Attitudes of professionally active adults towards patients with epilepsy. Pilot study

The attitude is reflected in the tendency to react in a certain way to a given stimulus (Mishra, 2018). This can be an object, an animal or a person, e.g. a person with epilepsy. Moreover, the stimulus is a result of three elements: knowledge, emotions and behaviour. The cognitive component refers to beliefs, the affective component represents the emotions the observed subject evokes, whereas the behavioural component represents our actions performed as a result of the two previous elements.

Attitudes are shaped throughout life. Initially, we are influenced by parents, teachers and a peer group, and in the later periods of life we tend to be influenced by people we meet, e.g. in the workplace, or as a result of shared interests. This process is explained by the theory of social learning, according to which attitudes are formed by imitating the models we choose (Hjerm et al., 2018; Mishra, 2018). In fact, attitudes may correspond to the general social norms or be group-specific (Hjerm et al., 2018). Negative attitudes result from incorrect components, i.e. stereotypes, prejudice and discrimination (Altmann, 2008; Mishra, 2018). The most common cause of prejudice is the uncritical transfer of the characteristics found in the entire group to individuals, without taking into account their individual differences, where the belief whereby all patients suffering from epilepsy have cognitive disorders can constitute an example (Brodie, 2003; Altmann, 2008). People are stigmatized if they present a trait which, in the group’s opinion, is badly perceived, such as epileptic seizures (Jacoby et al.,1978). Negative attitudes become stronger when the stigmatised person shares the same beliefs as the individuals evaluating that person (Brodie, 2003). Certain stereotypes still persist today in the group of people with epilepsy and in their families, such as the belief that individuals suffering from epilepsy should not have children or have no professional career development. Unfortunately, such an attitude reinforces low self-esteem and social isolation (Obeid, 2008; WHO, 2010). In fact, people with epilepsy abandon social contact and remain at home for fear of a social reaction to a generalised epileptic seizure (WHO, 2010). This, in turn, contributes to the development of aggression, anxiety and depression (Mlinar et al., 2016; Mishra, 2018).

There are a number of reasons for stigmatising the chronically ill, such as the relatively late introduction of regulations (also in the developed countries) prohibiting discrimination against people with various health disorders and disabilities in public areas, such as admission to school or employment (Obeid, 2008). Discrimination contributes to the withdrawal from social activity of individuals who are not accepted. Such forced isolation is not conducive to confrontation and, thus, to a better understanding of people with particular health disorders, including epilepsy. Research conducted in this area indicates that living with people suffering from epilepsy favours changing attitudes and rejecting the myths associated with this disease (Talarska et al., 2014).

As a chronic disease, epilepsy affects various aspects of human life. One of the areas of importance for patients is the psychosocial sphere. On an individual level, a well-developed social integration means active participation in social life, the development of abilities and an increase in prosperity through employment and, globally, a contribution to the economic development of the country (Mlinar et al., 2016).

Unemployment and under-employment of individuals with epilepsy occurs in many countries, including the highly developed (Brodie, 2003; WHO, 2010). Although the situation of people suffering from epilepsy has been improving, they continue to report difficulties in employment and suffer discrimination in the workplace (Murphy, 2017; Muller-Heyndyk, 2019). One stereotype is that people with epilepsy are more likely to take sick leaves and to have accidents at a workplace. Nevertheless, research in Ireland has demonstrated that the prevalence of these phenomena in healthy people is comparable (Murphy, 2017). Discrimination (stigmatisation) contributes to social exclusion with all its negative consequences and is seen as a determinant of poor social prognosis (Mlinar et al., 2016).

The aim of the study was to answer the following question: What attitudes towards patients with epilepsy are declared by adults undertaking professional activity?

This research study which has been undertaken in adults living in the Greater Poland Voivodeship 10 years after an earlier study was undertaken has revealed that the level of knowledge among respondents has increased, but first aid education is still necessary (Talarska et al., 2014). The lack of knowledge with regard to the rules of conduct during a generalised epileptic seizure is often reported in the studies analysing attitudes or the level of knowledge about epilepsy (Elhassan et al., 2017; Abbasi et al., 2019; Assadeck et al., 2020). Therefore, respondents and researchers often request that education be provided on the specificity of the disease and the rules for providing help during a seizure (Santos et al., 1998; Njamnshi et al., 2009; Abbasi et al., 2019; Assadeck et al., 2020). In our current research, the lowest score has been given to the part relating to the declared behaviour. Respondents would not marry a person suffering from epilepsy but would also object to such marriage to their closest family member. Furthermore, people with epilepsy themselves also emphasize the negative impact of the illness on finding a partner and starting a family (Mlinar et al., 2016). The positive attitude towards people with epilepsy usually refers to the functioning of the sick person in their further environment, however, it deteriorates when they refer directly to the subjects (Shehata, Mahran, 2011; Talarska et al., 2014; Kiwanuka, Olyet, 2018; Dargie et al., 2019; Akça, Kurt, 2020). The majority of positive answers were given to the question concerning friendship with a person suffering from epilepsy, a trend which can be observed also in other research studies.

Women, respondents who have completed higher education, are single, and those who work intellectually in our research would be more likely to employ people suffering from epilepsy and also have a more positive perception of the affected individuals. Furthermore, the positive impact of education and female gender was also observed by other researchers (Santos et al., 1998; Karimi, Akbarian, 2016; Kiwanuka, Olyet, 2018; Dargie et al., 2019). In addition, the attitude is positively influenced if the respondents know a person suffering from epilepsy and if they have more knowledge about the disease (Talarska et al., 2014). In contrast, the low socio-economic status favours prejudice.

In comparison with the previous study, the perception of people with epilepsy as employees has improved. In the previous research 88% of the respondents believed that people with epilepsy should be employed, whereas now it amounts to 96%. Moreover, previously 80% of the respondents would be willing to work with a person suffering from epilepsy, now it has increased to 88%. In 2012 in Poland about half of people with epilepsy of working age were employed. What is more, they did both intellectual and technical work (Majkowska-Zwolińska et al., 2012).

In the UK, the 2018 report on the economic activity of the population indicated that more than half of people with epilepsy are not economically active. Despite anti-discrimination laws, individuals suffering from epilepsy are more than twice as likely to be unemployed compared to the rest of the population (Muller-Heyndyk, 2019). In addition, the study also revealed a lack of adequate knowledge among employers. The main cause of restricting the employment of people with epilepsy is the fear of having an epileptic seizure at work and the resulting risks (Jacoby et al., 2005; Murphy, 2017, Muller-Heyndyk, 2019). In fact, people suffering from epilepsy often conceal the disease from their friends and employers for fear of negative reactions (Jacoby et al., 2005; Mlinar et al., 2016). On the other hand, many employers stress the need to obtain information about the disease during job interviews (Talarska et al., 2014; Murphy, 2017). As a result, they could take measures to improve the safety and efficiency of work for employees with epilepsy, for example, by transferring part of their duties to other workers, giving extra breaks, offering flexible working hours or working from home (Jacoby et al., 2005). According to our study, as well as to other authors, employers of larger companies more often declare the possibility of employment (Jacoby et al., 2005).

The significance of work in the lives of people with epilepsy can be demonstrated in the study by Clarke et al. (2006), which compared employed and unemployed people with epilepsy. Individuals who were not professionally active stressed that work increased self-esteem and provided opportunities for independent living. However, they also emphasised that their families did not encourage them to take up employment; they did not have a proper education or feared that they would jeopardise their co-workers in the event of a seizure.

The authors concerned with attitudes towards people with disabilities point out that not only educational programmes and legislation are important in order to reduce discriminatory behaviour, but also well-thought-out strategies based on the cooperation of all sources affecting society, such as school education, the media, associations working for the benefit of people with disabilities, lawyers or employers’ associations (Mishra, 2018). The change of attitudes requires a longer period of time and requires the involvement of the majority of society (Mlinar et al., 2016).

Majority of people participating in the study showed a positive attitude. The study group had biggest difficulty answering questions about first aid and direct relations with the patients. Women, respondents with higher education, single and those who do intellectual work have a better perception of people with epilepsy. Most employers declared their willingness to employ a person with epilepsy. White-collar workers and women would employ more willingly and collaborate with a person with epilepsy.