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Seizure 23 (2014) 280–283
Primary school teacher’s knowledge and attitudes toward childrenwith 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
Article history:
Received 29 September 2013
Received in revised form 14 December 2013
Accepted 28 December 2013
Keywords:
Teacher
School
Knowledge
Attitude
Child
Epilepsy
A B S T R A C T
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 37-
item 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.
� 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect
Seizure
jou r nal h o mep age: w ww.els evier . co m/lo c ate /ys eiz
1. Introduction
Epilepsy is one of the most common pediatric neurologicaldisorders with higher incidence during the school years.1,2 Theseyears represent a critical period of the child’s social, psychological,and physical development. The school period will significantlyimpact the child’s quality of life and future adult roles.3,4 Childrenwith epilepsy are at increased risk of educational underachieve-ment, learning difficulties, mental health problems, social isola-tion, and poor self-esteem.5,6 Teacher’s knowledge and attitudestoward epilepsy can have significant impact on these difficultiesincluding student’s performance, social skill development, andfuture employment.7 International studies have indicated thatteachers often have insufficient knowledge, inadequate training,
* Corresponding author. Tel.: +966 505698843; fax: +966 26403975.
E-mail addresses: [email protected], [email protected] (M.M. Jan).
1059-1311/$ – see front matter � 2014 British Epilepsy Association. Published by Else
http://dx.doi.org/10.1016/j.seizure.2013.12.010
and misconceptions about epilepsy and its management.8–14
Despite the significant impact of teacher’s role in the lives ofthese children, very little research has been conducted in SaudiArabia to assess these issues.15,16 Our objectives were to studyprimary school teacher’s attitudes toward epilepsy and identifyareas in which further teacher training and education are required.We also aimed to identify contributing factors to inadequateknowledge and negative attitudes. We hypothesized that manyteachers are not well informed about epilepsy and some aremisinformed from unreliable sources, which contributes to theirnegative attitudes toward the student with epilepsy.
2. Methods
A stratified random sample survey involving a group of primaryschool teachers in Jeddah, Saudi Arabia was conducted from the 1stof January, 2012 to the 1st of January, 2013. Multiple private/publicprimary schools designated for male and female students were
vier Ltd. All rights reserved.
Table 1Summary of the teacher’s knowledge and negative attitudes toward children with
epilepsy (n = 615).
Questionnaire Positive
answer
Knowledge
Epilepsy is a life time disorder 59%
One of the causes of epilepsy is spirit possession 27%
The intelligence of an epileptic child is below average 25%
Evil eye is a cause of epilepsy 22%
Epilepsy cannot be cured 21%
Attitudes
Children with epilepsy have abnormal behavior in class 47%
They have future career limitations 42%
Children with epilepsy should be placed in a special classroom 28%
They should be placed in a special school 27%
I mind having a child with epilepsy in my classroom 25%
They should not participate in sport activities 18%Fig. 1. Results to the Likert scale item that examined the degree of knowledge about
epilepsy.
A.S. Abulhamail et al. / Seizure 23 (2014) 280–283 281
included from the Jeddah area. These schools were randomlyselected from an official list obtained from the Ministry ofEducation and included a sample from all four regions of our city(north, center, south west, and south east). A structured 37-itemquestionnaire was designed to examine the teacher’s demo-graphics, knowledge, attitudes, and experience with children withepilepsy. Key questions are listed in Table 1. A 4-point Likert scaleitem was included to examine the degree of knowledge aboutepilepsy with response categories of very well informed, moder-ately informed, somewhat informed, and not informed at all. Thestudy design and questionnaire were approved by King AbdulazizUniversity hospital ethics committee. The nature of the study andquestionnaires were explained to the principles of the includedschools and all involved teachers signed an informed consentbefore voluntarily participating in the study. An assigned coauthorconducted the interviews during a school visit and individuallyassisted all available teachers to complete the questionnaires. Theidentity of the teacher was not requested to ensure privacy andencourage accurate response. Data were collected in Excel sheetsand statistical analyses were performed using SPSS 17 (SPSS, Inc.,Chicago, IL, USA). Descriptive analyses were performed and thevariables were examined using chi-square test. Statistical signifi-cance will be defined as p values of less than 0.05.
3. Results
Six hundred and twenty primary school teachers working inpublic (58%) or private (42%) schools were included during thestudy period. Five forms were incomplete and therefore excluded.The ages of the remaining 615 teachers ranged between 21 and 59years (mean 36, SD 7.9), with 53% being females. Most teachers(79%) were of Saudi Arabian nationality and 66% had a college oruniversity degree. Their years of experience ranged from 1 to 35(mean 13.5, SD 8.6 years). Only 17% of the teachers felt very wellinformed about epilepsy on the Likert scale (Fig. 1), mostly fromthe media, relatives, and personal experience. Teachers were ableto correctly identify many aspects of epilepsy in terms of etiologyand symptoms, however, several weak aspects of knowledge andnegative attitudes were encountered as summarized in Table 1.Teacher’s age, gender, years of experience, or type of school did notcorrelate significantly with their knowledge about epilepsy.However, teachers with higher education (college or universitydegrees) were more likely to have good knowledge (moderate orvery well on the Likert scale) when compared to those with lesseducation (57% vs 21%, p = 0.009). Teachers of Saudi nationalitywere also more likely to report good knowledge when compared tothose of other nationalities, independent of their educational level(67% vs 52%, p = 0.013). This correlated with their attitudes, as
Saudi teachers were less likely to think that children with epilepsyhave lower intelligence (p = 0.002), should be placed in a specialclassroom or school (p = 0.0001), or that they should notparticipate in sport activities (p = 0.04).
Overall, teacher’s attitudes correlated highly with theirknowledge. Those with good knowledge were less likely to mindhaving a child with epilepsy in their class (p = 0.028) or think thatthey should be placed in a special classroom (p = 0.029). On theother hand, teachers working in private schools were more likely tomind having a child with epilepsy in their class (p = 0.02), thinkthat they should be placed in a special class (p = 0.004) or specialschool (p = 0.0001) when compared to teachers in public schools.Overall, 28% of the teachers have encountered a child with epilepsyin their class. At the time of the questionnaire, this group had betterknowledge 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 ofthem (58%) did not know what to do and the majority felt thatputting something in the student’s mouth to prevent tongueswallowing was a correct maneuver. Teachers with goodknowledge were more likely to report that they know what todo in such acute seizure situation (p = 0.0001).
4. Discussion
This study evaluated a number of aspects of primary schoolteacher’s knowledge and attitudes toward epilepsy. Only 17% ofthe teachers felt very well informed and many had negativeattitudes and misconceptions about epilepsy. Many teachers feltthat the intelligence of children with epilepsy is below average andthat these children should be placed in a special classroom or aspecial school (Table 1). Although these teachers were highlyeducated and quite experienced, up to 27% continued to believethat spirit possession or evil eye are causes of epilepsy. A recentstudy from a different region of Saudi Arabia found that possessionby demons (Jinns) is still believed to be a cause of epilepsy among40% of university-educated school teachers.15 We had a lowerpercentage reflecting possible regional variations. Another Saudistudy revealed that 14% of the public believed that epilepsy isinfectious and 8% believed that epilepsy was a type of mentalillness.16 It is clear that the level of epilepsy awareness in the Saudipopulation needs improvement.
Ours findings confirms that teachers have insufficient knowl-edge about epilepsy, inadequate training, and erroneous acuteseizure management. This is similar to what has been previouslyreported by many international studies.7–14 In a study fromTaiwan, more than 30% of participants thought epileptic seizures
A.S. Abulhamail et al. / Seizure 23 (2014) 280–283282
were associated with insanity and had problems in the acceptanceof children with epilepsy.7 In a study from Thailand, 38% of theprimary school teachers had not heard of or read about epilepsyand 15% preferred to place all children with epilepsy in a specialclassroom.8 Even in developed countries, most teachers do not feelconfident when teaching children who had epilepsy and someconsidered their knowledge of the subject to be adequate.9
Overall, teacher’s attitudes correlated highly with theirknowledge. As one would expect, those with good knowledgewere less likely to have negative attitudes. This correlation isdocumented by several authors from different countries.17–20 In astudy from Korea, teachers’ knowledge was the most importantfactor influencing teacher’s attitudes toward epilepsy.17 Othersfound stronger negative attitudes with up to half of the teachersopposed having a child with epilepsy in their classes because theyfeared a child having a seizure during class and they felt that theylacked knowledge of first-aid for seizures.18 In addition, teacherswho had inaccurate knowledge of epilepsy demonstrated negativeattitudes toward the marriage and employment of persons withepilepsy.18 A recent study from Nigeria found significant deficits inthe general knowledge about epilepsy and first aids measures inthe classrooms even in those with high level of education.19 Even indeveloped countries, such as Italy, 33% considered epilepsy alimitation for marriage, 25% for having children, 40% for regularemployment, and 33% for sports and leisure activities.20 In thisstudy, 66% of the teachers declared they were unable to manage aseizing 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 knowledgeabout epilepsy. Other studies have found an association with moreyears of teaching experience and female gender.21–23 On the otherhand, a Turkish study found young teacher’s age and male genderpredictive of positive attitudes.24 Interestingly, we found thatteachers of Saudi nationality were more likely to report goodknowledge, independent of their educational level. One couldrelates such finding to over-reporting, however, this associationmay be genuine as our Saudi teachers were less likely to havenegative attitudes such as thinking that children with epilepsyhave lower intelligence, should be placed in a special classroom orschool, or that they should not participate in sport activities.Interestingly, teachers working in private schools were more likelyto have some negative attitudes toward children with epilepsy,which may be related to lowered tolerance for children with suchchronic disorders in our private schools. These teachers should betargeted with educational programs. Most teachers (58%) did notknow what to do during an acute seizure. However, those withpersonal epilepsy experience were more likely to report that theyknow what to do in such acute situation. Consistent with ourfinding, other authors found that teachers with personal experi-ence of epilepsy had greater knowledge of the illness.25
There are some limitations to our study. Our sample may not berepresentative of all teachers working in Saudi Arabia as it onlyincluded those from the Jeddah area. This will limit our ability togeneralize our findings to Saudi Arabia or other neighboring Arabcountries. However, our sample is large and included public andprivate schools with representation of all ages, experiences, andequal gender contribution. Another possible limitation is theinability to generalize from our finding to all teacher categories aswe did not include secondary or high school teachers. We selectedprimary teachers due to the importance of these early stages in theschool career of children with epilepsy and their psycho-socialdevelopment. It will be interesting to evaluate teachers fromhigher school grades and also assess less urbanized regions of ourcountry. In addition, replication of the questionnaire in the MiddleEast is needed.
We conclude that primary school teacher’s knowledge needsimprovements. Their attitudes correlated highly with theirknowledge. Therefore, focused education and training aboutepilepsy are needed during the preparation of school teachers.Several studies have documented that such educational coursesresulted in significant improvements of teacher’s beliefs andattitudes.26,27 Existing epilepsy resources, available throughnational epilepsy societies should be made accessible to allteachers. Public educational epilepsy campaigns should beencouraged as this can improve the quality of life of childrenwith epilepsy and their families by helping to develop a wellinformed and tolerant community.
Acknowledgement
The authors acknowledge with thanks the statistical assistanceand advice of Dr. Bakr M. Bin Sadiq, King Faisal Specialist Hospitaland 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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