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Jour nal of Cari ng Sciences, 2013 , 2(4), 329-335doi: 10.5681/jcs.2013.039http:// journals.tbzmed.ac.ir/ JCS

* Corresponding Author: Kritaya Sawangchareon (PhD), E-mail: krisaw@ kku.ac.th

Copyright 2013 by Tabriz University of Medical Sciences

Moving the Self-Esteem of People with Epilepsy by Supportive Group: AClinical TrialKritaya Sawangchareon 1*, Sineenard Pranboon 2, Somsak Tiamkao 3, Kittisak Sawanyawisuth 3

1 Facult y of Nu rsing, Khon Kaen University, Khon K aen, Thail and2 Nur sing Di vision, Srinagari nd Hospital, Faculty of M edicine, Khon Kaen University, Khon K aen, Thail and3 Department of M edicine, Faculty of M edicine, Khon Kaen Uni versity, Khon Kaen, Thail and

ARTICLE INFO ABSTRACT

Ar ticl e Type:Original Article

Introduction: People with epilepsy (PWE) face physical and mental illness, and socialstigma, which affect their self-esteem and quality of life. The aim of this study was toexamine the effects of a support group on the self-esteem of PWE.M ethods: A quasi-experimental study was performed on 120 PWE in the epilepsy clinic atSrinagarind hospital. The experimental group (n=60) attended the support group beforereceiving regular health care services. The control group (n=60) received only regularhealthcare services. Data was collected by using the Rosenberg self-esteem scale scoring

before and after the experiment. The scores were analyzed by using t-test.Results: The study showed that before the experiment, the self esteem score of thecontrol group was significantly higher than the experimental group. After theexperiment, the scores of the control group and the experimental group showed asignificant statistical difference. The score in the control group was significantly lowerthan the experimental group, while the score in the experimental group wassignificantly higher than before the experiment. Changes of self-esteem (before toafter) in two groups showed significant statistical difference.Conclusion: The support group improves the self-esteem of PWE. Medical personnelshould set up a support group for PWE to enhance their self-esteem.

Arti cle Hi story:Received: 2 Oct. 2013Accepted: 20 Nov. 2013ePublished: 30 Nov. 2013

Keywords:EpilepsySupport groupSelf-esteem

Introduction

Epilepsy is one of the most commonneurological disease and serious public healthproblem. It has an impact on daily living ofpeople with epilepsy (PWE) 1,2; especiallypsychosocial issue makes PWE feel they are aburden to their family and society.Consequently, PWE suffer fromstigmatization in society and low self-esteemwhiles their lack social opportunities. Studiesshow that over 60% of PWE are depressed andanxious 3,4, and 56.6% are ashamed and havelow self-esteem. 5 These impacts lower thequality of life of PWE. 6 The Epilepsy clinic at Srinagarind hospitalproviding care for PWE by multidisciplinaryteam including physicians, pharmacists, andnurses. Physicians role were provide caring of

PWE based on standard of treatment.Pharmacists role were collect data and surveyproblems related to the use of antiepilepticdrugs (AEDs), solve the problems, and educatePWE how to correctly take AEDs. Nurses areclosest to PWE and therefore have major rolesto provide caring of PWE by support andencouragement them to learn from group

participants through the support group.The support group enables PWE to sharingcommon issue or problem and their experienceof illness. Including; exchange information andadvice members to learning about conditionsand their management. In the support group,PWE will do not feel discriminated becausethey have a relationship with members,listening to and accepting others experiences, share similar problems, providing sympatheticunderstanding. It raises self-esteem and self-

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confidence in PWE. Having expressed theirfeelings makes them happier, understandthemselves and their lives better, coping withproblems and make them emotional stability.With the support group, PWE will learn aboutmanagement to improve self-care. With ameans to solve their own problems, thepatients have better quality of life. 7-10 Generally,the support group as a brief group therapyshould be practice 4 to 60 times. In practice,outpatients department (OPD), PWE is usuallyvisit physicians every 1-3 months, so PWE that joined the support group only once. Eventhough, joined in the support group 1 time hasshown improvements in social relationship soit affect to self-esteem. 11 However, apsychodynamic problem solution requireslong-term therapy.Thus, the researchers wanted to study theeffects of the support group on the self-esteemof people with epilepsy.Research Objectives were as: to compare self-esteem of PWE before and after joining thesupport group and to compare the self-esteem of PWE who joined the support group

and PWE who did not join the supportgroup.Hypothesis in this study set as: PWE joiningthe support group have better self-esteemthan before joining the group and PWE joining the support group have better self-esteem than PWE not joining the supportgroup.

Materials and methods

This research was developed from routine to

research (R2R) to evaluate a nursing activity.The quasi-experimental method was appliedbased on the randomized controlled trial(RCT) to compare the results of the supportgroup called the exchange group. Theresearch method followed the followingframework. In control group, subjectsevaluated for self-esteem then participantsreceived regular health care services, followedby evaluation of self-esteem score once again .

In experimental group, subjects evaluatedfor self-esteem then participants joined thesupport group 1 time and followed byreceiving regular health care services. Thenthey evaluated for self-esteem once again.We conducted surveys at Epilepsy clinic,Srinagarind hospital, which opens everyMonday from 8.00 12.00 a.m. Providing carefor PWE by multidisciplinary team includingphysicians, pharmacists, and nurses. Theparticipants of the study must arrivedEpilepsy clinic before meeting theirphysician. The nurse will informed PWEabout the support group during the week thegroup was set up. For participants in thecontrol group, that come to follow up in theday support group set up were able to jointhe group without being evaluated in self-esteem.Sampling conducted based on inclusioncriteria considering as: I- PWE who arevoluntarily and would like to join withsupport group and II- PWE did not fatigue and poor recognition, and exclusion criteriaas: I- PWE who are fatigued with poor

recognition skills. Vital signs and mentalstatus are evaluated via examination by apsychiatric nurse; if poor attention, memory,perception, or concentration is discovered anindividual will be excluded. Sample size was calculated by considering = .05, =0.10 and 59 cases for each groupdetected. Sixty subjects were entered.It was selected first week for experimentaland next week for control group untilcompleted by number of sample size. There

was run 4 months to complete collectingdata.The experimental group was informedconsent and evaluated in self-esteem before joining the support group. Then, they willreceived regular health care services by metthe physician, pharmacist, and nurse, in thatorder. They were evaluated for self-esteemonce more before returning home. Theexperimental group was evaluated in

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Diagram of study

self-esteem during the first week, whereasthe control group was evaluated during thefollowing week. The support group wasscheduled in alternate weeks.The control group was evaluated in self-esteem during the week when no supportgroup was set up. Then, they will receivedregular health care services by met thephysician, pharmacist, and nurse, in thatorder. They were evaluated for self-esteemonce more before returning home (Diagramof study).The self-esteem form used was the Thaiversion of Rosenburg modified bySrimorakot. 11 It consisted of 10 questions, 5positive questions. 5 negative questions.Questions were in value-estimated ratio.Each question had 4 choices. Positivequestion ranged from 4 to 1(strongly agree tostrongly disagree). Negative questions whichare reversed scores.The score range from 0- 40. Score of 15 to 25are within normal range; scores below 15suggest low self-esteem. The evaluation formhas undergone validity by 5 experts and 10PWEs for reliability test in Thailand, with thereliability by cronbachs alpha coefficientlevel of 0.97 One of outpatient nurse ask PWEvolunteer to complete this form before and

after the process. There were 3- 4 hours frompre test to post test.The intervention was performing the supportgroup for the members to sharing, exchangeexperiences of illness, self-care, learning aboutconditions and their management.The members provide each other and askedinformation and problems of the othersrelated to epilepsy. Members could alsocommunication their illnesses to the medicalteam through the group leader.

The group leader was a lecturer in psychiatryand a mental health nurse who had over 10years of experience working with supportgroups. The second group leader was a nursefrom the Epilepsy clinic who had experiencein attending to PWE.The support group was set up every Mondayfrom 08.00 09.30 a.m. PWE were invited toenter the support group voluntarily. Thegroup consisted of 5 to 10 members and wascarried out from January to December, 2012.Before the process of support group will bedone, the group leader asked permission torecord the information obtained from themembers for benefits in care for PWE. Someinformation was taken to consideration withmultidisciplinary team. The group leaderinformed the members after the support

group if there was any information they didnot want disclosed. The support group activities were dividedinto 3 stages:Stage 1. Relationships building, objectivesinforming, and introduction of members.Stage 2. Sharing of experiences, memberslistening to and accepting others experience,asking questions about conditions and theirmanagement, leader encouragementmembers to exchanges of information and

giving support.Stage 3. Ending relationship, membersconclude what was learned, usefulness, andproviding sympathetic understanding andestablishing social networks.The personal information was analyzed bydescriptive statistics. Chi-square and t-testwere used in analysis of comparison thepersonal information and self-esteem scoresbetween two groups. The test was applied atthe reliability level of 95%.

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This research has been reviewed andapproved by the Khon Kaen university ethicscommittee for human research (reference No.HE 541379). Consent was obtained from allparticipants (both in control andexperimental group) who were assured ofconfidentiality and anonymity. Theparticipants were able to withdraw from thestudy at any time without any consequence.

ResultsThe control group and experimental groupconsisted of more females (58.3%) than males

(41.7%). The control group range for age was16-60 with average of 32.78 years and theexperimental group range for age was 13-79with average of 37.73 years. Duration ofillness in the control group was 1-34 withaverage of 8.36 years and the experimentalgroup was 1 - 37 with average of 8.98 years. Itcan be seen that the age and sex of bothgroups did not differ significantly, whereasthe duration of illness differed significantly)as shown in Table 1).

Table 1. Personal information of the control and experimental groups

Information Control groupN=60

Experimental groupN=60

P

Age 32.78 37.73 P = 0.47Sex

MalesFemales

25(41.7) 25 (41.7) P = 0.5135 (58.3) 35( 58.3)

Duration of illness 8.36 8.98 P=0.00*Age and duration of illness reported as mean, sex reported as N (%).

Table 2:

Comparison of self-esteem scores before to after joining the support group ofPWE in control group and experiment group

Time Control group Experimental groupnaeM )DS( 95% CI for

dif.StatisticalIndicators

naeM )DS( 95% CI fordif.

StatisticalIndicators

Before 35.01(4.95) 3.49,5.24 t=9.97P=0.00032.80 (5.59) -2.89,-0.13 t= - 2.19P=0.032

After 30.65 (4.33) 34.32 (2.38)

In Table 2, the control group andexperimental group showed significantlydifferent self-esteem scores both before andafter experiment. The control groups self -esteem score decreased significantly prior to

receiving regular health care services. Incontrast, the experimental groups self -esteem scores increased significantly ehT .95% confidence of interval for changes (before toafter) showed in Table2.

Table 3. Comparison of self-esteem scores between control to experimental groups beforeand after joining the support group

Time Control groupMean (SD)

Experimental group Mean (SD)

Statistical Indicators

Before 35.01(4.95)30.65 (4.33)

32.80 (5.59)34.32 (2.38)

T=2.38, P=0.02After T= -6.61, P=0.00

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became simpler even though they stillreceived AEDs and had seizures. 12 Due to the support groups efficiency, PWEbecame more hopeful and felt better towardsthemselves. They knew that they were notalone to overcome the disease. The membersin the support group shared the hard time,understanding in life, gave and receivedmoral support to each other. 15 The process ofthe support group helped PWE to accept thephysical and psychological impact of thedisease. They were encouraged to do theirduty to the society, perceived that oneselfuseful to the other and continue living, andthus accepted the treatment with confidence.The control group did not receive anysupport and so the self-esteem decreased,especially when they had to continue takingmedicine and living with seizures. The studyindicated that PWE adjusted themselves tothe symptoms and had significantly lowerself-esteem than diabetic patients. 16 Familieswith epileptic children have many stressfulevents than other families. Thus, useful ofthe support group can help patients to adjustthemselves and leads to higher self-esteem. 17 So, PWE join the support group are affect toself-esteem which able to adjust themselvesto the illness and stress management, andcan continue their social roles. Nursing roletherefore should set up the support groupand encourage PWE to join with the groupso that their self-esteem will be high andthey will be able to live more happily. 18There were some limitations in this studythat should be recognized. Nurses who

provide group support ideally should befree from performing other jobs, becauseeffective leader group requires a longerperiod of time. During support group nurseas a leader may face a patient need to haveindividual counseling. The self-esteem is adynamic; it is possible to change whenpeople contact each other as the form ofrelationship. So, it was evaluated in the sameday after meeting process. In additionevaluations were conducted in the same day;

therefore, changes could not be anticipated

even though the participants showedmoving of self- esteem. Besides that,continued research should be done to followup on PWE after go back home and then facewith family in order to see discover whetheror not levels of self esteem have increased.

ConclusionThis study showed that changes of self-esteem scores (before to after) in two groupswere statistically significant. Therefore,nurses should regularly hold the supportgroup for PWE to increase their self-esteem

and enable them to adjust themselves toepilepsy. The nurses should understand thegroup process and understand PWE wellenough through regular training. Thesupport group should also be a policy of theOPD.The study researchers recommend that acomparative study should be conducted inwhich the period of illness is controlled inorder to study the clear effects of the supportgroup. In this study, PWE in the control and

experimental group had different illnessperiods.

AcknowledgementWe are grateful to the integrated Epilepsyresearch group, Khon Kaen university forthe funding support. The authors also wishto thank the participants, who made thisstudy possible.

Ethical issues

None to be declared.

Conflict of interest

The authors declare no conflict of interest.

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