Seizure 23 (2014) 280–283

Contents lists available at ScienceDirect

Seizure
journal homepage: www.elsevier.com/locate/yseiz

Primary school teacher’s knowledge and attitudes toward children

with epilepsy
Albaraa S. Abulhamail, Fahad E. Al-Sulami, Mouneeb A. Alnouri, Najeeb M. Mahrous,
Dima G. Joharji, Maha M. Albogami, Mohammed M. Jan *
Faculty of Medicine, King Abdulaziz University, Pediatrics, PO Box 80215, Jeddah 21589, Saudi Arabia

A R T I C L E I N F O A B S T R A C T

Article history: Purpose: Primary school teacher’s knowledge and attitudes toward epilepsy can have significant impact
Received 29 September 2013 on the performance and psycho-social development of the child with epilepsy. Our objectives were to
Received in revised form 14 December 2013 study teacher’s knowledge and attitudes and identify areas in which further teacher training and
Accepted 28 December 2013
education are required.
Methods: A stratified random sample survey involving a group of primary school teachers in Jeddah,
Keywords: Saudi Arabia included private/public schools designated for male and female students. A structured 37-
Teacher
item questionnaire was used to examine their demographics, knowledge, attitudes, and experience with
School
Knowledge
epilepsy.
Attitude Results: Six hundred and twenty primary school teachers working in public (58%) or private (42%)
Child schools were included with ages ranging between 21 and 59 years (mean 36). Most teachers (79%) were
Epilepsy of Saudi Arabian nationality and 66% had a college or university degree. Their years of experience ranged
from 1 to 35 (mean 13.5). Only 17% of the teachers felt very well informed about epilepsy. Teachers with
higher education were more likely to have good knowledge (p = 0.009). Teachers of Saudi nationality
were also more likely to report good knowledge, independent of their educational level (p = 0.013).
Overall, teachers with good knowledge were less likely to have negative attitudes including minding to
have an epileptic child in their class (p = 0.028) or thinking that they should be placed in a special
classroom (p = 0.029).
Conclusions: Primary school teacher’s knowledge about epilepsy needs improvements. Their attitudes
correlated highly with their knowledge. Educational campaigns about epilepsy are needed to develop a
well informed and tolerant community.
ß 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

1. Introduction and misconceptions about epilepsy and its management.8–14

Epilepsy is one of the most common pediatric neurological
disorders with higher incidence during the school years.1,2 These
years represent a critical period of the child’s social, psychological,
and physical development. The school period will significantly
impact the child’s quality of life and future adult roles.3,4 Children
with epilepsy are at increased risk of educational underachieve-
ment, learning difficulties, mental health problems, social isola-
tion, and poor self-esteem.5,6 Teacher’s knowledge and attitudes
toward epilepsy can have significant impact on these difficulties
including student’s performance, social skill development, and
future employment.7 International studies have indicated that
teachers often have insufficient knowledge, inadequate training,
* Corresponding author. Tel.: +966 505698843; fax: +966 26403975.
E-mail addresses: mmjan@kau.edu.sa, mmsjan@yahoo.ca (M.M. Jan).
Despite the significant impact of teacher’s role in the lives of
these children, very little research has been conducted in Saudi
Arabia to assess these issues.15,16 Our objectives were to study
primary school teacher’s attitudes toward epilepsy and identify
areas in which further teacher training and education are required.
We also aimed to identify contributing factors to inadequate
knowledge and negative attitudes. We hypothesized that many
teachers are not well informed about epilepsy and some are
misinformed from unreliable sources, which contributes to their
negative attitudes toward the student with epilepsy.
2. Methods
A stratified random sample survey involving a group of primary
school teachers in Jeddah, Saudi Arabia was conducted from the 1st
of January, 2012 to the 1st of January, 2013. Multiple private/public
primary schools designated for male and female students were

1059-1311/$ – see front matter ß 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.seizure.2013.12.010
 A.S. Abulhamail et al. / Seizure 23 (2014) 280–283
Table 1
Summary of the teacher’s knowledge and negative attitudes toward children with
epilepsy (n = 615).
Questionnaire
Knowledge
Epilepsy is a life time disorder
One of the causes of epilepsy is spirit possession
The intelligence of an epileptic child is below average
Evil eye is a cause of epilepsy
Epilepsy cannot be cured
Attitudes
Children with epilepsy have abnormal behavior in class
They have future career limitations
Children with epilepsy should be placed in a special classroom
They should be placed in a special school
I mind having a child with epilepsy in my classroom
They should not participate in sport activities
included from the Jeddah area. These schools were randomly
selected from an official list obtained from the Ministry of
Education and included a sample from all four regions of our city
(north, center, south west, and south east). A structured 37-item
questionnaire was designed to examine the teacher’s demo-
graphics, knowledge, attitudes, and experience with children with
epilepsy. Key questions are listed in Table 1. A 4-point Likert scale
item was included to examine the degree of knowledge about
epilepsy with response categories of very well informed, moder-
ately informed, somewhat informed, and not informed at all. The
study design and questionnaire were approved by King Abdulaziz
University hospital ethics committee. The nature of the study and
questionnaires were explained to the principles of the included
schools and all involved teachers signed an informed consent
before voluntarily participating in the study. An assigned coauthor
conducted the interviews during a school visit and individually
assisted all available teachers to complete the questionnaires. The
identity of the teacher was not requested to ensure privacy and
encourage accurate response. Data were collected in Excel sheets
and statistical analyses were performed using SPSS 17 (SPSS, Inc.,
Chicago, IL, USA). Descriptive analyses were performed and the
variables were examined using chi-square test. Statistical signifi-
cance will be defined as p values of less than 0.05.
3. Results
Six hundred and twenty primary school teachers working in
public (58%) or private (42%) schools were included during the
study period. Five forms were incomplete and therefore excluded.
The ages of the remaining 615 teachers ranged between 21 and 59
years (mean 36, SD 7.9), with 53% being females. Most teachers
(79%) were of Saudi Arabian nationality and 66% had a college or
university degree. Their years of experience ranged from 1 to 35
(mean 13.5, SD 8.6 years). Only 17% of the teachers felt very well
informed about epilepsy on the Likert scale (Fig. 1), mostly from
the media, relatives, and personal experience. Teachers were able
to correctly identify many aspects of epilepsy in terms of etiology
and symptoms, however, several weak aspects of knowledge and
negative attitudes were encountered as summarized in Table 1.
Teacher’s age, gender, years of experience, or type of school did not
correlate significantly with their knowledge about epilepsy.
However, teachers with higher education (college or university
degrees) were more likely to have good knowledge (moderate or
very well on the Likert scale) when compared to those with less
education (57% vs 21%, p = 0.009). Teachers of Saudi nationality
were also more likely to report good knowledge when compared to
those of other nationalities, independent of their educational level
(67% vs 52%, p = 0.013). This correlated with their attitudes, as
281
Positive
answer
59%
27%
25%
22%
21%
47%
42%
28%
27%
25%
18%
Fig. 1. Results to the Likert scale item that examined the degree of knowledge about
epilepsy.
Saudi teachers were less likely to think that children with epilepsy
have lower intelligence (p = 0.002), should be placed in a special
classroom or school (p = 0.0001), or that they should not
participate in sport activities (p = 0.04).
Overall, teacher’s attitudes correlated highly with their
knowledge. Those with good knowledge were less likely to mind
having a child with epilepsy in their class (p = 0.028) or think that
they should be placed in a special classroom (p = 0.029). On the
other hand, teachers working in private schools were more likely to
mind having a child with epilepsy in their class (p = 0.02), think
that they should be placed in a special class (p = 0.004) or special
school (p = 0.0001) when compared to teachers in public schools.
Overall, 28% of the teachers have encountered a child with epilepsy
in their class. At the time of the questionnaire, this group had better
knowledge than teachers who never encountered such a situation
(p = 0.0001). The first encounter of some of these teachers (14%)
was during an acute seizure in the classroom. At that time, most of
them (58%) did not know what to do and the majority felt that
putting something in the student’s mouth to prevent tongue
swallowing was a correct maneuver. Teachers with good
knowledge were more likely to report that they know what to
do in such acute seizure situation (p = 0.0001).
4. Discussion
This study evaluated a number of aspects of primary school
teacher’s knowledge and attitudes toward epilepsy. Only 17% of
the teachers felt very well informed and many had negative
attitudes and misconceptions about epilepsy. Many teachers felt
that the intelligence of children with epilepsy is below average and
that these children should be placed in a special classroom or a
special school (Table 1). Although these teachers were highly
educated and quite experienced, up to 27% continued to believe
that spirit possession or evil eye are causes of epilepsy. A recent
study from a different region of Saudi Arabia found that possession
by demons (Jinns) is still believed to be a cause of epilepsy among
40% of university-educated school teachers.15 We had a lower
percentage reflecting possible regional variations. Another Saudi
study revealed that 14% of the public believed that epilepsy is
infectious and 8% believed that epilepsy was a type of mental
illness.16 It is clear that the level of epilepsy awareness in the Saudi
population needs improvement.
Ours findings confirms that teachers have insufficient knowl-
edge about epilepsy, inadequate training, and erroneous acute
seizure management. This is similar to what has been previously
reported by many international studies.7–14 In a study from
Taiwan, more than 30% of participants thought epileptic seizures
282 A.S. Abulhamail et al. / Seizure 23 (2014) 280–283
were associated with insanity and had problems in the acceptance
of children with epilepsy.7 In a study from Thailand, 38% of the
primary school teachers had not heard of or read about epilepsy
and 15% preferred to place all children with epilepsy in a special
classroom.8 Even in developed countries, most teachers do not feel
confident when teaching children who had epilepsy and some
considered their knowledge of the subject to be adequate.9
Overall, teacher’s attitudes correlated highly with their
knowledge. As one would expect, those with good knowledge
were less likely to have negative attitudes. This correlation is
documented by several authors from different countries.17–20 In a
study from Korea, teachers’ knowledge was the most important
factor influencing teacher’s attitudes toward epilepsy.17 Others
found stronger negative attitudes with up to half of the teachers
opposed having a child with epilepsy in their classes because they
feared a child having a seizure during class and they felt that they
lacked knowledge of first-aid for seizures.18 In addition, teachers
who had inaccurate knowledge of epilepsy demonstrated negative
attitudes toward the marriage and employment of persons with
epilepsy.18 A recent study from Nigeria found significant deficits in
the general knowledge about epilepsy and first aids measures in
the classrooms even in those with high level of education.19 Even in
developed countries, such as Italy, 33% considered epilepsy a
limitation for marriage, 25% for having children, 40% for regular
employment, and 33% for sports and leisure activities.20 In this
study, 66% of the teachers declared they were unable to manage a
seizing child, 25% were convinced that epilepsy impairs learning,
and 26% believed that it carries mental/behavioral alterations.20
We were unable to find any correlations between teacher’s age,
gender, years of experience, or type of school with their knowledge
about epilepsy. Other studies have found an association with more
years of teaching experience and female gender.21–23 On the other
hand, a Turkish study found young teacher’s age and male gender
predictive of positive attitudes.24 Interestingly, we found that
teachers of Saudi nationality were more likely to report good
knowledge, independent of their educational level. One could
relates such finding to over-reporting, however, this association
may be genuine as our Saudi teachers were less likely to have
negative attitudes such as thinking that children with epilepsy
have lower intelligence, should be placed in a special classroom or
school, or that they should not participate in sport activities.
Interestingly, teachers working in private schools were more likely
to have some negative attitudes toward children with epilepsy,
which may be related to lowered tolerance for children with such
chronic disorders in our private schools. These teachers should be
targeted with educational programs. Most teachers (58%) did not
know what to do during an acute seizure. However, those with
personal epilepsy experience were more likely to report that they
know what to do in such acute situation. Consistent with our
finding, other authors found that teachers with personal experi-
ence of epilepsy had greater knowledge of the illness.25
There are some limitations to our study. Our sample may not be
representative of all teachers working in Saudi Arabia as it only
included those from the Jeddah area. This will limit our ability to
generalize our findings to Saudi Arabia or other neighboring Arab
countries. However, our sample is large and included public and
private schools with representation of all ages, experiences, and
equal gender contribution. Another possible limitation is the
inability to generalize from our finding to all teacher categories as
we did not include secondary or high school teachers. We selected
primary teachers due to the importance of these early stages in the
school career of children with epilepsy and their psycho-social
development. It will be interesting to evaluate teachers from
higher school grades and also assess less urbanized regions of our
country. In addition, replication of the questionnaire in the Middle
East is needed.
We conclude that primary school teacher’s knowledge needs
improvements. Their attitudes correlated highly with their
knowledge. Therefore, focused education and training about
epilepsy are needed during the preparation of school teachers.
Several studies have documented that such educational courses
resulted in significant improvements of teacher’s beliefs and
attitudes.26,27 Existing epilepsy resources, available through
national epilepsy societies should be made accessible to all
teachers. Public educational epilepsy campaigns should be
encouraged as this can improve the quality of life of children
with epilepsy and their families by helping to develop a well
informed and tolerant community.
Acknowledgement
The authors acknowledge with thanks the statistical assistance
and advice of Dr. Bakr M. Bin Sadiq, King Faisal Specialist Hospital
and Research Center in Jeddah.
Appendix A. Supplementary data
Supplementary data associated with this article can be found,
in the online version, at http://dx.doi.org/10.1016/j.seizure.2013.
12.010.
References
1. Jan MM. Clinical review of pediatric epilepsy. Neurosciences 2005;10(4):255–
64.
2. Seidenberg M, Berent S. Childhood epilepsy and the role of psychology. Am
Psychol 1992;47:1130–3.
3. Williams J. Learning and behavior in children with epilepsy. Epilepsy Behav
2003;4:107–11.
4. Kokkonen J, Kokkonen E, Saukkonen A, Pennanen P. Psychosocial outcome of
young adults with epilepsy in childhood. J Neurol Neurosurg Psychiatry
1997;62:265–8.
5. Sbarra DA, Rimm-Kaufmann SE, Pianta RC. The behavioral and emotional
correlates of epilepsy in adolescence: a seven-year follow-up study. Epilepsy
Behav 2002;2:358–67.
6. Fraser RT, Clemmons DC. Vocational and psychosocial interventions for youths
with seizure disorders. In: Hermann B, Seidenberg M, editors. Childhood epi-
lepsies: neuropsychological, psychosocial, and intervention aspects. New York:
Wiley; 1989. p. 201–18.
7. Hsieh L, Chiou H. Comparison of epilepsy and asthma perception among
preschool teachers in Taiwan. Epilepsia 2001;42:647–50.
8. Kankirawatana P. Epilepsy awareness among school teachers in Thailand.
Epilepsia 1999;40:497–501.
9. Bannon MJ, Wildig C, Jones PW. Teachers’ perceptions of epilepsy. Arch Dis Child
1992;67:1467–71.
10. Mielke J, Adamolekun B, Ball D, Mundanda T. Knowledge and attitudes
of teachers towards epilepsy in Zimbabwe. Acta Neurol Scand 1997;96:
133–7.
11. Dantas FG, Cariri GA, Ribeiro Filho AR. Knowledge and attitudes toward
epilepsy among primary, secondary and tertiary level teachers. Arq Neuro-
Psiquiatr 2001;59:712–6.
12. Madsen LP. Danish primary school teachers’ knowledge about epilepsy in
children. Ugeskrift Laeger 1996;158:1977–80.
13. Prpic I, Korotaj Z, Vlasic-Cicvcaric I, Paucic-Kirincic E, Valerjev A, Tomac V.
Teachers opinions about capabilities and behavior of children with epilepsy.
Epilepsy Behav 2003;4:142–5.
14. Seva-Diaz A, Abad Alegria F, Ferrando L. Epileptics at school. Arch Neurobiol
1986;49:113–20.
15. Obeid T, Abulaban A, Al-Ghatani F, Al-Malki A, Al-Ghamdi A. Possession by ‘Jinn’
as a cause of epilepsy (saraa): a study from Saudi Arabia. Seizure 2012;21:
245–9.
16. Alaqeel A, Sabbagh A. Epilepsy; what do Saudi’s living in Riyadh know? Seizure
2013;22:205–9.
17. Lee SA, Yim SB, Rho YI, Chu M, Park HM, Lee GH, et al. Factors contributing to
Korean teachers’ attitudes toward students with epilepsy. Epilepsy Behav
2011;20(2):378–81.
18. Lee H, Lee SK, Chung CK, Yun SN, Choi-Kwon S. Familiarity with, knowledge of,
and attitudes toward epilepsy among teachers in Korean elementary schools.
Epilepsy Behav 2010;17(2):183–7.
19. Mustapha AF, Odu OO, Akande O. Knowledge, attitudes and perceptions of
epilepsy among secondary school teachers in Osogbo South-West Nigeria: a
community based study. Niger J Clin Pract 2013;16(1):12–8.
 A.S. Abulhamail et al. / Seizure 23 (2014) 280–283
20. Mecarelli O, Capovilla G, Romeo A, Rubboli G, Tinuper P, Beghi E. Knowledge
and attitudes toward epilepsy among primary and secondary school teachers in
Italy. Epilepsy Behav 2011;22(2):285–92.
21. Bishop M, Boag EM. Teachers’ knowledge about epilepsy and attitudes toward
students with epilepsy: results of a national survey. Epilepsy Behav 2006;8:397–
405.
22. Bishop M, Slevin B. Teachers’ attitudes toward students with epilepsy: results of a
survey of elementary and middle school teachers. Epilepsy Behav 2004;5:308–15.
23. Antonak RF, Livneh H. Development, psychometric analysis, and validation of
an error-choice test to measure attitudes toward persons with epilepsy. Rehab
Psychol 1995;40:25–39.
283
24. Aydemir N. Familiarity with, knowledge of, and attitudes toward epilepsy in
Turkey. Epilepsy Behav 2011;20(2):286–90.
25. Brabcova D, Lovasova V, Kohout J, Zarubova J. Familiarity with and attitudes
towards epilepsy among teachers at Czech elementary schools—the effect of
personal experience and subspecialization. Seizure 2012;21(6):461–5.
26. Fernandes PT, Noronha AL, Araújo U, Cabral P, Pataro R, de Boer HM,
et al. Teachers perception about epilepsy. Arq Neuropsiquiatr 2007;65(1):
28–34.
27. Alkhamra H, Tannous A, Hadidi M, Alkhateeb J. Knowledge and attitudes
toward epilepsy among school teachers and counselors in Jordan. Epilepsy
Behav 2012;24(4):430–4.