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Epilepsy perception amongst university students: a survey

Percepção de epilepsia em estudantes universitários: uma enquete

Abstracts

PURPOSE: To evaluate the information that university students have on epilepsy and to compare the differences in attitudes and perception among groups with different levels of information. METHODS: A questionnaire with 13 questions regarding knowledge, attitudes and perception about epilepsy was completed by first, third and sixth year medical students and to students from Arts and Science courses. RESULTS: First year medical students gave inadequate answers, especially with regard to information about epilepsy and actions to take during seizures. Answers of third and sixth year medical students were more adequate. Arts and Science students gave the poorest responses in relation to specialist information and attitudes regarding epilepsy. DISCUSSION: This study suggests that there is an inverse relationship between knowledge and stigma on epilepsy. Nevertheless, the best results did not reflect an ideal situation, revealing an urgent need for an improved level of overall health education programs. This can be achieved by implementing educational policies, training programs and the universal inclusion of these subjects in the global educational program.

stigma; epilepsy; prejudice


OBJETIVO: Avaliar os conhecimentos de estudantes universitários sobre epilepsia e verificar se há diferenças entre atitudes e percepção em grupos que são submetidos a diferentes graus de informação. MÉTODO: Foram aplicados questionários contendo 13 questões sobre conhecimentos, percepção e atitudes em epilepsia em alunos da Unicamp, divididos em: primeiro, terceiro e sexto anos de medicina, e alunos de cursos da área de exatas e humanas. RESULTADOS: os alunos do primeiro ano de medicina apresentaram muitas respostas inadequadas, principalmente às relacionadas ao conhecimento sobre epilepsia e atitudes durante a crise. Os alunos do terceiro e do sexto ano apresentaram respostas mais adequadas para percepção e atitudes. Os alunos de ciências exatas e humanas apresentaram os piores níveis de resposta para os aspectos de conhecimento técnico e atitudes. DISCUSSÃO: O estudo mostrou que existe uma relação inversa entre conhecimento e estigma. Entretanto, a melhora destes índices não reflete uma condição ideal, existindo a necessidade imediata de melhorar o nível de educação sobre saúde em geral, o que pode ser feito mediante a implantação de políticas educacionais, programas de capacitação e até mesmo da inclusão destes assuntos transversalmente em toda a trajetória de ensino.

estigma; epilepsia; preconceito


Epilepsy perception amongst university students: a survey

Percepção de epilepsia em estudantes universitários: uma enquete

Juliana CaixetaI; Paula T. Fernandes, MSc, PhDI, II; Gail S. Bell, MRCGP, MDIII; Josemir W. Sander, MD, PhD, FRCPIII, IV; Li M. Li, MD, PhDI, II

IDepartment of Neurology, Faculty of Medicine, UNICAMP, Campinas, SP, Brazil

IIAssistência à Saúde de Pacientes com Epilepsia – ASPE, Campinas, SP, Brazil

IIIDepartment of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London UK

IVEpilepsy Institute of the Netherlands, SEIN, Heemstede, Achterweg 5, 2103 SW Heemstede, the Netherlands

ABSTRACT

PURPOSE: To evaluate the information that university students have on epilepsy and to compare the differences in attitudes and perception among groups with different levels of information.

METHODS: A questionnaire with 13 questions regarding knowledge, attitudes and perception about epilepsy was completed by first, third and sixth year medical students and to students from Arts and Science courses.

RESULTS: First year medical students gave inadequate answers, especially with regard to information about epilepsy and actions to take during seizures. Answers of third and sixth year medical students were more adequate. Arts and Science students gave the poorest responses in relation to specialist information and attitudes regarding epilepsy.

DISCUSSION: This study suggests that there is an inverse relationship between knowledge and stigma on epilepsy. Nevertheless, the best results did not reflect an ideal situation, revealing an urgent need for an improved level of overall health education programs. This can be achieved by implementing educational policies, training programs and the universal inclusion of these subjects in the global educational program.

Key words: stigma, epilepsy, prejudice.

RESUMO

OBJETIVO: Avaliar os conhecimentos de estudantes universitários sobre epilepsia e verificar se há diferenças entre atitudes e percepção em grupos que são submetidos a diferentes graus de informação.

MÉTODO: Foram aplicados questionários contendo 13 questões sobre conhecimentos, percepção e atitudes em epilepsia em alunos da Unicamp, divididos em: primeiro, terceiro e sexto anos de medicina, e alunos de cursos da área de exatas e humanas.

RESULTADOS: os alunos do primeiro ano de medicina apresentaram muitas respostas inadequadas, principalmente às relacionadas ao conhecimento sobre epilepsia e atitudes durante a crise. Os alunos do terceiro e do sexto ano apresentaram respostas mais adequadas para percepção e atitudes. Os alunos de ciências exatas e humanas apresentaram os piores níveis de resposta para os aspectos de conhecimento técnico e atitudes.

DISCUSSÃO: O estudo mostrou que existe uma relação inversa entre conhecimento e estigma. Entretanto, a melhora destes índices não reflete uma condição ideal, existindo a necessidade imediata de melhorar o nível de educação sobre saúde em geral, o que pode ser feito mediante a implantação de políticas educacionais, programas de capacitação e até mesmo da inclusão destes assuntos transversalmente em toda a trajetória de ensino.

Palavras-chave: estigma, epilepsia, preconceito.

Epilepsy is the most common serious neurological condition, affecting approximately 1% of people in the world1,2. Traditionally, the criteria used to assess the condition’s impact on the individual’s life are exclusively clinical parameters: frequency of seizures, response to treatment, type and severity of the seizures. Currently, an assessment of success also includes the patient’s own perception of the difficulties caused by the condition, since social and cultural problems also interfere in quality of life3,4.

Lack of education is likely to be one of the main causes of the stigma related to epilepsy5-7. Even today, dubious comments can often be heard about causes, treatment and consequences of epilepsy in many walks of life.

This study assessing the level of information that university students at the State University of Campinas (UNICAMP) have about epilepsy and their attitudes and perception regarding this condition was part of phase III of the Demonstration Project on Epilepsy in Brazil, part of WHO/ILAE/IBE Global Campaing Against Epilepsy, carried out by ASPE8.

METHOD

Instrument – The questionnaire, shown in the appendix appendix , consisted of 13 objective questions on epilepsy, including questions related to:

– Students’ self-assessment on the information they have about epilepsy (advanced, average, insufficient or none).

– Main source of information on epilepsy (books, physicians, relatives, personal experience, television, scientific meetings).

– Information on epilepsy (cause, treatment, etiology, having witnessed a seizure, knowing a person with epilepsy).

– Attitudes (behavior and attitudes in relation to people with epilepsy).

– Perceptions and feelings (driving vehicles, physical activities, beliefs and feelings regarding seizures).

– Demographic data (age, sex, course) was also collected.

Subjects – Undergraduate students at the State University of Campinas, UNICAMP, divided into the following groups:

– Group 1: First year medical students.

– Group 2: Third year medical students (who had completed the neurosciences module).

– Group 3: Sixth year medical students (who completed the neurosciences and neurology modules).

– Group 4: Science students reading physics, mathematics, mechanical engineering, or computer science (Sciences).

– Group 5: Art and Humanity students reading economy, history, social sciences, history, philosophy, arts, languages or literature (Arts).

Procedure – Questionnaires were completed by first year and third year medical students at a time they were sitting an exam. Sixth year medical students carrying out internship activities completed the questionnaires during a lunch break. In the other groups, questionnaire were completed before lectures

All questionnaires were returned immediately after they were completed. The procedures were the same for all subjects and the questionnaire took around twenty minutes to complete.

RESULTS

Two hundred and forty eight questionnaires were completed. The majority (74%) of the subjects were between 19 years and 22 years old. The groups are shown in Table 1.

The responses are presented regarding the following areas in the questionnaire: 1. Information about epilepsy; 2. Attitudes towards epilepsy; 3. Prejudice (Stigma) towards people with epilepsy.

Information about epilepsy – Table 2 shows selected answers obtained on this item from the different groups.

Attitudes – Table 3 shows students’ attitudes and feelings towards epilepsy.

Stigma – Table 4 shows responses regarding stigma attached to epilepsy.

DISCUSSION

This study is important because these undergraduate students are expected to be future professionals in several fields, and are likely to be opinion formers.

First year medical students can be considered to be representative of that part of the population that has attended middle schools providing wholesome education, and are probably mainly from the Brazilian middle class. One interesting finding of this study is these first year students acquired information about epilepsy from physicians and books.

Information on epilepsy and knowledge about actions to be taken during a seizure were judged to be inadequate in view of their replies to the questions. The level of information possessed by these students may be similar to those from the Science and Arts students, although medical students may have a different view of epilepsy since their focus of interest is the individual, diseases and their management.

This study was conducted during the reformulation of the medical curriculum at UNICAMP. This reformulated curriculum aims to produce more humane and ethical physicians who are more aware of the social reality. The implementation of this curriculum started in 2001 and therefore third year students who participated in this study underwent the new curriculum. Hence, it was possible to compare the levels of information and perception of the students from both curricula (as sixth year medical students received the traditional curriculum). Under the new curriculum, students attend lectures on epilepsy in the second year (neuroanatomy and neurophysiology, included in the neuroscience module) that deal with theoretical aspects, clinical cases, videos and discussions on attitudes, prejudice and the social impact of the disease. This resulted in a qualitative improvement, mainly in relation to answers on perception and attitudes, which was similar to or better than the performance of the sixth year students (who had superior knowledge regarding information on epilepsy). Sixth year students had no exposure to epilepsy in the first half of their course and their first contact with epilepsy was in the fourth year, when they attended neurology. Learning through seminars or discussion of outpatient cases preferentially involves clinical aspects (diagnosis, treatment and evolution) to the detriment of discussions on social impact, intervention policies, discrimination and stigma.

Science and Arts students represent future Brazilian professionals without medical training. They can be considered part of the Brazilian intellectual elite as they all face very difficult university entrance examinations (Unicamp has one of the most competitive entrance exams in the country), have greater access to quality learning and more information than most of the Brazilian population. These two groups, however, showed the lowest levels in relation to technical knowledge and attitudes. These differences would most probably be more accentuated if the general population, with lower educational levels and less access to information, was evaluated and this may also reveal the high degree of stigma associated with epilepsy.

These results show that there is a relationship between the quantity of information and prejudice. The groups with less access to information (first year medical students, and students of human and exact sciences) presented the greatest number of inappropriate answers, especially about how to proceed during an epileptic seizure. Another important fact is the impact caused by the reformulated curriculum that brought students into contact with clinical cases earlier, and raised discussions about social problems. This is probably why the third and sixth year medical students presented very similar results.

Nevertheless, the best results found do not reflect an ideal situation. More information is needed about diverse clinical manifestations so that the students feel confident about dealing with people with epilepsy and are able to combat myths as well as beliefs. Moreover, the possibility that answers were given that were "socially correct" should be considered as they probably explain the high percentage (in all groups) of students who claimed that they would marry individuals with epilepsy although, according to these same students, individuals with epilepsy have a greater chance of developing mental diseases and having children with malformations.

Thus, this seems to suggest that there is an urgent need to improve the level of education in relation to epilepsy. This could be achieved by implementing educational policies, training programs and also by universally including these subjects from the basic educational level (to prevent the occurrence of stigma) right up to university level. Information is one of the best and cheapest instruments used to decrease stigma9-11 and is a simple and cheap way of successfully improving the quality of life of individuals who manage their own conditions and also have to deal with an excluding, untrained society that limits job possibilities, education and social relationships.

Dr. Li Li Min - Department of Neurology / UNICAMP - Cx. Postal 6111 - 13083-970 Campinas SP - Brazil. E-mail: limin@fcm.unicamp.br or li@aspebrasil.org; Site: http://www.aspebrasil.org

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  • 3. Fernandes PT, Souza EA. Identification of family variables in parents' groups of children with epilepsy. Arq Neuropsiquiatr 2001;59:854-858.
  • 4. Guerreiro CA, Guerreiro MM, Cendes F, Lopes-Cendes I. Considerações gerais. In: Lemos Editorial, ed. Epilepsia. Sao Paulo: 2000:1-10.
  • 5. Ablon J. The nature of stigma and medical conditions. Epilepsy Behav 2002;3:2-9.
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  • 7. McLin WM, de Boer HM. Public perceptions about epilepsy. Epilepsia 1995;36:957-959.
  • 8. Li LM, Sander JW. National demonstration project on epilepsy in Brazil. Arq Neuropsiquiatr 2003;61:153-156.
  • 9. Fernandes PT, Salgado PC, Noronha AL, Mory SB, Rio PA, Li LM. Combate ao estigma na epilepsia pela conscientização através da mídia. J Epilepsy Clin Neurophysiol 2004;10:167-170.
  • 10. Fernandes PT, Salgado PC, Noronha AL, Mory SB, Li LM. Formação de grupos como suporte psicológico e social na epilepsia. J Epilepsy Clin Neurophysiol 2004;10:171-174.
  • 11. Fernandes PT, Li LM. Estigma na epilepsia. 1-207. 2005. Departamento de Neurologia - FCM/UNICAMP. PhD Thesis.

appendix

Publication Dates

  • Publication in this collection
    29 Nov 2007
  • Date of issue
    June 2007
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