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Epilepsy: What do health-care professionals in Riyadh know?
Epilepsy & Behavior 29 (2013) 234–237
Contents lists available at ScienceDirect
Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh
Epilepsy: What do health-care professionals in Riyadh know? Ahmed Alaqeel a, Faris Alebdi a, Abdulrahman J. Sabbagh b,c,⁎ a b c
Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia
a r t i c l e
i n f o
Article history: Received 6 June 2013 Accepted 13 July 2013 Keywords: Epilepsy Awareness Health-care practitioner attitudes Perceptions of epilepsy Education Health
a b s t r a c t Purpose: The objective of this study was to report on the knowledge of epilepsy, as well as attitudes and practices toward individuals with epilepsy, among health-care professionals in Riyadh, the capital city of Saudi Arabia. Methods: A survey consisting of 23 questions pertaining to epilepsy awareness was distributed to health education workers (n = 51), nutritionists (n = 56), physicians (n = 265), dentists (n = 58), pharmacists (n = 41), nurses (n = 224), physiotherapists (n = 65), and fifth-year medical students (n = 62) in three tertiary hospitals in Riyadh. Results: Of the 822 respondents who completed the questionnaire, 100% had heard about epilepsy, and 92.6% would allow their children to interact with an individual who has epilepsy. However, 67% of respondents would not want their children to marry an individual with epilepsy, 97.9% of respondents believed that individuals with epilepsy should have the same employment opportunities as the general population, 10.5% believe that supernatural power is the cause of epilepsy, 67.2% did not know how to deal with an individual experiencing an epileptic episode, and 56% did not know that surgery was a treatment option for individuals with epilepsy in Saudi Arabia. Of the 822 respondents, 39% would not abide by a physician's advice not to operate a motor vehicle because of their illness, 91% of whom cited problems with the public transportation system as a reason for disregarding the doctor's advice. When asked if the participants had access to any information on how to deal with epilepsy during their professional training, 60.3% had access to such information during their graduate studies. Ninety-eight percent of those with access to this information were physicians and health-care educators (p b 0.001). Physicians and health-care educators were significantly more aware of epilepsy than any of the other groups. Conclusion: The level of epilepsy awareness among health-care professionals in Riyadh needs improvement. © 2013 Elsevier Inc. All rights reserved.
1. Introduction The prevalence of epilepsy is 6.54 per 1000 population in the Kingdom of Saudi Arabia [1], and the incidence of epilepsy is substantially greater in developing countries compared with developed countries [2]. Individuals with epilepsy experience socioeconomic problems that affect quality of life more than the condition itself [3,4]. False beliefs about epilepsy affect the social acceptance of individuals with the condition [5]. Studies investigating public awareness and attitudes toward epilepsy have been conducted in several countries including the United States (USA) [6], China [7], Austria [8], Italy [9], Turkey [10], Greece [11], New Zealand [12], Kuwait [13], and the United Arab Emirates [14]. A recent study conducted in Riyadh, Saudi Arabia [15]
⁎ Corresponding author at: Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, PO Box 59046, Riyadh 11525, Saudi Arabia. Fax: +966 12889999x1391. E-mail addresses: [email protected], [email protected] (A.J. Sabbagh). 1525-5050/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.yebeh.2013.07.009
found that the level of epilepsy awareness in the Saudi population needs improvement. The study revealed that 21.3% of respondents were not aware of any cause of epilepsy, 50.6% would not seek medical advice if one of their relatives had epilepsy, and 31.4% did not know how to deal with an individual experiencing an epileptic episode [15]. Another study from Saudi Arabia involving university-educated school teachers and undergraduate students [16] reported that ‘Jinn’, which are unseen creatures believed to exist in all major religions and have the power to possess humans and cause them harm, are still believed to be a cause of epilepsy in Saudi society. Health-care professionals' knowledge about epilepsy will affect their communication with individuals with the disorder and, in turn, affect the public perception of individuals with the condition. Physicians, nurses, and nonmedical health-care professionals in developing countries play the primary role in delivering medical care for individuals with epilepsy [16,17]. Several reports have demonstrated a lack of awareness regarding epilepsy among health-care professionals [16,18–20]. For example, in Brazil, a recent study involving health-care professionals found that their knowledge about epilepsy needs improvement. This lack of knowledge in some professional health-care
A. Alaqeel et al. / Epilepsy & Behavior 29 (2013) 234–237
workers could be due to gaps in information provided during graduate studies [20]. The poor knowledge base regarding epilepsy among some healthcare professionals has been suggested to be a causal factor for the epilepsy treatment gap [21]; furthermore, epilepsy knowledge among health-care workers has rarely been evaluated in the literature. The objective of the present study, therefore, was to report on epilepsy knowledge, as well as attitudes and practices toward individuals with epilepsy, among health-care professionals in Riyadh.
Table 1 Demographics of study sample (n = 822). Demographic variable
Distribution
Percentage (%)
Age (year)
15–30 30–45 45–60 N60 Male Female Health-care educator Nutritionist Physician Dentist Pharmacist Nurse Physiotherapist Fifth-year medical student
30.9 50.8 17.1 1.2 47.3 52.7 6.2 6.8 32.2 7.1 5 27.3 7.9 7.5
Gender Profession
2. Methods 2.1. Respondents Ethics approval for the present study was obtained from the Institutional Review Board at King Fahad Medical City (Ministry of Health, Riyadh, Saudi Arabia). A standardized questionnaire was distributed to health education workers (n = 51), nutritionists (n = 56), physicians (n = 265), dentists (n = 58), pharmacists (n = 41), nurses (n = 224), physiotherapists (n = 65), and fifth-year undergraduate medical students (n = 62) in three tertiary hospitals in Riyadh. 2.2. Survey setting and questionnaire Riyadh is the capital city of Saudi Arabia and is home to 5.8 million residents, comprising 24.1% of the country's population [22]. The present study was conducted during a two-month period in 2012 to identify the educational needs of professional health-care providers with regard to epilepsy. The standardized questionnaire consisted of 23 questions that have been used in several studies from the USA [6], China [7], Austria [8], Italy [9], Turkey [10], Greece [11], New Zealand [12], and the United Arab Emirates [14]. The questions pertain to epilepsy awareness and knowledge, the attitude and practices toward individuals with epilepsy, and motor vehicle operation (i.e., driving) for individuals with epilepsy. The questions were pilot-tested for comprehension and readability among 80 subjects who were not included in the study. The study team supervised the survey, ensuring confidentiality of the respondents' answers, and made the respondents feel relaxed in answering the questions. English is the official language of the health-care system in Saudi Arabia and the primary language of the education system; therefore, it was the language in which the survey was conducted. 2.3. Data analysis For statistical analysis, SPSS version 17 (IBM Corporation, USA) was used; a p-value b0.05 was considered to be statistically significant. A χ2 test was used to evaluate the association between interview responses and the profession of respondents. 3. Results Of the 1000 questionnaires distributed, 822 were completed, yielding a response rate of 82%. The demographic variables of the population surveyed are presented in Table 1. Table 2 shows the percentage of responses to questions regarding familiarity with and understanding of epilepsy. Although 92.6% of respondents would approve of their children interacting with individuals with epilepsy, 67% would object to their children marrying an individual with the disorder. When asked if individuals with epilepsy should have the same employment opportunities as other people, 97.9% respondents believed that individuals with the disorder should have the same employment opportunities as the general population. Analysis using χ2 tests showed that physicians and health-care educators were significantly more aware of epilepsy than any of the other groups (p b 0.001).
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When asked whether they had access to information regarding how to deal with epilepsy during their professional training, the majority (60.3%) of participants reported that they had access to such information during their graduate studies. Ninety-eight per cent of those with access to this information were physicians and health-care educators (p b 0.001). Table 3 summarizes the answers for questions regarding knowledge about epilepsy. Particularly noteworthy was the response regarding the cause of epilepsy, with 10.5% believing that a supernatural power is a cause of epilepsy. Table 4 summarizes the attitudes of respondents with regard to driving while suffering from epilepsy. A relatively high proportion (39%) indicated that they would not abide by a physician's advice not to operate a motor vehicle because of their illness. The vast majority (91%) cited deficiencies in the public transportation system as a reason for disregarding the doctor's advice, with more than one-third of respondents (35.5%) being unaware of why epilepsy would preclude anyone from driving a motor vehicle.
4. Discussion The research questionnaire investigating health-care professionals' knowledge of epilepsy in the present study was similar to one that examined the general population's knowledge of this disorder in the same city (i.e., Riyadh) [15], which used a much larger sample size (n = 7078) than the 822 respondents who completed the questionnaire in the present study but was comprised of a significantly more diverse group of individuals. Attitudes toward and knowledge of epilepsy have been addressed by several studies worldwide over the past two decades. An Australian study involving 107 general practitioners (GPs) in Sydney found an improvement in the attitude of GPs toward people with epilepsy as a consequence of a decade of educational promotion regarding the disorder. The majority of GPs were comfortable in referring patients with epilepsy to a neurologist for the initial management of the disorder but were dissatisfied with other health-care therapists because of impractical advice and a perceived lack of empathy [23]. Two studies from the United Kingdom, which were conducted in 1998 and 2005, respectively, examined the attitudes of GPs to the care of individuals with epilepsy [24,25]. The initial study, involving 182 questionnaire respondents, identified the lack of guidelines for epilepsy, which hindered best practices in the care of persons with epilepsy [24]. The second study, involving 115 respondents, reported that the attitudes of GPs to people with epilepsy were significantly associated with quality of care, with specific attitudes of GPs to the care of people with the disorder being clustered within general practices [25]. The importance of continued education regarding epilepsy for GPs and other health-care professionals is well recognized [26], and some of the responses given in the current
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A. Alaqeel et al. / Epilepsy & Behavior 29 (2013) 234–237 Table 2 (continued)
Table 2 Percentage of responses to questions on familiarity and understanding of epilepsy (N = 822). Q1. Have you ever heard of or read about the disease called “epilepsy” or “convulsive seizures” (“fits”)? Yes 100 No 0 Do not know 0 Q2. Did you know anyone who had epilepsy? Yes No Do not know
76 24 0
Q3. Have you ever seen anyone who was having a seizure? Yes No Do not know
45.7 55.3 0
Q4. Would you object to having any of your children play with persons who sometimes had seizures (fits)? Yes 7.4 No 92.6 Do not know 0 Q5. Would you object to having a son or daughter of yours marry a person who sometimes had seizures (fits)? Yes No Do not know
67 33 0
Q6. Do you think people with epilepsy can be employed in jobs like other people? Yes No Do not know
97.9 2.1 0
Q7. Do all patients with epilepsy have the same symptoms? Yes No Do not know
3 97 0
Q8. Does epilepsy strike at any particular age? Yes No Do not know
36.1 63.9 0
Q9. Is epilepsy a disease that can be treated? Yes No Do not know
82.3 17.7 0
Q10. Do you think it is appropriate for a person with epilepsy to have a child? Yes No Do not know
86.6 13.4 0
Q11. Do you think a person with epilepsy can live alone? Yes No Do not know
32.8 67.2 0
Q12. Do you find it acceptable to work with a person with epilepsy (colleague) at work? Yes 99 No 1 Do not know 0 Q13. Is it necessary for a student with epilepsy to be prevented from participating in sports activities? Yes 23.5 No 76.5 Do not know 0 Q14. In developing countries like Saudi Arabia, epilepsy affects a smaller number of people. Yes 42.9 No 55.0 Do not know 2.1 Q15. Does every person with epileptic seizure have to use an antiepileptic drug? Yes No Do not know
35.7 62.1 2.2
Q16. Is there a role for surgical intervention for advanced epileptic cases? Yes No Don't know
44 56 0
Q17. Did you have access to any information of how to deal with epilepsy during your professional training? Yes 60.3 No 39.7
questionnaire regarding knowledge of epilepsy suggest that continuing education about the disorder for health-care practitioners is warranted. Two questionnaire-based studies from Brazil, the first conducted in 2000 and the second in 2012, addressed the knowledge of health-care professionals regarding epilepsy. The first study, involving 31 GPs and 47 pediatricians who were residents in three training hospitals, identified continuing medical education as being important for dealing with people with epilepsy. This was due to a lack of knowledge of the disorder and was also an acknowledgment that quality of care for people with epilepsy was influenced by the attitude of GPs toward them [27]. The second study, involving 524 health-care professionals who held an undergraduate or postgraduate degree in medicine, nursing, physiotherapy, nutrition, psychology, or physical education, focused on the knowledge of epilepsy in each group. Physiotherapists, nutritionists, and physical education instructors had lower scores than each of the other groups of health-care professionals [28]. The data collected in the current study support the conclusions of the study by Vancini et al. [28], which emphasized the need for educational resources about epilepsy to be available for medical and nonmedical health-care professional personnel. Assessment of the knowledge, attitudes, and beliefs of 276 Zambian nonphysician health-care workers [29] showed some similarities to the results obtained in the present study. A greater knowledge of epilepsy was apparent in more recent graduates and in health-care workers
Table 3 Knowledge and practices toward epilepsy (%) (N = 822). Q18. What do you think is the cause of epilepsy? (more than one answer is allowed) 1. Hereditary 89.0 2. Brain disease 95.3 3. Mental or emotional stress disorder 27.5 4. Birth defect 10.2 5. Blood disorder 1.0 6. Jinn or supernatural power 10.5 7. Do not know 0 Q19. What do you think is the manifestation of an epileptic attack? (more than one answer is allowed) 1. Foaming from the mouth 89.0 2. Convulsions 99.8 3. Screaming 60.2 4. Changes in behavior 78.4 5. Don't know 5.1 Q20. What would you do if someone were having a seizure attack? (more than one answer is allowed) 1. Take them away from danger 98.0 2. Put a spoon or cloth in the patient's mouth 67.2 3. Force some medicine down the patient's throat 2.0 4. Put their head in a toilet hole 6.0 5. Hold or tie them down 18.2 6. Don't know 2.9 Q21. If your relatives or friends have epilepsy, what kind of treatment would you suggest? (more than one answer is allowed) 1. Ask a doctor 100.0 2. Ask for an herbal medicine 0.8 3. Acupuncture 5.2 4. Get medicine from a drug store 1.0 5. Read the Quran 50.1 6. No need for treatment 1.0
A. Alaqeel et al. / Epilepsy & Behavior 29 (2013) 234–237 Table 4 Epilepsy and driving (%) (N = 822). Q22. If you had epilepsy and the physician instructed you not to drive, would you abide by his instruction? Yes 61 No 39 Q23. If your answer was “No”, please choose a cause from the list: (more than one answer is allowed) (N = 321) Public transportation 91.0 Social reasons 26.9 Financial reasons 10.2 I do not see any reason that may prevent patients with epilepsy from driving. 35.5
who had received both bedside and didactic training. Improved knowledge of the disorder was associated with a higher degree of social tolerance, although there was no association between social tolerance and having a family member with epilepsy [29]. Approximately 25% of Zambian health-care workers would not allow their child to marry someone with epilepsy [29], compared with 67% of health-care workers in the present study who would object if their child married a person with the condition. Interestingly, the proportion of the general population surveyed in Saudi Arabia who would object to their child marrying a person with epilepsy was 76% [15], which is not substantially higher than the figure for health-care professionals. For the questions in common between the two Saudi surveys, the largest difference in respondents. In the Zambian study [29], 20% of health-care respondents believed that people with epilepsy should not marry or be employed. In contrast, 99% of health-care workers in the present study believed that it was acceptable to work with a person with epilepsy, and 86.6% believed that it was appropriate for a person with epilepsy to have a child. Our study showed that 10.5% of health-care professionals believe that ‘Jinn’ are a cause of epilepsy, compared with another study from Saudi Arabia [16] reporting that 40.3% of the school teachers and 50.4% of students believe that Jinn possession is a cause of the disorder. In conclusion, there is considerable evidence from studies involving medical and nonmedical health-care workers from around the world ([23–29], present study) that continued medical education for epilepsy is necessary. Acknowledgment This study was funded by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University. We would like to thank the nursing department at King Fahad Medical City for helping us to complete our project.
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[2] Ropper AH, Adams RD, Victor M, Samuels MA, Ropper AH. Adams and Victor's principles of neurology. 9th ed. New York: McGraw-Hill Medical; 2009. [3] Jacoby A. Impact of epilepsy on employment status: findings from a UK study of people with well-controlled epilepsy. Epilepsy Res 1995;21:125–32. [4] el-Hilu SM. Social aspects of epilepsy in Kuwait. Int J Soc Psychiatry 1990;36:68–73. [5] Kim MK, Kim IK, Kim BC, Cho KH, Kim SJ, Moon JD. Positive trends of public attitudes toward epilepsy after public education campaign among rural Korean residents. J Korean Med Sci 2003;18:248–54. [6] Caveness WF, Merritt HH, Gallup Jr GH. A survey of public attitudes toward epilepsy in 1974 with an indication of trends over the past twenty-five years. Epilepsia 1974;15:523–36. [7] Lai CW, Huang XS, Lai YH, Zhang ZQ, Liu GJ, Yang MZ. Survey of public awareness, understanding, and attitudes toward epilepsy in Henan province, China. Epilepsia 1990;31:182–7. [8] Spatt J, Bauer G, Baumgartner C, Feucht M, Graf M, Mamoli B, et al. Predictors for negative attitudes toward subjects with epilepsy: a representative survey in the general public in Austria. Epilepsia 2005;46:736–42. [9] Canger R, Cornaggia C. Public attitudes toward epilepsy in Italy: results of a survey and comparison with U.S.A. and West German data. Epilepsia 1985;26:221–6. [10] Bekiroglu N, Ozkan R, Gurses C, Arpaci B, Dervent A. A study on awareness and attitude of teachers on epilepsy in Istanbul. Seizure 2004;13:517–22. [11] Diamantopoulos N, Kaleyias J, Tzoufi M, Kotsalis C. A survey of public awareness, understanding, and attitudes toward epilepsy in Greece. Epilepsia 2006;47: 2154–64. [12] Hills MD, MacKenzie HC. New Zealand community attitudes toward people with epilepsy. Epilepsia 2002;43:1583–9. [13] Awad A, Sarkhoo F. Public knowledge and attitudes toward epilepsy in Kuwait. Epilepsia 2008;49:564–72. [14] Bener A, al-Marzooqi FH, Sztriha L. Public awareness and attitudes towards epilepsy in the United Arab Emirates. Seizure 1998;7:219–22. [15] Alaqeel A, Sabbagh AJ. Epilepsy; what do Saudi's living in Riyadh know? Seizure 2013;22(3):205–9. [16] Chomba EN, Haworth A, Atadzhanov M, Mbewe E, Birbeck GL. Zambian health care workers' knowledge, attitudes, beliefs, and practices regarding epilepsy. Epilepsy Behav 2007;10:111–9. [17] Elliott J, Shneker B. Patient, caregiver, and health care practitioner knowledge of, beliefs about, and attitudes toward epilepsy. Epilepsy Behav 2008;12:547–56. [18] Jensen R, Dam M. Public attitudes toward epilepsy in Denmark. Epilepsia 1992;33: 459–63. [19] Al-Adawi S, Al-Ismaily S, Martin R, Al-Naamani A, Al-Riyamy K, Al-Maskari M, et al. Psychosocial aspects of epilepsy in Oman: attitude of health personnel. Epilepsia 2001;42:1476–81. [20] Vancini RL, Benedito-Silva AA, Sousa BS, da Silva SG, Souza-Vancini MI, VanciniCampanharo CR, et al. Knowledge about epilepsy among health professionals: a cross-sectional survey in São Paulo, Brazil. BMJ open 2012;2. [21] Meinardi H, Scott RA, Reis R, Sander JW, ILAE Commission on the Developing World. The treatment gap in epilepsy: the current situation and ways forward. Epilepsia 2001;42:136–49. [22] Crankson SJ. Motor vehicle injuries in childhood: a hospital-based study in Saudi Arabia. Pediatr Surg Int 2006;22:641–5. [23] Frith JF, Harris MF, Beran RG. Management and attitudes of epilepsy by a group of Sydney general practitioners. Epilepsia 1994;35:1244–7. [24] Thapar AK, Stott NC, Richens A, Kerr M. Attitudes of GPs to the care of people with epilepsy. Fam Pract 1998;15:437–42. [25] Thapar AK, Roland MO. General practitioner attitudes to the care of people with epilepsy: an examination of clustering within practices and prediction of patient-rated quality of care. BMC Fam Pract 2005;6:9. [26] Elliott J, Shneker B. Patient, caregiver, and health care practitioner knowledge of, beliefs about, and attitudes toward epilepsy. Epilepsy Behav 2008;12:547–56. [27] Gomes MD. Doctors' perspectives and practices regarding epilepsy. Arq Neuropsiquiatr 2000;58:221–6. [28] Vancini RL, Benedito-Silva AA, Sousa BS. Gomes da Silva S, Souza-Vancini MI, Vancini-Campanharo CR, et al. Knowledge about epilepsy among health professionals: a cross-sectional survey in Sao Paulo, Brazil. BMJ Open 2012;2: e000919. [29] Chomba EN, Haworth A, Atadzhanov M, Mbewe E, Birbeck GL. Zambian health care workers' knowledge, attitudes, beliefs, and practices regarding epilepsy. Epilepsy Behav 2007;10:111–9.
Contents lists available at ScienceDirect
Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh
Epilepsy: What do health-care professionals in Riyadh know? Ahmed Alaqeel a, Faris Alebdi a, Abdulrahman J. Sabbagh b,c,⁎ a b c
Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia
a r t i c l e
i n f o
Article history: Received 6 June 2013 Accepted 13 July 2013 Keywords: Epilepsy Awareness Health-care practitioner attitudes Perceptions of epilepsy Education Health
a b s t r a c t Purpose: The objective of this study was to report on the knowledge of epilepsy, as well as attitudes and practices toward individuals with epilepsy, among health-care professionals in Riyadh, the capital city of Saudi Arabia. Methods: A survey consisting of 23 questions pertaining to epilepsy awareness was distributed to health education workers (n = 51), nutritionists (n = 56), physicians (n = 265), dentists (n = 58), pharmacists (n = 41), nurses (n = 224), physiotherapists (n = 65), and fifth-year medical students (n = 62) in three tertiary hospitals in Riyadh. Results: Of the 822 respondents who completed the questionnaire, 100% had heard about epilepsy, and 92.6% would allow their children to interact with an individual who has epilepsy. However, 67% of respondents would not want their children to marry an individual with epilepsy, 97.9% of respondents believed that individuals with epilepsy should have the same employment opportunities as the general population, 10.5% believe that supernatural power is the cause of epilepsy, 67.2% did not know how to deal with an individual experiencing an epileptic episode, and 56% did not know that surgery was a treatment option for individuals with epilepsy in Saudi Arabia. Of the 822 respondents, 39% would not abide by a physician's advice not to operate a motor vehicle because of their illness, 91% of whom cited problems with the public transportation system as a reason for disregarding the doctor's advice. When asked if the participants had access to any information on how to deal with epilepsy during their professional training, 60.3% had access to such information during their graduate studies. Ninety-eight percent of those with access to this information were physicians and health-care educators (p b 0.001). Physicians and health-care educators were significantly more aware of epilepsy than any of the other groups. Conclusion: The level of epilepsy awareness among health-care professionals in Riyadh needs improvement. © 2013 Elsevier Inc. All rights reserved.
1. Introduction The prevalence of epilepsy is 6.54 per 1000 population in the Kingdom of Saudi Arabia [1], and the incidence of epilepsy is substantially greater in developing countries compared with developed countries [2]. Individuals with epilepsy experience socioeconomic problems that affect quality of life more than the condition itself [3,4]. False beliefs about epilepsy affect the social acceptance of individuals with the condition [5]. Studies investigating public awareness and attitudes toward epilepsy have been conducted in several countries including the United States (USA) [6], China [7], Austria [8], Italy [9], Turkey [10], Greece [11], New Zealand [12], Kuwait [13], and the United Arab Emirates [14]. A recent study conducted in Riyadh, Saudi Arabia [15]
⁎ Corresponding author at: Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, PO Box 59046, Riyadh 11525, Saudi Arabia. Fax: +966 12889999x1391. E-mail addresses: [email protected], [email protected] (A.J. Sabbagh). 1525-5050/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.yebeh.2013.07.009
found that the level of epilepsy awareness in the Saudi population needs improvement. The study revealed that 21.3% of respondents were not aware of any cause of epilepsy, 50.6% would not seek medical advice if one of their relatives had epilepsy, and 31.4% did not know how to deal with an individual experiencing an epileptic episode [15]. Another study from Saudi Arabia involving university-educated school teachers and undergraduate students [16] reported that ‘Jinn’, which are unseen creatures believed to exist in all major religions and have the power to possess humans and cause them harm, are still believed to be a cause of epilepsy in Saudi society. Health-care professionals' knowledge about epilepsy will affect their communication with individuals with the disorder and, in turn, affect the public perception of individuals with the condition. Physicians, nurses, and nonmedical health-care professionals in developing countries play the primary role in delivering medical care for individuals with epilepsy [16,17]. Several reports have demonstrated a lack of awareness regarding epilepsy among health-care professionals [16,18–20]. For example, in Brazil, a recent study involving health-care professionals found that their knowledge about epilepsy needs improvement. This lack of knowledge in some professional health-care
A. Alaqeel et al. / Epilepsy & Behavior 29 (2013) 234–237
workers could be due to gaps in information provided during graduate studies [20]. The poor knowledge base regarding epilepsy among some healthcare professionals has been suggested to be a causal factor for the epilepsy treatment gap [21]; furthermore, epilepsy knowledge among health-care workers has rarely been evaluated in the literature. The objective of the present study, therefore, was to report on epilepsy knowledge, as well as attitudes and practices toward individuals with epilepsy, among health-care professionals in Riyadh.
Table 1 Demographics of study sample (n = 822). Demographic variable
Distribution
Percentage (%)
Age (year)
15–30 30–45 45–60 N60 Male Female Health-care educator Nutritionist Physician Dentist Pharmacist Nurse Physiotherapist Fifth-year medical student
30.9 50.8 17.1 1.2 47.3 52.7 6.2 6.8 32.2 7.1 5 27.3 7.9 7.5
Gender Profession
2. Methods 2.1. Respondents Ethics approval for the present study was obtained from the Institutional Review Board at King Fahad Medical City (Ministry of Health, Riyadh, Saudi Arabia). A standardized questionnaire was distributed to health education workers (n = 51), nutritionists (n = 56), physicians (n = 265), dentists (n = 58), pharmacists (n = 41), nurses (n = 224), physiotherapists (n = 65), and fifth-year undergraduate medical students (n = 62) in three tertiary hospitals in Riyadh. 2.2. Survey setting and questionnaire Riyadh is the capital city of Saudi Arabia and is home to 5.8 million residents, comprising 24.1% of the country's population [22]. The present study was conducted during a two-month period in 2012 to identify the educational needs of professional health-care providers with regard to epilepsy. The standardized questionnaire consisted of 23 questions that have been used in several studies from the USA [6], China [7], Austria [8], Italy [9], Turkey [10], Greece [11], New Zealand [12], and the United Arab Emirates [14]. The questions pertain to epilepsy awareness and knowledge, the attitude and practices toward individuals with epilepsy, and motor vehicle operation (i.e., driving) for individuals with epilepsy. The questions were pilot-tested for comprehension and readability among 80 subjects who were not included in the study. The study team supervised the survey, ensuring confidentiality of the respondents' answers, and made the respondents feel relaxed in answering the questions. English is the official language of the health-care system in Saudi Arabia and the primary language of the education system; therefore, it was the language in which the survey was conducted. 2.3. Data analysis For statistical analysis, SPSS version 17 (IBM Corporation, USA) was used; a p-value b0.05 was considered to be statistically significant. A χ2 test was used to evaluate the association between interview responses and the profession of respondents. 3. Results Of the 1000 questionnaires distributed, 822 were completed, yielding a response rate of 82%. The demographic variables of the population surveyed are presented in Table 1. Table 2 shows the percentage of responses to questions regarding familiarity with and understanding of epilepsy. Although 92.6% of respondents would approve of their children interacting with individuals with epilepsy, 67% would object to their children marrying an individual with the disorder. When asked if individuals with epilepsy should have the same employment opportunities as other people, 97.9% respondents believed that individuals with the disorder should have the same employment opportunities as the general population. Analysis using χ2 tests showed that physicians and health-care educators were significantly more aware of epilepsy than any of the other groups (p b 0.001).
235
When asked whether they had access to information regarding how to deal with epilepsy during their professional training, the majority (60.3%) of participants reported that they had access to such information during their graduate studies. Ninety-eight per cent of those with access to this information were physicians and health-care educators (p b 0.001). Table 3 summarizes the answers for questions regarding knowledge about epilepsy. Particularly noteworthy was the response regarding the cause of epilepsy, with 10.5% believing that a supernatural power is a cause of epilepsy. Table 4 summarizes the attitudes of respondents with regard to driving while suffering from epilepsy. A relatively high proportion (39%) indicated that they would not abide by a physician's advice not to operate a motor vehicle because of their illness. The vast majority (91%) cited deficiencies in the public transportation system as a reason for disregarding the doctor's advice, with more than one-third of respondents (35.5%) being unaware of why epilepsy would preclude anyone from driving a motor vehicle.
4. Discussion The research questionnaire investigating health-care professionals' knowledge of epilepsy in the present study was similar to one that examined the general population's knowledge of this disorder in the same city (i.e., Riyadh) [15], which used a much larger sample size (n = 7078) than the 822 respondents who completed the questionnaire in the present study but was comprised of a significantly more diverse group of individuals. Attitudes toward and knowledge of epilepsy have been addressed by several studies worldwide over the past two decades. An Australian study involving 107 general practitioners (GPs) in Sydney found an improvement in the attitude of GPs toward people with epilepsy as a consequence of a decade of educational promotion regarding the disorder. The majority of GPs were comfortable in referring patients with epilepsy to a neurologist for the initial management of the disorder but were dissatisfied with other health-care therapists because of impractical advice and a perceived lack of empathy [23]. Two studies from the United Kingdom, which were conducted in 1998 and 2005, respectively, examined the attitudes of GPs to the care of individuals with epilepsy [24,25]. The initial study, involving 182 questionnaire respondents, identified the lack of guidelines for epilepsy, which hindered best practices in the care of persons with epilepsy [24]. The second study, involving 115 respondents, reported that the attitudes of GPs to people with epilepsy were significantly associated with quality of care, with specific attitudes of GPs to the care of people with the disorder being clustered within general practices [25]. The importance of continued education regarding epilepsy for GPs and other health-care professionals is well recognized [26], and some of the responses given in the current
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A. Alaqeel et al. / Epilepsy & Behavior 29 (2013) 234–237 Table 2 (continued)
Table 2 Percentage of responses to questions on familiarity and understanding of epilepsy (N = 822). Q1. Have you ever heard of or read about the disease called “epilepsy” or “convulsive seizures” (“fits”)? Yes 100 No 0 Do not know 0 Q2. Did you know anyone who had epilepsy? Yes No Do not know
76 24 0
Q3. Have you ever seen anyone who was having a seizure? Yes No Do not know
45.7 55.3 0
Q4. Would you object to having any of your children play with persons who sometimes had seizures (fits)? Yes 7.4 No 92.6 Do not know 0 Q5. Would you object to having a son or daughter of yours marry a person who sometimes had seizures (fits)? Yes No Do not know
67 33 0
Q6. Do you think people with epilepsy can be employed in jobs like other people? Yes No Do not know
97.9 2.1 0
Q7. Do all patients with epilepsy have the same symptoms? Yes No Do not know
3 97 0
Q8. Does epilepsy strike at any particular age? Yes No Do not know
36.1 63.9 0
Q9. Is epilepsy a disease that can be treated? Yes No Do not know
82.3 17.7 0
Q10. Do you think it is appropriate for a person with epilepsy to have a child? Yes No Do not know
86.6 13.4 0
Q11. Do you think a person with epilepsy can live alone? Yes No Do not know
32.8 67.2 0
Q12. Do you find it acceptable to work with a person with epilepsy (colleague) at work? Yes 99 No 1 Do not know 0 Q13. Is it necessary for a student with epilepsy to be prevented from participating in sports activities? Yes 23.5 No 76.5 Do not know 0 Q14. In developing countries like Saudi Arabia, epilepsy affects a smaller number of people. Yes 42.9 No 55.0 Do not know 2.1 Q15. Does every person with epileptic seizure have to use an antiepileptic drug? Yes No Do not know
35.7 62.1 2.2
Q16. Is there a role for surgical intervention for advanced epileptic cases? Yes No Don't know
44 56 0
Q17. Did you have access to any information of how to deal with epilepsy during your professional training? Yes 60.3 No 39.7
questionnaire regarding knowledge of epilepsy suggest that continuing education about the disorder for health-care practitioners is warranted. Two questionnaire-based studies from Brazil, the first conducted in 2000 and the second in 2012, addressed the knowledge of health-care professionals regarding epilepsy. The first study, involving 31 GPs and 47 pediatricians who were residents in three training hospitals, identified continuing medical education as being important for dealing with people with epilepsy. This was due to a lack of knowledge of the disorder and was also an acknowledgment that quality of care for people with epilepsy was influenced by the attitude of GPs toward them [27]. The second study, involving 524 health-care professionals who held an undergraduate or postgraduate degree in medicine, nursing, physiotherapy, nutrition, psychology, or physical education, focused on the knowledge of epilepsy in each group. Physiotherapists, nutritionists, and physical education instructors had lower scores than each of the other groups of health-care professionals [28]. The data collected in the current study support the conclusions of the study by Vancini et al. [28], which emphasized the need for educational resources about epilepsy to be available for medical and nonmedical health-care professional personnel. Assessment of the knowledge, attitudes, and beliefs of 276 Zambian nonphysician health-care workers [29] showed some similarities to the results obtained in the present study. A greater knowledge of epilepsy was apparent in more recent graduates and in health-care workers
Table 3 Knowledge and practices toward epilepsy (%) (N = 822). Q18. What do you think is the cause of epilepsy? (more than one answer is allowed) 1. Hereditary 89.0 2. Brain disease 95.3 3. Mental or emotional stress disorder 27.5 4. Birth defect 10.2 5. Blood disorder 1.0 6. Jinn or supernatural power 10.5 7. Do not know 0 Q19. What do you think is the manifestation of an epileptic attack? (more than one answer is allowed) 1. Foaming from the mouth 89.0 2. Convulsions 99.8 3. Screaming 60.2 4. Changes in behavior 78.4 5. Don't know 5.1 Q20. What would you do if someone were having a seizure attack? (more than one answer is allowed) 1. Take them away from danger 98.0 2. Put a spoon or cloth in the patient's mouth 67.2 3. Force some medicine down the patient's throat 2.0 4. Put their head in a toilet hole 6.0 5. Hold or tie them down 18.2 6. Don't know 2.9 Q21. If your relatives or friends have epilepsy, what kind of treatment would you suggest? (more than one answer is allowed) 1. Ask a doctor 100.0 2. Ask for an herbal medicine 0.8 3. Acupuncture 5.2 4. Get medicine from a drug store 1.0 5. Read the Quran 50.1 6. No need for treatment 1.0
A. Alaqeel et al. / Epilepsy & Behavior 29 (2013) 234–237 Table 4 Epilepsy and driving (%) (N = 822). Q22. If you had epilepsy and the physician instructed you not to drive, would you abide by his instruction? Yes 61 No 39 Q23. If your answer was “No”, please choose a cause from the list: (more than one answer is allowed) (N = 321) Public transportation 91.0 Social reasons 26.9 Financial reasons 10.2 I do not see any reason that may prevent patients with epilepsy from driving. 35.5
who had received both bedside and didactic training. Improved knowledge of the disorder was associated with a higher degree of social tolerance, although there was no association between social tolerance and having a family member with epilepsy [29]. Approximately 25% of Zambian health-care workers would not allow their child to marry someone with epilepsy [29], compared with 67% of health-care workers in the present study who would object if their child married a person with the condition. Interestingly, the proportion of the general population surveyed in Saudi Arabia who would object to their child marrying a person with epilepsy was 76% [15], which is not substantially higher than the figure for health-care professionals. For the questions in common between the two Saudi surveys, the largest difference in respondents. In the Zambian study [29], 20% of health-care respondents believed that people with epilepsy should not marry or be employed. In contrast, 99% of health-care workers in the present study believed that it was acceptable to work with a person with epilepsy, and 86.6% believed that it was appropriate for a person with epilepsy to have a child. Our study showed that 10.5% of health-care professionals believe that ‘Jinn’ are a cause of epilepsy, compared with another study from Saudi Arabia [16] reporting that 40.3% of the school teachers and 50.4% of students believe that Jinn possession is a cause of the disorder. In conclusion, there is considerable evidence from studies involving medical and nonmedical health-care workers from around the world ([23–29], present study) that continued medical education for epilepsy is necessary. Acknowledgment This study was funded by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University. We would like to thank the nursing department at King Fahad Medical City for helping us to complete our project.
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