Effects of health education on improving intellectual knowledge among parents of people with epilepsy

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Introduction
Epilepsy embodies around 0.7% of the worldwide burden of diseases and is especially predominant and associated with substantial infirmity in low-and middle-income nations in Latin America 1 and fences to care including shortage of human resources, medical facilities, and resources 2 .In Pakistan, rate of occurrence of epilepsy is very alarming being more prevalent in people with low socioeconomic backgrounds and very limited medical resources.Considering the changes over the past 20 years little is known about the current epidemiological characteristics of epilepsy in Pakistan 3 .The standard characterization of epilepsy as an individual experiencing two or more gratuitous seizures more than 24 hours apart has been extended also to embrace those having one seizure and a great probability (more than 60%) of having another 4 .Epilepsy is a complex of symptoms with several determinants and a solid genomic tendency instead of a situation with one symptom and basis.These developments have given rise to the novel classification of epileptic seizures and epilepsies.A detailed clinical history and a reliable eyewitness account of a seizure are the cornerstones of the diagnosis 5 .Neurological insult, such as traumatic brain injury, hypoxia, or febrile seizures, is associated with neuronal death, dysfunctional synaptic modification, and the generation of a hyper-excitable network, which could predispose to spontaneous recurrent seizures 6 .Status epilepticus (SE) is a prevalent, fatal health disorder that entails early identification and treatment.In children, it may be part of a clinical exhibition of diverse disorders, as well as the first epileptic event 7 .Epilepsy in children not only affects their cognition, well-being, and behavior, but also impacts caregivers, including employment and household work, emotional and physical health, relationships of caregiver with spouse, other children and friends, and self-efficacy for caregiving 8 .Parents often had difficulty accessing professional knowledge about epilepsy.Early onset epilepsy often has a very significant impact on family functioning hence, parents want emotional support to extend beyond the initial diagnosis 9 .Therefore, this study sought to assess the knowledge among parents of people with epilepsy before and after the health education.

Study Design
Quasi experimental design (Pretest & posttest) will be used to assess the significance of health education on improving intellectual knowledge and family functioning among parents of people with epilepsy

Study Site
Study will be conducted at a tertiary care hospital in Lahore, Pakistan.

Target Population
All people with epilepsy of Lahore, Pakistan.

Sampling Technique
Study participants will be selected using convenient sampling method.

Inclusion Criteria
Any subject meeting the following criteria will be excluded from the study.
 The individual who has a definitive diagnosis of epilepsy documented in their medical chart. The individual who has experienced seizures recently i.e in <12 months span from the date of interview

Exclusion Criteria
Any subject meeting the following criteria will be excluded from the study.
 The individual who has any physical disability. The individual who has not experienced any seizures recently i.e. in <12-month span from the date of interview

Sample Size
Sample size is calculated by using formula in Open Epi.The sample size was 370 upon 95% of the confidence interval but due to limitation of time and according to the availability of participants, 100 subjects were interviewed through pre designed questionnaire.

Ethical Considerations
The rules and regulations set by the institutional review board were followed while conducting the research and the rights of the research participants were respected.Information sheet with detailed description of study aim and purposes was given to the study participant.

Data Collection Procedure
After approval from the institutional review board/ethical review committee of a leading tertiary care hospital, Lahore, data collection procedure was initiated.Parents of the patients admitted with diagnosis of Epilepsy and of those coming for follow up to the outdoor patient department were interviewed (pre assessment) using the pre-designed questionnaire (attached annexure I).After completing the pre-assessment, an educational/interventional program was conducted for one week.Upon completion of educational/interventional program, data will be collected using the same tool (post assessment) to observe any change in the knowledge of the participants.

Data Analysis Procedure
Statistical Package for Social Sciences (SPSS) version 24.0 will be used for data entry and analysis.Initial analyses included; computing frequency distribution for categorical variables, mean values (±standard deviation) and median values to describe the continuous data with and without normal distribution, respectively.T test was computed to compare pre and post interventions data and to evaluate the significance of interventions on health status of participants.

Results
A total of 100 participants were interviewed at the hospital using the pre-designed questionnaire (attached annexure I).The tool was divided in two components i.e., demographic variables and questions for assessment of intellectual knowledge regarding epilepsy.Thirty participants came from remote area for follow up and 70 were from urban area while 27 patients were accompanied by their fathers and rest of the parents interrogated were mothers of epileptic individuals.When asked that for how many years.As mentioned in the methodology section that Pretest and posttest scores were analyzed using two tailed t-test.Two scores were compared for their mean and standard deviation.Mean value for both scores was 45.56 and 52.42 respectively for pretest scores and posttest scores.Standard deviation measured as 3.99 for the two scores.T value was calculated as -17.182 (this value is in negative because posttest score was subtracted from pretest score) and significance level came in after application of t test as 0.00 which falls under 0.05 displaying how effective the health education was.

Discussion
Result of this study shows that empowering the parents of epileptic children with proper education about epilepsy can help the parents to lead a life free of any chaos and it can help preventing further ailments caused by the disease.Result of this study are strongly supported by the previous research evidence.The findings show that 100% (n=100) consider epilepsy as mental illness which is also evidenced in previous studies.When asked to handle their children at the time of having seizures, 85% parents denied their ability to manage the seizure but after attending health education 93% agreed that they are prepared to handle their children at home while having seizures.Kissani et al. had similar findings in their study suggesting the importance of health education 2 .
During pretest assessment 89% (n=89) parents indicated that they do not have any knowledge regarding epilepsy and after attending the education session 96% (n=96) parents showed to possess enough knowledge about epilepsy.Similar findings were reported by Ullah et al.where 75% parents had developed good knowledge after the intervention.Before joining health education delivered as study intervention, 98% (n=98) participants did not possess any information regarding different types of seizures but 91% (n=91) answered positively after the session 10,11 .Ninety six percent (n=96) parents considered epilepsy as medical emergency in their pretest assessment and 80% (n=86) participants denied it as a medical emergency in their posttest assessment.
Sixty two percent (n=62) attendants of patients answered that individuals with epilepsy can safely operate machinery but post intervention this response shifted drastically and 91% (n=91) disagreed that they cannot work with heavy machinery in a safe manner.Talking about life expectancy, 31% of the parents thought that individuals with epilepsy does not live a normal life expectancy but after taking health education training 93% parents disagreed to the statement and indicated that their children can have a normal life expectancy 4 .Eighty one percent (n=82) participants responded that the offspring of parents with epilepsy will also be born with epilepsy and after the taking health education 92% (n=92) disagreed to the declaration stressing on the fact that children of parents with epilepsy can be born healthy 12 .

Conclusion
The results of this study strongly suggest that educating the parents of children with epilepsy can help enhance their abilities to manage their children while having seizures at home.This can help minimize any chaotic situations and utilize the resources effectively.More efforts must be organized towards training the parents of epileptic children because this is how they can deal with lifelong ailments, it becomes very difficult to bring your child to the hospital or medical facility every time he/she has seizures.When a patient is diagnosed with epilepsy, he/she is usually admitted inpatient or outpatient department, where doctors or nurses can educate the parents or siblings accompanying the patient.
More studies using the same parameters must be conducted at a larger scale or commercial level where time and money are no constraints and it can yield very fruitful results which can help minimize the chaotic situations and effective utilization of resources in healthcare.

Disclosure of conflict of interest
No conflict of interest is to be disclosed.

Statement of informed consent
Informed consent was obtained from all individual participants included in the study.

Table 2
Demographic variables of the participantsAll the subjects were questioned to assess their intellectual knowledge at the beginning of data collection for pretest assessment.Assuming the maximum score for the questionnaire as 64, the average pretest score of the participants was calculated as 44.35.Table4.2below indicates the participants' responses.

Table 3
Pretest Assessment of intellectual knowledge of participants After delivering health education to the participants for 1 week, they were interviewed again using the same questionnaire for posttest assessment.The average posttest score was calculated as 52.48.Detail of posttest responses are shown inTable 4.3.

Table 4
Posttest Assessment of intellectual knowledge of participants

Table 5
Value of paired sample t-test