KNOWLEDGE AND ATTITUDES TOWARD EPILEPSY AMONGST STUDENTS IN THE HEALTH AREA

Arq Neurosiquiatr 2007;65(4-B):1181-1185 KNOWLEDGE AND ATTITUDES TOWARD EPILEPSY AMONGST STUDENTS IN THE HEALTH AREA Intervention aimed at enlightenment Glória Maria A.S. Tedrus 1, Lineu Corrêa Fonseca 1, Ana Lídia da Câmara Vieira 2 ABSTRACT - It is known that there is a lack of knowledge about eilesy amongst the oulation in general, with consequent rejudice and discrimination towards eiletic atients. Considering the imortance of health rofessionals in the diffusion of knowledge about this neurological condition, the objective of the resent study was to evaluate modifications in the knowledge and attitudes of students in the health area with resect to eilesy, after an including the resentation of secific audio-visual material and a discussion on the basic asects of eilesy. Simle self-administered questionnaires were alied to one hundred and sixteen health area students before and after the session of enlightenment. After the session there was significant (<0.05) imrovement in answers to different questions about etiology, eidemiology, education, work, and attitude during the seizure. The results suggest the need to include a routine low comlexity educational activity in the curriculum of various courses in the health area. KEY WORDS: eilesy, knowledge, attitudes, stigma, rejudice. Conhecimentos e atitudes sobre eilesia entre universitários da área de saúde: uma intervenção com esclarecimentos RESUMO - É sabido que na oulação em geral há falta de conhecimentos básicos referentes à eilesia e, conseqüentemente, reconceitos, discriminação e estigma. Considerando a imortância dos rofissionais da saúde na difusão de conhecimentos sobre essa doença, o objetivo deste estudo foi avaliar em universitários da área da saúde, as modificações de conhecimentos e atitudes em relação à eilesia, aós uma intervenção constituída de aresentação de material áudio-visual esecífico e discussão de asectos básicos da eilesia. Cento e dezesseis estudantes resonderam a um questionário sobre asectos biosicossociais da eilesia, antes e aós a intervenção educativa. Houve, aós essa intervenção, melhora significativa (<0,05) no nível de resostas adequadas relacionadas a questões sobre etiologia, eidemiologia, associação com doença siquiátrica, educação, casamento, trabalho e cuidados durante uma crise eilética. Os resultados favoráveis obtidos sugerem a necessidade de inclusão rotineira, de atividades educativas de baixa comlexidade, nos currículos dos vários cursos da área da saúde. PALAVRAS-CHAVE: eilesia, estigma, asectos sicossociais, conhecimento, atitudes. Stigma and discrimination generally cause more suffering to eiletics than the actual fits 1. Although the causes of stigma are comlex, a lack of knowledge about eilesy has been considered to be an imortant determinant factor in the negative attitudes towards eole with this clinical condition 2. A lack of knowledge about eilesy has been shown in a large art of the oulations throughout the World, as also rejudice and stigma 1-13. Eiletics are sometimes victims of discriminatory attitudes, and unnecessary, if not dangerous measures are alied in an attemt to assist them during an eiletic fit 8. A lack of rearation amongst many doctors with resect to the attention given to eiletic atients is also evident 14,15. The education of the oulation, and in articular of rofessionals in the health area is thus imortant in order to revert this discriminatory and stigmatising situation, due to the multilying effect of knowledge and ositive attitudes generated by their actions 16. In an earlier survey 17, the knowledge and attitudes of university students in the health area of a rivate university in the state of São Paulo, Brazil, were assessed at the beginning and end of their courses. It was shown that final year students were more famil- 1 Professor of Neurology of the Faculty of Medicine of the Pontifical Catholic University of Caminas, Caminas SP, Brazil (PUC- Caminas); 2 Placement scholarshi holder FAPIC/Reitoria, PUC-Caminas, Brazil. Received 20 june 2007, received in final form 27 July 2007. Acceted 31 August 2007. Dra. Gloria M.A S. Tedrus - Rua Sebastião de Souza 205/122-13013-910 Caminas SP - Brasil. E-mail: gmtedrus@uol.com.br 1181

Eilesy: knowledge, attitudes amongst health area students Arq Neurosiquiatr 2007;65(4-B) iar with eilesy in terms of the asects related to its causes, to work, to attitude during fits and to treatment. Nevertheless a significant ercentage of final year students still resented a considerable lack of knowledge with resect to eilesy, suggesting the need for actions directed at minimising this situation. A few studies exist assessing s aimed at imroving the enlightenment of medical students 18 and of students from other courses in the health area 11, with resect to eilesy. Considering the imortance of future health rofessionals in divulging information about eilesy, the resent study was carried out aimed at assessing ossible changes in the knowledge and attitudes of university students in the health area studying in a rivate university in the State of São Paulo, Brazil, with resect to eilesy, after an involving the resentation of secific audio-visual material and a discussion about the bio-sychosocial asects of eilesy. METHOD In the eriod between August 2005 and June 2006, a questionnaire was alied to university students of 5 different courses (4 th to 7 th semester students, deending on the course) in the health area (harmaceutical science, hysiotheray, medicine, nutrition and occuational theray) of a rivate university in the state of São Paulo, Brazil (1 st hase of the survey). Questionnaire The questionnaire was based on items related to familiarity, knowledge, attitudes and care during an eiletic fit, consisting of 15 questions already alied in the revious survey 17, and, to a large extent, already alied in other surveys as well 3,8,19. Intervention aimed at enlightenment About a week after alication of the questionnaire, the students were offered a worksho lasting for about 2 hours, consisting of the resentation of audio-visual material about biological and sychosocial asects related to eilesy, followed by a brief discussion. The questionnaire was then alied again (2 nd hase of the survey). The audio-visual material resented, roduced by the Brazilian League of Eilesy, consisted of two taes. The first showed atients during various tyes of seiures or describing how they felt during the seizures, also showing diagnostic asects of eilesy. The other tae told the history of a man who had suffered from eiletic seizures since childhood, showing various situations involving relatives and his doctor. An eiletic seizure was also reresented in the film, and the rincile bio-sychosocial asects aeared in the dialogues. Data analysis The resonses before and after (1 st and 2 nd hases, resectively) were comared using the chi-squared test, with a significance level of <0.05. Of the 258 students who took art in the first hase, 142 did not fill in the questionnaire in the 2 nd hase, and thus a comarison was also made between the initial resonses (1 st hase) of these students and of the 116 who concluded the 2 nd hase. Ethical asects The students were informed about the nature of the survey and of the strict secrecy maintained with resect to the names of the atients. All the subjects signed a free and informed consent form before taking art in the study, and the Ethics Committee for Research with Human Beings of PUC-Caminas aroved the roject. RESULTS Particiants Two hundred and fifty eight students from five courses in the health area took art in the first hase of the survey, corresonding to aroximately two thirds of the students registered in the semesters chosen (4 th to 7 th semesters deending on the course). Of the initial 258 students, 116 took art in the worksho and filled in the questionnaire a second time (2 nd hase). Of these, 20% were reading medicine. Sources of knowledge about eilesy before the survey In the first hase of the survey, 93% of the students stated they had certain knowledge about eilesy, the most cited sources being resectively the faculty (31.9% of the students) and television (29.3%). Other sources cited were: newsaers, the internet and articles in scientific journals, about 13% each. A high roortion of the students (42.2%) stated they had already witnessed an eiletic eizure, and 18.9% stated that some member of their family had already had one. Comarison of the resonses in the two hases of the survey for the 116 articiants Table 1 shows the resonses of the students to questions about their familiarity and knowledge with resect to eilesy. It can be seen that for the majority of the questions, the resonses were more adequate after, with statistically significant differences (chisquared; <0.05) (Table 1). Eilesy was not considered to be a contagious disease by any of the students in either of the hases, and nor was it mistaken for dysrhythmia. With resect to work, considering the absence and accident indices and restrictions for some job activities, the frequency of adequate resonses was higher in the 2 nd hase (Table 2). With resect to rejudiced cultural asects such as not emloying an eiletic, this was not cited more in the 2 nd hase than in the 1 st hase. 1182

Arq Neurosiquiatr 2007;65(4-B) Eilesy: knowledge, attitudes amongst health area students Table 1. Percent resonses in the two hases of the survey and value for to questions about familiarity and knowledge with resect to eilesy. Before After Questions Eilesy is usually hereditary 32.7 67.2 17.2 82.7 0.009* Eilesy is restricted to eole where brain damage already exists 30.1 69.8 5.1 94.8 Eilesy is more common in eole of lower socio-economic class 3.4 96.5 100 0.13 Eilesy is frequent and can aear at any age 36.6 63.6 83.6 16.3 Eilesy is the same as dysrhythmia 4.3 95.6 0.8 99.1 0.21 Peole with eilesy usually suffer from serious sychiatric illness 11.3 88.6 100 0.0001* Would you marry someone suffering from eilesy? 87.0 12.9 98.2 1.7 0.002* *statistically significant values (chi-squared; <0.05). Table 2. Percent resonses before and after and value for for questions concerning knowledge about the work of atients with eilesy. Before After With resect to work, atients with eilesy show Comromised erformance 3.4 96.5 100 0.13 Greater absenteeism indices 11.2 88.7 0.8 99.1 Greater accident indices 36.2 63.7 3.4 96.5 Restrictions for some activities 53.4* 46.5 98.2* 1.7 Would you emloy someone with eilesy? 93.8 6.1 100 0.006* *statistically significant values (chi-squared; <0.05). Table 3. Percent resonses before and after and value for for questions concerning care during eiletic seizures. 1 st hase 2 nd hase If, during an eiletic fit, the erson falls down and writhes on the floor, you should: Kee well away 0.86 99.1 100 NS Hold him down firmly 19.8 80.1 0.86 99.1 Remove objects he could hurt himself with 59.4 40.5 100 Introduce something into his mouth so that he will not bite his 35.3 64.6 100 tongue or become ashyxiated Throw water onto the erson 100 100 NS *statistically significant values (chi-squared; <0.05); NS: not significant. Table 4. Percent resonses after and value for for questions concerning the medication used by eiletics, comaring the resonses of medical students with those of students reading other courses. Medicine Other courses Eiletics take medication that: Can comletely cure them 3.3 96.6 0,8 99.1 NS Only decrease the frequency of the fits 16.6 83.3 56 30 0.000* Overcome the fits in the majority of cases 80.0 20.0 33 53 0.000* *statistically significant values (chi-squared; <0.05); NS: not significant. 1183

Eilesy: knowledge, attitudes amongst health area students Arq Neurosiquiatr 2007;65(4-B) Placing eiletic students in secial classrooms for educational uroses was not considered adequate either before or after. When faced with an individual suffering an eiletic seizure (Table 3), erroneous concets were more frequent in the 1 st hase. With resect to medication, there was no significant difference in the resonses between the two hases: drugs only decrease the frequency of the fits (according to about 45% of the students) or they overcome them in the majority of cases (53%). However, in the 2 nd hase, the medical students stated that medication would overcome the fits more frequently than students from other courses (Table 4), although they had still not done their training in neurology, where they would concentrate on activities connected with eilesy. Comarison of the resonses for the 1 st hase given by the students who took art in the 2 nd hase with those of the grou who did not Aiming to evaluate the imact of the 142 students who did not take art in the 2 nd hase on the results of the survey, the initial resonses of these students were comared with the initial resonses (1 st hase) of the 116 students who did. The students who only comleted the questionnaire in the 1 st hase showed statistically significantly more adequate resonses (chi-squared, <0.05) than those who took art in both hases for the following questions: eilesy only aears in cases of brain injury (resonse yes for 17.5% of those who only took art in the 1 st hase, and for 30.2% of those who took art in both hases), greater work absence indices (7% and 11.2%), greater work accident indices (10.5% and 36.2%) and restrictions for some job activities (76.2% and 53.4%), resectively). Considering the hyothesis that the favourable resonses obtained after occurred essentially due to the inferior level of initial information of the students who took art in both hases, as comared to those who only filled in the first questionnaire, the initial results of those who only took art in the 1 st hase were comared with the results obtained in the 2 nd hase for the students who comleted both hases. It can be seen that adequate resonses aeared with greater frequency for those students who comleted the 2 nd hase (chi-squared, <0.05). DISCUSSION In the resent survey, the degree of familiarity with eilesy indicated by university students in the health area and the levels of adequate resonses given to the questionnaire in the first hase of the study, were similar to those found in a similar survey carried out reviously in the same university 17, confirming a basic lack of knowledge about various asects of eilesy. The roosal for a worksho on the theme of eilesy stimulated interest amongst students in various courses in the health area, resulting in significant articiation. Nevertheless, many failed to fill in the questionnaire after the activity of enlightenment, robably due to reduced motivation in continuing with the survey. With resect to the effects of the aimed at enlightenment, a significant growth in adequate resonses for the items concerning knowledge of the causes and age distribution of eilesy was observed. With resect to the rejudiced oinion frequently observed in oulations, that eilesy is usually associated with sychiatric disease 10, such an oinion was not given by any of the students in the 2 nd hase of the survey. With resect to work, after the for enlightenment, the concet that eiletics show greater indices of absenteeism and accidents was rarely indicated. At the end of the survey, all the students admitted the ossibility of emloying someone suffering from eilesy, and with greater consciousness of the need for restrictions with resect to some job activities. With resect to care during a seizure, at first about 20% of the students affirmed the need to contain the atient and 35% of introducing something into the mouth, but by the end of the survey such ostures were no longer indicated. In the 2 nd hase all the students affirmed the need to remove objects that offered risk, whilst only 60% affirmed this conduct in the first questionnaire. Although the students showed rogress in the resonses to the above items, in questions related to medication, the ercentage of students indicating that drugs could overcome fits in the majority of cases was relatively low in both hases amongst the medical students, and even lower amongst the students from other faculties. For this question the was inadequate, and should involve a wider discussion. The differences shown in the resonses given to questions on medication by the medical students as comared to those from other courses could have been due to rior knowledge, their exeriences or rincially to different focuses given by the curricula of each course. 1184

Arq Neurosiquiatr 2007;65(4-B) Eilesy: knowledge, attitudes amongst health area students Another asect suggesting the imortant effect of the worksho was that for the majority of questions, the level of adequate resonses given by the students in the 2 nd hase of the survey was higher than that observed for final year students in health area courses in the earlier survey 17. Since the students who took art in both hases showed inferior erformance in the 1 st hase as comared to those who only filled in the first questionnaire, one could raise the hyothesis that the favourable effects were mainly due to the low levels the first grou resented in the initial hase. Nevertheless, the roof that their erformance in the 2 nd hase was suerior to that shown in the 1 st hase by the students who did not fill in the 2 nd questionnaire indicates that the latter grou could also benefit from the activity of enlightenment. One aer was found in the literature about a study in which the effects of an activity of enlightenment 11 were assessed. This study was characterised by exosure of university students to a brochure reared by the Eilesy Foundation of America containing the basic elements about eilesy. Some favourable effects were found, but were limited to asects of the revalence and causes of eilesy. The rocedure used in the resent survey was robably more motivating and of a wider scoe, allowing for ositive results in the majority of the items assessed in the questionnaire. In a study involving exclusively medical students and including activities with more detail and for a longer eriod (8 hours) than used in the resent study, greater imrovements in knowledge, attitude and ercetion about eilesy were observed 18. In the resent survey, the beneficial results of a short, low comlexity aimed at enlightenment were aarent, both in roviding enlightenment about basic questions concerning eilesy and in orientation about how to aid an individual suffering from an eiletic fit. It is hoed that this will lead to insertions into the curricula of courses in the health area of material that will lead to the formation of rofessionals better reared to deal with the theme of eilesy. REFERENCES 1. McLin WM, Boer HM. Public ercetions about eilesy. Eilesia 1995; 36:957-959. 2. Baker GA, Jacoby A, DeBoer H, Doughty J, Myon E, Taïeb C. Patients understanding of the adjustment to eilesy: interim findings from Euroean survey. Eilesia 1999;40(Sul 9):S26-S29. 3. Caveness WF, Gallu GH Jr. A survey of ublic a itudes toward eilesy in 1979 with an indication of trends over the ast thirty years. Eilesia 1980;21:509-518. 4. Iivanainen M, Uutela A, Villkkumaa I. Public awareness and a itudes toward eilesy in Finland. 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