The purpose of this survey was to elaborate teachers' knowledge and attitudes towards epilepsy and determine whether further epilepsy knowledge and first-aid training are required. Assessing teachers’ knowledge about epilepsy is an important issue in determining their attitudes towards children with epilepsy [17].
Overall staff knowledge about epilepsy is low. Epilepsy can be controlled with medication, but only 30.7% of the staff believe that epilepsy can be cured or controlled in this way. This rate was similar to the one found in survey in Togo [18], where only 30% of caregivers recognized that epilepsy could be cured by using medicines. However, Ibinga et al. reported that 42.8% of the staff in their survey thought that epilepsy could be treated by modern or traditional medicine [15]. Seventeen percent of the staff in this survey thought that epilepsy is an infectious disease, which is higher than the same figure in a survey (10%) from Ethiopia [11]. This misconception among school teachers has an impact on discrimination and social stigma towards school children, with negative consequences on their lives as a result [11]. The results of this survey indicate that the overall knowledge of staff members about epilepsy is lacking, as evidenced by the low but visible frequency of incorrect responses about how to work with children with epilepsy. When they have encountered a child experiencing a seizure in the past, only 17.6% of teachers applied first aid, which may be because the teachers lack knowledge about appropriate first-aid for seizures and fear legal consequences in the case of an accident. It is more common for teachers with health-care training to take appropriate first-aid measures than it is for teachers without health-care training to do so, which may be related to the former’s richer first-aid knowledge. In this survey, only 3.9% of teachers had administered the appropriate medicines to a child who was having a seizure. This is similar to the results of an Italian survey, which showed that only 9% of teachers administer such medication to children when they are having seizures [19]. In this survey, 40.1% of the staff members would choose to call an ambulance in the event of a child having a seizure, which is in keeping with other studies; another survey found both that 45% of the teachers would call an ambulance and that they did not have sufficient knowledge of the appropriate first aid [20]. In this survey, the rate of correct answers was particularly low (under 50%) for the questions about putting something inside the person’s mouth and epilepsy being a chronic brain disease that cannot be cured or controlled. These results are in line with those of studies conducted in Hong Kong [21], the USA [22], Korea [23], and France [24]. This survey determined that 69% of the staff would choose to put an object in the mouth of the child to prevent him or her from biting his or her tongue. The staff seemed to be unaware of the danger of putting an object between the teeth of a seizing child [15], and the rate was similar to that of a survey conducted in Germany [10]. In this survey, we compared the proportion of teachers with health-care training and teachers without health-care training who implemented the correct first-aid procedures during a seizure, and we found that it is more common for teachers with health-care training to implement the right measures, such as laying children on their side, than for other teachers to do so. This may be related to the teachers’ professional training regarding health-care. Dumeier et al. demonstrated that education may be useful in improving those issues, and the rate of teachers in their survey who would place something solid in a seizing child's mouth decreased from 13–7% after a 40-minute training session [25]. This shows that training on epilepsy knowledge is very useful. In some countries, including Italy [26], Nigeria [27], and Germany [25, 28], teachers have been trained on how to handle epileptic episodes, and the results have indicate that carrying out epilepsy knowledge training has a great effect on improving the appropriateness of teachers' first-aid measures for seizures and their attitudes towards children with epilepsy.
In this survey, most of the staff members’ attitudes towards children with epilepsy were positive: 63.7% of the staff members allowed their children to survey and play with children with epilepsy, 70.1% of the staff members believed that seizures are not dangerous for other children, and 81.7% of the staff members agreed that most children with epilepsy can attend public school. These findings are similar to another survey that found that the attitudes of teachers towards the enrollment of children with epilepsy in regular schools were positive [15]. However, some staff members’ attitudes towards children with epilepsy were negative: 55.4% of teachers were afraid to have children with epilepsy in the classroom, and they wanted other students to come into the classroom only after the children with epilepsy were controlled or cured. Narita et al. reported that 43% of teachers reacted negatively to the possibility of “having epileptic children in their class” because the teachers fear that such children may have seizures in their classroom, and the teachers will not know what to do [20]. A total of 60.9% of staff members in this survey thought that it is necessary to restrict the activity of children with epilepsy. Another survey indicated that attitudes towards the participation of children with epilepsy in physical activities are particularly negative, as such children have often been advised against participating in sports and exercise out of fear, over protection, and ignorance [29]. Having a better attitude towards epilepsy may be related to exposure, as staff who had acquaintances who had experienced seizures were most likely to demonstrate a positive attitude towards individuals with epilepsy [20]. Teachers who had previously taught children with epilepsy tended to have more positive attitudes in this regard, letting them, for example, play with their own children. Staff members who had previously participated in related training also showed positive attitudes and, for example, let the children with epilepsy participate in activities. Teachers with health-care training are more likely to have a positive attitude and give appropriate first aid to children with seizures. In another survey of Koreans, Dumeier indicated that teachers who had appropriate knowledge about and familiarity with epilepsy showed more positive attitudes [30]. Teachers with health-care training are more receptive to having children with epilepsy in their classrooms. This survey showed that most teachers’ attitudes towards children with epilepsy were positive, but increasing their actual first-aid knowledge and skills regarding epilepsy remains necessary.
This survey results clearly demonstrate that there are grave deficiencies among preschool staff in Shanghai in terms of knowledge about and first aid skills related to children with epilepsy. The level of first-aid knowledge among such staff was low, and more effort should be made to increase epilepsy training for preschool staff members. The lack of formal and effective training in teacher preparation programs coupled with a lack of continuing education requirements is one possible explanation for these results [31]. Carrying out epilepsy knowledge training with preschool staff can improve their level of first aid knowledge regarding epilepsy and improve their attitudes towards children with epilepsy [25–28]. There is an urgent need for effective measures to educate staff on epilepsy and give them training in relevant first-aid practices.
This survey has several limitations. First, the investigation of 1069 staff members in Shanghai is not representative of other parts of China because there are socioeconomic disparities between China's western and eastern provinces. Second, we investigated the level of knowledge among staff members by a written, self-report questionnaire, and thus no practical skills could be tested in this setting and the answers were most likely subjective. Last, this local cross-sectional survey cannot be generalized to other countries.