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Original article

Knowledge and attitudes of school teachers, preschool teachers and students in teacher training about epilepsy and emergency management of seizures Henriette K Dumeier,1 Martina P Neininger,1 Matthias K Bernhard,2 Steffen Syrbe,2 Andreas Merkenschlager,2 Jörg Zabel,3 Wieland Kiess,2 Thilo Bertsche,1 Astrid Bertsche2 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ archdischild-2015-308306) 1

Drug Safety Center and Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany 2 University Hospital for Children and Adolescents, Centre of Pediatric Research, Leipzig, Germany 3 Department of Biology Education, University of Leipzig, Leipzig, Germany Correspondence to Professor Thilo Bertsche, Drug Safety Center and Department of Clinical Pharmacy, University of Leipzig, Eilenburger Straße 15a, Leipzig 04317, Germany; [email protected] TB and AB contributed equally. Received 22 January 2015 Revised 28 May 2015 Accepted 4 June 2015 Published Online First 25 June 2015

ABSTRACT Problem School and preschool teachers play a key role in the care of children with epilepsy. Yet, data about their knowledge on epilepsy are scarce. Methods Assessment of knowledge and attitudes towards epilepsy in teachers by conducting a questionnaire survey in Leipzig and Blankenburg, Germany, from August 2013 to January 2014. Results 1243 questionnaires were completed by 302 school teachers, 883 preschool teachers, 56 students and two unclassified participants. Of the respondents, 140 (11%) stated to have already been actively involved in an epilepsy emergency situation, another 148 (12%) as observers. Only 214 (17%) of respondents felt sufficiently prepared for an emergency. A rescue medication had already been applied by 79 (6%) of respondents; only 186 respondents (15%) stated they would be willing to administer a prescribed rescue medication under any circumstances. In response to an open-ended question about the most common fatal outcomes of a seizure, status epilepticus and drowning were rarely mentioned. 233 (19%) of respondents assumed that epileptic seizures cannot result in death. 606 (49%) of respondents were concerned about the legal repercussions to an incorrect response to a seizure.129/403 (32%) of teachers with >20 years of professional experience claimed never to have had a child suffering from epilepsy in their care, even though the prevalence of childhood epilepsy indicates that they should. In total, 1066 (86%) respondents expressed a desire to gain more knowledge on epilepsy. Conclusions Training programmes for teachers should be established. Furthermore, a clear legal regulatory framework needs to be set up.

INTRODUCTION

To cite: Dumeier HK, Neininger MP, Bernhard MK, et al. Arch Dis Child 2015;100:851–855.

Epilepsy in children and adolescents is common with a prevalence rate of 4.5–5.0 per 1000.1 As most children spend the day in schools and preschools, teachers play a key role in the daily care provision of children with epilepsy. Seizures occur suddenly and at any time, causing potentially severe harm and even death.2 The likelihood of a successful cessation of a seizure lies at 96% if rescue medication is being administered during the first 15 min of the seizure. Success rates decline to 57% if rescue medication is being administered with undue delay.3 4 Therefore, a knowledge of basic treatment

What is already known on this topic ▸ Children with epilepsy should receive rescue medication if a seizure lasts >5 min to avoid prolongation of the seizure with potentially fatal consequences. ▸ The Practices in Emergency and Rescue Medication for Epilepsy Managed with Community Administered Therapy initiative focused on physicians’ and families’ perspective on emergency treatment of seizures outside the hospital. ▸ Precautionary measures to prevent harm from seizures are necessary, but, on the other hand, unnecessary exclusion of children from peer activities should be avoided.

What this study adds ▸ This study describes the teacher’s perspective on emergency treatment of seizures in schools and especially preschools. ▸ Teachers’ knowledge of epilepsy in children is insufficient. Tailored teaching programmes for teachers should be developed that address teachers’ misconceptions and fears. ▸ The need for clear legal protection of teachers playing an active part in an emergency in the context of a seizure is demonstrated. of acute seizures is essential for individuals caring for children suffering from epilepsy. In addition to gaining knowledge of basic treatment of seizures, the adherence to precautionary measures aimed at preventing bodily harm from seizures, in particular by drowning,5 is required. Precautions to prevent harm from seizures in children with epilepsy may cause stigma and worsen quality of life in these children, in addition to the negative impact on children suffering from epilepsy of the disease itself.6 7 Thus, teachers should avoid overprotecting the children concerned. They should, however, gain knowledge about necessary safety precautions and about basic emergency treatment of seizures.

Dumeier HK, et al. Arch Dis Child 2015;100:851–855. doi:10.1136/archdischild-2015-308306

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Original article Some data about teachers’ knowledge and attitudes towards epilepsy exist for a number of countries. Yet, most data are from outside Europe and to our knowledge no recent data from Germany exist.8–31 We therefore performed a status quo analysis aimed at assessing knowledge levels and attitudes of teachers towards children with epilepsy, emergency treatment of seizures and precautionary measures preventing harm from seizures.

METHODS Setting Following the approval by the Youth Welfare Office and the Supervisory School Authority, we performed a status quo analysis assessing the levels of knowledge and attitude of teachers in preschools and schools regarding children with epilepsy. We invited all teachers of schools and preschools in Leipzig, a large city with 534 000 inhabitants in Saxony/Germany, and Blankenburg (Harz), a town in Saxony-Anhalt/Germany with 22 000 inhabitants, to take part in the survey voluntarily. Additionally, students in teacher training at Leipzig University were invited to take part in the survey.

Study design An expert panel consisting of four neuropaediatricians, three pharmacists and one teacher developed a questionnaire. The preliminary questionnaire was pretested in a pilot survey of 18 teachers and six preschool teachers. The aim of the pilot survey was to improve readability and comprehensibility of the questions. The questions asked within this survey are shown in the online supplementary file. The same questionnaire was used for all survey groups (teachers, preschool teachers and students in teacher training). The questionnaire cover letter contained information about the study and a statement of voluntariness of participation in the study. The survey was performed between 1 August 2013 and 15 January 2014. All assessments were performed anonymously. Only the institution of respondents was documented.

Statistics Statistical analysis was conducted by IBM SPSS Statistics V.20.0 (IBM Corporation, Armonk, New York, USA) and Microsoft Office Excel 2010 (Microsoft Corporation, Redmond, Washington, USA). Frequencies are reported as numbers and percentages. Continuous data are presented as median with first (25%) and

Table 1 Respondents’ characteristics

Number Gender, n (%) Male Female Not stated Age (years) Median Q25; Q75

All participants

School teachers

Preschool teachers

Students in teacher training

Others

1243

302

883

56

2

106 (9) 1081 (87) 56 (5)

45 (15) 241 (80) 16 (5)

55 (6) 798 (90) 30 (4)

6 (11) 41 (73) 9 (16)

0 1 (50) 1 (50)

44 31; 52

48 35; 54

44 31; 51

23 22; 26

34*

RESULTS Characteristics of participants and of the setting During the study period, 1243 questionnaires were completed by 302 (24%) school teachers, 883 (71%) preschool teachers, 56 (5%) students in teacher training and two others. Altogether 125 schools and 337 preschools exist in Leipzig and Blankenburg (Harz). Teachers from 43 of these schools (34%) and 161 of these preschools (47%) agreed to participate in the survey. School teachers had a median work experience of 25 years (Q25/Q75: 8/31), preschool teachers of 21 years (5/30). School teachers taught 100 children/year (60/150), preschool teachers taught 18 children/year (15/30). The characteristics of the respondents are summarised in table 1.

Participants’ experiences with epilepsy A total of 668 (54%) of respondents reported a prior familiarity with epilepsy in children. The following sources of information were reported by the respondents in predefined categories (n=587 respondents in total, multiple categories were possible): the internet (150; 26%), teacher training (121; 21%), information leaflets (115; 20%) and others (333; 57%). A total of 107/302 (35%) teachers and 199/883 (23%) preschool teachers stated that at least one child suffering from epilepsy was in their care at the time of the study. Of teachers with >20 years of professional experience, however, 129/403 (32%) claimed to have never had a child suffering from epilepsy in their care. In total, 140 (11%) respondents had actively been involved in an epileptic emergency and 148 (12%) had witnessed such an emergency. Seventy-nine (6%) respondents had already administered an anticonvulsive rescue medication during a seizure.

General knowledge on epilepsy and its hazards In a question concerning the degree of knowledge about seizures, several descriptions of seizure symptoms including a generalised tonic-clonic seizure and an absence were presented. All five descriptions related to a possible seizure. Seventy-five (6%) respondents correctly related all symptoms to a possible seizure, whereas the remainder thought that at least one of the described symptoms did not indicate the presence of a seizure. Of all respondents (n=1243), 779 (63%) thought that epileptic seizures can result in death, 233 (19%) assumed no risk for death caused by a seizure exists and another 19% did not respond to this question. A total of 370/779 (47%) of the respondents, who believed that a child can die from a seizure, mentioned any kind of injury as one of the most common causes. Only 18 (2%) of the respondents mentioned drowning as one of the most common deadly hazards. All answers to the question of assumed most common causes for death are shown in figure 1. In total, 161/306 (53%) of respondents who knew about a child with epilepsy in their care at the time of the study did not mention any precautionary measures. Only four of 18 (22%) respondents who reported drowning as one of the most common causes for death during a seizure mentioned swimming under one-to-one supervision as necessary safety precaution.

Emergency treatment for seizures

*Only one of the two persons in this group stated age, thus no Q25 and Q75 can be calculated.

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third (75%) quartiles (Q25 and Q75). Dichotomous values were compared by χ2 test. A p value ≤0.05 is considered significant.

Two hundred and fourteen (17%) of all respondents felt very well or well prepared for an emergency resulting from epilepsy, whereas 504 (41%) individuals stated they felt badly or very

Dumeier HK, et al. Arch Dis Child 2015;100:851–855. doi:10.1136/archdischild-2015-308306

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Original article Figure 1 Answers to the question: ‘Can a child die from an epileptic seizure? If yes, what are the most common causes?’ ( percent; open question; more than one answer per respondent possible).

badly prepared. Significantly more school teachers than preschool teachers would practice obsolete procedures such as placing something hard in the child’s mouth (33% vs 18%; p

Knowledge and attitudes of school teachers, preschool teachers and students in teacher training about epilepsy and emergency management of seizures.

School and preschool teachers play a key role in the care of children with epilepsy. Yet, data about their knowledge on epilepsy are scarce...
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