|Year : 2015 | Volume
| Issue : 2 | Page : 42-49
Effectiveness of structured educational intervention on knowledge, attitude, and practice of self-management strategies among people with epilepsy
Ophelia M Kharmujai1, Rajeshwari Siva2, Shandrila Immanuel2, Maya M Thomas2
1 Public Health Nurse, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong
2 Professor, College of Nursing, CMC, Vellore, India
|Date of Web Publication||23-May-2020|
Source of Support: None, Conflict of Interest: None
In India, the prevalence of epilepsy is about 5.35/1000 and in Vellore it is 3.83/1000. People with epilepsy often have inadequate knowledge of the causes of epilepsy. Educational interventions have been associated with improvements in knowledge, seizure outcomes and coping among people with epilepsy. The main objective of the study was to assess and compare the knowledge, attitude and practice on self-management strategies among people with epilepsy before and after the structured educational intervention. A quasi-experimental study design was used to interview 52 people with epilepsy on self-management strategies of epilepsy with a semi-structured questionnaire and an attitude scale before and after a structured educational intervention using multimedia presentation. A booklet on self-management strategies was also given to the study subjects. Descriptive and inferential statistics were used to analyze the data. The pre-test knowledge of self-management strategies of all people with epilepsy in the study is inadequate compared to 51(98.1%) in the post-test. In the pre-test, 15 (28.8%) people with epilepsy had favourable attitude compared to 18 (34.6%) in the post-test and 30(57.7%) people with epilepsy in the pre-test had adequate practice compared to 40 (76.9%) in the post-test. There were statistically significant increase in knowledge (p<0.001), attitude (p<0.001), and practice scores (p<0.001).There were significant association between post-test attitude with place of treatment (p<0.001), pre-test and post-test practice with place of treatment (p<0.001) and with regularity of treatment (p<0.05). People with epilepsy need to be empowered with more knowledge and skill to have good seizure control.
Keywords: epilepsy, self management, strategies, structured educational intervention
|How to cite this article:|
Kharmujai OM, Siva R, Immanuel S, Thomas MM. Effectiveness of structured educational intervention on knowledge, attitude, and practice of self-management strategies among people with epilepsy. Indian J Cont Nsg Edn 2015;16:42-9
|How to cite this URL:|
Kharmujai OM, Siva R, Immanuel S, Thomas MM. Effectiveness of structured educational intervention on knowledge, attitude, and practice of self-management strategies among people with epilepsy. Indian J Cont Nsg Edn [serial online] 2015 [cited 2022 Dec 7];16:42-9. Available from: https://www.ijcne.org/text.asp?2015/16/2/42/284860
| Introduction|| |
The Epilepsy Atlas 2005 reported that there are about 50 million people with epilepsy in the world and 80% of these are in the developing countries (World Health Organisation, [WHO], 2005). The prevalence of epilepsy in India varies from 3.83 per 1000 to 8.8/1000 across the country (Gourie-Devi, Gururaj, Satishchandra, & Subbakrishnan, 2004; Rajshekhar, Raghava, Prabhakaran, Oomen, & Muliyil, 2006). People with epilepsy have inadequate knowledge of the causes of epilepsy and often believed that epilepsy is caused by unknown forces. The attitudes of people with epilepsy are favourable regarding their need for medication intake, safety and that they are employable (Al- adawi et al., 2003; Choi-Kwon et al., 2006).
The educational level of people with epilepsy, their age or number of years with epilepsy does not seem to have much influence on their knowledge of epilepsy (Long, Reeves, Moore, Roach, & Pickering, 2000). In view of the magnitude of the problem of epilepsy, educational programmes are recommended for people with epilepsy with a culture specific approach (Gourie-Devi, Satishchandra, & Gururaj, 1999).
Education programmes can be in the form of group education or individual education. Group education can help people with epilepsy to obtain information about epilepsy as well as provide them with an opportunity to share experiences about epilepsy among themselves (Helde, Brodtkorb, Brathen, & Bovim, 2003). The Modular Service Package Epilepsy (MOSES) is one educational programme that was successful in improving knowledge, seizure outcomes and coping among people with epilepsy (May & Pfafflin, 2002). A similar study in Iran also highlights the benefit of an educational programme for self-management of people with epilepsy (Aliasgharpour, Nayeri, Yadegary, & Haghani, 2013).
The distribution of educational material such as information leaflets can increase the knowledge of people with epilepsy as well as enable them to have a resource to refer to when needed (Liu, Yiu, Yen, Chou, & Lin, 2003). With emerging technology, widespread use of computers and the internet and an increasing literacy rate of people today, there is scope for electronic tools for people with epilepsy to manage their condition better and for caregivers, and healthcare providers to support them in self-management strategies (Shegog et al., 2013).
Community level interventions, like a treatment programme for those who are without appropriate treatment and a public health education programme on epilepsy, were successful in reducing the treatment gap of epilepsy as shown by The Global Campaign against epilepsy demonstration project in China (Wenzhi et al., 2008).
Social support also plays an important role in the ability of people with epilepsy to sustain self-management strategies. Often, parents and significant others are identified as important supporters for people with epilepsy (Walker, Bamps, Burdett, Rothkopf, & Dilorio, 2012).
Though there has been evidence that educational interventions are beneficial for people with epilepsy yet, there is not enough evidence in the literature of measures to help people with epilepsy in rural communities of India to manage their condition and to have good seizure control. There is a need to develop a culture specific approach in educating people with epilepsy in the rural communities of India to help reduce the treatment gap of epilepsy as well as to lend a hand to people with epilepsy as they face the challenge to lead normal lives, in spite of epilepsy.
The objectives ofthis study were to
- assess the knowledge, attitude and practice on self- management strategies among people with epilepsy before and after the structured educational intervention
- compare the knowledge, attitude and practice on self-management strategies among people with epilepsy before and after the structured educational intervention
- find the relationship between knowledge, attitude and practice on self-management strategies among people with epilepsy
- find the association between the knowledge, attitude and practice with selected demographic and clinical variables on self-management strategies among people with epilepsy.
The hypotheses for this study were as follows:
- There is a significant increase in the knowledge, attitude and practice on self-management strategies among people with epilepsy after the structured educational intervention.
- There is a significant relationship between the knowledge, attitude and practice on self- management strategies among people with epilepsy.
- There is a significant association between the knowledge, attitude and practice with selected demographic and clinical variables on self- management strategies among people with epilepsy.
The study selected the Transtheoretical model or Stages of Change model for its conceptual framework by James Prochaska, USA (Sharma & Romas, 2008) as shown in [Figure 1]. This model was selected for the study because the study aims to help people with epilepsy acquire desired behaviour change after the structured educational intervention. The model was also chosen with an outlook that the behaviour change is long-lasting though the process may take time.
|Figure 1: Conceptual framework based on Prochaska’s theoretical model 1997|
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| Methods|| |
The research approach used in this study was quantitative. A quasi-experimental design (one group pretest-post-test design) was selected. The study was conducted in Kaniyambadi Block of Vellore District in Tamil Nadu, which is served by the Community Health and Development (CHAD) programme of the Community Health Department of Christian Medical College, Vellore. The sample was selected by convenience sampling technique. A total of 300 names and addresses of people with epilepsy in Kaniyambadi Block were obtained from the existing CHAD Health Information System. Out of 300 people with epilepsy, 52 of them who reported to have active epilepsy with the last seizure having occurred within the last two years regardless of anti-epileptic drug treatment, who are 18 years of age and who can speak and understand Tamil were selected for the study. A written informed consent was obtained from them. Those who had psychiatric co-morbidity, who have low comprehension and women with epilepsy who were pregnant, were not selected for the study.
| Instruments|| |
The data collection instrument was partly constructed by the investigator from an extensive literature review. It is an interview questionnaire. It consisted of seven sections.
Section I: Demographic variables of the participants included age, gender, education, occupation, marital status, income, and address.
Section II: Clinical variables of the participants included year of onset of seizures, year diagnosed, place of diagnosis, treatment taken, place of treatment, details of treatment, cost of treatment, days since last seizure occurrence, complications present, description of the seizures, involvement of limbs/ body parts during the seizure, loss of consciousness, frequency of seizure occurrence, and clinical examination.
Section III: Questionnaire on knowledge of self- management strategies consisted of 25 questions regarding knowledge on self-management strategies of epilepsy. There were six sections in the knowledge questionnaire, namely, General Information about epilepsy, Medication Management, Management of a seizure, Safety Management, Lifestyle Management, and Perception of women with epilepsy on epilepsy. The maximum score from the six sections is 48 and the results were converted into percentage and interpreted as highly adequate knowledge (75-100%), moderately adequate knowledge (50-74.99%), and inadequate knowledge (< 50%).
Section IV: Attitude scale on self-management strategies of epilepsy consisted of 10 items to assess the attitude of clients with epilepsy towards self-management strategies; rated by a three-point Likert scale with a score of 0, 1 and 2. There were five positive items and five negative items. The maximum score is 20 and the results were interpreted as highly favourable attitude (75-100%), moderately favourable attitude (50-74.99%), and unfavourable attitude (< 50%).
Section V: Modified Epilepsy Self-management Scale to assess the frequency of practice of self-management strategies among people with epilepsy consisted of 17 items obtained after modifying the Epilepsy Self-management Scale (Dilorio, 2010). The maximum score is 85 and the minimum score is 17. The results were interpreted as highly adequate self-management (75- 100%), moderately adequate self-management (50-74.99%), and inadequate self- management (< 50%).
Section VI: Illness Related Lifestyle Changes Questionnaire consisted of 10 questions related to the changes in common lifestyle activities after the diagnosis of epilepsy. No scores were allotted for this.
Content validity of the tool was obtained from experts in the fields of Neurosciences and Community Health Nursing. The content validity index for the tool was .98. A pilot study enabled the investigator to test the reliability of the instrument.
| Data Collection Procedure|| |
The data were collected for six weeks. The investigator made two visits to each of the 52 participants of the study. During the first visit, a pre-test interview was conducted using the instrument described earlier. The knowledge, attitude, and practice of self-management strategies of people with epilepsy gap were assessed. The pretest interview lasted for 10 to 15 minutes for each participant. On the same visit, after the pre-test interview, a structured educational intervention of 20-30 minutes duration was conducted. It consisted of a multimedia presentation on self- management strategies of people with epilepsy. A booklet on self-management strategies of epilepsy and a patient identification card with the details filled were also given to the patient after an explanation of their use. For those who could not read, family members who can read were asked to read the booklet and the card and to express whether they could comprehend or not. The investigator clarified doubts of the participant and the family member on the use of the booklet and the card. The second visit was made on the fourteenth day after the first visit for the post-test interview with the same instrument used for pre-test. This interview lasted for 10 to 15 minutes duration. During this visit, the people with epilepsy were encouraged to perform the self- management strategies taught to them. Family members were also encouraged to assist them to maintain good practice of self-management strategies of epilepsy.
| Ethical considerations|| |
Approval to conduct the study was obtained from the College ofNursing Research Committee and the Institutional Review Board of Christian Medical College, Vellore. Financial assistance to conduct the study and to prepare the educational material was obtained from the Fluid Grant of the Institution. Permission was also obtained from the Head of Community Health Nursing Department and from the Head of the Community Health Department, to conduct the study in the villages of Kaniyambadi block. The participants were explained about the benefits of the study and written consent was obtained from them.
| Results|| |
The data were analyzed using descriptive statistics like percentage, mean and standard deviation and inferential statistics like Paired t-test, chi-square and Pearson’s correlation co-efficient.
The study revealed that majority, 30 (57.7%) of people with epilepsy were between 31-50 years and their mean age is 40 (SD=11.91 years). Majority of them, 29 (55.8%), were females and most 28 (53.8%) of them had five or less than five years of schooling. Most of the people with epilepsy, 41(78.8%) had more than five years duration of epilepsy. Half of them, 30 (57.7%), had the last seizure within the last six months and an almost equal number of 9 each, had seizure frequency of once in one, two, three, six months, one year, and two years. In the pre-test, all people with epilepsy had inadequate knowledge of self-management strategies compared to 98.1% of them after the educational intervention. Among the various components of knowledge, 90.4% of the people with epilepsy had highly adequate knowledge on medication management in the pre-test and 96.4% of them had highly adequate knowledge in the posttest compared with relatively low percentage in other components. Of the 52 people with epilepsy in the study, 15(28.8%) of them in the pre-test had highly favourable attitude compared to 18 (34.6%) in the post-test and an equal number, 33(63.5%) had moderately favourable attitude in both the pre-test and post-test. In the pre-test, 30(57.7%) of people with epilepsy had highly adequate practice compared to 40(76.9%) in the post-test. People with epilepsy in this study had highly adequate practice on medication management (90.4%), seizure management (94.2%), and safety management (84.6%), whereas it was low in healthy lifestyle management strategies (7.7%). Paired ‘t’ test revealed significant increase of post-test scores in knowledge, attitude, and practice of self management strategies among people with epilepsy as shown in [Table 1].
|Table 1: Comparison of pre-test and post-testmean scores of knowledge, attitude and practice of self-management strategies of epilepsy|
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Another component of practice of self-management strategies in this study is the change in lifestyle that occurred due to epilepsy. The results showed that almost half, 24(46.2%) of the people with epilepsy had altered food habits, 12 (23.1%) had altered work pattern, and 6 (11.5%) had interrupted schooling due to the onset of seizures.
The study showed that there is a significant association between post-test attitude with place of treatment at p < .001, pre-test and post-test practice with place of treatment (p < .001) and with regularity of treatment (p < .05). [Table 2] shows the correlation between knowledge, attitude, and practice of self-management strategies of people with epilepsy.
|Table 2: Correlation between knowledge, attitude, and practice of self-management strategies ofepilepsy|
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| Discussion|| |
The prevalence of epilepsy is about the same in men and women (Radhakrishnan et al., 2000; Rajshekhar et al., 2006) however, in the present study, more than half (29, 55.8%), of the subjects were women, which was similar to other studies (Helde, et al., 2003; May & Pfafflin, 2002).
The mean duration of epilepsy was 17 ± 12.1 years, almost similar to a study in Korea, where the mean duration of epilepsy among 178 people with epilepsy was 15.2 years (Choi et al., 2011).
A significant observation in this study could be the small increase in the knowledge, attitude and practice scores after the educational intervention, though the increase is statistically significant. In fact, the most common answer from all the people with epilepsy was that they could not recollect much about what was taught earlier and some expressed that their memory power seems to be declining over the years. Previous research has shown that long term memory impairment was observed in people with focal epilepsy (Hoppe, Elger, & Helmstaedter, 2007).
An interesting finding in this study was that knowledge on medication management among people with epilepsy was found highly adequate in both the pre-test (90.4%) and in the post-test (96.4%).This could be due to the fact that most of them have experienced the benefits of being on anti-epileptic drugs and the danger of omitting medications even for a single day. This result is similar to in a study conducted in Oman where 100% of the people with epilepsy knew the importance of antiepileptic drugs in the treatment of epilepsy (Al-adawi et al., 2003).
Various responses regarding the causes of epilepsy revealed that misconceptions and false beliefs were still common which was supported by other studies (Al-adawi et al., 2003; Choi-Kwon et al., 2006; Sunmonu, Afolabi, Komolafe, & Ogunrin, 2011).
This study also faced the challenge of having more participants with little or no formal schooling. The small increase in the knowledge scores may be that literacy is a confounding variable when educating people with epilepsy.
An assessment of the attitude of people with epilepsy on self-management strategies showed that 15 (28.8%) had highly favourable attitude in the pre-test compared to 18 (34.6%) in the post-test, and an equal number 33 (63.5%) had moderately favourable attitude in both the pre-test and posttest. This reflected that people with epilepsy do have a positive attitude on themselves (Shackleton, Kasteleijn- Noslst Trenite, de Craen, Vandenbroucke, & Westendorp, 2003).
From the results it also appeared that people with epilepsy practiced more highly adequate medication management, seizure management and safety management strategies than healthy lifestyle management strategies which were similar to the results of a study on self-efficacy among people with epilepsy (Dilorio & Kobau, 2003). These findings show that people with epilepsy in this study, have realized through experience which self-management strategies are extremely essential for their survival and therefore, practiced them out of the necessity to survive rather than because they have the knowledge of which strategies to practice. They also have several harmful and harmless practices of safety management strategies and seizure management strategies, which stems from myths and misconceptions like wearing an iron chain around the waist, making a person hold a sickle or keys during a seizure, holding a half-cut onion at all times and smelling it, and pinching the nose when the person experiences an aura. It is common practice in India that people with epilepsy are made to hold keys to terminate a seizure (Gourie-Devi, Singh, & Bala, 2010; Radhakrishnan et al., 2000).
The study also shows that there is only a moderately positive correlation between knowledge, attitude, and practice of self-management strategies of people with epilepsy (see Table 3). This explains the fact that people with epilepsy in the study may actually practice adequate self- management strategies, though they may not have been able to respond to questions on knowledge of self-management strategies.
The significant association between attitude and practice with selected clinical variables is similar to another study which states that attitude is associated with epilepsy control and duration, education, and marital status (Saengsuwan, Boonyyaleepan, Srijakkot, Sawanyawisuth, & Tiamkao, 2012).
| Conclusion|| |
The findings of this study have interestingly shown that people with epilepsy do practice certain self- management strategies that safeguard them, though they may not be able to answer questions on knowledge of self- management strategies. This study was an attempt to empower people with epilepsy with knowledge and skill to care for themselves and have good seizure control. Though, there were limitations in terms of a single setting of conducting the study and a limited time of interaction with people with epilepsy yet, the results of this study revealed that education on self-management strategies had improved the practice of self-management of people with epilepsy. Therefore, it is vital for practicing nurses who work with people with epilepsy to reinforce education on good self- management strategies during every interaction they have with them. Nursing students also need to be sensitized to the needs of people with epilepsy and be guided in the right way to care for them. Various research avenues are available for those who are concerned about people with epilepsy. The various areas for research include compliance to anti- epileptic drugs and its relationship with drug plasma levels and seizure control, quality of life of women with epilepsy, experiences of people on long term anti-epileptic drug therapy and impact of epilepsy on academic performance and lifestyle of adolescents with epilepsy.
Conflicts of Interest: The authors have declared no conflicts of interest.
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[Table 1], [Table 2]