Epilepsy & Behavior 41 (2014) 238–243

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Epilepsy & Behavior

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Knowledge, attitudes, and beliefs about epilepsy and their predictorsamong university students in Jordan

Jameel Khaleel Hijazeen a,⁎, Munir Ahmad Abu-Helalah b, Hussam Ahmad Alshraideh c,Omar Salameh Alrawashdeh d, Fadi Nather Hawa a, Tariq Asem Dalbah a, Fadi Walid Abdallah a

a Faculty of Medicine, Mutah University, Karak, Jordanb Department of Public Health, Faculty of Medicine, Mutah University, Karak, Jordanc Department of Industrial Engineering, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordand Department of Anatomy and Histology, Faculty of Medicine, Mutah University, Karak, Jordan

⁎ Corresponding author at: P.O. Box: 61245, Smakieh746872 (mobile).

E-mail address: jameel.hijazeen@hotmail.com (J.K. Hij

http://dx.doi.org/10.1016/j.yebeh.2014.10.0101525-5050/© 2014 Elsevier Inc. All rights reserved.

a b s t r a c t

a r t i c l e i n f o

Article history:Received 9 August 2014Revised 7 October 2014Accepted 8 October 2014Available online xxxx

Keywords:EpilepsyAttitudesKnowledgeUniversityStudentsArab

The aimof this cross-sectional studywas to assess the knowledge about epilepsy and the attitudes toward peoplewith epilepsy (PWE) and their predictors amonguniversity students in Jordan. A self-administered questionnairewas distributed in three of the largest public universities in Jordan, and a total of 500 questionnaireswere collect-ed from each university. The number of students who reported that they had heard or read about epilepsy was1165 (77.6%), and their data were analyzed. A significant proportion of students thought that epilepsy couldbe caused by the evil spirit (31.5%) and the evil eye (28.1%) or that it could be a punishment from God(25.9%). Epilepsy's most commonly reported treatment methods were the Holy Quran (71.4%), medications(71.3%), and herbs (29.3%). The most common negative attitudes toward PWE were that the students would re-fuse to marry someone with epilepsy (50.5%) and that children with epilepsymust join schools for persons withdisabilities (44.4%). Male students, students of humanities, and students with a low socioeconomic status tendedto have more negative attitudes toward PWE. In conclusion, many students have misconceptions about thecauses, treatment, and nature of epilepsy, and students have moderate negative attitudes toward PWE. Univer-sities should have health promotion programs to increase awareness of their students about major public healthproblems such as epilepsy.

© 2014 Elsevier Inc. All rights reserved.

1. Introduction

Epilepsy is one of themost common neurological disorders and rep-resents an important public health problem [1,2]. The WHO estimatesthat it affects about 50 million people worldwide [3].

Epilepsy has a negative impact on most aspects of health-relatedquality of life of its sufferers [3]. One important source of trouble forpeople with epilepsy (PWE) is the social stigma, which is commonboth in developed and in developing countries [4,5]. In a study conduct-ed in 15 European countries, about half of patients with epilepsyreported feeling stigmatized by their disease [6]. In developing coun-tries, where the incidence and prevalence of epilepsy are higher thanthose in developed countries, the stigma of epilepsy adds more burdento the patients who are already suffering from poor economic situationsand inadequate medical services [5,7,8].

As a result, several studies were conducted to measure the knowl-edge and conceptions of the public about epilepsy and their attitudes

, Karak, Jordan. Tel.: +962 795

azeen).

toward PWE [8–11]. A recent study reviewed the published researchon the psychosocial aspects of epilepsy in Arab countries in the pastthree decades and concluded that negative attitudes and misconcep-tions toward PWE are still widespread in these countries [8]. InJordan, results of a survey among the general population showed thattheir knowledge about and attitudes toward epilepsy are similar tothose from Asian countries. On the other hand, their attitudes weremore negative when compared with results from western countries[11].

Studies have shown that better educated individuals are less likely tohave negative attitudes toward PWE [12–14]. Although universitygraduates represent the most educated segment of modern societies,unfortunately, only few studies worldwide have assessed their knowl-edge about epilepsy and attitudes toward PWE [15–20]. For example,a study from Canada found that students' knowledge about epilepsywas variable but their attitudes were positive. Moreover, it found agender variation in attitudes as females had statistically significantlymore positive attitudes than males [15]. Very limited knowledgeabout epilepsy was found in a study conducted among university andschool students in Italy [16]. Similar limited knowledgewas also report-ed for university students in Trinidad and Tobago [17]. In contrast to

239J.K. Hijazeen et al. / Epilepsy & Behavior 41 (2014) 238–243

these studies, a study conducted among university students in Malaysiafound good levels of awareness and knowledge of epilepsy [18].

There are no published studies that were conducted among univer-sity students of different faculties in Jordan. There is, however, one re-cent study that was conducted only among clinical dental students atthe University of Jordan andwhich found an inadequate level of knowl-edge as well as negative attitudes toward PWE [21]. In Arab countries, astudy conducted among university students in Kuwait revealed that uni-versity students had limited knowledge about epilepsy and its causes.This was associated with a high rate of misconceptions and negative at-titudes toward PWE [19]. A study conducted among university studentsand schoolteachers in Saudi Arabia showed that the belief in possessionby Jinns (demons or devils) was still prevalent in Saudi society; abouthalf of university students believed in it [20].

The estimated population of Jordan in 2012 was 6,388,000 [22]. Forestimates of the year of 2010, Muslims constituted 97.2% of thepopulation, followed by Christians (2.2%) and other (0.6%) [23]. In theacademic year of 2012/2013, Jordan had 29 universities with a totalnumber of 249,432 undergraduate students [24]. With this large num-ber of undergraduate university students in Jordan, we explored towhat extent universities had a role in health promotion for studentsand the community [25,26]. Moreover, we evaluated the degree towhich university students were aware of the nature of, causes of, andsome of the treatment options for common and important diseasessuch as epilepsy.

2. Methods

2.1. Study design

This was a cross-sectional study conducted in three of the largestpublic universities located in the three administrative regions ofJordan: Mutah University (MU) in Karak (South); the University ofJordan (UJ) in Amman, the capital of Jordan (Middle); and the JordanUniversity of Science and Technology (JUST) in Irbid (North).

Most of the questions of this study's questionnaire were obtainedwith permission from the questionnaire developed by Al-Rashed et al.[19]. After literature review and discussionswith students, wemodifiedthe wording of some questions to meet the Jordanian environment andadded questions that explored contact with PWE (having family mem-bers or close friends who suffer from epilepsy) and questions to coverfor more beliefs (if epilepsy could be treated by exorcism or is treatableor curable).

The study questionnaire consisted of three sections. The first sectionasked about sociodemographic data (age, sex, nationality, religion, etc.).The second section asked the students if they had ever heard/read aboutepilepsy and assessed the students' personal experience with PWE(having close family members or friends suffering from epilepsy),their knowledge about the causes of and treatment options for epilepsy,and their perceptions of epilepsy. The third and last section containedten negatively phrased statements that assessed the students' attitudestoward PWE (both adults and children). The students responded toeach item using a five-point Likert scale ranging from strongly agreeto strongly disagree. This section also asked students about the sourcesof their information about epilepsy. Finally, the newly modifiedquestionnaire was piloted, and it was found to be adequate for thestudent population in Jordan.

This study was approved by the Scientific and Ethics Committees ofthe Faculty of Medicine at Mutah University.

2.2. Sample size

In the academic year of 2012/2013, Jordan had ten public universitieswith a total number of 185,617 undergraduate students [24]. The num-ber of undergraduate students in the participating universities (71,477)constituted more than one-third (38.5%) of them. The numbers of

undergraduate students at MU, the UJ, and JUST were 16,826; 32,912;and 21,739, respectively. Using the Kish formula [27] for sample sizeestimation at a 95% significance level and a 5% error margin, the repre-sentative samples in these universities were 376, 380, and 378, respec-tively. At the end of data collection, to ensure that students who hadheard or read about epilepsy exceeded the representative samples, itwas agreed upon by the authors to collect 500 questionnaires fromstudents in each of the participating universities.

2.3. Sample collection

Data collection took place during the summer semester of the aca-demic year of 2012/2013. The research assistants who helped in datacollection received training on the questionnaire and the data collectionmethodology. Exclusion criteria were studying health-related special-ties, being a postgraduate student, having a current or previous diagno-sis of epilepsy, and not consenting to participate in this study. To ensureequal representation of the different faculties, each universitywas strat-ified by faculty, and the number of questionnaires collected was, there-fore, based on the percentage of students in each faculty. Questionnaireswere randomly distributed to students in each faculty at differentweek-days and times of day, and an informed consent form was distributedwith each questionnaire. After the students read the consent form andagreed to participate in this study, they were asked to fill out the ques-tionnaire. Filling out the questionnaire took between 10 and 15 min,and while filling it out, the students were instructed not to discuss theanswers with each other.

2.4. Statistical methods

Analysis of the datawas carried out using SPSS software version 18.0(SPSS Inc., Chicago, IL, USA). The answers of missing questions wereeliminated when testing for associations and calculating proportions.Testing for factor association was performed using the x2 (chi-squared)testing procedure, and a P-value of b0.05 was considered statisticallysignificant. We presumed that the students' responses were affectedby their social and economic standing. To incorporate such social–eco-nomic status in the analysis, a Socioeconomic Index (SEI) was calculatedfollowing the suggestions of Hollingshead [28]. A total score was calcu-lated for each student based on four factors: (1) area of residence(being a village, town, or city), (2) education of father (at six levels of ed-ucation), (3) education of mother (at six levels of education), and (4)monthly family income (at five levels). These total scores were thendiscretized into three categories of equal frequency forming the SEI.The three categories were low (12–40), medium (41–53), and high(54–76).

3. Results

3.1. Demographic characteristics

Of the 1,500 students surveyed, 1,165 (77.7%) reported that they hadever heard or read about epilepsy. Their mean age was 20.8 ±1.54 years (range: 17–35 years) (n = 1,141), and the percentage ofmale students was 57.4% (n = 1,165). The majority of students wereJordanians (95.4%) (n = 1,157) and Muslims (96.0%) (n = 1,162) andstudied in scientific faculties (57.3%) (n = 1,165). Only 34.3% were intheir first and second academic years, while the rest (65.7%) were intheir third academic year and above (n = 1,138).

3.2. Personal experience with PWE

Almost half of the students (n= 597, 48.7%) reported that they hadever seen an epileptic seizure in front of them. In addition, 52 (4.3%) re-ported that they had a family member suffering from epilepsy, and 190(16.3%) reported that they had a close friend suffering from epilepsy.

240 J.K. Hijazeen et al. / Epilepsy & Behavior 41 (2014) 238–243

3.3. Knowledge about the causes of and treatment options for epilepsy

Table 1 shows the students' knowledge about the causes of andtreatment options for epilepsy. The most commonly reported causesof epilepsy were head trauma (56.5%), depression or anxiety (55.3%),and genetic cause (49.5%). According to 31.5% of students, epilepsycould be caused by the evil spirit, and 25.9% of students think that itcould be a punishment from God for wrong deeds. Statistically signifi-cantly more females than males reported head trauma (61.3% vs.50.1%, P = 0.001) and high temperature (52.7% vs. 43.3%, P =0.002)as causes of epilepsy. On the other hand, statistically significantlymore males reported depression/anxiety (59.6% vs. 52.1%, P = 0.028),the evil spirit (36.4% vs. 27.9%, P = 0.008), and punishment from God(34.6% vs. 19.5%, P b 0.001). Moreover, students of humanities statisti-cally significantly reported the evil spirit (31.9% vs. 31.2%, P = 0.001)and the evil eye (29.1% vs. 27.3%, P = 0.048) as causes of epilepsy. Onthe other hand, more students of scientific faculties statistically signifi-cantly reported punishment from God (26.3% vs. 25.5%, P = 0.049) asa cause of epilepsy.

Table 1 also shows the students' answers regarding the possibletreatment options for epilepsy. Themost commonly reported treatmentoptions for epilepsywere, in order of frequency, theHoly Quran (71.4%),medications (71.3%), herbs (29.3%), and exorcism (22.5%). “Othermethods” of treatment, such as surgery and special diets, were reportedby 5.8% of students. More males than females statistically significantlyreported exorcism (26.2% vs. 19.7%, P = 0.006) and “other methods”(8.9% vs. 3.4%, P b 0.001) as treatment options for epilepsy. Interestingly,the only statistically significant difference between students of human-ities and those of scientific faculties was in reporting exorcism (24.8%vs. 20.8%, P = 0.039). Of the students, 51.4% selected both the HolyQuran and medications as treatment options, while 12.9% selected theHoly Quran alone. The belief in the Holy Quran as a treatment methodfor epilepsy is statistically significantly higher among the studentswho believed that epilepsy could be caused by the evil spirit than thestudents who did not (89.2% vs. 61.7%, P b 0.001).

Comparing the students of different SEI groups, we found thatstudents with a low SEI reported more the evil spirit, the evil eye, andpunishment from God as causes of epilepsy and the Holy Quran and ex-orcism as treatment options for epilepsy, with a statistically significantdifference from the remaining groups (P = b0.001 for all of them). Onthe other hand, studentswith a high SEI statistically significantly report-ed more “certain medications” as causes of epilepsy (P = 0.005) andmedications (P b 0.033) as a treatment for epilepsy.

3.4. Perceptions of epilepsy

Table 2 shows the students' perceptions of epilepsy. Epilepsywas re-ported to be associated with madness and mental retardation by 27.5%

Table 1University students' knowledge about the causes of and treatment options for epilepsy.

Total(n = 1165)

Gender

Males(n = 496)

Females(n = 669)

P

Causes of epilepsy(% yes)

Head trauma 56.5 50.1 61.3 0.Depression or anxiety 55.3 59.6 52.1 0.Genetic 49.5 45.5 52.4 0.High temperature 48.7 43.3 52.7 0.Certain drugs 47.6 49.2 46.4 0.Evil spirit 31.5 36.4 27.9 0.Evil eye 28.1 30.6 26.2 0.Punishment from God 25.9 34.6 19.5 b0.

Treatment for epilepsy(% yes)

Holy Quran 71.4 70.9 71.8 0.Medications 71.3 71.7 71.0 0.Herbs 29.3 33.0 26.5 0.Exorcism 22.5 26.2 19.7 0.Other methods 5.8 8.9 3.4 b0.

and 15.6% of students, respectively. Only 2.9% of students reported thatepilepsy is a contagious disease. Statistically significantly more malesand students with a low SEI thought that epilepsy is a curable diseaseand a form of madness. Moreover, statistically significantly morestudents of humanities than those of scientific faculties thought thatepilepsy is a form ofmadness (29.2% vs. 26.2%, P= 0.002) ormental re-tardation (18.2% vs. 13.7%, P b 0.001) or that it is a contagious disease(4.3% vs. 1.8%, P = 0.008).

3.5. Attitudes toward PWE

Table 3 shows the students' attitudes toward PWE and comparisonsby gender, faculty type, and SEI. The most common negative attitudestoward PWE were that the students would refuse to marry a personwith epilepsy (50.5%), that children with epilepsy must join schoolsfor persons with disabilities (44.4%), and that children with epilepsymust be separated from other children (29.4%). Shockingly, 17.3% and16.2% of students thought that PWEmust not have children or get mar-ried, respectively. This table also shows that there is a statistically signif-icant difference between males and females in the answers to fourstatements. For all of these statements, males had more negative atti-tudes than did females. By comparing students based on the type of fac-ulty, students of humanities had statistically significantlymore negativeattitudes than students of scientific faculties had in answers to sevenstatements. Regarding the SEI, students with a low SEI had statisticallysignificantly more negative attitudes in the answers to three state-ments. We correlated also these ten statements with reporting havinga close friend suffering from epilepsy andwith reporting having a familymember suffering from epilepsy. Students who reported having a closefriend suffering from epilepsy had overall more negative attitudes to-ward PWE than students who did not have one as they statistically sig-nificantly agreed more with the statements that children with epilepsymust be separated from other children (21.4% vs. 15.6%, P= 0.050) andthat PWE are less intelligent than other people (20.3% vs. 14.4%, P =0.042). However, both these students and students who have a familymember suffering from epilepsy agreed less, with a statistically signifi-cant difference in the statement about refusing to marry someonewith epilepsy (32.7% vs. 51.5%, P = 0.008 and 42.3% vs. 52.1%, P =0.014). There were no other statistically significant correlations found.

3.6. Sources of students' information

Fig. 1 shows the sources of students' information about epilepsy. Themost commonly reported sources were the Internet (56.5%) and TV orradio (52.8%), while the least reported sources were university teaching(21.0%) and newspapers (20.0%). The percentage of students whoreported school teaching as one of the sources of their informationwas 31.6%.

Faculty type Socioeconomic Index

Humanities(n = 668)

Scientific(n = 497)

P Low(n = 410)

Middle(n = 373)

High(n = 382)

P

001 56.5 56.6 0.815 57.9 55.3 56.2 0.590028 52.8 57.1 0.298 55.0 57.1 53.7 0.672069 49.3 49.6 0.599 48.3 46.9 53.3 0.145002 51.5 46.7 0.229 51.2 46.6 48.1 0.599149 44.9 49.6 0.095 41.9 50.0 51.4 0.005008 31.9 31.2 0.001 37.3 32.4 24.3 b0.001255 29.1 27.3 0.048 32.4 30.0 21.5 b0.001001 25.5 26.3 0.049 31.0 27.0 19.5 b0.001933 73.9 69.4 0.242 79.7 71.4 62.4 b0.001833 68.5 73.3 0.203 68.5 68.8 76.7 0.033056 29.2 29.3 0.771 29.8 32.1 26.1 0.492006 24.8 20.8 0.039 29.7 23.1 14.3 b0.001001 5.7 5.8 0.302 5.2 5.7 6.4 0.701

Table 2University students' perceptions of epilepsy.

Perception Total(n = 1165)

Gender Faculty type Socioeconomic Index

Males(n = 496)

Females(n = 669)

P Humanities(n = 668)

Scientific(n = 497)

P Low(n = 410)

Middle(n = 373)

High(n = 382)

P

Treatable disease (% yes) 76.4 77.2 75.7 0.826 74.7 77.6 0.434 74.3 77.2 77.8 0.273Curable disease (% yes) 32.5 37.6 28.7 0.003 35.0 30.7 0.166 38.1 29.4 29.5 0.007Form of madness (% yes) 27.5 33.0 23.5 0.002 29.2 26.2 0.002 31.9 28.2 22.0 0.003Form of mental retardation (% yes) 15.6 17.8 14.0 0.181 18.2 13.7 b0.001 17.8 15.9 13.0 0.294Contagious disease (% yes) 2.9 4.3 1.8 0.045 4.3 1.8 0.008 2.5 3.0 3.2 0.571

241J.K. Hijazeen et al. / Epilepsy & Behavior 41 (2014) 238–243

4. Discussion

To our knowledge, this is the first study to assess the knowledgeabout epilepsy and the attitudes toward PWE among university stu-dents in Jordan. Although epilepsy is a common and stigmatizing dis-ease, epidemiological data about it are lacking in many countries,including Jordan [3,29].

In the present study, the percentage of students who reportedhaving heard or read about epilepsy was 77.7%. Interestingly, thispercentage is less than that reported in the study conducted amongthe Jordanian public (about 88%) [11]. There was, however, a selectionbias in that study as more than one-third of the participants (39%) hada health-care-related occupation. In studies among university studentsin Saudi Arabia and Malaysia, the percentages were 81.8% and 86.5%,respectively [18,20]. The Malaysian study, however, did not excludestudents studying health-related specialties [18].

In this study, around half of the students reported that they hadwitnessed a seizure in front of them at least once during their lifetime.This is relatively comparable to the Saudi and Malaysian studies inwhich this was reported by 53.3% and 55.6% of students, respectively[18,20].

In his seminal work on prejudice, Allport contributed significantly tothe contact hypothesis and stated that intergroup contact reduces anyexisting intergroup prejudice [30]. Allport put four conditions for thiscontact to produce positive outcomes. Nonetheless, latter researchproved that the mere contact between different groups is enough [31].In this study, we tried to explore the contact hypothesis by examiningthe effect of having close family members or friends who suffer fromepilepsy on the attitudes of the students reporting that. Unexpectedly,students who reported having a family member suffering from epilepsyhad statistically significantly more positive attitudes in only one out often statements. Furthermore, the students who reported having aclose friend with epilepsy had overall statistically significantly worse

Table 3University students' attitudes toward people with epilepsy.

Statement (% strongly agree/agree) Total Gender (n = 1165)

Female(n = 669)

Male(n = 496)

P

I refuse to:– marry someone with epilepsy. 50.5% 51.1% 49.7% 0– hire a person with epilepsy in an office job for me. 28.4% 25.2% 32.8% 0– go with someone with epilepsy to a public place. 20.7% 19.5% 22.4% 0

Children with epilepsy must:– join schools for persons with disabilities. 44.4% 42.3% 47.2% 0– be separated from other children. 29.3% 23.0% 37.9% b0– be prevented from participating in sport exercisesin school.

16.5% 14.3% 19.4% 0

People with epilepsy:– cannot think and judge on things like the restof people.

22.6% 17.7% 29.2% b0

– must not have children. 17.3% 17.7% 16.8% b0– must not get married. 16.2% 15.5% 17.1% 0– are less intelligent than other people are. 15.5% 10.9% 21.6% b0

a 96 missing values.

attitudes toward PWE when compared with students without such ahistory. The latter contradicts the contact hypothesis. Similar findingswere found in a Nigerian study conducted among secondary schoolstudents. Despite the fact that around 4 out of 10 students either knewsomeone or had a relative that had epilepsy, 64.9% of the participantswere willing to discontinue friendship with students with epilepsy, and41.1% and 42.2% of the participants believed that patients with epilepsyshould neithermarry nor have children, respectively [32]. Unexpectedly,this was even reported among physicians who judged PWE morenegatively than a healthy population [33]. These findings raise doubtsabout the application of the contact theory in PWE. Just like Allportsuggested, there might be some conditions that need to be met forcontact with PWE to reduce negative attitudes. Further research in thisarea, preferably starting with qualitative research, could therefore helpto clarify this.

It became obvious that the students had limited knowledge aboutepilepsy when they were asked about its causes. About 55% of the stu-dents thought that epilepsy is a form of psychiatric illness as they re-ported that it could be caused by depression or anxiety. Head traumawas the most commonly reported cause of epilepsy (56.5%). In theKuwaiti study, the most commonly reported causes were depressionand anxiety (42.1%) and medications (39.3%) [19].

Inmany cultures and formany ages, epilepsy has been believed to bea disease that results from evil spirits or supernatural powers [20,34]. Aconsiderable number of students in this study believed that epilepsycould be caused by the evil spirit (31.5%) and the evil eye (28.1%).These are close to the figures reported from the Kuwaiti study (24.6%and 34.1%, respectively). In the study from Saudi Arabia, “possessionby Jinn” was reported as a cause by 50.5% of students [20]. The lowestpercentage was reported by the Malaysian study in which only 5.3% ofstudents thought that epilepsy could be caused by “evil spirits” [18].The belief in the evil spirit and the belief in the evil eyewere both statis-tically significantly higher among students of humanities and students

Faculty type (n = 1165) Socioeconomic Index (n = 1096)a

Humanities(n = 497)

Scientific(n = 668)

P Low(n = 374)

Medium(n = 344)

High(n = 378)

P

.595 53.8% 48.0% 0.043 49.5% 52.9% 49.3% 0.558

.004 31.6% 26.1% 0.042 30.1% 29.2% 26.3% 0.493

.255 25.6% 17.1% 0.001 24.5% 21.1% 16.8% 0.032

.105 48.3% 41.5% 0.030 50.3% 44.6% 37.4% 0.002

.001 33.7% 26.1% 0.005 32.5% 30.8% 24.1% 0.027

.022 19.7% 14.2% 0.023 17.2% 17.1% 14.5% 0.535

.001 28.4% 18.4% b0.001 26.3% 21.5% 19.8% 0.094

.667 21.6% 14.1% b0.001 19.4% 18.0% 14.7% 0.216

.495 20.9% 12.6% 0.000 17.7% 15.4% 15.1% 0.592

.001 20.2% 11.9% b0.001 18.2% 16.0% 11.9% 0.054

56.5%52.8%

36.8% 34.9%31.6%

28.6%25.1%

21.0% 20.0%

6.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Fig. 1. Sources of university students' information about epilepsy.

242 J.K. Hijazeen et al. / Epilepsy & Behavior 41 (2014) 238–243

with a low SEI. Our results are consistentwith previous studies inwhichcomponents of the SEI (education, income, or employment status) pre-dicted knowledge about epilepsy and attitudes toward PWE [9,11,18,19]. Previous studies also showed differences in knowledge and healthhabits between students of humanities and those of scientific faculties[35].

Limited knowledge among students about epilepsy included also theknowledge about its methods of treatment. It was interesting that themost common treatment method chosen by students was the HolyQuran (71.4%), followed by medications (71.3%). In the Kuwaiti study,the most commonly reported methods were medications (81.0%),followed by the Holy Quran (74.4%) [19]. Reporting the Holy Quran asa treatment method for epilepsy probably reflects the belief thatepilepsy could be caused by evil spirits [20,34]. The analysis of thisstudy confirmed this assumption, as reporting the Holy Quran as atreatment method for epilepsy was statistically significantly higheramong students who believed that epilepsy could be caused by theevil spirit (P b 0.001). More males than females statistically sig-nificantly reported exorcism as a treatment option for epilepsy(P = 0.006). This could be explained by the fact that more malesthan females believed that the evil spirit could be a cause of epilepsy(P = 0.008).

It might not be a surprising finding that some people from thegeneral population associate epilepsy with mental illness [9,11,14],but it is surprising that 27.5% of university students in Jordan consideredepilepsy as a formofmadness. This ismuchhigher than that reported byuniversity students in Kuwait (10.5%) [19]. Moreover, in this study,15.6% of students considered epilepsy as a form of mental retardation,which is also higher compared with university students in Kuwait(12%) [19].

In this study, 17.3% of students answered that PWE must not havechildren. This is lower than that reported among the Jordanian public(29.6%) [11] and the clinical dental students at the University ofJordan (43.3%) [21], almost similar to results reported among universitystudents in Canada (16.0%) [15], but higher than results from Kuwait(12.1%) [11,15]. Male students had more negative attitudes towardPWE. A similar statistically significant but slight difference betweenmales and females was also reported in the Canadian study [15]. Somestudies among the general population also show that males tend tohave more negative attitudes than females [10,36].

In this study, more students reported that they had gained theirknowledge about epilepsy from close persons rather than fromschools or universities, with 36.8% and 34.9% of students reporting“parents” and “friends” as sources of their information, respectively.Relatives/friends and the media, sources other than formal educa-tion, were also reported as the top sources of information in theSaudi study [20].

5. Limitations of the study

This study has two major limitations. Firstly, the attitudes and con-ceptions about epilepsy could have been affected by having includednon-Jordanian students of Arab nationalities. Their attitudes probablyreflect their own cultures and not new attitudes that they gained inthe Jordanian universities. Nonetheless, these students constitutedonly 4.6% of our sample. Secondly, first-year students constituted only14.0% of our sample. This might had not given universities enoughtime to play a significant role in changing the knowledge and attitudesof their students. However, this study was conducted in the summersemester, and this means that most students had spent at least twosemesters in the universities.

Acknowledgment

We would like to thank Prof. Mona Mohamed and Prof. AmalAbdelrazeq from the Faculty of Medicine at Mutah University for theirfeedback about the study questionnaire and all the research assistantswho helped us in data collection.

Conflict of interest

The authors do not report any conflict of interest.

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