Few of the respondents considered epilepsy as contagious. None of participants objected to having epileptic children in their classes. Only 47 teachers (47%) in the primary schools had any knowledge of the initial procedures to help a child in seizure, presenting reasonable answers, compared to 64 (64%) teachers in the secondary schools.

Recommendations:

All school teachers should be given some kind of training in health services. The GECP should involve teachers in its current training programs for caregivers and lay association to help epileptic patients.

Evaluation of knowledge of and attitudes toward epilepsy among the health science students of Manipal University

This study was carried out to assess the knowledge, attitudes, and practices with respect to epilepsy among health science students of Manipal University. The study was conducted among first-year health science students of Kasturba Medical College on the Manipal and Mangalore campuses of Manipal University. All students willing to participate (n=587) were asked to answer a standardized questionnaire on epilepsy. Our study group included educated urban people from various ethnic backgrounds of various countries who chose health science as a career, which makes the study different from others. Even though most of the students had heard about epilepsy, very few knew about the underlying cause. Most of the students were ignorant about the drugs and ways to deal with epileptic seizures. Questions related to community and religion were deliberately avoided as some subjects found such questions offensive, which may have resulted in a difference in response as compared with previously published studies. It was observed that a large number of students were not aware of the nuances of epilepsy. However, we expect the knowledge, attitudes and awareness to improve considerably with time and increased exposure. These findings support a need to promote epilepsy awareness programs as a means of increasing public knowledge of epilepsy.

Factors contributing to Korean adolescents' perceptions of stigma with respect to epilepsy

We assessed knowledge and perceptions of epilepsy held by Korean adolescents in the general population, and investigated factors important in adolescents' perceptions of stigma with respect to epilepsy. Surveys were distributed to students at 22 schools. A total of 1377 students participated. Fewer than half of all students (45.1%) reported hearing or reading about epilepsy. Overall, students showed a general lack of familiarity with and knowledge of epilepsy. Stigma perception scores were significantly higher in boys than in girls (P<0.05) and in middle school than in high school (P<0.05) students. We also found that stigma perception scores were significantly correlated with both younger age (r=-0.074, P=0.006) and lower knowledge scores (r=-0.404, P=0.000). Linear regression analysis showed that stigma-related perception was associated with lower knowledge scores (P<0.001) and middle school (P<0.05). These results indicate a need for public education of adolescents in the general population to decrease the stigma associated with epilepsy.

Awareness and attitudes on epilepsy among undergraduate health care students in Southern Brazil

OBJECTIVE: To evaluate the awareness on epilepsy among undergraduate health care students in a private university. METHODS: A self-administered questionnaire about epilepsy was applied to 417 students at Universidade de Caxias do Sul. The answers were analyzed in two groups: group 1, medical and nursing students; group 2, psychology, physiotherapy and nutrition students. RESULTS: Most of the students were familiar with the disease. Although many of them recognize brain disease as a cause of seizure, it was observed that a quarter of them linked epilepsy with mental disease. Besides, a relevant portion of the sample presents mistaken attitudes on seizure management. CONCLUSION: There is lack of information on epilepsy among these students. The students and the health care professionals are important vectors of information. Therefore, further discussion on this subject is necessary in health care training to demystify some aspects concerning the disease.

Awareness, attitudes and perceptions on epilepsy in Southern Brazil

OBJECTIVE: To verify awareness and attitudes toward epilepsy in Southern Brazil. METHOD: A questionnaire about familiarity with the disease, awareness and attitudes toward epileptics was applied to 832 inhabitants of Caxias do Sul. The answers were analyzed in three different groups: G1, non-university students; G2, university students up to the second year; and G3, university students with more than two years education and university graduates. RESULTS: University students and graduates are better informed regarding causes and treatment of epilepsy. Moreover, those interviewees present less negative attitudes toward epileptics. However, a large part of that group lacks some basic information on the disease. CONCLUSION: There is lack of information on epilepsy among Brazilians. Education campaigns should be carried out in order to clarify some aspects concerning epilepsy.

Knowledge attitudes and practice toward epilepsy among adults in BaVi, Vietnam: first report from the population-based EPIBAVI study

PURPOSE

We conducted a survey to assess knowledge, attitudes, and practice toward epilepsy in a population-based study in a rural district of Vietnam.

METHODS

We utilized an established knowledge-attitudes-practice questionnaire. This was applied by trained surveyors in face-to-face interviews of 2005 randomly selected adult residents (19-71 years of age) of the BaVi district, 60 km west of Hanoi.

RESULTS

Of the respondents, 67.0% had heard about epilepsy, 52.1% had known someone with seizures, and 49.3% had witnessed seizures. In total, 36.3% would object to their children playing with someone with seizures and 82.0% to their children marrying someone with epilepsy. Only 32.6% thought that epilepsy patients should be employed in a job as other people, while 10% thought that epilepsy was a form of insanity. Familiarity with epilepsy, having heard of epilepsy, known someone with epilepsy, or having seen seizures was associated with less negative attitudes. About half of the respondents (50.4%) thought epilepsy was caused by a brain disease and 80.1% would suggest consultation of a medical doctor for epilepsy.

CONCLUSIONS

Knowledge of epilepsy among Vietnamese people is still limited compared to some Western countries and the attitudes more negative. Our findings indicated more negative attitudes than in another recent survey from Vietnam. This may be due to differences in sociodemographic characteristics and educational level of the study populations. The discrepancies demonstrate the importance of selection of study population and the need for caution in generalizing from results of surveys.

Development and psychometric properties of the Thinking about Epilepsy questionnaire assessing children's knowledge and attitudes about epilepsy

OBJECTIVE

Epilepsy is the most common neurological disorder in the world, yet it is still widely misunderstood. A lack of knowledge and negative attitudes about epilepsy are largely blamed for the stigma felt by people with epilepsy and their families. Recent calls for research into stigma have been made by the World Health Organization and international epilepsy organizations. Our objective is to describe the development, structure, and psychometric properties of the Thinking about Epilepsy questionnaire.

METHODS

A 36-item questionnaire was designed to assess Grade 5 (ages 9-11) students' knowledge of and attitudes about epilepsy and to evaluate changes in knowledge and attitudes following an epilepsy education program. The questionnaire contains 18 knowledge, 10 attitude, and 8 demographic questions.

RESULTS

Psychometric properties of the Thinking about Epilepsy questionnaire were ascertained using data from 783 Grade 5 students. Three items (one knowledge item and two attitude items) were removed prior to the factor analysis due to their low extraction communalities. Factor analysis revealed a bidimensional structure (knowledge and attitudes) with five knowledge factors and two attitude factors. The questionnaire was found to have good internal consistency reliability (Cronbach's alpha=0.74 for knowledge and 0.82 for attitudes). Both the knowledge and attitude measures were deemed to have acceptable face, content, and construct validity.

CONCLUSION

The final 33-item Thinking about Epilepsy questionnaire demonstrates adequate reliability for the knowledge measure, good reliability for the attitude measure, and excellent validity for both measures. The Thinking about Epilepsy questionnaire offers a viable option for assessing elementary school students' knowledge and attitudes regarding epilepsy in general or in conjunction with its affiliated Thinking about Epilepsy education program.

Adolescents' perception of epilepsy compared with other chronic diseases: "through a teenager's eyes"

Adolescent perception of physical and social impact of chronic illness was assessed to determine (1) if there is greater prejudice toward epilepsy than other chronic disease and (2) if adolescents with chronic disease have less prejudice toward similarly affected peers with all types of chronic disease or just their specific chronic disease. Cognitively normal teens aged 13 to 18 years without chronic disease (n = 41) and with epilepsy (n = 32), asthma (n = 38), diabetes (n = 21), and migraine (n = 17) were interviewed in the outpatient clinics of a tertiary care pediatric center regarding their perceptions of the physical and social impact of eight chronic diseases (epilepsy, asthma, diabetes, Down syndrome, arthritis, migraine, leukemia, human immunodeficiency virus [HIV] infection). Epilepsy was perceived to have a more adverse physical impact than all chronic illnesses except Down syndrome. The perception was that it more frequently caused mental handicap, injured the afflicted individual and bystanders, and led to death. Epilepsy was also perceived to have a more negative social impact, particularly on behavior, honesty, popularity, adeptness at sports, and fun. Significantly more adolescents expressed reluctance to befriend peers with epilepsy, both from their own and their perceived parental perspectives. Having a chronic disease did not generally alter the adolescents' perceptions of peers with chronic disease. However, cases with epilepsy ranked this disease to have less social impact than teens with other chronic diseases. In conclusion, adolescents consider epilepsy to have a greater physical and social impact than most chronic diseases. Educational efforts should focus on the "normality" of most persons with epilepsy and emphasize the low risk of injury when proper first aid is followed.

Attitudes of Brazilian psychiatrists toward people with epilepsy

The purpose of this survey was to evaluate the experience of Brazilian psychiatrists in treatment, formal training, attitudes, and knowledge with respect to epilepsy (and associated mental disorders). One hundred fifty-seven Brazilian psychiatrists completed a specially developed questionnaire. Most (95%) had previously treated patients with epilepsy and mental disorders. About one-third (35%) admitted a lack of any formal training in epilepsy, and only 46% confirmed having received some formal training in mental disorders related to epilepsy. Eighty percent were dissatisfied with their knowledge. Three knowledge-based questions were answered correctly by only 10%. Almost half (48%) admitted that among psychiatrists, prejudice exists toward patients with epilepsy. Difficulties with treatment (50%) and lack of knowledge of epilepsy (50%) were considered the main causes of such prejudice. These data indicate an urgent need for improvement in education on epilepsy and associated mental disorders, as well as inclusion of formal epilepsy training in psychiatry residency programs.

Conhecimentos e atitudes sobre epilepsia entre universitários da área da saúde

Vários estudos em diversos paises mostram em relação à epilepsia a falta de conhecimentos, os preconceitos e as repercussões negativas para os pacientes. Avaliamos os conhecimentos e atitudes de universitários da área da saúde no início e ao final dos cursos. Foram aplicados questionários contendo 15 questões em relação à epilepsia a 564 universitários (290 do primeiro e 274 do último ano) de cinco cursos (ciências farmacêuticas, fisioterapia, medicina, nutrição e terapia ocupacional). Os estudantes de último ano tiveram maior familiaridade com epilepsia, melhor conhecimento de suas causas e de seu tratamento. Também em questões relacionadas ao trabalho e à conduta durante as crises, ao final dos cursos cresceram as posturas positivas. Não obstante, porcentagem significativa dos universitários do último ano ainda apresentou importantes lacunas de conhecimento em relação à epilepsia o que sugere a necessidade de ações dirigidas a minorar essa situação.

An epilepsy questionnaire study of knowledge and attitudes in Canadian college students

PURPOSE

Controversy exists about the relation of societal knowledge and attitudes regarding epilepsy. We conducted a survey to examine knowledge and attitudes, to note gender and occupational influences, and to examine the effect of an informational brochure.

METHODS

We administered a standardized questionnaire that noted demographics and examined knowledge and attitudes regarding epilepsy and persons with epilepsy, respectively, to a wide variety of Canadian college students. In a separate class we gave every other student a brochure regarding epilepsy and then administered the questionnaire to both the naïve and brochure-exposed students.

RESULTS

Knowledge was patchy and weakest for the approximate prevalence of epilepsy in the population, hereditary epilepsy and several other etiologies, recognition of nonconvulsive seizures as a type of epilepsy, and knowledge of antiepileptic drug-induced teratogenicity. In contrast, attitudes were more uniformly favorable. However, 11 and 14%, respectively, showed negative bias against persons with epilepsy having children and equal opportunity for occupational employment. Women were slightly but significantly more tolerant than men. The brochure-exposed group showed better knowledge but equivalent attitudes compared with the naïve group.

CONCLUSIONS

Results compare favorably with surveys in other countries. Although knowledge was patchy, it could be easily improved on with an educational brochure. Attitudes were positive but show some discrepancies from knowledge and a gender effect.

Knowledge and attitudes toward epilepsy among primary, secondary and tertiary level teachers

The attitudes toward people with epilepsy are influenced by the degree of knowledge of the condition. Teachers usually do not receive any formal instruction on epilepsy during their training. This study was done to access three hundred teachers' knowledge and attitudes toward epilepsy by answering a questionnaire in order to quantify their knowledge, attitude and practice toward epilepsy. Almost all the teachers had heard about epilepsy yet could not demonstrate discrimination among the students. Some teachers still thought that epilepsy was contagious. A few others either objected to having epileptic children in their classes or did not think that an epileptic child could achieve higher studies. The knowledge about the clinical characteristics and initial procedures to attend a person during a seizure was unsatisfactory. We conclude that schools should offer some kind of knowledge or assistance in health services and physicians must ensure that these teachers have sufficient knowledge of epilepsy. Also general public education campaigns should be encouraged in this field.

Doctors' perspectives and practices regarding epilepsy

OBJECTIVE

The main aim of this study was to evaluate the knowledge, management practices and attitudes towards people with epilepsy (PWE) by a group of general practitioners (GP) and pediatrician (PD) residents.

METHODS

A cross-sectional study was carried out in three training hospitals, and had been selected 31 GP and 47 PD who agreed with the study. The collection of data was made by self-applied structured questionnaire.

RESULTS

Many respondents have positive values about PWE, and recognize prejudice in the population against them. The residents recognize in themselves and in the colleagues lack of knowledge about PWE, and that Medical School do not give enough importance to the study of PWE. The reference of PWE to the neurologist is a common practice among the doctors. Half of them are favorable to the idea of assuming the patients clinical management after an initial clientele appraisal by the neurologist.

CONCLUSIONS

The non-neurologist doctors do not feel comfortable in managing PWE due to barriers. Our doctors complain about the undergraduate medical training related to the epilepsy. Although, there is not a clear relationship between the undergraduate medical training, referral practices and satisfaction about the management of PWE. The patients care is influenced not only by knowledge, but also by doctors' attitudes. In this way, there are other barriers, perceived or not, to providing care to PWE by the generalists, and they need to be approached in the medical undergraduate curriculum and medical continuing education.