Although attitude is a complex and abstract construct, recent studies have demonstrated the manner in which teachers’ attitudes may be translated into behaviors that can have problematic results for students with epilepsy. Teachers’ perception of and approach to these students with epilepsy varies with the accuracy of their knowledge, which is often inadequate, limited, or even erroneous [
Evaluating middle and high school teachers’ knowledge about epilepsy. Assessing teachers’ attitudes toward students with epilepsy. Investigating the association of sociodemographic characteristics and teaching experience of teachers with their knowledge and attitudes.
This cross-sectional study was conducted during March 2015 in Kuwait. The target population was middle and high school teachers in the 6 governorates of Kuwait, namely, Capital, Hawalli, Al-Farwaniya, Al-Ahmadi, Al-Jahra, and Mubarak Al-Kabeer. Twenty-four schools (12 male and 12 female schools) were randomly selected from the sampling frame obtained from the Ministry of Education. The sampling method was multistage stratified cluster sampling. All available eligible teachers in selected schools during the data collection period were included in the study with schools as clusters. The total number of teachers who were approached was 850, of whom 824 accepted to participate. Hence, the response rate was 96.9%.
An informed consent was obtained from each participant; and it clearly stated that participation in this study is optional and that there is no risk as a result of participation in the study. In order to ensure the confidentiality, names of participants or other identifying information was not obtained from the teachers. A Human Subject Form was completed, and the research was approved by the Department of Community Medicine Ethics Review Board and the Research Ethics Committee of Health Sciences Center, Kuwait University. Permission for conducting the research was obtained from the Ministry of Education and the administration of each selected school.
Participants were asked to complete a self-administered questionnaire, comprising of 26 questions. The English version of the questionnaire was translated into Arabic using simple and clear words that would convey the same meaning as the English version. The Arabic version was back-translated into English by an independent bilingual person in order to ensure that the Arabic version provides the same meaning as the English one. The questionnaire was pretested by administrating it to 10 teachers, in order to emphasize that its items were clear and to estimate the time required to complete the questionnaire, which was found to be approximately 10 minutes. The study questionnaire was divided into 5 sections.
The Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA, 2010) version 19 was used for data entry and analysis. The
The multivariable logistic regression for a binary outcome variable was applied to identify the independent determinants of poor knowledge about epilepsy, after adjustment for potential confounders. The dependent variable was binary (0 for > median knowledge score and 1 for ≤ median knowledge score). Independent variables included sociodemographic variables, teaching experience, experience with epilepsy, and attitudes toward students with epilepsy.
Table
Sociodemographic characteristics and teaching experience among teachers.
Characteristic | All | School level |
| ||||
---|---|---|---|---|---|---|---|
Middle | High | ||||||
( |
( |
( |
|||||
|
(%) |
|
(%) |
|
(%) | ||
|
|||||||
Gender | 0.220 | ||||||
Male | 454 | (55.1) | 239 | (59.2) | 215 | (51.2) | |
Female | 370 | (44.9) | 165 | (40.8) | 205 | (48.8) | |
Age, years | 0.330 | ||||||
<30 | 137 | (21.0) | 99 | (25.5) | 74 | (17.6) | |
30–39 | 368 | (44.7) | 183 | (45.3) | 185 | (44.0) | |
40–49 | 185 | (22.5) | 79 | (19.6) | 106 | (25.2) | |
≥50 | 98 | (11.9) | 43 | (10.6) | 55 | (13.1) | |
Mean (SD) | 36.9 | (9.0) | 35.9 | (8.9) | 37.8 | (9.0) |
|
Nationality |
|
||||||
Kuwaiti | 340 | (41.3) | 193 | (47.8) | 147 | (35.0) | |
Non-Kuwaiti | 484 | (58.7) | 211 | (52.2) | 273 | (65.0) | |
Marital status | 0.578 | ||||||
Single | 106 | (12.9) | 57 | (14.1) | 49 | (11.7) | |
Married | 691 | (83.9) | 334 | (82.7) | 357 | (85.0) | |
Divorced/widowed | 27 | (3.3) | 13 | (3.2) | 14 | (3.3) | |
Number of children | 0.591 | ||||||
No children | 82 | (11.4) | 44 | (12.7) | 38 | (10.2) | |
1–3 | 428 | (59.6) | 204 | (58.8) | 224 | (60.4) | |
≥4 | 208 | (29.0) | 99 | (28.5) | 109 | (29.4) | |
Median (range) | 3 | (0–11) | 3 | (0–11) | 3 | (0–11) | 0.248 |
Highest level of education |
|
||||||
Intermediate diploma | 13 | (1.6) | 9 | (2.2) | 4 | (1.0) | |
University bachelor | 747 | (90.7) | 376 | (93.1) | 371 | (88.3) | |
High degree (M.S., Ph.D.) | 64 | (7.8) | 19 | (4.7) | 45 | (10.7) | |
|
|||||||
|
|||||||
Position | 0.158 | ||||||
Teacher | 713 | (86.5) | 355 | (87.9) | 358 | (85.2) | |
Senior teacher | 87 | (10.6) | 35 | (8.7) | 52 | (12.4) | |
Vice principle/principle | 24 | (2.9) | 14 | (3.5) | 10 | (2.4) | |
Number of years working as a teacher |
|
||||||
<5 | 157 | (19.1) | 90 | (22.3) | 67 | (16.0) | |
5–9 | 193 | (23.4) | 100 | (24.8) | 93 | (22.1) | |
10–14 | 179 | (21.7) | 90 | (22.3) | 89 | (21.2) | |
15–19 | 117 | (14.2) | 47 | (11.6) | 70 | (16.7) | |
≥20 | 178 | (21.6) | 77 | (19.1) | 101 | (24.0) | |
Median (range) | 11 | (1–40) | 10 | (1–36) | 12 | (1–40) |
|
(i) %: column%, (ii) SD: standard deviation, and (iii) frequencies may not add to the total due to missing values.
Subjects taught by teachers (percentages may not add to 100% since a teacher may have more than one subject).
Table
Self-reported experience with epilepsy by teachers.
Experience item | All | |
---|---|---|
( | ||
|
(%) | |
Have you ever dealt with a person with epilepsy? (Yes) | 241 | (29.3) |
Does any member of your family have epilepsy? (Yes) | 77 | (9.4) |
Have you been a teacher of a student with epilepsy? (Yes) | 197 | (24.0) |
Are you currently a teacher of a student with epilepsy? (Yes) | 47 | (5.7) |
Are you aware of the life circumstances of persons with epilepsy? (Yes) | 157 | (19.1) |
Will you be prepared to handle a seizure if one of your students had a fit during class? (Yes) | 289 | (35.1) |
Do you think you have sufficient training in first-aid management of seizures? (Yes) | 70 | (8.5) |
Are you aware of different types of seizures and what they look like? (Yes) | 57 | (6.9) |
Would you like to have more general knowledge about epilepsy? (Yes) | 688 | (83.5) |
Would you like to have more information about how to respond when a student is having a seizure? (Yes) | 714 | (86.7) |
Have you received adequate training about seizure management and epilepsy in your teaching training? (Yes) | 37 | (4.5) |
Figure
Number of persons with epilepsy ever dealt with.
Sources of teachers’ information for their knowledge about epilepsy (percentages may not add to 100% since a teacher may have more than one source).
Causes of epilepsy as were reported by teachers (percentages may not add to 100% since a teacher may choose more than one cause).
Methods of treatment for epilepsy (percentages may not add to 100% since a teacher may choose more than one treatment).
Table
Items of the knowledge score about epilepsy and teachers’ correct answers.
Knowledge item | Correct answer | Percentage of teachers with correct answers | |
---|---|---|---|
All | |||
( | |||
|
(%) | ||
Individuals with epilepsy are also mentally retarded. | Disagree | 695 | (84.3) |
The individual with epilepsy does not possess a normal life expectancy. | Disagree | 351 | (42.6) |
You can expect the condition of a person with epilepsy to deteriorate. | Disagree | 114 | (13.8) |
When their seizures are controlled by medication, persons with epilepsy are just like anyone else. | Agree | 542 | (65.8) |
Individuals with epilepsy can cope with a 40-hour work week. | Agree | 88 | (10.7) |
Persons with epilepsy can safely participate in strenuous activity. | Agree | 102 | (12.4) |
Persons with epilepsy can safely operate machinery. | Agree | 102 | (12.4) |
Individuals with epilepsy are accident-prone. | Disagree | 92 | (11.2) |
Epilepsy is not a contagious disease. | Agree | 679 | (82.4) |
The offspring of parents with epilepsy will also have epilepsy. | Disagree | 256 | (31.1) |
Persons with epilepsy prefer to live with others of similar characteristics. | Disagree | 407 | (49.4) |
Children with epilepsy in regular classes have an adverse effect on the other children. | Disagree | 334 | (40.5) |
Epilepsy and epilepsy medications can have a significant effect on the affected students’ mood, memory, and learning. | Agree | 442 | (53.6) |
Table
Association of knowledge score about epilepsy with sociodemographic characteristics and teaching experience of teachers.
Characteristic | Knowledge score |
| |
---|---|---|---|
(Out of 13) | |||
Median | (Range) | ||
|
|||
Gender | 0.452 | ||
Male | 5 | (0–11) | |
Female | 5 | (0–12) | |
Age, years | 0.087 | ||
<30 | 5 | (0–11) | |
30–39 | 5 | (0–12) | |
40–49 | 5 | (0–11) | |
≥50 | 5 | (0–11) | |
Nationality | 0.176 | ||
Kuwaiti | 5 | (0–12) | |
Non-Kuwaiti | 5 | (0–12) | |
Marital status | 0.770 | ||
Single | 5 | (0–9) | |
Married | 5 | (0–12) | |
Divorced/widowed | 5 | (0–9) | |
Number of children | 0.798 | ||
0 | 5 | (0–12) | |
1–3 | 5 | (0–12) | |
≥4 | 5 | (0–11) | |
Highest level of education | 0.550 | ||
Intermediate diploma | 5 | (0–11) | |
University bachelor | 5 | (0–12) | |
High degree (M.S., Ph.D.) | 5 | (0–9) | |
|
|||
|
|||
Position |
|
||
Teacher | 5 | (0–12) | |
Senior teacher | 6 | (0–10) | |
Vice principle/principle | 6 | (3–9) | |
Number of years working as a teacher |
|
||
<5 | 5 | (0–11) | |
5–9 | 5 | (0–12) | |
10–14 | 6 | (0–12) | |
15–19 | 6 | (0–11) | |
≥20 | 6 | (0–10) |
Frequency distribution of knowledge score of teachers about epilepsy.
Table
Association of knowledge score about epilepsy with teachers’ self-reported experience with epilepsy.
Experience item | Knowledge score |
| |
---|---|---|---|
(Out of 13) | |||
Median | (Range) | ||
Have you ever dealt with a person with epilepsy? |
|
||
Yes | 6 | (0–12) | |
No | 5 | (0–11) | |
Does any member of your family have epilepsy? |
|
||
Yes | 7 | (2–12) | |
No | 5 | (0–12) | |
Have you been a teacher of a student with epilepsy? |
|
||
Yes | 6 | (0–11) | |
No | 5 | (0–12) | |
Are you currently a teacher of a student with epilepsy? | 0.109 | ||
Yes | 6 | (2–10) | |
No | 5 | (0–12) | |
Are you aware of the life circumstances of persons with epilepsy? |
|
||
Yes | 6 | (0–12) | |
No | 5 | (0–11) | |
Will you be prepared to handle a seizure if one of your students had a fit during class? |
|
||
Yes | 6 | (0–12) | |
No | 5 | (0–12) | |
Do you think you have sufficient training in first-aid management of seizures? |
|
||
Yes | 6 | (1–11) | |
No | 5 | (0–12) | |
Are you aware of the different types of seizures and what they look like? |
|
||
Yes | 6 | (0–10) | |
No | 5 | (0–12) | |
Would you like to have more general knowledge about epilepsy? |
|
||
Yes | 5 | (0–12) | |
No | 5 | (0–12) | |
Would you like to have more information about how to respond when a student is having a seizure? | 0.116 | ||
Yes | 5 | (0–12) | |
No | 5 | (0–11) | |
Have you received adequate training about seizure management and epilepsy in your teaching training? | 0.159 | ||
Yes | 6 | (0–9) | |
No | 5 | (0–12) |
Table
Items of the attitude score and teachers’ positive attitude answers.
Attitude items | Positive attitude answer | Percentage of teachers with positive attitude | |
---|---|---|---|
All | |||
( | |||
|
(%) | ||
Persons with epilepsy have the same rights as all people. | Agree | 752 | (91.3) |
Equal employment opportunities should be available to individuals with epilepsy. | Agree | 662 | (75.5) |
Insurance companies should not deny insurance to individuals with epilepsy. | Agree | 545 | (66.1) |
Persons with epilepsy should be prohibited from driving. | Disagree | 129 | (15.7) |
Persons with epilepsy should not be prohibited from marrying. | Agree | 551 | (66.9) |
The individual with epilepsy should not be prevented from having children. | Agree | 522 | (63.3) |
The onset of epileptic seizures in a spouse is sufficient reason for divorce. | Disagree | 543 | (65.9) |
Persons with epilepsy are a danger to the public. | Disagree | 586 | (71.1) |
Persons with epilepsy are more likely to develop and express criminal tendencies than are other people. | Disagree | 515 | (62.5) |
Families of children with epilepsy should not be provided with supportive social services. | Disagree | 620 | (75.2) |
Parents should expect of their child who has epilepsy what they expect of other children. | Agree | 429 | (52.1) |
The responsibility for educating children with epilepsy rests on the community. | Agree | 630 | (76.5) |
Schools should not place children with epilepsy in regular classrooms. | Disagree | 482 | (58.5) |
Children need to be protected from classmates who have epilepsy. | Disagree | 389 | (47.2) |
Children with epilepsy should attend regular public schools. | Agree | 379 | (46.0) |
Table
Association of attitude score toward epilepsy with sociodemographic characteristics and teaching experience of teachers.
Characteristic | Attitude score |
| |
---|---|---|---|
(Out of 15) | |||
Median | (Range) | ||
|
|||
Gender | 0.104 | ||
Male | 10 | (0–15) | |
Female | 10 | (0–15) | |
Age, years | 0.095 | ||
<30 | 10 | (0–15) | |
30–39 | 10 | (0–15) | |
40–49 | 10 | (0–15) | |
≥50 | 10 | (0–14) | |
Nationality |
|
||
Kuwaiti | 11 | (0–15) | |
Non-Kuwaiti | 10 | (0–15) | |
Marital status |
|
||
Single | 9 | (0–15) | |
Married | 10 | (0–15) | |
Divorced/widowed | 10 | (1–15) | |
Number of children | 0.196 | ||
0 | 10 | (0–15) | |
1–3 | 10 | (0–15) | |
≥4 | 10 | (0–15) | |
Highest level of education | 0.167 | ||
Intermediate diploma | 10 | (0–14) | |
University bachelor | 10 | (0–15) | |
High degree (M.S., Ph.D.) | 10 | (0–15) | |
|
|||
|
|||
Position |
|
||
Teacher | 10 | (0–15) | |
Senior teacher | 11 | (0–15) | |
Vice principle/principle | 11 | (5–15) | |
Number of years working as a teacher |
|
||
<5 | 10 | (0–15) | |
5–9 | 9 | (0–15) | |
10–14 | 10 | (0–15) | |
15–19 | 11 | (0–15) | |
≥20 | 10 | (0–15) |
Frequency distribution of attitude score of teachers toward epilepsy.
Table
Association of attitudes score toward epilepsy with teachers’ self-reported experience with epilepsy.
Experience item | Attitude score |
| |
---|---|---|---|
(Out of 15) | |||
Median | (Range) | ||
Have you ever dealt with a person with epilepsy? |
|
||
Yes | 11 | (0–15) | |
No | 10 | (0–15) | |
Does any member of your family have epilepsy? |
|
||
Yes | 11 | (2–15) | |
No | 10 | (0–15) | |
Have you been a teacher of a student with epilepsy? |
|
||
Yes | 11 | (0–15) | |
No | 10 | (0–15) | |
Are you currently a teacher of a student with epilepsy? | 0.363 | ||
Yes | 10 | (4–15) | |
No | 10 | (0–15) | |
Are you aware of the life circumstances of persons with epilepsy? |
|
||
Yes | 11 | (0–15) | |
No | 10 | (0–15) | |
Will you be prepared to handle a seizure if one of your students had a fit during class? |
|
||
Yes | 11 | (0–15) | |
No | 10 | (0–15) | |
Do you think you have sufficient training in first-aid management of seizures? | 0.559 | ||
Yes | 10 | (0–15) | |
No | 10 | (0–15) | |
Are you aware of the different types of seizures and what they look like? | 0.629 | ||
Yes | 10 | (0–15) | |
No | 10 | (0–15) | |
Would you like to have more general knowledge about epilepsy? |
|
||
Yes | 10 | (0–15) | |
No | 8 | (0–15) | |
Would you like to have more information about how to respond when a student is having a seizure? |
|
||
Yes | 10 | (0–15) | |
No | 8 | (0–15) | |
Have you received adequate training about seizure management and epilepsy in your teaching training? | 0.515 | ||
Yes | 9 | (0–15) | |
No | 10 | (0–15) |
Table
Significant associated variables with poor knowledge about epilepsy using logistic regression analysis
Variable | Adjusted odds ratio | 95% CI |
|
---|---|---|---|
Does any member of your family have epilepsy? | |||
Yes (reference) | 1.00 | ||
No | 2.14 | (1.21–3.77) |
|
Are you aware of the life circumstances of persons with epilepsy? | |||
Yes (reference) | 1.00 | ||
No | 1.59 | (1.03–2.51) |
|
Attitude score |
|||
Positive >11 (reference) | 1.00 | ||
Medium 8–11 | 2.19 | (1.50–3.19) |
|
Poor <8 | 4.08 | (2.47–6.75) |
|
(i)
(ii) 95% CI: 95% confidence interval for adjusted odds ratio.
(iii)
Our results showed that most respondents (86.7%) positively answered the item “would you like to have more information about how to respond when a student is having a seizure?”. Similarly, 83.5% of them positively responded to the item “would you like to have more general knowledge about epilepsy?” These results are in concert with another study [
In the meantime, 35.1% of our participants positively answered the question “will you be prepared to handle a seizure if one of your students had a fit during class?” Besides, 29.3% positively responded to the question “have you ever dealt with a person with epilepsy?”. Surprisingly, 8.5% of our participants answered that they had sufficient training in first-aid management of seizures. This result is in keeping with Abbas and Babikar [
Our study also showed that only 6.9% of respondents reported that they are aware of the different types of seizures and how they look like. A study carried out in Nigeria [
Our results also showed that most of respondents (60.5%) reported that their source of information about epilepsy was the public media, followed by the Internet (41.3%), parents of students with epilepsy (19.2%), health care professionals (19.3%), and courses (0.6%). These data accord with another study [
In this study, the majority of our respondents (73%) reported genetic disorders as causes for epilepsy, followed by head trauma (47.4%) and brain disease (47.3%). This result is consistent with previous studies [
Concerning methods of treatment for epilepsy, a high proportion (73%) of respondents reported Holy Qur’an and 9.1% of them reported meditation as possible treatment methods. This is an evidence that social norms, culture, and religion play important roles in the Kuwaiti society. Among our respondents, 16.8% of them reported the use of herbal medicine for treating epilepsy, consistently with another study [
The present study showed that a high proportion of participants (84.3%) disagreed with the knowledge statement “individuals with epilepsy are also mentally retarded.” This result does not accord with Dantas et al. [
Misconceptions about epilepsy are still prevalent. Only 31.3% of our respondents correctly answered the knowledge item “the offspring of parents with epilepsy will also have epilepsy.” This result is consistent with other studies, which concluded that a high proportion of their participants thought that epilepsy usually passes to the offspring from an epileptic parent [
Sociodemographic characteristics of teachers may affect their extent of knowledge and attitudes toward students with epilepsy. Our data showed that the median knowledge score of participating teachers was 5 (out of 13) with a range from 0 to 12. It was significantly higher in senior teachers and in those with longer teaching years of experience. This finding is in keeping with another study [
In this study, the median knowledge score was significantly higher among respondents who had ever dealt with a person with epilepsy than those who never dealt with an epileptic person. This result is in concert with other studies. Brabcova et al. [
Our study indicated that a high proportion (91.3%) of the participants showed positive attitudes to the statement “persons with epilepsy have the same rights as all people.” Similarly, 66.9% positively responded to the item “persons with epilepsy should not be prohibited from marrying,” which accords with prior studies [
Interestingly, only 15.7% of our participants showed positive attitudes toward the item “persons with epilepsy should be prohibited from driving,” which is significantly lower than Lee et al. [
Previous research has shown that differences in sociocultural environments could account for differences in people’s experiences with epilepsy [
Moreover, the median attitude score was significantly higher in senior teachers or principles than teachers, which is also consistent with another study [
Our data showed that the median attitude score was significantly higher among respondents who had ever dealt with an epileptic person than those who never dealt with a person having epilepsy. This result is in concert with another study [
Also, there was a significant difference in our median attitude score with respect to the attitude items “would you like to have more knowledge about epilepsy?” and “would you like to have more information about how to respond when a student is having a seizure?”. This result is consistent with another study [
This study has some limitations. It may be susceptible to information bias since we relied on self-reported data. Besides, temporal relationships could not be established. Because the respondents clearly knew that the purpose of the study was to measure attitude, their attitudes may be more positive than the actual attitudes because the teachers were aware of socially desirable responses. This may have led to inflation of the median attitude score and its imbalance in relation to the median knowledge score.
In conclusion, this study assessed the level of knowledge about epilepsy and attitudes toward students with epilepsy among middle and high school teachers in Kuwait. The median of the knowledge score about epilepsy was 5 (out of 13) and ranges from 0 to 12 (38.4%), which is lower than that of other populations like North Staffordshire (70%) and Kentucky, USA (70%) [
A number of historically problematic and stigmatizing ideas about epilepsy and persons with epilepsy remain prevalent.
We recommend to increase the level of teachers’ knowledge about epilepsy and preparation to handle seizures throughout providing them with information about epilepsy and seizure first aid in the educational setting of teacher-in-training. In addition, further teacher attitude research and ongoing development and implementation of epilepsy education programs are needed.
In order to dismiss myths surrounding epilepsy and to break the stigma associated with it, educators and other professionals must work together to convey accurate information and to enhance the development of positive attitudes in school teachers.
The authors declare that they have no competing interests.