Volume 27, Issue 5 (3-2019)                   Avicenna J Nurs Midwifery Care 2019, 27(5): 361-369 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Bahiraei N, Dehghani M, Khachian A. The Effect of Educational Program on Self-Management of Patients with Epilepsy: A Randomized Clinical Trial Study. Avicenna J Nurs Midwifery Care 2019; 27 (5) :361-369
URL: http://nmj.umsha.ac.ir/article-1-1974-en.html
1- Department of Medical Surgical Nursing, School of Nahavand Paramedical, Hamadan University of Medical Sciences, Hamadan, Iran
2- Department of Pediatrics Nursing, School of Nahavand Paramedical, Hamadan University of Medical Sciences, Hamadan, Iran
3- Department of Medical-Surgical Nursing, Assistant Professor, Faculty of Nursing and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran , alicekhachian@hotmail.com
Persian Full-Text [PDF 506 kb]   (1092 Downloads)     |   Abstract (HTML)  (14960 Views)

The results of the study indicated that the education has been effective in information, seizure control and safety of people with epilepsy. Implementation of such programs in order to better accommodate people with epilepsy with their illness is recommended.

Extended Abstract:   (880 Views)

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.


Materials and Methods

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.


Conflicts of Interest

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


Type of Study: Original Research | Subject: Nursing
Received: 2018/12/25 | Accepted: 2019/03/4 | Published: 2019/03/27

1. Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Brunner & Suddarht's of textbook of Medical- Surgical Nursing. 12th edition .Philadelphia: Lippincott Williams & Wilkins; 2010.
2. Binagwaho A, Cohen L, Galea S, Grover A, Jabbour S, Jha V, Kickbusch L, Kieny MP, Land MA, Majdzadeh R, Nuwayhid I, Saxena S, Seng CK, Sissay L, Woodward A. Epilepsy.Available at:URL:http: //www.who.int/.Accessed :March 7,2012
3. Masoud SA, Kochaki E. Surveying the family attitude of a patients with epilepsy hospitalized in Shahid Beheshti Hospital in Kashan, 1378-79. Feyz. 2004; 8(1):79-86.
4. Oh A, Thurman DJ, Kim H. Comorbidities and risk factors associated with newly diagnosed epilepsy in the US pediatric population. Epilepsy & Behavior. 2017; 75:230-60 [DOI:10.1016/j.yebeh.2017.07.040] [PMID]
5. Perzynski AT, Ramsey RK, Colón-Zimmermann K, Cage J, Welter E, Sajatovic M. Barriers and facilitators to epilepsy self-management for patients with physical and psychological co-morbidity. Chronic Illness. 2017; 13(3):188-203. [DOI:10.1177/1742395316674540] [PMID] [PMCID]
6. Ferrari CMM, de Sousa RMC, Castro LH. Factors associated with treatment non-adherence in patients with epilepsy in Brazil. Seizure. 2013; 22 (5):384-9. [DOI:10.1016/j.seizure.2013.02.006] [PMID]
7. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuriesin 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859):2197-223. [DOI:10.1016/S0140-6736(12)61689-4]
8. Edward KL, Cook M, Giandinoto JA. An integrative review of the benefits of self-management interventions for adults with epilepsy. Epilepsy & Behavior. 2015; 45:195-204. [DOI:10.1016/j.yebeh.2015.01.026] [PMID]
9. Ashktorab T, Yadollahi S, Safavi Bayat Z, Zayery F. The correlation between self-management behaviors and drug adherence among people with epilepsy in Iran Epilepsy Association. Scientific Journal of Hamadan Nursing & Midwifery Faculty. 2013; 21(2):5-15.
10. Ridsdale L, Wojewodka G, Robinson EJ, Noble AJ, Morgan M, Taylor SJ, et al. The effectiveness of a group self‐management education course for adults with poorly controlled epilepsy, SMILE (UK): A randomized controlled trial. Epilepsia. 2018; 59(5):1048-61. [DOI:10.1111/epi.14073] [PMID] [PMCID]
11. Smithson WH, Hukins D, Buelow JM, Allgar V, Dickson J. Adherence to medicines and self-management of epilepsy: a community-based study. Epilepsy & Behavior. 2013; 26(1):109-13. [DOI:10.1016/j.yebeh.2012.10.021] [PMID]
12. Xiao X, Si Y, Mo Q, Liu Y, Li C, Zhao J, et al. Development and validation of the Chinese Version of the Adult Epilepsy Self-Management Scale (C-ESMS) in Western China. Epilepsy Research. 2018; 144:43-8. [DOI:10.1016/j.eplepsyres.2018.04.014] [PMID]
13. Escoffery C, McGee R, Bidwell J, Sims C, ThroppEK, Frazier C, et al. A review of mobile apps for epilepsy self-management. Epilepsy & Behavior. 2018; 81:62-9. [DOI:10.1016/j.yebeh.2017.12.010] [PMID]
14. Taylor SJ, Pinnock H, Epiphaniou E, Pearce G, Parke HL, Schwappach A, et al. A rapid synthesis of the evidence on interventions supportingself-management for people with long-term conditions. Health Services and Delivery Research. 2014; 2(53):1-580. [DOI:10.3310/hsdr02530] [PMID]
15. Johnson EK, Fraser RT, Miller JW, Temkin N, Barber J, Caylor L, et al. A comparison of epilepsy self-management needs: provider and patient perspectives. Epilepsy & behavior. 2012; 25(2):150-5. [DOI:10.1016/j.yebeh.2012.07.020] [PMID]
16. Dash D, Sebastian TM, Aggarwal M, Tripathi M. Impact of health education on drug adherence and self-care in people with epilepsy with low education. Epilepsy & Behavior. 2015; 44:213-7. [DOI:10.1016/j.yebeh.2014.12.030] [PMID]
17. Noble AJ, Snape DA, Morgan M, Goodacre S, Marson AG, Ridsdale L. PO051 Seizure first aid training for people with epilepsy attending emergency departments, and informal carers.: BMJ Publishing Group Ltd; 2017. [DOI:10.1136/jnnp-2017-ABN.84]
18. Sahebolzamani M, Shakuri A, Aliloo A, Rashidi A. The efficacy of self-care education on knowledge and performance of epileptic patients who referred to selected educational hospitals of Tehran University of Medical Sciences in 2008. The Journal of Urmia University of Medical Sciences. 2010; 20(4):284-9.
19. Dilorio C, Faherty B, Manteuffel B. The development and testing of an instrument to measure self-efficacy in individuals with epilepsy. The Journal of neuroscience nursing: journal of the American Association of Neuroscience Nurses. 1992 Feb;24(1):9-13. [DOI:10.1097/01376517-199202000-00004] [PMID]
20. McLaughlin DP, McFarland K. A randomized trial of a group based cognitive behavior therapy program for older adults with epilepsy: the impact on seizure frequency, depression and psychosocial well-being. Journal of Behavioral Medicine. 2011; 34(3):201-7. [DOI:10.1007/s10865-010-9299-z] [PMID]
21. Kralj-Hans I, Goldstein LH, Noble AJ, Landau S, Magill N, McCrone P, et al. Self-Management education for adults with poorly controlled epilepsy (SMILE (UK)): a randomised controlled trial protocol. BMC neurology. 2014;14 (1):69. [DOI:10.1186/1471-2377-14-69] [PMID] [PMCID]
22. Tong X, Chen J, Park SP, Wang X, Wang C, Su M, et al. Social support for people with epilepsy in China. Epilepsy & Behavior. 2016; 64:224-32. [DOI:10.1016/j.yebeh.2016.08.010] [PMID]
23. Laybourne AH, Morgan M, Watkins SH, Lawton R, Ridsdale L, Goldstein LH. Self-management for people with poorly controlled epilepsy: Participants' views of the UK Self-Management in epILEpsy (SMILE) program. Epilepsy & Behavior. 2015; 52:159-64. [DOI:10.1016/j.yebeh.2015.08.023] [PMID]
24. DiIorio C, Escoffery C, McCarty F, Yeager KA, Henry TR, Koganti A, et al. Evaluation of WebEase: an epilepsy self-management Web site. Health Education Research. 2008; 24 (2):185-97. [DOI:10.1093/her/cyn012] [PMID]
25. May TW, Pfäfflin M. The efficacy of an educational treatment program for patients with epilepsy (MOSES): results of a controlled, randomized study. Epilepsia. 2002; 43(5):539-49. [DOI:10.1046/j.1528-1157.2002.23801.x] [PMID]
26. Aliasgharpour M, Nayeri ND, Yadegary MA, Haghani H. Effects of an educational program on self-management in patients with epilepsy. Seizure. 2013; 22(1):48-52. [DOI:10.1016/j.seizure.2012.10.005] [PMID]
27. Moursy AME, Mekky GF. Effect of self management guidelines for adult patients with epilepsy on their health practices. Life Science Journal. 2015; 12(4):77-64.
28. Wichit N, Mnatzaganian G, Courtney M, Schulz P, Johnson M. Randomized controlled trial of a family-oriented self-management program to improve self-efficacy, glycemic control and quality of life among Thai individuals with Type 2 diabetes. Diabetes research and clinical practice. 2017; 123:37-48. [DOI:10.1016/j.diabres.2016.11.013] [PMID]
29. Seethalakshmi A, Shankar V. Effectiveness of an epilepsy education programme on the self-management among patients with epilepsy. IOSR Journal of Nursing and Health Science. 2015; 4(5):33-54.
30. Yoo H, Kim HS. Development and evaluation of the Empowering A Self-Efficacy (EASE) program for children with epilepsy. Journal of Korean Academy of Nursing. 2015; 45(1):54-63. [DOI:10.4040/jkan.2015.45.1.54] [PMID]

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Avicenna Journal of Nursing and Midwifery Care

Designed & Developed by : Yektaweb