Knowledge, Attitude, And Practice Among The Practitioners Regarding Epilepsy In Bhutan- A Rural And Remote Country

Background: The correct knowledge and attitude among the practitioners is key to provide good quality patient care on epilepsy. The objective was to assess the knowledge-attitude-practice on epilepsy among various medical workforce in Bhutan. Methods: A one-day face-to-face training was organized on the diagnosis of epilepsy and treatment course with suitable prior advertising and public invitation to participate. Those interested were requested to answer a short questionnaire on various aspects of epilepsy before the start with 17 items related to socio-demography, level and source of knowledge on epilepsy, etiological nature, contagiousness, relation to past life/sins, warning signs and precipitants of seizures, encephalogram, definitions of epilepsy and active epilepsy, first-aid and epilepsy management, treatability of epilepsy, with two feedback questions. Results: A total of 65 (57.0% males) subjects successfully completed their necessary pre-event questionnaire. Of them 72.0% were lecturer or clinician, 22.0% were nurses, 3.0% were from medical administration, and 3.0% were traditional practitioners. The positive aspects were: none recognised epilepsy as contagious or epilepsy related to the past life or sins, including traditional medicine participants. All responded favorably to that they found this event useful and this event added something meaningful to them personally or professionally . All participants responded positively to do you know what epilepsy is , although it was clearly not the case. The negative aspects were: 38.0% participants reponded electroencephalogram as essential in the diagnosis of epilepsy. For 6.0% participants, inserting an object in the mouth is the first they would do if they see an epilepsy patient. A 48.0% of participants could not identify correct definition of epilepsy, and about 90.0% participants could not recognise the correct definition of active epilepsy. About 68.0% participants recommended modern treatment alone, while 20.0% recommended a mix of both modern and traditional treatment and 3.0% recommended traditional treatment alone. Additionally, after excluding items with low (<0.4) item-test correlation, the alpha coefficient was found to be 0.81. The factor structure showed a two factor model fit with cumulative variance of 81.6%, coefficient of determination of 92.6%, and CFI of 0.81. Perspectives:(a) Multi-lingual short course structured modules on epilepsy (print and online) for allocation (on fee or free) to institutions in and outside Iran; (b) Academic-cum-advocacy annual exchange for in-person annual training on epilepsy; (c) Field exposure on epilepsy through field research projects, as well as (d) First-ever Iranian Journal on epilepsy, for which the process is underway. Conclusions: Although all participants reponded that they know what epilepsy is, important gaps on the knowledge of epilepsy were found. Fortunately, there were no stigmatizing attitudes about the nature of epilepsy or its treatment among our participants.Our work emphasizes the need for multi-purpose structured educational-cum-advocacy programs, which can ameliorate knowledge and professional development among the practitioners in order to improve the quality of epilepsy care.