|Year : 2021 | Volume
| Issue : 4 | Page : 58-63
A cross-sectional study on knowledge and attitude of schoolteachers about epilepsy in Saudi Arabia
Norah Alharbi1, Yousef Mohammed Alharbi2, Abdulrahman Khalifah Almasaud2, Tareq Naseer Alsamarh2, Saleh Abdullah Alwasil2, Ahmed Hamoud Aldaham2, Omar Abdulaziz Alolayan2, Abdulrahman Obaid Alharbi3
1 Department of Clinical Science, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
2 Unaizah College of Medicine, Unaizah, Saudi Arabia
3 Department of Medicine, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
|Date of Submission||14-May-2021|
|Date of Decision||03-Jul-2021|
|Date of Acceptance||27-Aug-2021|
|Date of Web Publication||16-Oct-2021|
Department of Clinical Science, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh
Source of Support: None, Conflict of Interest: None
Introduction: Epilepsy is a chronic brain disease characterised by intermittent nervous system derangement due to sudden excessive cerebral neuron discharge that results in almost instantaneous sensation disruption and loss of consciousness. There is a clear lack of epilepsy information among the general population. This study was carried out with an aim to examine the knowledge, attitude and practice of schoolteachers towards epilepsy. Materials and Methods: This cross-sectional survey was administered to 433 schoolteachers working in the Al-Qassim region of Saudi Arabia from October to December 2020. A 20-item pretested validated questionnaire was distributed as a Google survey link, and the data collected were analysed using SPSS version 22. P < 0.05 was considered statistically significant. The Chi-square test was used to evaluate the categorical variables. Results: Around two-thirds of the teachers (35.2%) gained their information about epilepsy from public resources such as newspapers, television and the internet, and around half of them (53.1%) gained their information about epilepsy from multiple resources, namely from doctors, public resources and parents of students with epilepsy. Almost all teachers (99.3%) acknowledge that epilepsy is not a contagious disease, and more than half of the participants (58.4%) believed that there are multiple causes of epilepsy, including genetics, head trauma, infection, brain tumour and insanity. Conclusion: The study showed that teachers' knowledge of epilepsy was promising, but still, there are gaps in knowledge and attitude towards first aid management. There is a need to address this issue with the training of schoolteachers with the cooperation of local health professionals.
Keywords: Attitude, epilepsy, management, schoolteacher
|How to cite this article:|
Alharbi N, Alharbi YM, Almasaud AK, Alsamarh TN, Alwasil SA, Aldaham AH, Alolayan OA, Alharbi AO. A cross-sectional study on knowledge and attitude of schoolteachers about epilepsy in Saudi Arabia. Adv Hum Biol 2021;11:58-63
|How to cite this URL:|
Alharbi N, Alharbi YM, Almasaud AK, Alsamarh TN, Alwasil SA, Aldaham AH, Alolayan OA, Alharbi AO. A cross-sectional study on knowledge and attitude of schoolteachers about epilepsy in Saudi Arabia. Adv Hum Biol [serial online] 2021 [cited 2021 Dec 4];11:58-63. Available from: https://www.aihbonline.com/text.asp?2021/11/4/58/328405
| Introduction|| |
Epilepsy is essentially a chronic brain condition marked by repetitive nervous system dysfunction due to a sudden abnormal cerebral discharge that results in nearly acute sensational disturbance and consciousness loss epilepsy. The World Health Organization (WHO) defines recurring at least two unprovoked seizures as a diagnosis of epilepsy. On the basis of economic, cultural and community health background, epilepsy effects on stigma differ across the world on death, morbidity and quality of life. The WHO reports that 8 out of 1000 individuals worldwide have this disorder; the incidence is higher in developing countries as compared to developed countries.
Various psychological problems, including anxiety, psychosis and depression, are prevalent in epilepsy patients. Management of epilepsy is affected by the sociocultural attitudes in many countries. Superstition, discrimination and stigma are associated with the disorder in many countries.
Apart from the physical injuries, children with epilepsy are frequently stigmatised, mostly due to anxiety and public loss of self-control. This, in turn, can change the perception of social inclusion and can lead to exclusion from the schools., Children with epilepsy and normal children have the same range of intelligence and abilities. Although children with epilepsy can attend standard schooling, their attitudes are affected by the attitude of their schoolteachers.
School life is very impactful on children's quality of life as well as for further adult roles; these are associated with children's psychological, social and physical development. There are numerous psychological, economic or wellness challenges, and one of these is epilepsy with the plausibility of undereducation, academic disabilities, mental health disorders and low self-esteem.
In the development of attitudes and strong bearing mind towards any disease and problem, the schoolteacher plays a vital role. The schoolteacher does not undergo any formal epilepsy education in their training and their professional teaching life. Only a few studies were conducted to examine the knowledge, attitude and practice of schoolteachers towards epilepsy in major cities in Saudi Arabia.
| Materials and Methods|| |
This cross-sectional study was conducted to measure the knowledge, attitude and practice about epilepsy among schoolteachers in the Al-Qassim region, Saudi Arabia. The sample includes all teachers working in the Al-Qassim region. The exclusion criteria were individuals who could not complete the questionnaire for any reason. The survey was constructed on a Google Survey (Google LLC, Mountain View, California, USA) web network. Verbal informed consent was taken from the teachers. In this study, we used a 20-item questionnaire that included single choice, multiple selections or fill-in-the-blank responses and had the following variables: demographic factors (age, gender, education, address, nationality and occupation), knowledge, attitude and practice of schoolteachers about epilepsy. The questionnaire was in two parts: first part with sociodemographic characteristics of participants and the second part included questions on their knowledge, experience and attitude towards epilepsy. The data were collected between October and December 2020.
SPSS version 22 was used to evaluate the results (IBM Corp., Armonk, NY, USA). A statistically relevant value of P < 0.05 was calculated. The categorical variables were evaluated with the Chi-square test.
| Results|| |
Out of 500 schoolteachers invited to participate in the study, 433 (86.6%) returned valid questionnaires. Participants who reported not hearing or reading about epilepsy (n = 32) were asked to discontinue the survey. Accordingly, the final valid sample size was 401.
Characteristics of the sample
As shown in [Table 1], around 63% of the participating teachers were female. In addition, around half of the participants (51.1%) were aged 41 years and upper, and the majority (90.3%) were married. Concerning years of teaching experience, 39.4% of the sample had 19 years or more experience, whereas only 6.2% had 3 years or fewer experience.
|Table 1: Demographic characteristics of the participating teachers (n=401)|
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Schoolteachers' knowledge and familiarity with epilepsy
[Table 2] summarises schoolteachers' knowledge and familiarity with epilepsy. The vast majority of the teachers (92.6%) reported reading or hearing about epilepsy. Around thirds of the teachers (35.2%) gained their information about epilepsy from public resources such as newspapers, television and the internet, and around half of them (53.1%) gained their information about epilepsy from multiple resources, namely from doctors, public resources and parents of students with epilepsy. In addition, 16% of the teachers reported having family members diagnosed with epilepsy. Almost all teachers (99.3%) acknowledge that epilepsy is not a contagious disease. Furthermore, more than half of the participants (60.3%) did not have the thought that epilepsy cannot be cured or controlled. More than half of the participants (58.4%) believed that there are multiple causes of epilepsy, including genetics, head trauma, infection, brain tumour and insanity.
|Table 2: Schoolteachers' knowledge and familiarity with epilepsy (n=433)|
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Schoolteachers' attitude towards epilepsy
[Table 3] summarises schoolteachers' attitudes towards epilepsy by their years of teaching experience. Approximately two-thirds of the teachers (60.8%) answered that they are afraid of having an epileptic student in their class; there were no differences in their answers by their years of teaching experience. In addition, the majority of the teachers (84.5%) preferred to have a controlled epileptic student before entering their class. Yet, there were significant differences in the teacher's answers according to their years of experience. Less expert teachers were more to be uncertain about their answers, and teachers with 4–9 experience were more likely to disapprove of the statement. Furthermore, with differences in their experiences, the majority of the teachers (73.1%) disapproved of the statement that they preferred all students having epilepsy to be placed in a special classroom. Regarding whether or not the teachers would allow their children to play with an epileptic child, the majority (80.5%) answered yes, with differences in their experiences. Finally, when it came to allowing their sons/daughters to marry a person with epilepsy, only 11.7% agreed to do, with differences in their experiences.
|Table 3: Schoolteachers' attitude towards epilepsy by teaching experience (n=433)|
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[Table 4] provides a summary of teacher's first aid management of an epileptic attack. More than one-third of the participants (37.7%) had ever witnessed a student's epileptic seizure, among which 26.2% of them provided first aid seizure management. Concerning what are the initial procedures to attend a person during a seizure, 56.9% of the teachers indicted “call the doctor,” while 10.7% indicated “restrict the movement of the child.”
| Discussion|| |
In this cross-sectional study, most of the schoolteachers (92.6%) reported that they had heard or read about epilepsy. About one-third of respondents (35.2%) reported that their source of information was public sources (e.g. newspaper, television and the internet). Only 14 participants (3.5%) answered that the source of information was parents of students with epilepsy, 17 (4.2%) did not remember and only 16 (4%) answered doctors as the source of their information. These data accord with other studies which concluded that the majority of respondents (60.5%, 43% and 37.9%) gain knowledge about epilepsy from public media.,,
In comparison with prior studies, a study that was done in Taif, Saudi Arabia, found that 95% of schoolteachers had heard or read about epilepsy and 43% of them know about epilepsy from public media. In addition, a study that was conducted in Riyadh, Saudi Arabia, 2017, found that 99.4% of teachers had heard or read about epilepsy, and 38% of them know epilepsy from media. In Brazil and Sudan, 98% and 92.7% of schoolteachers had heard or read about epilepsy, respectively., On the other hand, in a study carried out in Istanbul, Turkey, 69.3% of the respondents had either read or heard about epilepsy.
Therefore, this allows us to employ educational programs about epilepsy using public media, as this source is considered more suitable than other sources. However, teachers would require special programs to properly educate them about epilepsy, including in-service training. This issue was addressed, and different acts were implemented to resolve it. An educational campaign was set up in Italy to act against inadequate awareness of epilepsy, which was found to have a positive impact on the knowledge of teachers.,
In our study, it was found that 64 (16%) of schoolteachers have a family member who has been diagnosed with a seizure, and 337 (84%) do not. A concurrent study found that 44 (13%) of teachers have a family member or a relative with epilepsy, and 356 (89%) of them do not. Another study in Khamis Mushaite, Saudi Arabia, also reported that only 13% of schoolteachers have a family member with epilepsy. On the other hand, a study done in Brazil had higher percentages (88%) of teachers having a family member or someone they know with epilepsy.
Regarding thoughts on epilepsy, the present study has revealed that most schoolteachers (99.3%) correctly believed that epilepsy was not infectious. Similar conclusions were also reached by studies conducted in Taif, Kuwait and Istanbul (99%, 82.4% and 97.6%, respectively).,, Regarding the cause of epilepsy, different beliefs were reported. Moreover, when schoolteachers were asked about the cause of epilepsy, 234 (58.4%) of teachers reported that it could be due to more than one reason, while others reported that it could be due to genetic reasons and head trauma. None of the teachers thought that it was due to an infection, and 21.2% did not know the cause of epilepsy. In line with previous studies, the majority of the teachers (58.5%) also reported more than one reason as the cause of epilepsy, and others thought that it was due to one factor. In a study done in Kuwait, some schoolteachers believed that genetics (34.3%) could be the cause of epilepsy, while others thought that it was an acquired disease (36.5%), and 46.0% believed that epilepsy was caused by electrical discharges. This latter finding was also reported in a study done in Riyadh, which showed that 70.3% of teachers believe that epilepsy is caused by abnormal electrical discharges in the brain. On the other hand, a study was done in 2013 in Jeddah, Saudi Arabia, found that more than 25% of teachers thought that spirit possession or evil eye was the cause of epilepsy. In a similar study carried out in Sudan, 77.3% of teachers thought that epilepsy is caused by some sort of neurological aetiology.
Regarding schoolteachers' attitude towards epilepsy, 244 (60.8%) of teachers stated that they are afraid of having a student with epilepsy in their class, whereas 126 (31.4%) are not, and 31 (7.7%) are uncertain or do not know. Furthermore, 339 (84.5%) of teachers preferred to have a controlled epileptic student before entering their classrooms, 32 (8.0%) did not prefer that and 30 (7.5%) are uncertain. On the contrary, 57% of schoolteachers in Taif stated that they are afraid of having a student with epilepsy in their class, while 41.3% were not. Moreover, 83.5% of teachers preferred to have a controlled epileptic student before entering their classrooms. In India and Brazil, 32.2% and 93% (respectively) of teachers were afraid of having an epileptic child attending their classroom.,
Furthermore, around 81 (20.2%) of teachers preferred all epileptic students to be placed in a special classroom, while the majority (73.1%) preferred not to have a separate classroom. This finding is corroborated by studies done in Taif, Khamis Mushait and Jeddah, where 21%, 20.1% and 28% of teachers, respectively, preferred epileptic students to be placed in a special classroom.,,
Regarding first aid management of an epileptic attack, our result shows that 151 (37.7%) of schoolteachers have been exposed to an epileptic seizure in one of their students, while 250 (62.3%) have not. Of those exposed, 105 (26.2%) performed first aid seizure management on them. When teachers were asked about their initial procedure to attend a person during a seizure, 228 (56.9%) chose to call a doctor, 164 (40.9%) would open the mouth and prevent tongue swallowing, 114 (28.4%) would put the child on the left side and give breath and 43 (10.7%) would restrict the movement of the child. Despite the high (>10 years) teaching experience in the majority of the participating teachers, it seems that they did not receive proper instruction about epilepsy nor first aid seizure management. Some points need attention, especially when it comes to first aid management, as it could be a life-saving first aid measure. Almost half of the teachers would attempt to open the mouth of a student having an attack, which could have harmful consequences. In addition, other studies have also reported that teachers did not take the proper first aid measures., Therefore, special training programs for all teachers with a focus on first aid management of an epileptic attack should be considered. Performing the proper initial first aid management is not only important for the safety of epileptic students but also of educational importance to their friends and classmates in case they encounter similar events in the future.
In comparison to our result, other studies conducted in Saudi Arabia showed that about 29.8% of teachers in Taif had witnessed an epileptic seizure in one of their students, while 55.2% of teachers in Riyadh have been exposed to such an event., Of those exposed in Taif, 22.5% of teachers had performed first aid seizure management, 40.3% chose to open the mouth forcefully and prevent tongue swallowing and 5% choose to restrict the movement of the child. Furthermore, in Jeddah, 58% of teachers had no idea of how to perform first aid management during a seizure attack, but most of them thought that opening the mouth and putting something to prevent tongue swallowing is the proper step.
Overall, our study illustrated in many ways that the majority of schoolteachers had poor knowledge when it comes to first aid management of an epileptic attack. This issue may result in harmful consequences. We suggest that teachers need to be provided with focused educational campaigns, awareness programs and courses on how they could safely manage an epileptic attack in one of their students.
This research should be interpreted within the context of several limitations. It may be vulnerable to information bias since we depended on a self-reported survey. Since the respondents clearly understood that the aim of the analysis was to measure attitude, their attitudes could be more positive than their real attitudes as teachers are aware of socially acceptable responses. Furthermore, more focused questions should have been asked to participants as this might guide future awareness of epilepsy to increase knowledge, attitude and first aid management level of schoolteachers.
| Conclusion|| |
This research brings out a conclusive lack of awareness of schoolteachers with regard to immediate first aid management of epilepsy. Schoolteachers are the first ones to come in contact with school children experiencing seizures and hence can play a pivotal role in preventing untoward incidents and timely referral. They need to be provided with focused educational campaigns, awareness programs and courses on how they could safely manage an epileptic attack. It is possible that better-trained teachers will have a more optimistic outlook, thereby strengthening epilepsy management.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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