Public Health الصحة العامة

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Browsing Public Health الصحة العامة by Author "Abeer Ali Mohammad Ghanayem"

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    Understanding and Improving Epilepsy Care in Primary Healthcare: A Mixed-Methods Study in the West Bank, Palestine
    (Al-Quds University, 2025-08-24) Abeer Ali Mohammad Ghanayem; عبير علي محمد غنايم
    Introduction: Epilepsy is a chronic neurological condition affecting over 70 million people worldwide, with the majority residing in low- and middle-income countries. In Palestine, epilepsy care is challenged by fragmented healthcare delivery, limited access to specialized services, inadequate provider training, and pervasive social stigma. Although primary healthcare centers are the main access point for people with epilepsy, care at this level remains underdeveloped, with no standardized treatment protocols or structured self-management support. Addressing these gaps requires a comprehensive understanding of the lived experiences of people with epilepsy, the readiness of the healthcare workforce, and the effectiveness of contextually tailored interventions. Aim: This study aimed to explore and improve epilepsy management in primary healthcare settings in the West Bank, Palestine, by examining patients’ experiences, assessing healthcare providers’ knowledge, attitudes, and practices, and evaluating the impact of an educational intervention based on the WHO Mental Health Gap Action Program. Methods: A sequential exploratory mixed-methods design was employed across three interrelated studies. Study I used Husserlian phenomenology to conduct in-depth interviews with 12 people with epilepsy recruited from governmental primary healthcare centers. Thematic analysis was used to identify essential themes of their lived experience. Study II utilized a cross-sectional survey to assess the knowledge, attitudes, and practices of 300 healthcare professionals working in primary healthcare facilities across the West Bank. Study III implemented a quasi-experimental intervention using mental health-based training, with 68 healthcare providers randomized into intervention and control groups. Pre- and post-training assessments were conducted to evaluate changes in knowledge, attitudes, and self-efficacy after two months. Results: Study I identified three major themes: emotional and existential disruption, social vulnerability and stigma, and unsatisfactory healthcare experiences. Participants reported living with fear, social exclusion, denial of diagnosis, and a lack of trust in the healthcare system. Stigma was a pervasive theme shaping concealment, low self-esteem, and reduced access to care. Study II revealed substantial gaps in healthcare providers’ knowledge and practices regarding epilepsy care. Pearson’s correlation revealed a significant negative relationship between practices and knowledge (r = -0.170, p < 0.01) and a positive association with attitudes (r = 0.279, p < 0.01). Nurses and less experienced staff scored significantly lower in all KAP dimensions p< 0.05. While attitudes were moderately positive, providers showed poor familiarity with epilepsy self-management, seizure triggers, and psychosocial aspects of care. Multivariate analysis showed that knowledge were negatively correlated with gender and specialty but positively with educational degree (OR = 0.640, 95 % CI: 1.260–0.020, p = 0.043; OR = 1.970, 95 % CI: 2.841–0.099, p < 0.001). Knowledge scores were lower among certain genders and specialties but increased with higher educational attainment (p < 0.05). Attitudes were positively associated with age (OR = 2.552, 95 % CI: 0.974–4.130, p = 0.002) and years of experience (OR = 2.387, 95 % CI: 0.546–4.227, p = 0.011). Study III demonstrated that the mhGAP training significantly improved knowledge (p < 0.001) and self-efficacy (p < 0.001) in the intervention group. However, attitudinal change was modest and not statistically significant, suggesting that longer-term or targeted interventions may be required to influence stigma and empathy. Conclusion: Epilepsy care in Palestinian primary healthcare settings is hindered by systemic fragmentation, insufficient provider training, and sociocultural barriers that limit access to quality care. People with epilepsy experience profound emotional and social burdens, while healthcare providers lack adequate preparation to deliver patient-centered epilepsy management. However, brief, context- sensitive training interventions like WHO mhGAP can effectively enhance provider knowledge and confidence in the short term. Keywords: Epilepsy, Primary Healthcare, Palestine, Phenomenology, mhGAP, Mixed Methods, Self-Management, Health Workforce, Stigma, Health Systems Strengthening.