Effects of an Educational Comic Book on Knowledge, Attitudes, and Practices Regarding Epilepsy among Adolescents in...

Beyond its medical manifestations, people living with epilepsy face barriers to healthcare access and high levels of stigma. Educational interventions have been shown to improve knowledge and reduce stigma, particularly when adapted to diverse social and cultural contexts. This study aimed to evaluate the effects of an educational comic book on knowledge, attitudes, and practices (KAPs) regarding epilepsy among adolescents in Quito, Ecuador.

A quasi-experimental study was conducted among students from urban and rural schools in Quito. Data were collected using a structured KAP questionnaire administered before and after the intervention. Changes in global and subscale KAP scores were analyzed, and logistic regression was used to identify factors associated with greater improvement of the score.

A total of 344 students participated (mean age: 13.8 years; 52.9% male). The median global KAP score increased significantly from 11.5 (IQR: 8.8-13.7) before, to 15.1 (IQR: 13.2-16.4) after the intervention (p < 0.001). A very large majority of students showed significant improvement of the score regardless of baseline level, with the greatest gains observed among those with initially lower scores. Students who had previously witnessed an epileptic seizure were less likely to achieve a high improvement on the score (OR = 0.40; 95% CI: 0.24-0.68; p < 0.001).

The educational comic book improved adolescents' KAPs related to epilepsy in both urban and rural schools in Quito. Comic books were therefore very effective, regardless of sociodemographic characteristics, highlighting the value of culturally adapted narrative tools in strengthening epilepsy education to help reduce stigma.