A Study to Assess the Effectiveness of Structured Teaching Programme Regarding the Knowledge of Epilepsy Among Mothers of Under Five Children in Selected Areas, at Tumkur, Karnataka

Introduction

The term epilepsy is derived from the Greek word “epilamabavian” meaning “to seize or to take hold of”. To the Greeks, epilepsy was a sacred disease. To Hippocrates, it was a disease of the brain. In later ages, it was known as “the falling sickness” with the victims being consigned to as glum as for the insane. Regardless of the insight gained into epilepsy, lack of knowledge, stigma and fear are still associated with this problem.¹

Epilepsy is a common neurological disorder characterized by abnormal movement with or without loss of consciousness. It can be either generalized or focal and is due to the disturbance of spread of electrical discharge of cortical neurons.²

Epileptic seizures result from abnormal, excessive or hypersynchronous neuronal activity in the brain. About 50 million people world-wide have epilepsy and nearly 90% of epilepsy occurs in developing countries. Epilepsy has become more common as age of onset of new cases occur most frequently in infants and elderly. As a consequence of brain surgery, epileptic seizures may occur in recovering patients.³

Epilepsy is usually controlled, but cured, with medication. However, over 30% of people with epilepsy do not have seizure control even with the best available medications. Surgery may be considered in difficult cases.⁴ Not all epilepsy syndromes are lifelong; some are confined to particular stages of childhood. Epilepsy should not be understood as a single disorder, but rather as syndromic with vastly divergent symptoms all involving episodic abnormal activity in the brain and numerous seizures.⁴

Epilepsy affects all age groups, but for children a variety of issues exists that can affect one’ s childhood. Some forms of epilepsy end after childhood, some forms are associated only with conditions of childhood that cease once a child grows up. Approximately 70% of children who suffer epilepsy during their childhood eventually outgrow. There are also some seizures, such as febrile seizures, that are one-time occurrence during childhood and they do not result in permanent epilepsy.⁵

Seizures are caused by malfunction of the brain’s electrical system. The manifestations of seizures are determined by the site of origin and may include unconsciousness or altered consciousness. In children, it can occur with a wide variety of conditions involving the central nervous system.⁶

Many children with epilepsy are over protected by their parents, who put restrictions on them in the name of safety, requiring more adult supervision than other children and not allowing them to participate in certain activities normal to the age group such as sports. It is a subject of debate if a child with controlled seizures needs additional protection or if the benefits outweigh the losses a child face.⁷

The World Health Organization estimated that 3-10 per 1000 of world’s population have epilepsy. However, epilepsy is a hidden disorder and many cases go unreported. There may be as many as 40 billion epileptics. Epilepsy can strike at any age. However, most persons who develop seizures during their formative years tend to experience a reduction in intensity and frequency of their seizures as they grow older.⁸

In addition to its medical impact with respect to loss of control, drug effects, and co morbidity, epilepsy has a marked impact on a child’s life. Population – based studies show that 70-76% of children with epilepsy have some type of disability or handicap affecting their daily life and choices for the future. Co – morbidity, specifically learning disability (sometime referred to as mental retardation) modifies the life of a child and the family. To improve their position in society, they should have the same opportunities and be allowed to make choices on basis of their abilities, not their diagnosis of epilepsy. Supporting the development of acceptance, self-reliance, self-respect and self-empowerment of children with epilepsy is crucial to their achieving a place in the community equal to their abilities. This is a challenging task for their families, relatives, mothers of under five children, employers and legislators.

Objectives

• To assess the level of knowledge regarding epilepsy among mothers of under five children.

• To administer and determine the effectiveness of structured teaching programme regarding epilepsy among mothers of under five children.

• To evaluate the effectiveness of structured teaching programme on epilepsy in children through knowledge questionnaire by post-test.

• To find out the association between pre-test knowledge scores and the socio-demographic variables of mothers of under five children.

Keywords

• Assess: It refers to evaluate and analyze the level of knowledge regarding epilepsy among mothers of under five children.

• Effectiveness: It refers to the extent to which information in structured teaching programme has achieved desired outcome as measured by gain in knowledge.

• Structured teaching programme: It refers to the administration of written or verbal material on epilepsy which was developed by investigator and validated by experts. This includes general information, causes, signs and symptoms, treatment and care of epilepsy.

• Knowledge: It refers to the scores obtained by mothers of under five children on knowledge items of structured interview schedule regarding epilepsy.

• Epilepsy: Epilepsy is a common neurological disorder characterized by abnormal movement with or without loss of consciousness. It can be either generalized or focal and is due to disturbance of spread of electrical discharge of cortical neurons.

• Mothers: Refers to the mothers of under five children belonging to selected areas in Tumkur.

• Under five children: Refers to the children aged of 0-5 years living in selected areas in Tumkur.

• Socio-demographic variable: Refers to variables like age, education of the mother, occupation, income, religion, number of children, history of epilepsy.

Conceptual Frame

Conceptual frame work for the study was based on concepts of Dorothy Orem’s general theory of nursing.

Methodology

Research approach

An evaluate research approach was selected to determine the success of structured teaching programme in increasing the knowledge of mothers of under five children on epilepsy.

Research design

One group pre-test and post-test pre-experimental design.

Sample

In this study, sample consisted of mothers of under five children from selected areas in Tumkur Sample size The present study included a sample of 50 mothers of under five children, in Tumkur.

Sampling technique

Purposive sampling technique was used.

Criteria for sample selection

Inclusion criteria

- Mothers of under five children from selected areas in Tumkur.

- Those who were available at the time of data collection.

- Mothers who were willing to participate in the study.

Exclusion criteria

-  Mothers who were not willing to participate.

- Mothers who were not available at the time of data collection.

- Mothers of children in the age group other than under five.

Description of the tool

A structured knowledge questionnaire was prepared with the help of review of literature and discussion with experts. A blue print was prepared which showed distribution of items according to the content areas. The tool was classified into three areas i.e. meaning, causes and risk factors of epilepsy, signs and symptoms of epilepsy and first aid and management of epilepsy.

The self-administered questionnaire consisted of section-I and section-II

Section-I – Demographic proforma

It consisted of four items including age of mother, educational qualification and source of knowledge.

Section-II—Knowledge questionnaire on epilepsy in children

The knowledge questionnaire consisted of 30 items that were divided into three areas. Tool was translated into Kannada and retranslated into English by another language expert.

Data collection procedure

The data was collected from 50 subjects who fulfilled the inclusive criteria. Permission was obtained from medical officer and concerned staff nurses of the PHC, Kyathsandra, Tumkur. Prior to data collection, the investigator familiarized with the subjects and explained the purpose of study to them. Confidentiality was assured to all the subjects and informed consent was obtained. Pre-test was conducted using knowledge questionnaire. The average time taken for pre-test was 20 minutes. Teaching programme was administered by using flash cards and discussion with them. The average time taken for post-test was 15 minutes.

Results

Majority of the subjects (42%) were in the age group of 18-22 years. Most of them (84%) belonged to nuclear families. Majority of the subjects (42%) were collie workers with most of the subjects (48%) having educational qualification of secondary education. Majority of the subjects (62%) had source to health information through health personnel. The pre-test and post–test knowledge scores of subjects ranged between 6-15 and 13-24 respectively. The mean pretest knowledge score was 11.32 and mean post-test knowledge score of subjects was 19.96 with mean difference of 8.4, suggesting that structured teaching program was effective. The mean post-test knowledge score (19.96) was found to be significantly higher than mean pre-test knowledge score (11.32) at 0.05 level of significance (t49 = 1.613, p<0.05).

Study Implications on Nursing

The findings of the study have implications for nursing practice, nursing education, nursing research and nursing administration.

1) Nursing practice:

Today more than ever, partnership in health care is being viewed as the ability of component professionals to deliberately transfer some of their specialist skills and knowledge to other resource personnel in the society as child health nurse. Health education is an important nursing responsibility. Nurses can enhance knowledge of mothers who care for the children at most in school timings, thereby building strong lives for tomorrow.

2) Nursing education:

The nursing curriculum should be more community oriented to provide better health education with special emphasis on epilepsy in children with appropriate teaching aids. From this study, it was found that structured teaching programme was effective in educating the mothers of under five children about epilepsy. The teaching programme can be further developed in the form of mass campaign and focus on group discussions.

3) Nursing research:

Research essentially is a problem-solving process and there is a need for extensive and intensive research in the area of epilepsy in children, as well as utilization of available resource personnel where health personnel are limited. No studies have examined actual knowledge of mothers in the matter of epilepsy in children in India. Health professionals and nursing professionals should look more into research related to epilepsy in children and evaluate such training from a clinical skill perspective.

4) Nursing administration:

As health service management structure changes, nurse managers’ role and responsibilities have become more multifaceted. The nurse managers should possess the abilities to integrate knowledge of clinical nursing realities into effective decision-making. The nurse as an administrator should organize and implement health teaching programmes to make the public aware of their health.

Recommendations for further studies

On the basis of the findings of present study, the following recommendations have been made for further studies:

• A study can be conducted on a large sample

• A comparative study between urban and rural

• An experimental study may be conducted with controlled group and an experimental group to assess the effectiveness of structured teaching programme

• Similar studies could be undertaken using other strategies like video films, telephone instructions etc

• A similar study can be done to test the effectiveness of structured teaching programme on epilepsy in children for improving knowledge of parents

Conflict of Interest

None.