Development and validation of a public attitudes toward epilepsy (PATE) scale

Psychometric properties of the Arabic version of the public attitudes toward epilepsy (PATE) scale

BACKGROUND & OBJECTIVES

No validated questionnaires exist to examine the public's attitudes about epilepsy in Arabic in particular. Therefore, this study aimed to test the validity and reliability of the Arabic version of the Public Attitudes Toward Epilepsy (PATE) scale.

METHODS

In this cross-sectional study, Egyptian Arabic-speaking adults aged >18 from different socioeconomic backgrounds were enrolled. To capture the factor structure of the items, exploratory factor analysis was performed using Equamax rotation with Kaiser Normalization. The reliability of the scale was tested by measuring Cronbach's alpha.

RESULTS

Five hundred sixty participants (205 males and 355 females) with a median age of 33 (25-41) years were enrolled. Cronbach's alpha was 0.806 for the general domain, indicating excellent reliability, while it was 0.644 for the personal domain, indicating satisfactory reliability. No ceiling or floor effects were detected. Also, the correlation coefficients between each item and its corresponding domain were higher than that of the other domain or the total score. Exploratory factor analysis confirmed that items on the PATE scale were loaded on their two hypothesized domains.

CONCLUSION

The Arabic version of the PATE scale is a valid and reliable tool for assessing the attitudes toward epilepsy in Arabic-speaking populations.

Comparative cultural study using the Public Attitudes Toward Epilepsy Scale (PATE scale) in Japan and Malaysia

Aim

Epilepsy-related stigma significantly impacts quality of life, with severity noted in Asian countries. This study compared public attitudes towards epilepsy in Japan and Malaysia, two Asian nations with distinct religious and healthcare backgrounds.

Methods

We used the Public Attitudes Toward Epilepsy (PATE) scale, including its Japanese version (PATE-J), to survey 113 Japanese and 130 Malaysian participants. Demographic data and PATE scores were compared using t-tests and χ² tests. Covariance analysis (ANCOVA) was conducted to adjust for potential confounding factors such as age and education level.

Results

No significant differences were found in PATE total scores (P = 0.484), general domain (P = 0.101), or personal domain (P = 0.217) between Japan and Malaysia. However, after adjusting for age and education using ANCOVA, education significantly influenced the general domain (F = 4.512, P = 0.012) and total scores (F = 3.302, P = 0.038), while country (F = 7.191, P = 0.008) and age (F = 6.633, P = 0.011) were significant for the personal domain. Malaysian participants were significantly younger (P < 0.001) and had higher education levels (P < 0.001) compared to Japanese participants.

Conclusion

While no significant differences in epilepsy-related stigma were observed between Japan and Malaysia, demographic variations in age, education, and regional characteristics may have masked potential cultural differences. The adjusted analysis underscores the importance of controlling for these factors to better elucidate cultural influences on epilepsy stigma formation in Asia.

The attitude of medical students, resident doctors, and nurses toward people with epilepsy: A multi-centre study

INTRODUCTION

The rising incidence of epilepsy has not been accompanied by sufficient public education, contributing to persistent social stigma towards people with epilepsy. This stigma leads to their exclusion and discrimination in key areas such as employment, education, and social interactions, ultimately diminishing their quality of life. This study aimed to assess the attitudes of medical students, resident doctors, and nurses toward people with epilepsy in three large cities in Indonesia.

METHODS

A cross-sectional multi-centre study was conducted in Jakarta, Manado, and Banda Aceh between June 2020 to January 2021 in three tertiary hospitals. Subjects were medical students, resident doctors, and nurses, aged over 18 years, with no known history of epilepsy. Sociodemographic characteristics were recorded, and attitude was assessed using the validated Indonesian version of the Public Attitudes Toward Epilepsy questionnaire. Data were analyzed using Kruskal-Wallis with post-hoc pairwise Mann-Whitney U comparison.

RESULTS

The findings revealed that most respondents held positive attitudes in both the general and personal domains. However, negative perceptions persisted on more personal topics, particularly regarding dating and marriage with people who have epilepsy. Sociodemographic characteristics that correlated with attitudes toward individuals with epilepsy included centre, sex, educational level, occupation, and ethnicity.

CONCLUSION

Despite overall positive attitudes, certain stigmatizing beliefs remain, particularly in personal areas such as marriage and relationships. These findings highlight the need for targeted educational interventions to address persistent misconceptions and reduce stigma, ultimately improving the social inclusion and quality of life for people with epilepsy in Indonesia.

Impact of problem-based learning on stigma toward epilepsy among medical students: An intervention verification study

INTRODUCTION

Stigma toward epilepsy is widespread not only among the general population but also among healthcare professionals. Therefore, the necessity of providing educational opportunities for epilepsy from an early stage in student education has been emphasized. Recently, problem-based learning (PBL) has gained importance in higher education, with reports indicating that it not only enhances knowledge but also reduces stigma.

OBJECTIVE

This study aimed to evaluate the effects of an epilepsy-related problem-based learning (E-PBL) program on medical students' stigma toward epilepsy. Additionally, we assessed whether the E-PBL program improved medical students' knowledge of epilepsy.

MATERIALS AND METHODS

Participants were fourth-year medical students. The E-PBL program was conducted over 5 days, from July 3, 2023 to July 7, 2023. The outcomes included the Japanese version of the Public Attitudes Toward Epilepsy (PATE-J) scale, which was used to assess stigma toward epilepsy before and after the E-PBL program. We also administered a short, structured questionnaire to assess participants' knowledge of epilepsy.

RESULTS

In total, 112 students were examined. The total PATE-J score was significantly lower after E-PBL (median: 18; interquartile range [IQR]: 14-20) than before PBL (median: 19; IQR: 16-23) (p = 0.013). Additionally, the number of correct responses to the short, structured questionnaire after the E-PBL program was significantly higher than before the program (p < 0.001).

CONCLUSIONS

E-PBL programs have the potential to decrease stigma toward epilepsy while enhancing knowledge about epilepsy among medical students. E-PBL represents a novel educational approach for medical students in the context of epilepsy education.

The Effect of Fatalistic Tendency in Individuals on Attitudes Toward Epilepsy Patients

OBJECTIVE

This study was conducted to determine the effect of fatalistic tendency on attitudes toward epilepsy patients.

METHODS

The study was conducted between August 17 and October 1, 2022 in a family health center in Sakarya province in western Türkiye. The sample consisted of 479 adults. Data were collected in descriptive information forms, the fatalism tendency scale and the epilepsy attitude scale. The data were analyzed using SPSS 22.0, AMOS V 24.0, and G*Power 3.1 statistical package programs.

RESULTS

Results showed that the model built according to the hypotheses was compatible, and the model fit indices χ2/Sd = 1.857, RMSEA = 0.04, CFI = 0.98, GFI = 0.99, AGFI = 0.97, and IFI = 0.98 were within the desired limits. Structural equation modeling to determine the effect of fatalistic tendency on attitudes toward epilepsy revealed that fatalistic tendency affected the attitudes toward epilepsy patients (β = 0.87, p < 0.05).

CONCLUSION

In our study, as the fatalistic tendency of individuals increased, their negative attitudes toward epilepsy patients increased. Longitudinal studies on attitudes toward epilepsy patients are recommended.

Development and validation of the Japanese version of the Public Attitudes Toward Epilepsy (PATE-J) Scale

Aim

This study aimed to develop and validate a Japanese version of the Public Attitudes Toward Epilepsy (PATE-J) Scale to measure attitudes towards epilepsy among the general Japanese population.

Methods

The study employed a cross-sectional design using an online survey of 537 participants from the general public in Japan, with follow-up surveys at 2 weeks and 3 months. The PATE Scale was translated following standard guidelines and validated by conducting confirmatory factor analysis (CFA) on the complete data set to assess the original two-factor structure of the PATE Scale. Internal consistency assessment, and convergent validity testing with the Modified Epilepsy Stigma Scale (M-ESS), Perceived Devaluation Discrimination Scale (PDDS), and Epilepsy Knowledge Scale (EKS) were carried out.

Results

CFA confirmed the two-factor structure of the PATE-J, comprising "Personal Domain" and "General Domain." The model showed acceptable fit indices (χ²(76) = 607.974, comparative fit index = 0.849, Tucker-Lewis index = 0.820, root-mean-square error of approximation = 0.114, standardized root-mean-square residual = 0.078) and high reliability (Cronbach's α = 0.87 for Personal Domain and 0.75 for General Domain). Strong correlations with the M-ESS (r = 0.713, p < 0.001), and weaker correlations with the PDDS, along with a negative correlation with the EKS (r = -0.306, p < 0.001), highlighted the PATE-J's distinctiveness. No significant associations were found between demographic factors and PATE-J scores.

Conclusion

The PATE-J demonstrates strong psychometric properties and cultural relevance for measuring public attitudes toward epilepsy in Japan. Its validated two-factor structure supports cross-cultural comparisons and provides a reliable tool for assessing public attitudes, informing interventions, and guiding education campaigns.

Teachers' Negative Attitudes and Limited Health Literacy Levels as Risks for Low Awareness of Epilepsy in Turkey

OBJECTIVES

For students with epilepsy, schools are a critical environment for managing the disease properly. This study examined awareness of epilepsy, attitudes toward epilepsy, and health literacy among school teachers in Turkey.

METHODS

This study was conducted in a city in Turkey with 1408 public school teachers from June 2021 to September 2021.

RESULTS

The median scores of the scales were 5, 29, and 32 for epilepsy awareness, epilepsy attitudes, and health literacy, respectively. Epilepsy awareness was higher in women, and epilepsy attitudes were more positive in women than men (p<0.05). While epilepsy awareness was higher in primary school teachers, epilepsy attitudes were more positive in secondary school teachers (p<0.05). Epilepsy awareness was lower in secondary school teachers (odds ratio [OR], 1.27; p<0.05), those who did not have an individual with epilepsy in their family/social environment (OR, 1.57; p<0.001), those who did not have a student with epilepsy in their class (OR, 1.45; p<0.05), and in those who had not witnessed an epilepsy seizure (OR,1.19; p<0.05). Compared to those with positive attitudes regarding epilepsy, epilepsy awareness was 1.36 times lower in those with negative attitudes (p<0.001). Epilepsy awareness was 1.92 times lower in those with limited health literacy than those with adequate health literacy (p<0.001).

CONCLUSIONS

In this study, low epilepsy awareness, negative epilepsy attitudes, and limited health literacy were common among teachers. The findings from this study suggest that panels, workshops, and health training on epilepsy should be organized for school teachers and included at regular intervals in certified first-aid practices.

The development of The Epileptic Seizure Parental Burden Scale: A validity and reliability study

OBJECTIVE

It is common for parents to shoulder the burden of care for their children with chronic diseases. However, there are no robust scales to measure the burden of care of parents of children with epilepsy. This study aimed to develop the "Epileptic Seizure Parental Burden Scale (ESPBS)" and evaluate its psychometric properties.

MATERIALS AND METHODS

This was a methodological study. The sample consisted of 333 voluntary parents of children with epilepsy. Data were analyzed using the Statistical Package for Social Sciences (SPSS v. 25) at a significance level of p < .05. Content validity, item-total correlation, explanatory factor analysis (EFA), confirmatory factor analysis (CFA), the "upper- and lower-27 percent rule," Cronbach's alpha coefficient, and the split-half reliability method were used for psychometric analysis.

RESULTS

The scale consisted of 15 items and two subscales. The Kaiser-Meyer-Olkin (KMO) was 0. 961, for which Bartlett's test of sphericity was significant (X2 = 5079.527, p < .001), indicating sampling adequacy and correlation between the items for factor analysis. The scale had item-total item correlations of 0.311 to 0.741. The Explanatory Factor Analysis (EFA) revealed a two-factor structure. According to the confirmatory factor analysis, x2/df, GFI, AGFI, CFI, and RMSEA were 2.012, 0.93, 0.91, 0.97, and 0.055, respectively. These values were very close to a good fit. The items had factor loadings of 0.508 to 0.890. The total scale explained 60.432% of the total variance. The scale had a Cronbach's alpha of 0.93. The split-half reliability indicated a significant (p < .001) and high (r = 0.890) correlation.

CONCLUSION

The Epileptic Seizure Parental Burden Scale (ESPBS) has high psychometric properties. It is a valid and reliable instrument that can measure the epileptic seizure burden of parents of children with epilepsy.

Have attitudes toward epilepsy improved in Germany over the last 50 years?

OBJECTIVE

In Germany, six previous representative surveys on attitudes toward epilepsy (AE) have been conducted between 1967 and 2008 using the four original Caveness questions (CQs) from 1949 to 1980. The aims of this study were (1) to investigate changes in AE over the time span of 50 years, including the current survey in 2018 (2) to investigate the first-time emotional reactions measured with the Scales of Attitudes toward People with Epilepsy (SAPE) (3) to identify predictors of AE.

METHODS

A representative face-to-face survey with CQ, in addition with the SAPE scales of Social Distance, Stereotypes, Personal Concerns, and Emotional Reactions was carried out in Germany in 2018. One thousand and twenty-six persons who ever had heard of epilepsy participated. Respondents who answered "don't know" in the CQs were subsequently asked to answer only yes/no. The analysis of trends from 1967 to 2018 was based on the pooled data of the surveys. The four CQs in the 2018 survey were included in the SAPE item pool and an exploratory principal axis factor analysis was performed. General linear models were performed to identify predictors.

RESULTS

For all four CQs, the trend of improved AE was significant over the past 50 years. In the 2018 survey, excluding the "don't know" answer option increased the proportion of negative responses for contact of one's own children with a person with epilepsy (PWE) from 6.9% to 11.4% and for the marriage of one's own children with a PWE from 13.9% to 23.8%. When encountering a PWE, 30.1% would feel insecure or uncomfortable and nearly 60% were concerned that the PWE might be injured in case of a seizure. Knowing what to do in case of a seizure, knowing that seizures can be treated successfully, personal contact with a PWE along with younger age, and higher education were found to be the strongest predictors for positive AE identified by multivariate analyses. Exploratory principal axis factor analysis revealed that three of the four CQs items loaded > 0.30 at the factors of Social Distance and Stereotypes of SAPE but none on the factors measuring emotional reactions.

SIGNIFICANCE

AE measured by CQs have markedly improved in Germany over the last 50 years. Germany is to our knowledge the only country with such a long-term trend investigation in AE. Negative AE may be underestimated by survey questions with "don't know" answer option. Emotional aspects of attitudes are underexposed resp. neglected in the CQs, which are used worldwide for measuring AE. Additional tools like SAPE can close this gap. The identified predictors may help to derive interventions against negative AE.

Attitudes toward epilepsy assessed by the SAPE questionnaire in Germany - Comparison of its psychometric properties and results in a web-based vs. face-to-face survey

OBJECTIVE

The aims of this study were (1) to investigate psychometric properties of a new questionnaire (SAPE, Scales of the Attitudes toward People with Epilepsy) that assesses attitudes toward people with epilepsy (PWE) (2) to compare the effects of mode of survey administration (web-based vs. face-to-face) on attitudes, and (3) to identify predictors of attitudes.

METHODS

A face-to-face and a web-based survey were performed in Germany. Weighting factors were used to achieve representative samples of the German population. Reliability and validity of the 6 scales of the SAPE (social distance, stereotypes, personal concerns, and emotional reactions differentiated by fear, anger, and pity) were evaluated and compared for both surveys. Epilepsy knowledge was also assessed. General linear models were performed to investigate predictors of attitudes toward PWE including the type of survey.

RESULTS

In total, 1001 participants of the web-based survey and 1026 participants of face-to-face survey were included. Psychometric analyses indicated satisfactory reliability and validity of the scales and differed only slightly between modes of survey. In both surveys, fears and concerns were more pronounced than stereotypes and social distance. However, mean values of two scales were slightly or moderately higher in the face-to-face survey indicating more negative attitudes toward PWE (p < 0.001). Fewer participants of the face-to-face survey reported personal experience with PWE, claiming to know what to do in case of a seizure and claiming to know that seizures can be treated successfully (p < 0.001). These variables proved to be important predictors of positive attitudes toward PWE, besides demographic factors (e.g. age < 65, female gender). When controlling for them, the differences remained significant only for the scales Social Distance (moderately) and Fear (slightly).

SIGNIFICANCE

In total, psychometric analyses show that web-based surveys using the SAPE may be an alternative to face-to-face surveys to assess attitudes toward PWE. This applies also to the scales Social Distance and Emotional Reactions that allow comparisons with other diseases, e.g. psychiatric disorders. Most scales differ only slightly between survey modes, except social distance. This indicates that single components of attitudes toward PWE may be dependent on the mode of survey or different characteristics of respondents.

Validation of the Chinese Version of the Stigma Scale of Epilepsy

Purpose

This study was carried out to test the validity and reliability of the Chinese version of the Stigma Scale of Epilepsy (SSE), with aim to better understand the public stigmatizing attitudes of epilepsy in China and help elucidate stigma determinants for interventions.

Methods

The SSE was translated into Simplified Chinese Mandarin. In this study, most of the participants were enrolled via convenience sampling by randomly distributing questionnaires on the streets and parts of the participants were recruited by an online platform named Wenjuanxing. We assessed the psychometric properties of the SSE in 310 Chinese native-speaker. Cronbach's alpha was tested for reliability. Index of Content Validity (CVI) was calculated. Exploratory and confirmatory analysis were used to explore the factor structure and verify the validity of SSE.

Results

The Cronbach's alpha is 0.936 for the overall scale, and the CVI value is greater than 0.78. The exploratory factor analysis (EFA) extracted SSE six factors: the fear of seizure attacks (factor 1), sympathy for patients with epilepsy (PWEs) (factor 2); difficulties faced by PWEs (factor 3); speculation on PWEs' feeling (factor 4); discrimination against PWEs (factor 5); and knowledge about epilepsy (factor 6). The item 13 was proven to be problematic and has been eliminated. The confirmatory factor analysis (CFA) ensured the great construct validity (χ²/SD = 1.725, goodness of fit index (GFI) = 0.916, and root mean square error of approximation (RMSEA) = 0.048), convergent validity (the factor loads of each item corresponding to each latent variable >0.6, average variance extracted (AVE) > 0.5, and composite reliability (CR) > 0.7), and discrimination validity (all of the absolute value of correlation coefficient are <0.5,and less than the square root of AVE) of the SSE.

Conclusions

The Chinese version of the SSE scale was a valid and reliable tool to measure epilepsy-associated stigma in the Chinese society.

What is the community's knowledge and understanding regarding epilepsy? Epilepsy knowledge and its determinants among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia, 2019: a cross-sectional study

OBJECTIVE

Epilepsy is a neurological condition marked by recurring seizures. People with epilepsy, particularly in low-income and middle-income countries, are stigmatised due to a lack of understanding and a negative attitude towards the disease. Increased public awareness of epilepsy will aid in the search for therapy and the quality of life of the patients. The study aimed to assess knowledge about epilepsy and the associated factors among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia in 2020.

SETTING

This community-based, cross-sectional study triangulated with qualitative method was conducted from 25 April 2020 to 20 May 2020. Multistage sampling technique was used to select 601 participants. A structured and interviewer-administered questionnaire was used to collect data. Data were entered in EpiData Manager V.4.0.2.101 and exported to SPSS V.23 for analyses. Multivariable logistic regression was carried out to identify the factors associated with knowledge of epilepsy. A p value of <0.05 was taken to indicate statistical significance.

RESULTS

A total of 601 respondents participated, of whom 340 (56.6%) were male. The mean age of the respondents was 34.84±11.42 years. The proportion with good knowledge of epilepsy was 55.1%. Factors associated with good knowledge of epilepsy were attending primary education (adjusted OR (AOR)=2.06, 95% CI 1.27 to 3.34), secondary education (AOR=5.01, 95% CI 2.62 to 9.58), above secondary education (AOR=5.67, 95% CI 2.35 to 13.69), being in high wealth index (AOR=1.74, 95% CI 1.09 to 2.78), being a government employee (AOR=3.69, 95% CI 1.39 to 9.83), being a merchant (AOR=3.16, 95% CI 1.80 to 5.54) and being an urban resident (AOR=2.15, 95% CI 1.36 to 3.42).

CONCLUSION

Only 55% of the residents have sufficient knowledge about epilepsy. Factors associated with knowledge of epilepsy were educational status, wealth index, occupation and residence.

Epilepsy-related stigma and attitudes: Systematic review of screening instruments and interventions - Report by the International League Against Epilepsy Task Force on Stigma in Epilepsy

OBJECTIVE

This is a systematic review aimed at summarizing the evidence related to instruments that have been developed to measure stigma or attitudes toward epilepsy and on stigma-reducing interventions.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. A broad literature search (1985-2019) was performed in 13 databases. Articles were included if they described the development and testing of psychometric properties of an epilepsy-related stigma or attitude scale or stigma-reducing interventions. Two reviewers independently screened abstracts, reviewed full-text articles, and extracted data. Basic descriptive statistics are reported.

RESULTS

We identified 4234 abstracts, of which 893 were reviewed as full-text articles. Of these, 38 met inclusion criteria for an instrument development study and 30 as a stigma-reduction intervention study. Most instruments were initially developed using well-established methods and were tested in relatively large samples. Most intervention studies involved educational programs for adults with pre- and post-evaluations of attitudes toward people with epilepsy. Intervention studies often failed to use standardized instruments to quantify stigmatizing attitudes, were generally underpowered, and often found no evidence of benefit or the benefit was not sustained. Six intervention studies with stigma as the primary outcome had fewer design flaws and showed benefit. Very few or no instruments were validated for regional languages or culture, and there were very few interventions tested in some regions.

SIGNIFICANCE

Investigators in regions without instruments should consider translating and further developing existing instruments rather than initiating the development of new instruments. Very few stigma-reduction intervention studies for epilepsy have been conducted, study methodology in general was poor, and standardized instruments were rarely used to measure outcomes. To accelerate the development of effective epilepsy stigma-reduction interventions, a paradigm shift from disease-specific, siloed trials to collaborative, cross-disciplinary platforms based upon unified theories of stigma transcending individual conditions will be needed.

Attitudes toward epilepsy in Indonesia

BACKGROUND

Indonesia is the largest island country in the world with diverse ethnicity and cultural backgrounds. This study aimed to understand the variation in attitudes toward epilepsy among the Javanese, Sundanese, and the Minahasa ethnic groups in Indonesia.

METHOD

This study recruited Sundanese from Tasikmalaya and Minahasan from Manado using the Indonesian Public Attitudes Toward Epilepsy (PATE) scale. The results were compared to the Javanese and Malaysian data in previous studies.

RESULT

A total of 200 respondents, 100 from each ethnic group were recruited, with a mean age of 38.51 years. They were predominantly females (54%) and had secondary education level or lower (56.67%). The Javanese had a higher total mean score, indicating poorer attitudes toward epilepsy, as compared to the Minahasan and Sundanese groups. These differences were noted in the personal domain, but not the general domain. There were no significant differences in the mean scores in both personal and general domains between the Minahasan, Sundanese, and Malaysian populations. Subanalysis on the aspects of life showed that the Javanese had a significantly higher score in the aspects of education, marital relationship, and employment.

CONCLUSION

The attitudes toward epilepsy were similar between the Indonesian (Sundanese and the Minahasan) and Malaysian, except the Javanese with poorer attitude. These differences could be socioeconomically or culturally related.

Attitudes of individuals in Eastern Turkey toward epilepsy and the factors associated with these attitudes

AIM

This study was performed to analyze the attitudes of individuals in eastern Turkey toward epilepsy and the factors associated with these attitudes.

METHODS

Designed as a cross-sectional descriptive study, this study was performed from January 28 to February 8, 2021. A snowball sampling technique was used to select the study sample, and a survey was sent online to individuals aged 18 or above. A total of 617 individuals who filled in this online survey form were included in this research. Data were collected via a personal information form and the Public Attitudes Toward Epilepsy (PATE) scale.

RESULTS

The results showed that the mean scores of the participants on the PATE scale, on its general domain, and on its personal domain were 1.79±0.63, 1.70±0.63, and 1.96±0.77, respectively. Comparing the participants' mean PATE scale scores on the basis of their descriptive characteristics revealed statistically significant differences in the mean scores on the scale and its two domains in terms of age, place of residence, educational level, knowing anyone who had epilepsy or experienced epileptic seizures, and witnessing a person having an epileptic seizure (p < 0.05).

CONCLUSION

Individuals living in eastern Turkey have positive attitudes toward epilepsy. Moreover, it was found that, among all the participants, those who were relatively young, those who lived in a provincial center, those who had a relatively high educational level, those who knew an individual with epilepsy, and those who had witnessed an epileptic seizure have more positive attitudes toward epilepsy than their counterparts.

IMPLICATIONS

It is recommended to design educational programs focusing on raising the level of public awareness and knowledge regarding epilepsy.

Perceptions associated with the public attitudes toward epilepsy (PATE) scale: A mixed-method study

BACKGROUND

In epilepsy stigma, certain perceptions are culturally dependent and greatly influence a person's attitudes. Hence, we aimed to explore the perceptions associated with attitudes toward epilepsy in various urban subpopulations.

METHOD

This is a mixed-method study employing the Public Attitude Toward Epilepsy (PATE) scale as the quantitative measure, followed by a semi-structured interview. The qualitative data were then counted and analyzed concurrently with the quantitative data.

RESULT

A total of 410 respondents (104 people with epilepsy [PWE]; 104 family members [FM]; 100 medical students [MS]; 102 public [Pb]) aged 37 years (IQR 23-55) were recruited. They were mostly female (57.3%), Chinese (52.0%), and highly educated (63.7%). The attitudes toward epilepsy among medical students are the best, followed by the PWE and their family members, and the worst among the public. The qualitative results revealed 4 main themes, which were "general social values", "epilepsy severity and control", "PWE's abilities", and "harms and burdens to the respondents and others". A two-dimensional perception model was constructed based on these themes, which consisted of general-personal and universal-specific dimensions. Generally, the PWE/FM subgroup focused more on PWE's abilities, whereas the MS/Pb subgroup more on general social values, and harms and burden. In the education aspect, most attitudes were related to the epilepsy severity and PWE's abilities, whereas in employment, the main consideration was the PWE's abilities. Burden to life and concern about inheritance were major considerations in the marital relationship. Those with positive attitudes tend to highlight the importance of general social values, while negative attitudes associated more with epilepsy severity. In general domain, general social values were the main considering factor but in personal domain, most participants will consider epilepsy severity and control, harms and burden to themselves.

CONCLUSION

The perceptions underlying attitudes toward epilepsy were complex and varied between subpopulations, attitude levels, domains, and aspects of life. (304 words).

Attitudes Toward Epilepsy Among Parents of Children With Epilepsy in Southern China

Purpose: To evaluate the attitudes toward epilepsy among parents of children with epilepsy (CWE) in China and identify some related factors for future interventions for parents to offer more social support for CWE.

Method: The Chinese Public Attitudes Toward Epilepsy (CPATE) scale was administered to 234 parents of CWE and 203 parents of normal children in Xiangya hospital during 2019–2020.

Results: The cumulative score of the parents of CWE (26.427 ± 6.688) was significantly lower than that of the normal children group (32.330 ± 7.234, p < 0.001). Subanalysis showed more positive attitudes among parents of CWE than the control group (p < 0.001) toward education (4.765 ± 1.985 vs. 6.621 ± 2.419), social life (6.556 ± 2.456 vs. 8.010 ± 2.683), marriage (9.586 ± 2.675 vs. 11.025 ± 2.900), and employment (3.876 ± 1.364 vs. 4.5123 ± 1.283). The attitudes toward epilepsy among parents of CWE with seizures in public (27.16 ± 6.66) or during sleep (27.10 ± 6.38) were more negative than those without (25.35 ± 6.62 and 25.08 ± 7.10, respectively) (p < 0.05). In addition, female and low income were negatively related to parents' attitudes toward epilepsy.

Conclusions: More active policy guidance and adequate social support should be given to parents of children with seizures in public or during sleep to instruct their children to form a positive perception about epilepsy, which is expected to have a positive impact on their social abilities in the future.

Evaluation of attitudes toward epilepsy and health fatalism in northeastern Turkey

PURPOSE

This study was carried out to identify the attitudes toward epilepsy, health fatalism, and the factors affecting these in individuals living in Artvin in the northeast of Turkey.

METHOD

This descriptive and cross-sectional study involved 1443 healthy individuals at a hospital in Artvin in northeastern Turkey between January and March 2020. An individual information form, an epilepsy attitude scale, and a religious health fatalism scale were used to assess their views. An independent sample t-test, Mann-Whitney U test, one-way analysis of variance (ANOVA), and Pearson correlation analysis were used to analyze the data.

RESULTS

The mean score of participants' attitudes on epilepsy was 48.17 (standard deviation (SD) = 12.93), while the mean of their health fatalism score was 48.43 (SD = 17.41). There was a significant negative correlation between attitude scores and health fatalism (r = -0.084, p = 0.001). Significant differences were found among attitude, health fatalism mean scores, and misconceptions associated with religion about epilepsy being a contagious, psychiatric, and incurable disease that should be hidden. Significant differences were additionally observed among attitude, health fatalism mean scores, and education, marital status, income, employment status, and presence of chronic disease (p < 0.05).

CONCLUSION

It was found that most individuals had moderate level attitude toward epilepsy and had high health fatalism. Individuals with a high degree of health fatalism were found to have more negative attitude toward epilepsy. Attitude was found to be more negative, and health fatalism was found to be higher in individuals with low education level, low-income level, who were married, who were unemployed, who had a chronic disease, and in those who thought epilepsy was a contagious, psychiatric, and incurable disease associated with religion that should be hidden.

IMPLICATIONS

It is recommended that health professionals organize training programs to increase public understanding of epilepsy, improving individual attitudes toward the condition, and minimizing health fatalism.

Validity and reliability of the Turkish version of Public Attitudes Toward Epilepsy scale

OBJECTIVE

This study was conducted to test the validity and reliability of the Turkish version of the Public Attitudes Toward Epilepsy (PATE) scale, which aims to understand public perceptions of seizures and epilepsy.

METHODS

The scale was translated following the standard procedures. For psychometric validation, the Turkish version of the PATE scale was administered to 201 native Turkish speakers above the age of 18 who had no history of seizures or epilepsy. It was found that the respondents were able to fill out the scale quickly and without difficulty in understanding the translated items on the scale.

RESULTS

Cronbach's alpha coefficient was found to be 0.843 for the overall scale and above 0.7 for each individual item. Cronbach's alpha was 0.78 for the general domain and 0.792 for the personal domain. Exploratory and confirmatory factor analyses were carried out and showed that the scale had a structure similar to that of the original scale, with the 14 items grouped under two dimensions, similar to the original scale.

CONCLUSION

The Turkish version of the PATE scale was a valid and reliable tool to measure the attitudes toward epilepsy in Turkish society.

Attitudes toward epilepsy in East Malaysia using the Public Attitudes Toward Epilepsy (PATE) scale

BACKGROUND

Epilepsy stigma is an important issue affecting people with epilepsy (PWE) in various social aspects of life. Most studies on stigma were among the metropolitan population but rarely on indigenous people. Hence, this study aimed to understand the attitudes toward epilepsy of the East Malaysians, comparing with the West Malaysians previously reported.

METHOD

This study was performed among the indigenous people in Kuching and Sibu (Sarawak) and Kota Kinabalu (Sabah) using the Public Attitudes Toward Epilepsy (PATE) scale. A higher score indicates poorer attitude.

RESULT

A total of 360 respondents (41.7% Kadazan-Dusun, 30.6% Bidayuh, and 24.7% Iban) aged 34.6 ± 12.6 years completed the questionnaire. They were predominantly females and had lower education level and income compared with the West Malaysians. The Sabah population had significantly lower mean scores (better attitudes) than those in Sarawak, in both personal and general domains (p < .001). As compared with West Malaysia, the mean score in the personal domain was significantly lower in Sabah, while Sarawak had significantly higher scores in general domain (p < .001). Subanalysis showed that the Sabah population had better attitudes toward marriage and employment in PWE than the West Malaysians, whereas Sarawak had poorer attitudes toward education and social contact in PWE.

CONCLUSION

The attitudes toward epilepsy were different among the indigenous populations in Sabah and Sarawak, and from the West Malaysians, which could be attributable to their sociocultural differences.

Indonesian Public Attitudes Toward Epilepsy (PATE) scale: Translation and psychometric evaluation

INTRODUCTION

Epilepsy stigma has been associated with poor quality of life among people with epilepsy (PWE). It is important to understand the variation and degree of epilepsy stigma in one of the most populous and culturally diverse nations in the world, Indonesia. Hence, this study aimed to test the validity and reliability of the Indonesian version of the Public Attitudes Toward Epilepsy (PATE) scale.

METHOD

The translation was performed according to standard principles and tested in 200 native Indonesian speakers who were aged above 18-year-old for psychometric validation.

RESULTS

The items in each domain had similar means and standard deviations (equal item variance), means ranging from 2.17 to 2.86 in general domain and 2.75 to 3.56 in personal domain and, standard deviations ranging from 0.87 to 1.05 and 0.88 to 1.01 in general and personal domain, respectively. Item-domain correlations were more than 0.5 for all items, and they correlate higher within their own domain compare with the other domain (convergent and divergent validity). Multitrait analysis showed similar variance, floor, and ceiling patterns to a great extent compared with the initial study. The Indonesian PATE scale also showed mostly similar correlation with demographic characteristics except monthly income. Principle axis analysis revealed strong factor loading (>0.3) in their hypothesized domain, except item 14. The Cronbach's α values for general and personal domains were 0.836 and 0.765, which were within the accepted range of 0.7 to 0.9.

CONCLUSION

The Indonesian PATE scale is a validated and reliable translation for measuring public attitudes toward epilepsy.

Who is the bigger stigmatizor?: The loved one or the society

OBJECTIVE

Epilepsy has long been considered by the society as a dangerous and frightening spiritual possession or even a contagious disease. This results in an unavoidable embarrassment for both the patient and the family leading to social isolation, seclusion, and secretiveness about the diagnosis. The aim of this study was to determine the stigmatizing level of the general Turkish population and to compare these results with the stigmatizing level of the patients' relatives group (PRG).

METHODS

This is a substudy of our main study which aimed to develop two scales for the quantification of the stigma level in patients with epilepsy (PWE) and their relatives [Stigma Scale for Epilepsy (SSE) -Self Report (SR) and -Informant Report (IR)]. First-degree relatives of the patients had been included in the main study. For the present study, 202 healthy people who were caregivers and relatives of neurologic patients other than epilepsy were recruited for the control group (CG). A sociodemographic and clinical data form and SSE-IR scale were administered to the CG as well. The relationship between sociodemographic characteristics and SSE-IR scores was evaluated, and a regression analysis was performed in order to analyze sociodemographic factors contributing to SSE-IR scores. Stigmatizing levels were compared between PRG and CG. Statistical analysis was performed using Statistical Package for the Social Sciences version 22.0 software.

RESULTS

Comparison of stigma scores among different sociodemographic strata of the CG showed that there was a statistically significant difference in terms of educational status and occupation (p < 0.01). Multivariate linear regression analysis revealed that education accounted for 10.8% and 8.9% of the variance in the SSE-IR scale respectively in the PRG and the CG. Prejudgment scores and total scores of the PRG were significantly higher than those of the CG. There was no statistically significant difference between two groups in terms of discrimination and false beliefs subscales scores. The proportion of highly stigmatizor participants in the PRG was statistically significantly higher than that of the CG.

DISCUSSION/CONCLUSIONS

This study showed us that the stigmatization levels in a group of subjects drawn from general population without acquaintance of epilepsy were lower than the relatives of the patients. This result may be partially explained by the ambivalent attitudes of the relatives, as those high scores may stem from not only enacted but also the felt stigma that they were experiencing themselves. It must be a warning sign for both of all the clinicians treating epilepsy and national association against epilepsy, as well as public health officials to increase efforts for awareness raising.

Knowledge, attitudes and practice towards epilepsy among medical staff in Southern China: Does the level of hospitals make a difference?

PURPOSE

To assess knowledge, attitudes, and practice (KAP) toward epilepsy among medical staff from different levels of hospitals in Southern China.

METHOD

An adapted and structured questionnaire was administered to medical personnel from tertiary (n = 451) and basic-level (n = 448) hospitals in Southern China. The questionnaire comprised of three domains which consisted of 6 items for awareness, 12 items for knowledge and a 14 item scale for attitudes.

RESULTS

Almost 40% of medical staff in basic-level hospitals held that epilepsy could be caused by evil spirits/eyes, or transmitted from other patients, which was almost 6 times higher than that of tertiary hospitals. The mean score from general knowledge about epilepsy was higher among medical staff in tertiary hospitals than in basic-level hospitals. The mean scores in the general and personal domain of the Chinese Public Attitudes Toward Epilepsy (CPATE) scale were both significantly lower among medical staff in tertiary hospitals, when compared to those of basic-level hospitals.

CONCLUSIONS

The overall KAP from medical staff in response to seizures, was found to be better in tertiary hospitals than those of basic-level hospitals in Southern China, which was associated with the education level and impact of traditional culture. To date, there is a need for effective public intervention programs in China to improve the awareness of epilepsy and reduce discrimination among medical workers, especially for those working in basic-level hospitals in rural regions, to finally promote a better living environment for patients with epilepsy in China.

Attitudes toward epilepsy among medical staffs in basic-level hospitals from southern China

OBJECTIVE

The objectives of the study were to assess attitudes toward epilepsy among medical staffs from basic-level hospitals in southern China and identify significant predictive factors for future stigma reduction interventions.

METHODS

The Public Attitudes Toward Epilepsy (PATE) scale, a two dimensional 14-item scale addressing two major domains: general domain and personal domain, was administered to 448 medical staffs from basic-level hospitals in southern China. Positively stated items in the PATE scale were reversely scored; in this case, a higher score would indicate a more negative attitude. Also, we compared the overall score and per-item scores of the medical staffs versus those of the general population reported in the previous studies using the same scale.

RESULTS

The cumulative score of the medical staffs was 41.65 ± 6.99, which is significantly lower as compared with 51.38 ± 6.80 of the general population (t (645) = -16.473, p < 0.001). The general average score (t (645) = -16.473, p < 0.001) and the mean score in the general domain (t (645) = -22.573, p < 0.001) of the PATE scale were both significantly lower in the medical staffs compared with the general population, whereas there was no significant difference between the two groups in the personal domain (t(645) = -0.180, p = 0.857). Age or years in clinical practice, specialty, and title had a significant impact on both the general domain and personal domain. Residence was the only factor found affecting the medical staffs' attitudes toward epilepsy in the personal domain but not in the general domain.

CONCLUSION

Medical staffs from basic-level hospitals in southern China demonstrate significant positive attitudes toward people with epilepsy in general aspects when compared with the general population. However, they still showed negative and conservative attitudes when it comes to the personal domain. Future strategies for stigma-reducing public interventions could focus on increasing better understanding of epilepsy among medical staffs in basic-level hospitals in China.

Attitudes toward epilepsy and perceptions of epilepsy-related stigma in Korean evangelical Christians

PURPOSE

The scriptural description of Jesus driving out an evil spirit from a boy with epilepsy supported the idea of the spiritual nature of epilepsy for centuries. Korea has a shorter history of Christianity than the Western world. We determined whether there are differences in attitudes toward epilepsy and perception of epilepsy-related stigma between people with and without belief in evangelical Christianity in Korea.

METHODS

Data were collected from evangelical churches and theological colleges. People without religious beliefs were enrolled as a control group through convenience sampling. The Public Attitudes Toward Epilepsy (PATE) scale and the modified Stigma Scale for epilepsy were used. Familiarity with and knowledge of epilepsy were also assessed. Evangelical Christians were categorized as professional or nonprofessional depending on whether they had received professional education in Christian theology.

RESULTS

A total of 227 evangelical Christians and 139 controls were included. The scores on the Stigma Scale and in the two PATE domains were significantly lower in the professional Christian group than in the controls or the nonprofessional group (p<0.05) but did not differ between the nonprofessional group and controls. After controlling for confounders, only the professional group was independently associated with lower scores on the Stigma Scale and in the PATE personal domain (p<0.05). The remaining associations lost their significance.

CONCLUSIONS

We found no differences in attitudes toward epilepsy and perception of stigma between people with and without belief in evangelical Christianity in Korea.

Validation of the Chinese version of public attitudes toward epilepsy scale in Mainland China

PURPOSE

Epilepsy is a significant yet seriously underappreciated public health issue in Mainland China. The stigma and discrimination toward people with epilepsy (PWE) and their families are especially severe in China based on cultural misconceptions which cause tremendous psychological, economic and social burdens. It is imperative to formulate a targeted public intervention to eliminate knowledge gaps and correct these misconceptions of epilepsy. However, to date, the essential tools that may drive such an intervention by measuring the public perspective on PWEs is lacking in China. The goal of this study is to test the reliability and validity of a Simplified Chinese version of the "Public Attitude Toward Epilepsy" scale (PATE) in Mainland China which can be used to understand the content and identify the possible sources of stigma to better inform the design and focus of future stigma reduction interventions.

METHODS

The standard procedure of cross-cultural adaptation was used in the translation process. Subjects from different economic and social backgrounds were enrolled by convenience sampling in central China. Exploratory factor analysis and confirmatory factor analysis were used to check the underlying factor structure of the items. Furthermore, Cronbach's alpha was utilized to assess internal consistency.

RESULTS

199 respondents were included in the final analysis. Content validity of this Chinese PATE was assessed to be adequate for assessing public attitudes toward epilepsy among the mainland Chinese. Two factors were extracted from the data by exploratory factor analysis; confirmatory factor analysis further confirmed good consistency of theoretical constructs between the original Public Attitudes Toward Epilepsy scale and our Chinese PATE. Our Chinese PATE presented excellent internal consistency (α=0.853-0.909).

CONCLUSION

This version of the Chinese PATE showed acceptable psychometric properties, indicating that it can be implemented in surveying public attitudes toward epilepsy in Mainland China.

Malay public attitudes toward epilepsy (PATE) scale: translation and psychometric evaluation

INTRODUCTION

None of the quantitative scales for public attitudes toward epilepsy had been translated to Malay language. This study aimed to translate and test the validity and reliability of a Malay version of the Public Attitudes Toward Epilepsy (PATE) scale.

METHOD

The translation was performed according to standard principles and tested in 140 Malay-speaking adults aged more than 18 years for psychometric validation.

RESULTS

The items in each domain had similar standard deviations (equal item variance), ranging from 0.90 to 1.00 in the personal domain and from 0.87 to 1.23 in the general domain. The correlation between an item and its domain was 0.4 and above for all items and was higher than the correlation with the other domain. Multitrait analysis showed that the Malay PATE had a similar variance, floor and ceiling effects, and relative relationship between the domains as the original PATE. The Malay PATE scale showed a similar correlation with almost all demographic variables except age. Item means were generally clustered in the factor analysis as the hypothesized domains, except those for items 1 and 2. The Cronbach's α values were within acceptable range (0.757 and 0.716 for the general and personal domains, respectively).

CONCLUSION

The Malay PATE scale is a validated and reliable translated version for measuring public attitudes toward epilepsy.

A web-based survey of attitudes toward epilepsy in secondary and tertiary students in Malaysia, using the Public Attitudes Toward Epilepsy (PATE) scale

BACKGROUND

Students' attitudes toward epilepsy have been studied in several countries, but none of the studies used a quantitative scale. We aimed to determine the validity and reliability of the Public Attitudes Toward Epilepsy (PATE) scale in a homogenous population consisting of secondary and tertiary students in Malaysia and to quantify their attitudes toward epilepsy, using a web-based survey.

RESULTS

A total of 227 respondents with a mean age of 19.6±2.07 years, predominantly Chinese (85%), female (62%), and in a pre-university education level (71%) completed the web-based survey. Psychometric testing showed that the PATE is a valid and reliable scale to be applied in a homogenous population. The mean score in the personal domain was significantly higher than that in the general domain (2.73±0.61 vs. 2.12±0.60, respectively, p<0.001). Compared with a study previously performed on a general population (Lim et al., 2012 [10]), the mean score in the general domain was significantly lower (p<0.01), whereas there was no significant difference between the mean scores in the personal domain. The mean scores in the general domain were significantly lower for those with tertiary education (p<0.001) but did not correlate with gender and ethnicity.

CONCLUSION

The attitudes of secondary and tertiary students are more positive than those of the general population in the general domain but not in the personal domain.