اثر برنامه آموزش بهداشت بر خود مدیریتی در بیماران مبتلا به صرع

Purpose Self-management majorly determines the health status of patients with epilepsy because the most important strategies for controlling seizures include receiving and adhering to prescribed therapies, and making appropriate lifestyle adjustments. Patients with epilepsy have various educational needs and must adopt many self-management behaviors to control their condition. This study was a clinical trial that evaluated the effects of an educational program on self-management in patients with epilepsy. Methods Participants (n = 60) were recruited from the Neurology Clinic in Zanjan, Iran. Patients were randomly assigned to the intervention and control groups (n = 30 in each). The intervention group received four educational sessions on epilepsy, including a self-management plan. All participants completed the Epilepsy Self-Management Scale before the intervention and 1 month post-intervention. The chi-square test, Fisher's exact test, independent t-test, and paired samples t-test were used to compare the groups. Results At baseline, demographic characteristics and self-management scores did not differ significantly. One month after the intervention, self-management scores differed significantly (p < 0.001) between the two groups. Conclusion The educational program had beneficial effects on self-management behaviors in patients with epilepsy.

Epilepsy is one of the most common chronic neurological conditions, secondary only to headache.1 According to a report of the World Health Organization (WHO), approximately 50 million people worldwide have epilepsy.2 The incidence is approximately 50–70 cases per 100,000 per year, excluding febrile seizures, which have a similar incidence. Age-specific incidence rates are highest in young children and the elderly and lowest in young and middle-aged adults. The lifetime prevalence is between 2% and 5% of the population.3 and 4 Epilepsy is both a medical diagnosis and a social label that affects life physiologically, psychologically, and socially.5 In fact, as a group, patients are affected more strongly by social and psychological aspects related to epilepsy than by seizures themselves, and many studies indicate that patients with epilepsy have a lower annual income, a lower quality of life, poorer school performance, social stigma, and low self-esteem; thus, 75% of patients with epilepsy have serious adjustment problems.6 and 7 There is a linear relationship between seizure severity and psychosocial problems. In addition, achieving full seizure control seems to be the most important factor in decreasing psychosocial problems. Based on the scope of the reported psychological and social problems associated with epilepsy (adjustment, self-image, unemployment, financial distress, insurance issues, and stigma), it is reasonable to conclude that this disease has a major impact on the patient, his or her family, and the society as a whole. Therefore, better seizure control is essential for patients with epilepsy and the society.7 Traditional medical care of patients with epilepsy tends to focus on seizure control through drug treatment and surgical interventions.8 Recently, it has been widely acknowledged that comprehensive epilepsy treatment goes far beyond medication.9 In 1997, the Centers for Disease Control and Prevention (CDC-P) began crafting a public health agenda in this area, which culminated in the 2003 Living Well with Epilepsy II conference sponsored by the Epilepsy Foundation, CDC-P, and other epilepsy organizations. A number of priority recommendations resulting from this conference were directly related to self-management research in epilepsy.10 Self-management in patients with epilepsy refers to adaptive health behaviors and activities that an individual can perform to promote seizure control and enhance well-being.11 Kobau and Dilorio describe behavioral and psychosocial adjustments made by patients with epilepsy to control seizures and attain a higher quality of life. Behavioral adjustments include medication adherence, adequate sleep, good nutrition, and stress reduction. Coping with the loss of independence and dealing with embarrassment and stigma are psychosocial adjustments. All these adjustments comprise self-management behaviors.12 Patients’ diligence in adhering to their medication regimen as well as non-drug-related behavioral factors such as management of information, concern for personal safety, management of the seizures themselves and lifestyle issues play an important role in the overall success of epilepsy therapy.13 The findings of previous studies on self-management in epilepsy indicate that self-efficacy is the primary determinant of general epilepsy self-management and that people with high self-efficacy levels are more successful at managing self-care tasks such as taking medications, avoiding triggers for symptoms, and monitoring health status.14

Within one of month the start of recruitment. 106 patients with epilepsy had been referred to the Valiasr Hospital in Zanjan. Of these, 66 patients met the inclusion criteria, were initially entered into the study and randomized to the control (33 patients) or intervention groups (33 patients) using a table with random numbers. Three patients in the treatment group left the study prematurely because they failed to participate in the self-management training sessions. Three patients were excluded from the control group because they failed to complete the post-test questionnaire. After these exclusions, data from 60 participants was available for analysis, 30 in the control group and 30 in the intervention group. The participants were aged between 18 and 53 years [mean = 26, standard deviation (SD) = 8.02] (Table 1). Fifty percent were female, more than half were single (61.7%), less than half were employed (41.7%), 96.7% reported having a generalized type of seizure, 51.7% noted having a seizure within the previous 30 days, and most (70%) were on monotherapy regimes (Table 1). No statistically significant differences were noted between the intervention and control groups with respect to any personal or clinical characteristics (Table 1).