Epilepsy is a syndrome that occurs with recurrent seizure attacks [1]. In addition to appropriate drug treatment, seizure control is dependent on self-management behaviors [10]. Self-management in epilepsy, comprises wide range of adaptive behaviors that patients with epilepsy use to control or reduce the occurrence of seizures. These individuals can contribute to self-management behaviors in the areas of adherence to drug treatment, access to disease information and personal life management [8,12]. However they do not get enough support in terms of self-management behaviors; this leaves people with little knowledge of their illness, especially those with low education [17]. In the context of chronic diseases, including epilepsy, nurses play a key role in raising clients' awareness and providing educational tips that can help clients cope with illnesses and enhance their self-care abilities [21]. Therefore, the present study was conducted to determine the effect of educational program on self-management of patients with epilepsy.

 

This study was quasi-experimental. The statistical population consisted of all patients with epilepsy referred to Epilepsy Society of Iran in 2017. In this study, 90 patients with epilepsy were recruited through convenience sampling method. In this study, demographic information questionnaire (including information about age, sex, marital status, employment status, economic status, residence, education level), disease profile form (including age of diagnosis, duration of illness, other illnesses, family history of the disease, time of last seizure, medication use), and self-management questionnaire for epileptic patients were used. Written consent was obtained from all participants.
Prior to intervention, both experimental and control groups completed the disease profile form as well as demographic and epilepsy self-management questionnaires. The experimental group was then asked to participate in three 1.5-hour sessions of routine training in the community, attended by a researcher at the Epilepsy Society weekly. For this purpose, patients with epilepsy were divided into two groups of 21 and 22. Two subjects in the experimental group were excluded from the study because of not participating in all training sessions and one of the control group due to withdrawal from the study. Finally, 43 patients in the experimental group and 44 patients in the control group participated in the study. During the training intervention for the experimental group, the control group received only routine epilepsy training. Six weeks after the last training session, both groups completed the questionnaires and the disease profile form.

The results showed that there were no significant differences between the two groups in terms of demographic variables and disease characteristics. Data on demographic variables and disease characteristics are fully listed in Table 1.

Table 1. Comparison of demographic variables of people with epilepsy by test and control group

According to the results of the paired t-test, there was a significant difference in the experimental group regarding the dimensions of medication self-management, information, safety, lifestyle and seizure before and after the intervention (P<0.05), while the control group had a significant difference in self-management. There was no significant difference between the two groups before and after the intervention (P<0.05). Also, the results of independent t-test showed that before the intervention, the two groups did not show significant differences in the dimensions of drug self-management, information, safety, seizure and lifestyle (P<0.05) but after the educational program, self-management in both groups showed significant differences in these dimensions (P<0.05) (Table 2).

Table 2. Comparison of safety self-management dimension, seizure and information before and after educational intervention in experimental and control group

The purpose of this study was to determine the effect of educational program on self-management of people with epilepsy. The results showed that the mean score of seizure control, safety, information, lifestyle, and medication in the experimental group before and after the intervention was significantly different.
In a study, Kralj-Hans et al. also showed that self-management training program has a positive effect on improving quality of life, seizure rate, adherence to treatment, managing drug side effects, and improving self-efficacy in people with epilepsy [21]. In the study of Dilorio et al., (2008) after 6 weeks of internet education intervention, despite increasing adherence to the medication regimen, the scores of other self-management and general self-management dimensions did not change significantly (P=0.098) [24]. The reason for the lack of impact of Internet education on overall self-management seems to be the lack of coverage of the curriculum; that is, the intervention focuses only on pharmacological self-management, stress, and sleep self-management and has not addressed the rest of its dimensions. It seems that the different method of education in the present study from the one in the present study may be an important reason for contradicting the results of the two studies, because considering the advantages of face-to-face education and educational and learning problems in patients with epilepsy, the use of The face-to-face education used in this study can have more benefits than online education. In the study of Seethalakshemi et al., three months after the intervention, the mean score of self-management in the intervention group increased in all dimensions of self-management, but six months after the intervention, the mean scores of self-management in all dimensions except for safety factor (P<0.001) increased [29]. The results for the six months following the intervention are inconsistent with the results of the present study and may be because the stability of learning self-management behaviors requires a longer intervention.
The results of another study showed that after the intervention, self-efficacy of 10 to 15 year old children with epilepsy was not significantly different between the experimental and control groups [28]. Perhaps different results may be due to the intensive training intervention in this study over a day. Also, the difference between learning age groups of children and adults can be mentioned as a possible cause of these differences in the findings.

 

According to the findings of this study, education has a positive effect on self-management behaviors of patients with epilepsy. One of the goals of nursing education is to plan the necessary care to meet the needs of people with chronic diseases, including epilepsy. Therefore, the findings of the present study can be considered to pay more attention to the importance of education and awareness in patients with epilepsy.

 

The present study is part of a Master's thesis entitled "The Impact of Family-Based Approaches on Self-Management Behaviors of Epilepsy Patients" with Code of Ethics IR.IUMS.REC1395.9311686005 approved by the Ethics Committee of Iran University of Medical Sciences and Research Center No. 19812.
We would like to thank the esteemed colleagues of Iran University of Medical Sciences, Iranian Epilepsy Society and Research Vice President and members of the Faculty of Nursing and Midwifery, Faculty of Nursing and Midwifery of Iran University of Medical Sciences, as well as all patients who participated in this study.

 

The authors declared no conflict of interest regarding the publication of this article.