Objective: This systematized literature review identified reports describing epilepsy misconceptions in the developed Western countries and research interventions focused on reducing these misconceptions. Materials and Methods: English language publications from January 2004 to January 2015 that described original research conducted in Europe, North/Central/South America or Australia on misconceptions about epilepsy among the general public. Results: 81 publications were selected. Most studies were conducted in the Americas (N=30) and Europe (N=31). Misconceptions and attitudes about epilepsy were assessed among clinical providers (N= 9), family members of people with epilepsy (PWE, N=5), teachers (N= 11), students (N=22), and the general public (N= 25). Most studies used structured questionnaires, sometimes adding open-ended questions. Misconceptions reflected socially exclusionary attitudes directed at PWE, ignorance about treatment, and over-generalizations that are stigmatizing when applied to all PWE. Misconceptions were more prevalent in those with less education, lower socioeconomic status, and no exposure to PWE. There were only 12 intervention studies. While intervention studies were generally effective in improving attitudes, many were targeted to healthcare and education settings, were time intensive, and impractical for broad general population implementation. None incorporated newer technology-based strategies regarding effective health communication approaches. Conclusions: Types of epilepsy misconceptions were similar in reports published over the last decade, although most referred to misconceptions that have already been previously described. Existing questionnaires may fail to identify more subtle forms of current misconceptions and negative attitudes. Few interventional studies specifically target epilepsy stigma. Practical and broad scalable approaches to de-stigmatize epilepsy may help reduce misconceptions.
Background: There are thousands of fitness-related smartphone applications ("apps") available for free and purchase, but there is uncertainty if these apps help individuals achieve and maintain personal fitness.Technology usage attrition is also a concern among research studies on health technologies.Methods: Usage of three fitness apps was examined over 5 months to assess adherence and effectiveness.Initially, 64 participants downloaded three free apps available on Android and iOS and 47 remained in the study until posttest. With a one group pre-posttest design and checkpoints at months 1, 3, and 5, exercise and exercise with fitness apps were examined in the framework of the Theory of Planned Behavior (TPB) using a validated survey. Apps were selected based on their function from the Functional Triad. Perceived fitness was also measured. T-tests, sign tests, Fisher's exact tests, and linear and logistic regression were used to compare pre to posttests and users to non-users of the apps.Results: Forty-seven participants completed both pre and posttests. Individual item scores indicated no significant change pre to posttest except for decreases observed in usefulness of using apps for exercise (attitude) (−0.78, P<0.01), peer influence on exercise (subjective norm) (−0.51, P<0.05), peer influence on exercise with apps (subjective norm) (−1.02, P<0.01), perceived difficulties in exercising with apps (perceived behavioral control) (−1.29, P<0.001), and the expected frequency of exercise with apps over the next 2 weeks (behavioral intention) (P<0.0001 in a sign test). Subscale total scores indicated significant decreases in subjective norm regarding exercise (−0.72, P<0.05), subjective norm regarding exercise with apps (−1.72, P<0.01), and perceived behavioral control over exercising with apps (−2.56, P<0.01) between pre and posttest.When comparing app users (n=32) to non-users (n=15), there was only a significant difference in subscale total scores at posttest for attitude toward exercising using apps, which was significantly more favorable among users than non-users (32.3 vs. 27.6, P<0.05). Fitness perception did not change over 5 months regarding cardiovascular fitness, strength, endurance, flexibility, or body composition. Technology usage attrition was desirable at 31.9%.Conclusions: App usage and effectiveness appears to have a connection to usefulness (attitude) and to perceived difficulties of exercising using apps (perceived behavioral control). Exercise and exercise using apps are not influenced by peer influence (subjective norm). Intention to exercise using these particular apps decreased (behavioral intention). Those who utilized the apps were more likely to have a positive attitude about the apps. Usefulness and perceived difficulties in particular should be considered with future app development.App usefulness and ease of use may be facilitated by using health behavior theories to guide development.
Summary: Objective: Epilepsy is a common neurological condition that is often associated with stigmatizing attitudes and negative stereotypes among the general public. This randomized controlled trial (RCT) tested two new communication approaches targeting epilepsy stigma vs. an education-alone approach Methods: Two brief stigma-reduction videos were developed, informed by community stakeholder input; one highlighted role competency in people with epilepsy; the other, social inclusion of people with epilepsy. A control video was also developed. A web-based survey using a prospective RCT design compared effects of experimental videos and control on acceptability, perceived impact, epilepsy knowledge, and epilepsy stigma. Epilepsy knowledge and stigma were measured with the Epilepsy Knowledge Questionnaire (EKQ) and Attitudes and Beliefs about Living with Epilepsy (ABLE) respectively. Results: 295 participants completed the study. Mean age was 23.1 (SD 3.27) years, 59.0% male, 71.4% white. Overall, respondents felt videos impacted their epilepsy attitudes. EKQ scores were similar across videos, with a trend for higher knowledge in experimental videos versus control (p = 0.06). The role competency and control videos were associated with slightly better perceived impact on attitudes. There were no differences between videos on ABLE scores (p=0.568). There were sub-group differences suggesting that men, younger individuals, whites, and those with personal epilepsy experience had more stigmatizing attitudes. Significance: This RCT tested communication strategies to improve knowledge and attitudes about epilepsy. While this initial effort will require follow-up, we have demonstrated the acceptability, feasibility and potential of novel communication strategies to target epilepsy stigma, and a web-based approach for assessing them.
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