Improving epilepsy knowledge, attitudes & practices among primary health care providers: findings from a pre-post...

Epilepsy remains highly underdiagnosed and undertreated in low- and middle-income countries, largely due to inadequate training, misconceptions, and stigma among Primary Healthcare Providers (PHCPs). They play a pivotal role in reducing the epilepsy treatment gap, particularly in rural and tribal regions of India. However, evidence on the long-term impact of structured epilepsy training on their knowledge, attitudes, and practices (KAP) is limited.

We conducted a longitudinal pre-post intervention study for PHCPs in two rural blocks of Chhattisgarh, India. A one-day, cadre-specific epilepsy training workshop was delivered to doctors, nurses/community health officers (CHOs), and Accredited Social Health Activists (ASHAs). The training covered epilepsy recognition, basic management, seizure first aid, referral pathways, and stigma reduction. All PHCPs underwent a questionnaire-based KAP assessment administered twice - six months before the intervention and one year after. Item-level responses were compared using McNemar and Wilcoxon signed-rank tests. Domain-wise composite scores were analysed using paired Student's t-test or Wilcoxon signed-rank test, as appropriate.

A total of 978 PHCPs (40 doctors, 191 nurses/CHOs, and 747 ASHAs/ASHAs Trainers) with matched and sufficiently complete pre-post responses were included in the final analysis. Significant improvements in knowledge, attitudes, and practices were observed within all participant groups at the one-year post-intervention assessment compared with baseline (p < 0.0001). Among doctors and nurses/CHOs, improvements were greatest in the knowledge domain, whereas among ASHAs/ASHAs Trainers the largest improvement was observed in the attitude domain.

A structured, role-specific epilepsy training intervention was associated with statistically significant improvements in knowledge, attitudes, and practices within PHCPs in a resource-limited rural setting that remained evident at the one year follow-up suggesting retention of training-related gains over time when compared to baseline. Scaling up such culturally tailored training programs may contribute meaningfully to reducing stigma and narrowing the epilepsy treatment gap in similar contexts.