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7
Educating People with
Epilepsy and Their Families
Accurate information for individuals with epilepsy and their families, edu-
cation about the consequences of epilepsy, and skills development in self-
management are essential components for helping individuals become better
partners in patient-centered care. People with epilepsy and their families are
often not educated about epilepsy’s risks, including injury and mortality.
Parents of children with epilepsy need information about the disorder and
available support resources. Children and youth with epilepsy, as they get
older, need increasing information about the disorder and its implications
for their future. Adults’ information priorities relate to employment, driving,
and management of stress; and women need information about hormonal
influences on the disorder and the potential effects of seizure medications on
pregnancy. Older adults also may have specific information needs, given the
likelihood they are taking medications for other chronic health conditions
and have an increased risk of falls. People often rely on health care providers
for this information, and a wealth of information is offered in written form
and online. However, research suggests that both printed and online epilepsy
information is written at too high a literacy level. Actions needed to improve
education for people with epilepsy and their families include evaluating avail-
able educational resources, such as Internet resources and tools; expanding
the reach and dissemination of available resources; engaging people with
epilepsy and their families in developing and testing educational resources;
evaluating, replicating, and expanding the use of self-management programs;
and exploring new opportunities for improving education, such as a central-
ized web resource to connect people with epilepsy to reliable websites and a
certification program for epilepsy health educators.
327
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328 EPILEPSY ACROSS THE SPECTRUM
Our introduction to epilepsy came when we were abruptly woken to the
sound of Savannah shaking and gagging. Doctors called her seizures at-
tacks and spells, but never seizures. . . . [A]s a family living with these
[epilepsy] statistics, what do we need? In the early years, we needed the
facts—like the fact that approximately 33 percent of people with epilepsy
don’t respond to treatment. We lost a great deal of trust in doctors because
of their choice to censor.
–Tracy Dixon-Salazar
T
he diagnosis of epilepsy, although given to an individual, affects the
entire family and its constellation of friendships and other relation-
ships. At onset all are confronted with the immediate need to learn
about the disorder and its management. Receiving helpful information
and education1 in the diagnostic phase of a chronic health condition can
facilitate coping, because early perceptions may affect long-term adjustment
to the condition (Johnson, 2003). Living with epilepsy, its unpredictable
seizures, and its comorbid conditions presents many challenges over time.
Again, continued educational efforts can play a key role in helping people
learn to live with and understand epilepsy and its effects over the life span.
Thus, individuals and families need education and skills building through-
out the course of the disorder, particularly during times of change, such as
an increased frequency of seizures, changes in treatment (e.g., switching
medications, starting a new treatment option, discontinuing a medication
or other treatment option), and major life transitions (e.g., from youth to
adulthood, from adulthood to older adulthood).
This chapter describes goals and priorities for educating people with
epilepsy and their families, their knowledge acquisition needs across the life
span, and methods through which individuals and families currently learn
about epilepsy. It reviews different models, programs, and approaches to
providing epilepsy education that have been developed and contrasts them
with educational efforts in other chronic disease fields, in order to identify
strategies for improvement.
1 Forthis report, the committee conceptualized awareness, information, education, and skills
building as representing a rough continuum of knowledge development regarding epilepsy.
Awareness is often the first step in knowledge development (discussed further in Chapter 8)
and can be targeted to reducing stigma. For some diseases and conditions, awareness suffices
for people in the general public. Information is what the public, to be well informed, needs
to know about epilepsy (or other common medical conditions). Information tends to be gen-
eral but suffices for most people not involved in the care or supervision of individuals with
epilepsy. Education is the goal of efforts to provide more in-depth knowledge that increases
understanding, decision-making capacity, and preparedness for action among people with
epilepsy, families, and caregivers. Skills-building efforts are aimed at helping people acquire
the specific capacities to carry out certain tasks. In the context of epilepsy, skills-building is
often aimed at improving self-management and care provided by family members or other
caregivers and begins with education.
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EDUCATING PEOPLE WITH EPILEPSY AND THEIR FAMIILIES
GOALS AND PRIORITIES FOR EDUCATION
In conceptualizing goals for patient and family education,2 the com-
mittee considered recommendations for health care from the Institute of
Medicine in Crossing the Quality Chasm: A New Health System for the
21st Century. The report recommends that health care in the 21st century
be patient centered, which involves health care providers’ partnering with
patients and families so that the care provided “is respectful of and respon-
sive to individual patient preferences, needs, and values and [ensures] that
patient values guide all clinical decisions” (IOM, 2001, p. 6). As described
in Chapter 4, patient-centered care is the committee’s foundation for an
epilepsy care model. The medical literature supports the importance of a
patient-centered approach and indicates that people prefer patient-centered
care. It even suggests which aspects of patient-centered care are most im-
portant to them. For example, a study of UK patients found that three
important components of a patient-centered approach were “communica-
tion, partnership, and health promotion” (Little et al., 2001, p. 468). For
patient-centered care and physician-patient partnerships to work, consis-
tent, relevant health education efforts for patients and families are required.
Cochrane (1995) emphasizes that epilepsy education helps people with
epilepsy become self-confident, competent in self-management, aware of
their needs, and able to access resources to meet their needs—in other
words, it helps them become better partners in patient-centered care. More-
over, having accurate, in-depth information about epilepsy helps people bet-
ter understand the disorder, prevents misconceptions, and reduces concerns
about stigma. Finally, epilepsy education helps promote optimal well-being
and quality of life. The committee’s vision is for all individuals with epilepsy
and their families to have access to relevant and usable knowledge to meet
their individual needs and allow them to participate effectively in patient-
centered care, to be competent in the management of their epilepsy, and to
attain the best possible physical and emotional well-being.
UNDERSTANDING INFORMATION NEEDS
In patient-centered care, the specific health and quality-of-life needs of
people with epilepsy and their family members must be paramount in guid-
ing the care provided by health professionals; similarly, the information,
2 As noted in Chapter 1, terminology is a challenge for people with epilepsy and for the field
in general. The committee was purposeful in the terms used throughout this report. The com-
mittee recognizes that people with epilepsy and their families should not always be identified
as patients, and throughout the report individuals are usually referred to as patients only when
there is a direct intersection with health care providers or the health care system. However, for
the sake of brevity, the committee uses the phrase “patient and family education” or “patient
and caregiver education” in this chapter.
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330 EPILEPSY ACROSS THE SPECTRUM
knowledge, and skills-building needs of patients and families must guide
educational efforts.
Lack of Knowledge and Familiarity with Epilepsy
At the time of epilepsy onset and diagnosis, most patients and families
probably know as much about epilepsy as the general public does, and
their knowledge does not always improve in the period following diagnosis
(Elliott and Shneker, 2008). Literature reviews and U.S. surveys show that
knowledge about epilepsy among the general public is low (Chapter 8):
• An analysis of the 2002 Porter Novelli HealthStyles Survey re-
sults concluded that only about one-fourth of respondents believed
they were knowledgeable about epilepsy, and only about one-third
thought they knew what to do in the event of a seizure (Kobau and
Price, 2003).
• A large telephone survey of U.S. Spanish-speaking adults found a
similar lack of information about epilepsy and many mispercep-
tions about the causes of seizures, beliefs that people with epilepsy
were dangerous, and the use of unconventional treatments such
as vitamins, herbal remedies, and spiritual healing (Sirven et al.,
2005).
• According to Paschal and colleagues (2005), lack of knowledge
and misperceptions about epilepsy in the African American com-
munity increase the stigma burden on African Americans with epi-
lepsy. Moreover, people with epilepsy reported they had to spend
a substantial amount of time teaching family members about their
disorder.
Research consistently demonstrates that people with epilepsy them-
selves do not have a solid understanding of basic information about the
condition, including knowledge about their diagnosis, seizure precipitants
or triggers, specific seizure type(s), the purpose and potential side effects
of seizure medications, safety concerns, and the risks and potential conse-
quences of seizures (Bishop and Allen, 2007). In one of the few U.S. studies
that examined knowledge about epilepsy among people with the disorder,
less than 60 percent of the questions were answered correctly (Long et al.,
2000). Thirty percent of respondents believed that epilepsy is contagious
or a type of mental disorder. Some of this misinformation had the potential
to affect personal safety; for example, 41 percent of people with epilepsy
believed that something should be put in the mouth of the person having
a seizure, 25 percent thought that women should discontinue medication
when they are pregnant, and 25 percent believed it is safe to drive if they
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EDUCATING PEOPLE WITH EPILEPSY AND THEIR FAMIILIES
double their medication dose before driving, do not drive alone, or pull over
when they feel a seizure coming on (Long et al., 2000).
When children lack knowledge about epilepsy, they are more likely to be
worried and to have more negative attitudes about having epilepsy (Austin
et al., 2006b). Moreover, when parents of children with epilepsy lack ad-
equate knowledge or hold inaccurate beliefs about epilepsy, they may develop
negative attitudes and reduced expectations for their children (Frank-Briggs
and Alikor, 2011).
Knowledge Needs of All People with Epilepsy and Their Families
The literature indicates that all individuals with epilepsy and their fami-
lies need to receive some level of education about the disorder, especially as
it relates to each person’s specific diagnosis and treatment plan. It is espe-
cially important that individuals with epilepsy and their families be given,
preferably in writing, specific information about their syndrome, seizure
type, and treatment plan. A review of literature on health information for
adults with epilepsy by Couldridge and colleagues (2001) identified specific
information needs related to diagnosis and treatment options, medications
and their side effects, seizures and seizure control, safety and injury pre-
vention, and common social and psychological problems. Individuals with
epilepsy and their families also need to be informed about the full range of
comorbid conditions associated with the disorder, including mental health,
cognitive, neurological, and somatic disorders (Chapter 3).
People with epilepsy and their family members may have many fears
when the diagnosis is made. The onset of epilepsy during childhood can
be particularly frightening (Oostrom et al., 2001), and seeing seizures
may make parents believe their child’s condition is life-threatening (Besag
et al., 2005). Children and adults with epilepsy likewise fear that mental
health conditions, injury, or death may ensue (Austin, 2000). To manage
these fears and prevent unnecessary anxiety, people with epilepsy and their
families need complete and accurate information about the comorbidities
and mortality risks associated with epilepsy, including sudden unexpected
death in epilepsy (SUDEP), suicide, the risks of seizure-related injuries,
and the risks of prolonged seizures such as status epilepticus (Ficker et al.,
1998; Kwon et al., 2011; So et al., 2009). Patients and families need to be
made aware of the risk for suicidal ideation associated with seizure medica-
tion, including symptoms of depression and mood changes that should be
reported to health care providers (FDA, 2008).
My son, Tyler Joseph Stevenson, passed away on January 23, 2011, from
a seizure in his sleep at the young age of 20. The more research we do and
the interactions with families who have lost loved ones to SUDEP all share
that they were never advised that their loved one could die from epilepsy
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332 EPILEPSY ACROSS THE SPECTRUM
or a seizure. I knew in my previous research that people with epilepsy do
not normally live as long as others but did not think that Tyler would die
so young.
–Mark J. Stevenson
My son, Dallas, at the age of 5, passed away on January 12, 2011, of
SUDEP. I and many other parents had never even heard of SUDEP until
we lost our child. Physicians don’t want to scare parents, so they don’t
discuss SUDEP, but the medical community has a responsibility to prop-
erly inform patients and parents of SUDEP risk factors. The risk factors
may not always be controlled, but it is only fair to tell parents the risks
that are involved.
–Mylissa Daniels
The majority of families first hear about [SUDEP] upon the loss of their
loved one. Realization of a lack of prior knowledge can have a devastating
emotional impact, not only for individuals bereaved by a death in their
family but also for individuals who first learn of SUDEP after having lived
with epilepsy for some time. Education and communication is paramount
to prevent this.
–Tamzin Jeffs
During its public workshops, the committee heard testimony from
several families who had lost loved ones due to SUDEP; all of the families
reported that health professionals had not discussed SUDEP with them, and
they advocated for SUDEP education and information for people with epi-
lepsy and their families (see excerpts of testimony above). Additional work
is necessary to determine if health professionals need more education and
knowledge about SUDEP generally and if they need more education on how
to discuss this and other sensitive topics related to risks and mortality with
their patients. Hirsch and colleagues (2011) recommended the development
of evidence-based guidelines to inform health professionals of “why, when,
and how SUDEP should be discussed with people affected by epilepsy”
(p. 1937) based on discussion at a 2008 SUDEP workshop hosted by the
National Institute of Neurological Disorders and Stroke. Additionally, the
efficacy and reach of existing SUDEP educational materials designed for
health professionals and individuals with epilepsy and their families needs
to be reviewed and additional materials may have to be developed.
Interviews with UK adults with epilepsy indicated a desire for more
information about a broad range of disease-related topics, including mor-
tality risks (Prinjha et al., 2005). A survey of UK neurologists indicated
that only 30 percent discussed SUDEP with all or a majority of their
patients, and one of the most common reasons for such a discussion was
that the patients requested it (Morton et al., 2006). Similarly, a UK survey
of pediatric neurologists and parents found that 91 percent of the parents
desired information about SUDEP, but only 20 percent of the neurologists
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EDUCATING PEOPLE WITH EPILEPSY AND THEIR FAMIILIES
consistently provided it to all patients (Gayatri et al., 2010). In this study,
61 percent of parents did not want their children to be told about SUDEP,
while 21 percent did. Of those wanting their children to be told, almost
half of the parents wanted to be the ones to tell them, and about one-third
wanted the health professional to do so (Gayatri et al., 2010).
People with epilepsy and their families also need information about
living a healthy lifestyle, not only because of the impact of epilepsy, but
also because of the associated physical comorbidities (e.g., diabetes, heart
disease, high blood pressure). A survey of adults showed that in addition
to information about epilepsy and their treatment, they wanted informa-
tion on self-management, available social and community resources, sup-
port groups, and counseling (Paschal et al., 2007). Box 7-1 provides an
overview of these broad information needs. Having access to information
about healthy lifestyles and community resources is essential for ensuring
that people with epilepsy are able to achieve the best possible quality of
life (see also Chapter 6).
In a survey conducted by Paschal and colleagues (2007), concerns
about stigma were prominent, with 89 percent of respondents perceiving
that the public lacks awareness of and knowledge about epilepsy, 65 per-
cent experiencing stress because of this lack of awareness, and 42 percent
reporting stigma in the general public. Feelings of secrecy, shame, and
worry about stigma also were identified in a qualitative study of children
and adolescents (Lewis and Parsons, 2008). As described in Chapter 6,
stigma has been associated with diminished quality of life. Additional work
is needed to examine the role that educational materials and programs,
support groups, and counseling resources may play in helping individuals
and their families successfully cope with stigma and related concerns, such
as the fear of having a seizure in public.
Knowledge Needs of Children, Adolescents, and
Youth Transitioning to Adulthood
Studies consistently indicate that children and adolescents with epilepsy
need increasing knowledge about their condition over time, tailored to
their growing ability to comprehend the information and its implications.
Empirical evidence suggests that children’s information needs are not being
met. For example, a prospective study indicated that these needs remained
high even 2 years after seizure onset, with 64 percent of children continuing
to have questions about epilepsy’s causes, 64 percent still wanting to talk to
another child who has seizures, and 62 percent wanting more information
about keeping safe during a seizure (Shore et al., 2009).
Children and adolescents want to understand and resolve their fears
related to epilepsy, to understand how it might affect their future, and to
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EXAMPLES OF BROAD KNOWLEDGE AREAS FOR
Box 7-1 PEOPLE WITH EPILEPSY AND THEIR FAMILIES
Basic Educational Needs of All People with Epilepsy
• pilepsy—seizure type, syndrome, causes
E
• reatment and management—options, medications, devices, surgery, dietary
T
modifications, side effects, treatment discontinuation, seizure triggers, risk for
suicidal ideation associated with medications, other management strategies
• afety risks—risk assessment, seizure first aid, injury prevention, equipment to
S
prevent injury
• ortality risks—sudden unexpected death in epilepsy, status epilepticus,
M
seizure-related injury, suicide
• ealthy lifestyle—general health, sleep, fatigue, physical exercise
H
• ossible comorbidities
P
ental health (e.g., anxiety, depression, attention problems, behavior prob-
M
lems, psychosis, seizure-like events with a psychological basis)
Cognitive (e.g., memory, information processing problems, learning
problems)
Neurological (e.g., stroke, autism spectrum disorders, migraine)
Somatic (e.g., heart disease, bone health)
• ocial concerns—engaging new friends, seizures in social settings, telling oth-
S
ers, family burden, stigma
• motional response—coping, dealing with fears, stress management
E
• vailable informational and community resources—websites, state and local
A
Epilepsy Foundation affiliates, community agencies, health care providers
Specific Educational Needs for Population Subgroups
Children, adolescents, and youth transitioning to adulthood
• chool—managing seizures at school, common learning problems, safety, partici-
S
pation in extracurricular activities
learn how to manage it in their daily lives, especially at school (McNelis
et al., 1998). A UK study demonstrated that providing information about
mortality, including SUDEP, is especially relevant for youth, because of the
higher death rates in individuals under age 30 who have long-term epilepsy
(Mohanraj et al., 2006). While reluctant to initiate a conversation about
sensitive topics such as alcohol use and sexual activity, older adolescents
participated in these discussions when health professionals began them
(Lewis et al., 2010). However, the researchers found that young people
believed health professionals were more interested in providing medical
information than in helping with more practical aspects of daily living
(Lewis et al., 2010).
Youth transitioning into adulthood need information and knowledge
that will help them assume appropriate responsibility for managing their
epilepsy and living a healthy lifestyle. However, few studies could be found
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EDUCATING PEOPLE WITH EPILEPSY AND THEIR FAMIILIES
• ental health—attention deficit hyperactivity disorder, autism spectrum disor-
M
ders, social withdrawal
• ealing with fears—future, death, mental health conditions, stigma
D
• ifestyle management—establishing healthy habits
L
• pportunity to discuss sensitive information, such as puberty, sexuality, drugs,
O
and alcohol
• areer planning
C
• ransition to adulthood, such independence and driving
T
Adults
• C
areer and vocational concerns
• D
iscussions with employers
• D
riving regulations and transportation concerns
• S
exual and gender-specific topics, such as reproductive health and family plan-
ning, hormonal changes and seizure frequency, effects of seizure medications on
pregnancy
• rug-alcohol interactions
D
• mpact on relationships
I
• ndependent living
I
Older adults
• M
edication side effects, adverse interactions, and adherence
• D
rug-alcohol interactions
• I
ndependent living
• S
afety and injury risks
that focused on the needs of this “in-transition” group. Jurasek and col-
leagues (2010) believe these youth need to be knowledgeable about the
following:
• Epilepsy management—Knowledge about their specific epilepsy
condition (e.g., specific syndrome, seizure type and triggers) and
treatment plans helps them make informed decisions about care.
• Topics that emerge during adolescence—Knowledge about topics
such as sexuality, alcohol and drug use, and driving, in the context
of living with epilepsy, helps to support informed decision making.
• Living independently—Skills that facilitate independent living are
related to (1) education, career, and employment decisions; (2)
living a healthy lifestyle, including managing stress and getting
sufficient sleep; (3) self-management skills, such as knowing which
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health care provider to contact, getting to appointments, knowing
how to fill prescriptions, and medication adherence strategies; and
(4) obtaining and paying for medications.
Knowledge Needs of Adults
In a large national survey, adults with epilepsy indicated that they have
many fears related to seizures or dying during a seizure and that they face
specific social challenges, including potential embarrassment about hav-
ing a seizure in public (Fisher, 2000). Areas in which adults desired more
information were related to employment (e.g., discussion of epilepsy with
employers), the link between seizures and stress, dealing with cognitive
problems, managing their emotions, and sleep and fatigue (Fraser et al.,
2011). In another study, adults also needed more information about driving
regulations (Couldridge et al., 2001) (see also Chapter 6).
Gender-Specific Needs
The predominant knowledge needs of women and men with epilepsy
are summarized in Box 7-2.
Women The specific knowledge needed by women with epilepsy, which
may vary by age, has generally received insufficient attention. Because sex
hormones can affect seizure frequency, girls and women need information
related to hormonal fluctuations and seizure frequency.3 Further, women of
reproductive age need to understand how their epilepsy and its treatment
could affect pregnancy. In a UK survey, adult women with epilepsy between
the ages of 19 and 44 identified their most important information needs as
relating to risks of epilepsy and medication affecting the fetus (87 percent),
the effect of pregnancy on seizure control (49 percent), and the risk of their
children developing epilepsy (42 percent) (Crawford and Hudson, 2003).
For example, recent findings that show an increased risk for congenital
malformations and impaired cognition in children of women treated during
pregnancy with valproate, a commonly used seizure medication, suggest
that all women of child-bearing age need to be kept apprised of the lat-
est research in this area (Harden et al., 2009). Women with epilepsy also
have been found to have higher-than-expected rates of sexual dysfunction
(Pennell and Thompson, 2009). Among women over age 44, the most
3 Studies have found higher-than-expected onset of seizures during the year of menarche;
in girls with preexisting seizures, 29 percent experienced more frequent seizures during peri-
menarche (Klein et al., 2003). Because of hormonal fluctuation, some women have a cyclic
pattern of seizure frequency associated with their menses that often is unrecognized (Pennell
and Thompson, 2009).
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EDUCATING PEOPLE WITH EPILEPSY AND THEIR FAMIILIES
EXAMPLES OF SPECIFIC KNOWLEDGE NEEDS FOR
Box 7-2
WOMEN AND MEN
• regnancy, effects of medications on the fetus, and breastfeeding (women)
P
• one health
B
• ormonal states (e.g., sexual dysfunction; fertility rates; for women: menarche,
H
monthly hormonal patterns, menopause, hormone replacement therapy)
• exual dysfunction
S
• eproductive endocrine disorders (women)
R
• riving and transportation
D
• mployment
E
• ognitive problems—memory
C
• ocial concerns
S
important information needs concerned epilepsy medication and osteopo-
rosis (63 percent), seizure medications and aging (57 percent), and seizure
changes during menopause (44 percent) (Crawford and Hudson, 2003).
Men One of the least studied subgroups of people with epilepsy is men.
Studies show that men with epilepsy are less likely to be married, they have
lower-than-expected fertility rates, and about one-fourth have problems
with sexual dysfunction (Pennell and Thompson, 2009). In one of the few
studies examining the perceptions and experiences of adult men with epi-
lepsy, 18 percent rated themselves at the highest level of knowledge about
the condition, but 25 percent said they have a low level of knowledge (Sare
et al., 2007). In that study, the men’s most common concerns related to
limitations on driving and employment. More than half of the men reported
that their epilepsy affected them either “a lot” or “some” in other areas,
such as memory problems, confidence, ambition and plans for the future,
sense of self-esteem, overall health, social life, and quality of life. Finally,
more than half indicated that they worried about the possibility that their
children might inherit their epilepsy.
Knowledge Needs of Older Adults
The education needs of older adults with epilepsy, their family mem-
bers, and other caregivers are poorly understood and underexplored
(Martin et al., 2003). The committee found few studies that considered
them. Likely areas for education were identified by extrapolating factors
that are unique to older adults with epilepsy. For example, because older
adults are especially vulnerable to the adverse effects of medication (Leppik,
2006), they need education about the side effects of seizure medications,
particularly given the likely complications of aging-related factors, such as
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effectiveness of generic chronic care versus epilepsy-specific educa-
tion programs individually and in combination are needed.
• The use of the Internet presents many potential opportunities to ex-
pand the reach and sophistication of epilepsy education programs,
enabling them to respond to the needs of individual learners of dif-
ferent literacy levels, language proficiencies, cultural backgrounds,
and learning styles. Increased availability of online educational
information and the use of social networking websites provide
new opportunities for sharing information about the epilepsies and
providing interpersonal support.
• Individuals and their families need guidance to ensure that they are
connected to the most accurate and reliable information resources
and tools available, especially those available online.
• High-quality, validated epilepsy education programs can pro-
vide individuals, families, and caregivers with accurate informa-
tion and education to build the skills needed to achieve optimal
self-management. In order to be effective and to maximize reach,
programs eventually will need to stratify and balance many
dimensions—the severity of the disorders, the existence of co-
morbidities, the racial/ethnic and cultural background of users,
language, the level of general literacy and health literacy, age and
gender, and preferred learning styles.
Throughout this chapter, the committee has provided the basis for its
research priorities and recommendations regarding improvements needed
in education for people with epilepsy and their families, which are detailed
in Chapter 9. In order to improve this education and build the necessary
knowledge and skills of people with epilepsy and their families, additional
research and time needs to be devoted to
• evaluating available educational resources and tools, including
those available on the Internet;
• expanding the reach and dissemination of available resources;
• engaging people with epilepsy and their families in developing and
testing educational resources;
• evaluating, replicating, and expanding the use of self-management
programs; and
• exploring new opportunities for improving education, such as
a centralized web resource to connect people with epilepsy to
reliable websites and a certification program for epilepsy health
educators.
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EDUCATING PEOPLE WITH EPILEPSY AND THEIR FAMIILIES
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