Seizure 23 (2014) 280–283
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Primary school teacher’s knowledge and attitudes toward children with epilepsy Albaraa S. Abulhamail, Fahad E. Al-Sulami, Mouneeb A. Alnouri, Najeeb M. Mahrous, Dima G. Joharji, Maha M. Albogami, Mohammed M. Jan * Faculty of Medicine, King Abdulaziz University, Pediatrics, PO Box 80215, Jeddah 21589, Saudi Arabia
A R T I C L E I N F O
A B S T R A C T
Article history: Received 29 September 2013 Received in revised form 14 December 2013 Accepted 28 December 2013
Purpose: Primary school teacher’s knowledge and attitudes toward epilepsy can have signiﬁcant impact on the performance and psycho-social development of the child with epilepsy. Our objectives were to study teacher’s knowledge and attitudes and identify areas in which further teacher training and education are required. Methods: A stratiﬁed random sample survey involving a group of primary school teachers in Jeddah, Saudi Arabia included private/public schools designated for male and female students. A structured 37item questionnaire was used to examine their demographics, knowledge, attitudes, and experience with epilepsy. Results: Six hundred and twenty primary school teachers working in public (58%) or private (42%) schools were included with ages ranging between 21 and 59 years (mean 36). Most teachers (79%) were of Saudi Arabian nationality and 66% had a college or university degree. Their years of experience ranged from 1 to 35 (mean 13.5). Only 17% of the teachers felt very well informed about epilepsy. Teachers with higher education were more likely to have good knowledge (p = 0.009). Teachers of Saudi nationality were also more likely to report good knowledge, independent of their educational level (p = 0.013). Overall, teachers with good knowledge were less likely to have negative attitudes including minding to have an epileptic child in their class (p = 0.028) or thinking that they should be placed in a special classroom (p = 0.029). Conclusions: Primary school teacher’s knowledge about epilepsy needs improvements. Their attitudes correlated highly with their knowledge. Educational campaigns about epilepsy are needed to develop a well informed and tolerant community. ß 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Keywords: Teacher School Knowledge Attitude Child Epilepsy
1. Introduction Epilepsy is one of the most common pediatric neurological disorders with higher incidence during the school years.1,2 These years represent a critical period of the child’s social, psychological, and physical development. The school period will signiﬁcantly impact the child’s quality of life and future adult roles.3,4 Children with epilepsy are at increased risk of educational underachievement, learning difﬁculties, mental health problems, social isolation, and poor self-esteem.5,6 Teacher’s knowledge and attitudes toward epilepsy can have signiﬁcant impact on these difﬁculties including student’s performance, social skill development, and future employment.7 International studies have indicated that teachers often have insufﬁcient knowledge, inadequate training,
* Corresponding author. Tel.: +966 505698843; fax: +966 26403975. E-mail addresses: [email protected]
, [email protected]
and misconceptions about epilepsy and its management.8–14 Despite the signiﬁcant impact of teacher’s role in the lives of these children, very little research has been conducted in Saudi Arabia to assess these issues.15,16 Our objectives were to study primary school teacher’s attitudes toward epilepsy and identify areas in which further teacher training and education are required. We also aimed to identify contributing factors to inadequate knowledge and negative attitudes. We hypothesized that many teachers are not well informed about epilepsy and some are misinformed from unreliable sources, which contributes to their negative attitudes toward the student with epilepsy. 2. Methods A stratiﬁed random sample survey involving a group of primary school teachers in Jeddah, Saudi Arabia was conducted from the 1st of January, 2012 to the 1st of January, 2013. Multiple private/public primary schools designated for male and female students were
1059-1311/$ – see front matter ß 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.seizure.2013.12.010
A.S. Abulhamail et al. / Seizure 23 (2014) 280–283
Table 1 Summary of the teacher’s knowledge and negative attitudes toward children with epilepsy (n = 615). Questionnaire
Knowledge Epilepsy is a life time disorder One of the causes of epilepsy is spirit possession The intelligence of an epileptic child is below average Evil eye is a cause of epilepsy Epilepsy cannot be cured
59% 27% 25% 22% 21%
Attitudes Children with epilepsy have abnormal behavior in class They have future career limitations Children with epilepsy should be placed in a special classroom They should be placed in a special school I mind having a child with epilepsy in my classroom They should not participate in sport activities
47% 42% 28% 27% 25% 18% Fig. 1. Results to the Likert scale item that examined the degree of knowledge about epilepsy.
included from the Jeddah area. These schools were randomly selected from an ofﬁcial list obtained from the Ministry of Education and included a sample from all four regions of our city (north, center, south west, and south east). A structured 37-item questionnaire was designed to examine the teacher’s demographics, knowledge, attitudes, and experience with children with epilepsy. Key questions are listed in Table 1. A 4-point Likert scale item was included to examine the degree of knowledge about epilepsy with response categories of very well informed, moderately informed, somewhat informed, and not informed at all. The study design and questionnaire were approved by King Abdulaziz University hospital ethics committee. The nature of the study and questionnaires were explained to the principles of the included schools and all involved teachers signed an informed consent before voluntarily participating in the study. An assigned coauthor conducted the interviews during a school visit and individually assisted all available teachers to complete the questionnaires. The identity of the teacher was not requested to ensure privacy and encourage accurate response. Data were collected in Excel sheets and statistical analyses were performed using SPSS 17 (SPSS, Inc., Chicago, IL, USA). Descriptive analyses were performed and the variables were examined using chi-square test. Statistical signiﬁcance will be deﬁned as p values of less than 0.05.
Saudi teachers were less likely to think that children with epilepsy have lower intelligence (p = 0.002), should be placed in a special classroom or school (p = 0.0001), or that they should not participate in sport activities (p = 0.04). Overall, teacher’s attitudes correlated highly with their knowledge. Those with good knowledge were less likely to mind having a child with epilepsy in their class (p = 0.028) or think that they should be placed in a special classroom (p = 0.029). On the other hand, teachers working in private schools were more likely to mind having a child with epilepsy in their class (p = 0.02), think that they should be placed in a special class (p = 0.004) or special school (p = 0.0001) when compared to teachers in public schools. Overall, 28% of the teachers have encountered a child with epilepsy in their class. At the time of the questionnaire, this group had better knowledge than teachers who never encountered such a situation (p = 0.0001). The ﬁrst encounter of some of these teachers (14%) was during an acute seizure in the classroom. At that time, most of them (58%) did not know what to do and the majority felt that putting something in the student’s mouth to prevent tongue swallowing was a correct maneuver. Teachers with good knowledge were more likely to report that they know what to do in such acute seizure situation (p = 0.0001).
Six hundred and twenty primary school teachers working in public (58%) or private (42%) schools were included during the study period. Five forms were incomplete and therefore excluded. The ages of the remaining 615 teachers ranged between 21 and 59 years (mean 36, SD 7.9), with 53% being females. Most teachers (79%) were of Saudi Arabian nationality and 66% had a college or university degree. Their years of experience ranged from 1 to 35 (mean 13.5, SD 8.6 years). Only 17% of the teachers felt very well informed about epilepsy on the Likert scale (Fig. 1), mostly from the media, relatives, and personal experience. Teachers were able to correctly identify many aspects of epilepsy in terms of etiology and symptoms, however, several weak aspects of knowledge and negative attitudes were encountered as summarized in Table 1. Teacher’s age, gender, years of experience, or type of school did not correlate signiﬁcantly with their knowledge about epilepsy. However, teachers with higher education (college or university degrees) were more likely to have good knowledge (moderate or very well on the Likert scale) when compared to those with less education (57% vs 21%, p = 0.009). Teachers of Saudi nationality were also more likely to report good knowledge when compared to those of other nationalities, independent of their educational level (67% vs 52%, p = 0.013). This correlated with their attitudes, as
This study evaluated a number of aspects of primary school teacher’s knowledge and attitudes toward epilepsy. Only 17% of the teachers felt very well informed and many had negative attitudes and misconceptions about epilepsy. Many teachers felt that the intelligence of children with epilepsy is below average and that these children should be placed in a special classroom or a special school (Table 1). Although these teachers were highly educated and quite experienced, up to 27% continued to believe that spirit possession or evil eye are causes of epilepsy. A recent study from a different region of Saudi Arabia found that possession by demons (Jinns) is still believed to be a cause of epilepsy among 40% of university-educated school teachers.15 We had a lower percentage reﬂecting possible regional variations. Another Saudi study revealed that 14% of the public believed that epilepsy is infectious and 8% believed that epilepsy was a type of mental illness.16 It is clear that the level of epilepsy awareness in the Saudi population needs improvement. Ours ﬁndings conﬁrms that teachers have insufﬁcient knowledge about epilepsy, inadequate training, and erroneous acute seizure management. This is similar to what has been previously reported by many international studies.7–14 In a study from Taiwan, more than 30% of participants thought epileptic seizures
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were associated with insanity and had problems in the acceptance of children with epilepsy.7 In a study from Thailand, 38% of the primary school teachers had not heard of or read about epilepsy and 15% preferred to place all children with epilepsy in a special classroom.8 Even in developed countries, most teachers do not feel conﬁdent when teaching children who had epilepsy and some considered their knowledge of the subject to be adequate.9 Overall, teacher’s attitudes correlated highly with their knowledge. As one would expect, those with good knowledge were less likely to have negative attitudes. This correlation is documented by several authors from different countries.17–20 In a study from Korea, teachers’ knowledge was the most important factor inﬂuencing teacher’s attitudes toward epilepsy.17 Others found stronger negative attitudes with up to half of the teachers opposed having a child with epilepsy in their classes because they feared a child having a seizure during class and they felt that they lacked knowledge of ﬁrst-aid for seizures.18 In addition, teachers who had inaccurate knowledge of epilepsy demonstrated negative attitudes toward the marriage and employment of persons with epilepsy.18 A recent study from Nigeria found signiﬁcant deﬁcits in the general knowledge about epilepsy and ﬁrst aids measures in the classrooms even in those with high level of education.19 Even in developed countries, such as Italy, 33% considered epilepsy a limitation for marriage, 25% for having children, 40% for regular employment, and 33% for sports and leisure activities.20 In this study, 66% of the teachers declared they were unable to manage a seizing child, 25% were convinced that epilepsy impairs learning, and 26% believed that it carries mental/behavioral alterations.20 We were unable to ﬁnd any correlations between teacher’s age, gender, years of experience, or type of school with their knowledge about epilepsy. Other studies have found an association with more years of teaching experience and female gender.21–23 On the other hand, a Turkish study found young teacher’s age and male gender predictive of positive attitudes.24 Interestingly, we found that teachers of Saudi nationality were more likely to report good knowledge, independent of their educational level. One could relates such ﬁnding to over-reporting, however, this association may be genuine as our Saudi teachers were less likely to have negative attitudes such as thinking that children with epilepsy have lower intelligence, should be placed in a special classroom or school, or that they should not participate in sport activities. Interestingly, teachers working in private schools were more likely to have some negative attitudes toward children with epilepsy, which may be related to lowered tolerance for children with such chronic disorders in our private schools. These teachers should be targeted with educational programs. Most teachers (58%) did not know what to do during an acute seizure. However, those with personal epilepsy experience were more likely to report that they know what to do in such acute situation. Consistent with our ﬁnding, other authors found that teachers with personal experience of epilepsy had greater knowledge of the illness.25 There are some limitations to our study. Our sample may not be representative of all teachers working in Saudi Arabia as it only included those from the Jeddah area. This will limit our ability to generalize our ﬁndings to Saudi Arabia or other neighboring Arab countries. However, our sample is large and included public and private schools with representation of all ages, experiences, and equal gender contribution. Another possible limitation is the inability to generalize from our ﬁnding to all teacher categories as we did not include secondary or high school teachers. We selected primary teachers due to the importance of these early stages in the school career of children with epilepsy and their psycho-social development. It will be interesting to evaluate teachers from higher school grades and also assess less urbanized regions of our country. In addition, replication of the questionnaire in the Middle East is needed.
We conclude that primary school teacher’s knowledge needs improvements. Their attitudes correlated highly with their knowledge. Therefore, focused education and training about epilepsy are needed during the preparation of school teachers. Several studies have documented that such educational courses resulted in signiﬁcant improvements of teacher’s beliefs and attitudes.26,27 Existing epilepsy resources, available through national epilepsy societies should be made accessible to all teachers. Public educational epilepsy campaigns should be encouraged as this can improve the quality of life of children with epilepsy and their families by helping to develop a well informed and tolerant community. Acknowledgement The authors acknowledge with thanks the statistical assistance and advice of Dr. Bakr M. Bin Sadiq, King Faisal Specialist Hospital and Research Center in Jeddah. Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/j.seizure.2013. 12.010.
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