Knowledge of and attitudes towards epilepsy among homeroom teachers of children with epilepsy in the Czech Republic.

OBJECTIVE: Significant attention has been devoted to knowledge of and attitudes toward epilepsy among teachers, and the importance of their previous experience with epilepsy has been proved. However, no information about a specific group of homeroom teachers is available despite their importance in forming a positive climate in class and preventing related stigma. Thus, we aim to evaluate knowledge of and attitudes towards epilepsy in this group and compare the results with previously studied groups of 136 teachers in training and 123 primary school teachers not having, in most cases, experience with children with epilepsy. METHODS: One hundred and four homeroom teachers of children with epilepsy attending mainstream schools were involved in the study. They fulfilled an 18-item knowledge test, a 5-item questionnaire focusing on epilepsy-related self-confidence, and a 21-item Czech version of the Attitudes Towards People with Epilepsy scale. All instruments were used and validated in our previous research focusing on the other groups of teachers, making possible the direct comparison of the results. RESULTS: We found that homeroom teachers had significantly better knowledge of epilepsy (total score of 11.75 ± 2.29 points compared with 10.21 ± 2.08 points for primary school teachers and 9.60 ± 2.08 points for teachers in training) as well as more positive attitudes (30.81 ± 11.11 vs. 24.80 ± 11.01, and 25.81 ± 10.20, respectively). Regarding self-confidence, homeroom teachers were comparable with primary school teachers (total score of 18.31 ± 3.74 compared with 17.71 ± 3.86) but significantly better than teachers in training (16.37 ± 3.20). CONCLUSIONS: The results suggest that despite having a higher level of epilepsy-related knowledge, self-confidence, and attitudes, homeroom teachers still have significant shortages in some specific issues, especially regarding the ability to recognize the adverse effects of antiepileptic drugs. Tailored education interventions focusing on these groups and topics are thus highly needed.

Educational interventions improving knowledge about epilepsy in preschool children.

OBJECTIVE: Sufficient public knowledge about epilepsy is a starting point for reducing epilepsy-related stigma and improving quality of life of people with this condition. Thus, interventions aimed at improving such knowledge are greatly needed. However, there is a significant lack of such interventions and none have been applied to preschool children. We aimed to develop effective interventions using the educational board game Action Zone! and a technique known as educational story, and by focusing on the acquisition of knowledge about epilepsy in children aged 5-6 years with no previous knowledge of epilepsy. METHODS: Knowledge about epilepsy was measured using a 20-item test consisting of questions selected from educational game and an 11-item test used successfully in our previous intervention study focused on children aged 9-11 years. Both measures exhibited acceptable internal consistency with Cronbach's alpha of 0.72 and 0.67. In total, 296 children participated in three intervention studies (educational game, educational story, and a revised version of educational story). Level of knowledge was assessed immediately after each intervention and again one month later. RESULTS: We found that all interventions were effective (p = 0.001) in comparison of retest results with baseline of zero level of knowledge based on the statements of children before intervention. Intervention based on educational game resulted in a higher percentage of correct responses in comparison with educational story (p = 0.020). However, the revised version of educational story developed using participatory action research was superior in comparison with the original version (p < 0.001) and fully comparable with educational game (p = 0.864). CONCLUSIONS: The results showed the aforesaid interventions were significant and effective ways to establish basic knowledge about epilepsy in the given age group.

Psychometric properties of the Czech versions of the Impact of Pediatric Epilepsy Scale (IPES) and Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48).

OBJECTIVE: In order to introduce a complex system of monitoring and evaluation of the heath-related quality of life (HRQoL) of children and adolescents with epilepsy (CWE) and their families in the Czech Republic, we aimed to validate the Czech versions of two appropriate instruments - the Impact of Pediatric Epilepsy Scale (IPES) and the Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48). METHODS: The verification of the 11-item IPES was carried out in the group of parents of 248 CWE aged 2-18 years. One hundred and thirty-five CWE from the given group aged 11-18 years then completed the 48-item QOLIE-AD-48. Internal consistency, test-retest reliability (with a three-month interval) and the factorial structure of the Czech versions were determined and compared with the original instruments. RESULTS: We found that the Czech version of the IPES exhibited very good psychometric properties including high internal consistency (Cronbach's alpha, α, of 0.93), high test-retest reliability (intraclass correlation coefficient, ICC, of 0.76) and the same 3-factor structure as the original instrument. The superiority of this 3-factor solution over the alternate 2-factor model proposed for some language versions of the IPES was determined using confirmatory factor analysis. We found 8 items in the Czech version of the QOLIE-AD-48 belonging to original Attitudes towards epilepsy and Social support subscales that do not fit well with the Czech version due to their low correlation with the total score and insufficient test-retest reliability and should be omitted. For the remaining 40 items, we have determined high internal consistency (α = 0.95) and test-retest reliability (ICC = 0.82). Confirmatory factor analysis revealed that the 6-factor solution derived from the original instrument (without two removed subscales) was appropriate for the Czech version. The individual subscales exhibited high internal consistency with α = 0.61-0.91. The external validation of both instruments was confirmed based on a significant correlation between test results and physicians' reports of the characteristics of the child's epilepsy. CONCLUSIONS: The Czech versions of both instruments studied are reliable and valid, and can be used in the next research focusing on the effect of different treatment approaches on the HRQoL of CWE and their families.

Psychometric properties of the Czech version of the Stigma Scale of Epilepsy.

Although significant attention has been devoted to analyzing stigma associated with epilepsy, there is still a significant lack of valid and reliable instruments. We aimed to validate the 23-item Czech version of the Stigma Scale of Epilepsy (SSE; originally developed in Brazil), which has been used to evaluate epilepsy-related stigma in the general population. Verification of the SSE questionnaire was carried out in a group of 207 students aged 15-18 years of whom none had epilepsy. These students completed the SSE twice in a period of 3-6 months as part of standard test-retest evaluation practice. The instrument exhibits good psychometric properties including internal consistency higher than in the original version (Cronbach's alpha of 0.856 here compared with 0.81 reported in Brazil) and acceptable test-retest reliability. Using exploratory factor analysis (not provided for the original version), four factors were identified and corresponding subscales were described and interpreted. Two items did not fit into the structure and were eliminated. Confirmatory factor analysis was used to propose and verify the hierarchical 4-factor structure of the Czech version of SSE confirming the existence of a common factor corresponding to stigma. The results showed that the Czech version of SSE has good psychometric properties and can be used in further research and clinical practice.

Educational video and story as effective interventions reducing epilepsy-related stigma among children.

Stigma has been related to epilepsy since ancient times. Despite the importance of this issue, only a few interventions focusing on the reduction of epilepsy-related stigma may be found in the literature. Thus, the aim of this study is to evaluate the effectiveness of two interventions focused on the reduction of epilepsy-related stigma in children aged 9-11years. The first group of children involved in the study (n1=89) completed the 23-item Czech version of the SSE (Stigma Scale of Epilepsy) questionnaire and an 11-item multiple-choice knowledge test, then watched a video and completed the same questionnaire and test immediately after the intervention. The same procedure was used for the second group (n2=93) where a story was read by an instructor. Both groups were retested 6months later using the same methods. Both interventions resulted in long-term decrease of epilepsy-related stigma - the average value on SSE decreased from 55.15 points at baseline testing to 43.28 points in the 6-month follow-up for the case of the video (p<0.001) and from 48.68 points to 36.97 points for the case of the story (p<0.001). Knowledge about epilepsy was also significantly improved with the average result in the knowledge test increasing from 6.58 to 9.09 points in case of the video (p<0.001) and from 6.88 to 8.99 points in case of the story (p<0.001). The results showed that both aforementioned interventions were significant and effective ways to reduce epilepsy-related stigma in the given age group.

Knowledge about epilepsy and attitudes towards affected people among teachers in training in the Czech Republic.

The aim of this study was to compare knowledge about, confidence with, and attitudes towards epilepsy and affected people between groups of freshmen and senior teachers in training (preservice teachers) at the Faculty of Education in Pilsen, Czech Republic. Two hundred thirty-six freshmen and 138 seniors completed the 21-item Scale of Attitudes Towards People with Epilepsy (ATPE), an 18-item multiple-choice test measuring their knowledge about epilepsy, and a 5-item questionnaire focused on confidence with epilepsy in a school environment. We found that despite a higher level of knowledge about epilepsy among seniors (mean score of 9.6 points compared with 8.48 points for freshmen, p<0.001), attitudes towards epilepsy, and also confidence in how to manage children affected with this disease did not differ significantly. The presented findings suggest that epilepsy-related training of preservice teachers should be more effective especially with respect to their ability to resolve problems that may happen to children with epilepsy in a class.

Effect of learning disabilities on academic self-concept in children with epilepsy and on their quality of life.

Academic self-concept could significantly affect academic achievement and self-confidence in children with epilepsy. However, limited attention has been devoted to determining factors influencing academic self-concept of children with epilepsy. We aimed to analyze potentially significant variables (gender, frequency of seizures, duration of epilepsy, intellectual disability, learning disability and attention deficit hyperactivity disorder) in relation to academic self-concept in children with epilepsy and to additional domains of their quality of life. The study group consisted of 182 children and adolescents aged 9-14 years who completed the SPAS (Student's Perception of Ability Scale) questionnaire determining their academic self-concept and the modified Czech version of the CHEQOL-25 (Health-Related Quality of Life Measure for Children with Epilepsy) questionnaire evaluating their health-related quality of life. Using regression analysis, we identified learning disability as a key predictor for academic-self concept of children with epilepsy. While children with epilepsy and with no learning disability exhibited results comparable to children without epilepsy, participants with epilepsy and some learning disability scored significantly lower in almost all domains of academic self-concept. We moreover found that children with epilepsy and learning disability have significantly lower quality of life in intrapersonal and interpersonal domains. In contrast to children with epilepsy and with no learning disability, these participants have practically no correlation between their quality of life and academic self-concept. Our findings suggest that considerable attention should be paid to children having both epilepsy and learning disability. It should comprise services of specialized counselors and teaching assistants with an appropriate knowledge of epilepsy and ability to empathize with these children as well as educational interventions focused on their teachers and classmates.

Academic self-concept in children with epilepsy and its relation to their quality of life.

OBJECTIVES: Academic achievement in children with epilepsy is a highly studied topic with many important implications. However, only little attention has been devoted to academic self-concept of such children and the relation of academic self-concept to their quality of life. We aimed to examine academic self-concept in children with epilepsy, to assess its relationship to academic achievement and to determine possible correlations between academic self-concept and quality of life. METHODS: The study group consisted of 182 children and adolescents aged 9-14 years who completed the student's perception of ability scale (SPAS) questionnaire to determine their academic self-concept and the modified Czech version of the CHEQOL-25 questionnaire to determine their health-related quality of life. RESULTS: We found that academic self-concept in children with epilepsy was on average significantly lower than in their peers without seizures, especially with regard to general school-related abilities, reading, and spelling. On the other hand, the variance in the data obtained from the group of children with epilepsy was significantly higher than in the whole population and the proportion of individuals with very high academic self-concept seems comparable among children with and without epilepsy. Moreover, it was found that correlations between academic self-concept and academic achievement are significantly lower in children with epilepsy than in the whole population. DISCUSSION: The presented results suggest that considerable attention should be paid to the role of academic self-concept in education of children with epilepsy and to the factors influencing this self-concept in this group.

Psychometric properties of the modified Czech version of the children self-report Quality-of-life Measure for Children with Epilepsy (CHEQOL-25).

Quality of life (QoL) is a crucial factor in the treatment of individuals suffering from epilepsy. We aimed to adapt the children's version of the CHEQOL-25 questionnaire to allow the QoL measurement in children suffering from epilepsy in the Czech Republic. The adaptation was conducted on a group of 250 children and adolescents aged 8-15years. It was found that the questionnaire required modification to fit the Czech pediatric population. Indirect questions were changed to direct questions, and two items were omitted from the original version of the questionnaire. The reasons for these modifications are discussed. The modified questionnaire was subjected to exploratory factor analysis, and a 4-factor structure was favored over the 5-factor structure of the original version. The internal consistency measured using Cronbach's alpha was found to be in the range of 0.78-0.83 for the individual scales, and test-retest reliability was expressed using intraclass correlation coefficient which was found to be in the range of 0.65-0.75. The modified Czech version of the CHEQOL-25 questionnaire displayed very good results with regard to construct validity. Its strength is its simplicity and clarity which allows it to be used in children with impaired cognitive functions. The results showed that the modified version of the Czech CHEQOL-25 has very good psychometric properties and could be used in further research and clinical practice.

Improving the knowledge of epilepsy and reducing epilepsy-related stigma among children using educational video and educational drama--a comparison of the effectiveness of both interventions.

PURPOSE: This study was intended to compare the effectiveness of educational animated video and educational drama in improving the knowledge of epilepsy and reducing epilepsy-related stigma among children aged 9-11 years. METHOD: The first group of children involved in the study (n(1)=762) watched a video and then completed a questionnaire on epilepsy. The second group (n(2)=400) completed the questionnaire after participating in a drama. Both groups were retested 6 months later by the same questionnaire, which was also completed by a control group (n(3)=180) not subjected to intervention. RESULTS: Both groups subjected to intervention achieved significantly higher scores (P<0.001) than the control group on knowledge of epilepsy and on attitudes towards children with the disease. Educational video was more effective than drama in improving knowledge of epilepsy. On the other hand, there was no significant difference (P>0.05) between the two kinds of intervention regarding attitudes towards children with this disease. CONCLUSION: The results suggest that both interventions could be used to reduce epilepsy-related stigma in this age group.

Familiarity with and attitudes towards epilepsy among teachers at Czech elementary schools--the effect of personal experience and subspecialization.

This study was intended to study the effect of personal experience and subspecialization on the knowledge of epilepsy of teachers at Czech elementary schools, and on their attitudes towards children with epilepsy and on epilepsy itself in general. 193 teachers from 10 different elementary schools in Pilsen, Czech Republic, were involved in the study. We found that teachers with personal experience of epilepsy had greater knowledge of the illness. There were significant differences (P<0.05) between the attitudes of teachers with and without personal experience, mostly in terms of their views on the self-realization and the integration of children with epilepsy into the school collective. In contrast, no differences were found in their views of the intellectual capabilities of children with epilepsy or the overall quality of life of children with epilepsy. Furthermore, we found that subspecialization, aside from a few exceptions given by the specific position of first grade teachers, did not have major effect on teachers' knowledge of epilepsy and their attitudes towards children with epilepsy. The results suggest that it would be appropriate to focus educational interventions about epilepsy for teachers on those individuals who do not have any experience of epilepsy.