Research question

Knowledge and attitude towards epilepsy amongst the African community in England is an important topic for undertaking research in the field of health promotion. The proposed research would consider carrying out an analysis of the knowledge and attitude towards epilepsy amongst the Africn community in England. The research question for the proposed research is “What is the level of knowledge and attitude towards epilepsy amongst African community in England”? The study would aim at addressing this research question that would hold much significance for health promotion activities in the country in future.

The aim of writing a research proposal is to bring into focus and justify the requirement to study the chosen research problem. The paper is to present the practical methods through which the study is to be conducted. The study design and elements for carrying out the research must be governed by certain standards. Persuasive evidence is to be presented to establish the need for the study (Flick 2015).

The present research proposal is the document proposing the research project on the level of knowledge and attitude towards epilepsy among African community in England. The proposal has been divided into major sections, each addressing certain points usually covered in a proposal. The first section of the proposal highlights the background to the research and the rationale for the study. This would provide background information of important contextual and historical events related to the research topic that would inform how the research problem exists. Studies conducted in relevance to the proposed study would be analysed and mentioned in this section. The research to be conducted would be objectively justified with the help of literary sources. The next section of the paper would mention the aim and objectives of the proposed research in a clear manner.

The subsequent section of the paper would describe the proposed methodology in details. The complete method of conducting the study would be written in this section, which is the research methodology. The literature search strategy would be thereby highlighted. The search engines, academic databases, relevant keywords, and inclusion and exclusion criteria to be used would be after that included. The next section of the paper would bring into focus the ethical and anti-oppressive issues related to the research practice. The project outline for the final paper would be discussed after that. Lastly, the project timetable would be mentioned, highlighting the time frame within which the research is to be completed.

Epilepsy is a neurological condition in which the patient suffers recurrent seizures. In the medical dictionary, a seizure is referred to the transient disturbance of the cerebral function and abnormal paroxysms in the brain leading to the sudden excessive discharge of the cerebral neurons. The patient suffers an instantaneous disturbance of sensation, convulsive movements and loss of psychic function due to such discharge. Sociocultural attitudes cause a drastic negative impact on the management of epilepsy in many nations. Religious and sociocultural beliefs are known to make an impact on the treatment and management received by epilepsy patients (Teferi and Shewangizaw 2015).

Background and rationale for the research

In the UK, 1 in every 103 people suffer from epilepsy and accounts for almost 600000 people in the country. every day, about 80 people are diagnosed with the disease. While 52 per cent of patients in the country is seizure free, 70 per cent can be made seizure free through appropriate treatment. Epilepsy is covered by the Disability Discrimination Act in Northern Ireland and the Equality Act in England, Scotland and Wales. Attitude and knowledge of epilepsy are woven into religious and cultural practices in the UK. This is further made complicated by the multiplicity of ethnic groups and diverse cultures. The syncretic amalgamation of indigenous traditions with foreign cultures has made a drastic influence on popular attitudes towards epilepsy (Hamandi et al. 2017). Around 3 per cent of the UK’s population was of Black origin as per the reports of the year 2011. Around 95% of Black British live in England. Doctrines of different cultures that are foreign to that of the UK, particularly African culture, have created distinct patterns of understanding of the disease. Thus, there is a wide gap generated in the attitude of the populace in the country (Snape et al. 2017).

Otte et al. (2013)  pointed out that epilepsy is a common non-infectious neurologic disease prevalent in a number of developing as well as developed countries. Around 50 million people across the world suffer from this disease and need health care facilities at an adequate level. On the historical front, epilepsy was thought to be a sacred disease that is caused by the invasion of the body by some supernatural forces. The convulsions were believed to be the result of this supernatural power. Disappointingly, the historical legacy has been found to continue to make a drastic public attitude towards epilepsy. As a result, the diseases have been denoted as a dreaded one, and the patients have been misunderstood, stigmatised and ostracised. The social implications of these in appropriate attitude is serious. What is of prime importance sis that per the African belief, epilepsy is due to poisoning and witchcraft. A combination of lack of medical care, poverty, traditional beliefs, and failure to justify the social roles has made a deeply negative impact on the lives of epilepsy patients.

Margolis et al. (2018) had commented that it is unfortunate that epilepsy, in spite of being a common disease, carries a social stigma which is much strong. The discrimination, stigma and social attitude have prevented the adequate implementation of health promotion strategies for those in need. Such discrepancies are more common for people from diverse racial backgrounds such as those with African origin. A comprehensive epilepsy care has been attempted to be delivered to people from different racial backgrounds; however, low level of public awareness and poor social education have acted as barriers. Social discrimination varies among the population on the basis of the culture they uphold, and their personal beliefs and viewpoints. There is a need for a comprehensive study that would highlight the attitude towards epilepsy amongst people coming from the different cultural background.

Methodology

According to Allard et al. (2017), people suffering from epilepsy have more chances of living in areas that are economically and socially deprived. This section of the population is also prone to suffer from chronic physical conditions and ill health. People suffering from the disease are not allowed to join particular professions and are implicitly discriminated in the respective workplace. Though some patients suffering from the disease have comorbid learning difficulties, antileptic medication is known to cause education impairment. A social disadvantage might be apparent at diagnosis. Deprivation status has not been quantified effectively in the recent past. The study conducted by the researchers had pointed out that the prevalence of epilepsy is not uniform in the United Kingdom. Further, the variability can be explained by the differences in components of socioeconomic deprivation. The study conclusively demonstrated that there exists a distinct correlation between indicators of socioeconomic deprivation and epilepsy prevalence on a population basis. The study recommended that the designing and implementation of public health policies, which aim at ameliorating the differences in approach towards epilepsy care, must be based on novice strategies. In this regard, the strategies might be different for different cities in the country.

According to Ezeala-Adikaibe et al. (2014), one dimension of the sociocultural belief regarding epilepsy is that the disease is contagious and can spread through body secretions. This belief has resulted  in the isolation of carers to protect and care for patients from injury at the time of seizures. The sociocultural belief also greatly influences the health seeking behaviour and the management. There is also a scarcity of trained personnel who can address the health needs of individuals suffering from the disease.

Research highlights that the health department in UK has been making several attempts to address the needs of epilepsy patients at present. It is evident that the concerned authorities are trying to set up valuable policies and reform the older ones in order to make epilepsy care more successful. Health promotion for the disease has been has been given much emphasis for a long time with sets of clear goals to be achieved. The gaps in understanding the disease act as prime drivers of social stigma and negative attitude towards non-native population, such as the Africans. It has been realised that there is an urgent need of robust multi-faceted educational interventions that are aimed at bringing improvement in the understanding and awareness of the condition by all segments of the community. Interpersonal as well as mass media delivered programs are needed for this process (Ridsdale et al. 2017).

At present, there is a scarcity of information on the prevalence of epilepsy among the African community in the UK. There is a need for further research to establish the knowledge and attitude of epilepsy among African population in the UK. The research gap generated from previous research would form the basis for the research to be carried out in future. Based on the further research, community-based epilepsy programs can outline for improving the access to epilepsy treatment among African population in the UK. Healthcare organisations can advocate the use of community-based services for equalising the social integration of individuals living with the disease. For coming up with suitable public health projects, there is a need for understanding the scenario of epilepsy knowledge and attitude among African community in the UK (Krishnamoorthy, Shorvon and Schachter, 2017). A rich pool of evidence points out that ethnic and racial minorities receive poor quality of care than nonminorities. Even though several attempts have been made to eliminate the disparity in care delivery between minority and non-minority population, there is still much to achieve. Reporting on this inequality, scholars say that disparities cannot be eliminated adequately since research into such areas is limited. There is a scarcity of information on the exact prevalence of certain diseases such as epilepsy, and the related social factors among the ethnic groups. Interventions, therefore, are difficult to be outlined aligned with the comprehensive needs of the patients. There is an urgent need of a renewed interest in gaining an increased understanding of the reasons behind disparities, contributing factors, and evaluation of effective interventions for these population (Noble et al. 2017).

Ethical considerations

For projects to be successful in this domain, three major aspects are to be researched into. First is the prevalence of epilepsy amongst the African Community in England. Second is the challenges and barriers faced by people with epilepsy among African cultures in England. Last is the effectiveness of the local authority strategies. A study focusing on these three aspects would effectively pave the way for improving services for people living with epilepsy in England. Based on the findings, all interventions can be integrated completely into the context of primary healthcare delivery. Local communities can be thereby brought into the planning and implementation process with the aim of fostering long-term sustainability. The chief aim of epilepsy awareness and education program for the public is to address stigma, and public health professionals can only promote quality of life of patients when the whole patient population is identified and approached. Since misconceptions and misinformation regarding the disease have a long history in society, research is needed for identifying the changes witnessed in this regard to come up with relevant policies. Comparing contemporary attitudes with those prevalent decades back would be a valuable approach (Berkovic 2017).

Research aim refers to the general intentions of the study that is to be carried out. The aim emphasises on what is to be accomplished at the end of the research. In the present case the proposed research would have the following aim-

• To examine the knowledge and attitude towards epilepsy amongst the African Community in England.

Research objectives are the precise study outcomes and these give an accurate view of the different elements of the research aim. The proposed research would have the following research objectives-

• To critically investigate the prevalence of epilepsy among the African community in England.
• To analyze the challenges faced by people with epilepsy among African cultures in England.
• To analysis local authority strategies for improving services for people living with epilepsy in England.

Research design

The research design refers to the overall plan selected for integrating the different elements of the research in a logical and coherent manner. The aim of selecting the proper research design is to make sure that the evidence obtained can properly address the chosen research problem in a logical manner. The type of design is determined by the research problem (Taylor, Bogdan and DeVault 2015). The proposed research would be a systematic literature review that would focus on analysing the attitude and knowledge of epilepsy among the African population in England. Systematic literature review is a form of a literature review that collects and critically analyses a wide range of research studies against the research question formulated. The aim of the proposed systematic literature review would be to provide an exhaustive, complete summary of current literature against the research question. Apart from health interventions, examination of public health interventions is also possible with the help of such reviews (Flick 2015).

The question of what works best in development of national healthcare policy and practice is best answered with a literature review that is conducted in a rigorous manner. Since the urgency of creating advanced health promotion programs is felt at present, there is an accountability of gathering maximum data from already existing research. Systematic reviews are a transparent and rigorous form of a literature review that aids in extraction of optimal information from literary sources. Evidence-based policy making can only be possible when there is a proper use of empirical evidence on the relevant research. Government funded programs and policies in many countries across the globe consider the use of systematic reviews in development research (Neuman and Robson 2014).

Project outline

A systematic review would be the most comprehensive and reliable review on the topic of knowledge and attitude of epilepsy among African community in London as it would help in synthesising and assessing all evidence. Both qualitative and quantitative studies can be used for this purpose, enhancing the value of the research to a great extent. Such a review would address the gaps in understanding about the research topic by critically evaluating and integrating all the study findings that are of high quality. The assessment would establish to what degree research gained success in clarifying the knowledge and attitude of epilepsy among African community in the UK. Relationships between the cofactors of epilepsy prevalence in the country can be established through the research. Further, inconsistencies and gaps in literature can be brought into focus along with the reasons behind them.

A systematic literature review is to be undertaken by completing a meticulous search based on a pre-set strategy. The literature search strategy would determine the success of the research in general (Panneerselvam 2014). The aim of the literature search would be to find relevant published work throwing light on the research questions. The search would be done with the help of important databases and keywords. With ideal searching comes the need of carefully inspecting the same. The databases would be searched for relevant published work, and a series of steps would be followed for making the search suitable. One database would be searched on to at a time, and the next databased would be accessed when there would be no more resources in that databases to consider. The title and the abstract of all the works would be identified and read for understanding its relevance to the research topic. After the first step of screening, the full text would be read to further understand whether the paper can be included in the study. Shifting to full-text version is necessary to see whether the inclusion criteria are met. At this stage, the pool of possible studies can be reduced rapidly by having a focus on the content. Since the research aim is multidimensional, there would be need of searching for ‘grey literature’. These are literature available in electronic and print form that is not controlled by commercial publishers. These include reports from scientific research groups, technical and research reports published by government agencies, doctoral dissertation, official publications and conference proceedings.

Since the search would reveal a large number of results, it would be advisable to export the search results to a citation manager such as he RefWorks and EndNote. There would be much benefit in doing so since it would save time, enabling an electronic process rather than a manual process. The research results can be saved, implying that there would be no loss of valuable information. Further, duplicate versions of the same paper can be deleted appropriately (Flick 2015).

Search engines and online databases are the useful tools utilised by researchers who aim at undertaking a proper systematic literature review for their research. One must be careful while identifying the correct databases that can provide valuable information on the research topic (Matthews and Ross 2014). The proposed research is to be undertaken by using online databases such as PubMed, CINAHL, Ovid, Web Search, Proquest, Science Direct and others. The above mentioned databases are known for the vast range of literary sources they hold. These are some of the popular databases having information on public health domain. The pool of journals and other sources are highly valuable. The databases have access to full-text journal articles which are peer reviewed. This makes the paper reliable and highly authentic. Apart from journal articles, one can get books, organisational reports, dissertations, newspaper articles and other literary sources.

Project timetable

Keywords are the search terms used and act as a crucial element of the systemtic literature search. These are the words and short phrases extracted from the research question and objectives and entered into the different search engines for extracting the relevant data. Only suitable keywords can make the search a praiseworthy one and researchers must focus on using as many as keywords as possible (Flick 2015). The keywords that are to be used for the proposed research are knowledge, attitude, belief, perception, idea, epilepsy, health, disease, African, United Kingdom, UK, London, population, prevalence, incidence, community, challenge, barrier, difficulty, culture, strategy, plan.

Together with the significance of utilising proper keywords emerges the need of using proper Boolean operations. These are the logical terms placed along with the keywords for making the search process easier. An authentic search can be carried out if such operations are used. The credibility of the operations lies in having the search process channelled in a particular direction. The inappropriate hits can be eradicated with a proper combination of keywords and Boolean operation. The search results are productive which is a fundamental feature of systematic literature review (Neuman 2016). The Boolean operations to be applied for the proposed research are AND and  OR.

Not all resources extracted through the search can be included in the study in case of a systematic literature review. One needs to set up basic criteria for including particular literary pieces in the review. Inclusion and exclusion of literature are to be done strictly by following the criteria so that the ultimate result is as desired (Panneerselvam 2014). For the proposed review, papers published after the year 2010 would be considered. This would be done with the purpose of including recent papers in the review. Since there is an evolution in the key concepts regarding the research topic, it would be desirable to reflect on recent publications that bring into focus the new developments in the topic. in case of journal articles, only those with full-text content would be considered for inclusion. This is necessary so that comprehensive information from the papers can be included in the review. Papers that would not be in the English language would be excluded from the review. Further, articles not providing key information on the research topic would be excluded (Neuman 2016).

Ethical principles hold a prime place in the process of conducting research, be it primary or secondary. Ethics ensure that the research is praiseworthy and appropriate for dissemination among the community at large. Literature is the basis for policy decisions, and those contributing to it must be careful about the responsibility to ensure accurate and unbiased information included in the paper. Since publications are used for judging the social context of public health issues, it would be important to give fair credit to those who have undertaken research in the same field previously. This would be done by citing the proper references for all information included. The proposed research would be undertaken in an accountable manner for ensuring elimination of misconduct and inclusion of integrity. Plagiarism would be avoided by acknowledging the authors of every idea, data, image and viewpoint. Misinterpretation of other person’s work would be avoided. Another ethical challenge faced in literature review is a conflict of interest between the researcher and the researched. It is necessary to declare any arising conflict of interest in the research paper.

Anti-oppressive practice is the approach embedded within research that has the focus on eliminating socioeconomic oppression. For the proposed research, the researcher is to critically examine the power inbalance prevalent in the society in relation to epilepsy prevalence among Africans in the UK. There would be no traces of racial comments and biasness that might become the reason for discrimination against the selected study population. There would be no alteration made in the information available (Silverman 2016).

The research report would follow a standard protocol that would include different chapters arranged in a logical manner. The project would be formall aligned with sections having information placed in a interlinked manner. The structure would be as follows-

1- The very first chapter of the project would include the introduction, background and rationale, literature search strategy, ethical considerations and project outline. The introduction would explain the rationale behind selecting the topic and its importance. The background of the study would highlight the importance of the topic in the domain of public health. It i necessary to mention the literature search strategy in an accurate manner so that the study can be replicated by researchers in future. How the investigation would be carrid out would be mentioned clearly.

2 and 3- The second chapter would focus on an in-depth literature review. This would highlight the gaps in existing literature and the need of further studies in the same field. The systematic literature review would be done in the third chapter as the main research. Thematic headings and subheading would be formulated in this chapter. Interpretation of information is a sensitive matter and much attention is to be given while writing this section.

4- This chapter would contain the conclusion, recomemdnation and reflection. The conclusion would be a short section that would summarise the main findings of the study and the inferences drawn. It would provide no new evidence and argument. Recomemdnations for future research would be mentioned as well keeping in mind the limitations of the proposed research. Suggestions for actions might also be included in here. The reflection part would be a critical analysis and evaluation of what would be learnt while undertaking the project. This would highlight the errors made while doign the project and the lessons learnt through the process of research. Actions for future would be mentioned thereafter (DePoy and Gitlin 2015).

The project is to be compeleted within a span of six months. The different phases of the research is to be divided into different time periods and it would be ensured that the timetable is maintained for managing the completion of the research propely.

	Month 1	Month 2-3	Month 4-5	Month 6
Preparation for research	·
Data collection in databases		·
Data analysis			·
Preparation of  research report				·

References 

Allard, J., Shankar, R., Henley, W., Brown, A., McLean, B., Jadav, M., Parrett, M., Laugharne, R., Noble, A.J. and Ridsdale, L., 2017. Frequency and factors associated with emergency department attendance for people with epilepsy in a rural UK population. Epilepsy & Behavior, 68, pp.192-195.

Berkovic, S.F., 2017. Epilepsy research in 2016: new treatment directions. The Lancet Neurology, 16(1), p.7.

DePoy, E. and Gitlin, L.N., 2015. Introduction to Research-E-Book: Understanding and Applying Multiple Strategies. Elsevier Health Sciences.

Ezeala-Adikaibe, B.A., Achor, J.U., Nwabueze, A.C., Agomoh, A.O., Chikani, M., Ekenze, O.S., Onwuekwe, I.O. and Orakwue, M., 2014. Knowledge, attitude and practice of epilepsy among community residents in Enugu, South East Nigeria. Seizure, 23(10), pp.882-888.

Flick, U., 2015. Introducing research methodology: A beginner’s guide to doing a research project. Sage.

Hamandi, K., Beniczky, S., Diehl, B., Kandler, R.H., Pressler, R.M., Sen, A., Solomon, J., Walker, M.C. and Bagary, M., 2017. Current Practice and Recommendations in UK Epilepsy Monitoring Units. Report of a national survey and workshop. Seizure.

Krishnamoorthy, E.S., Shorvon, S.D. and Schachter, S.C. eds., 2017. Epilepsy: A Global Approach. Cambridge University Press.

Margolis, S.A., Nakhutina, L., Schaffer, S.G., Grant, A.C. and Gonzalez, J.S., 2018. Perceived epilepsy stigma mediates relationships between personality and social well-being in a diverse epilepsy population. Epilepsy & Behavior, 78, pp.7-13.

Matthews, B. and Ross, L., 2014. Research methods. Pearson Higher Ed.

Neuman, W.L. and Robson, K., 2014. Basics of social research. Pearson Canada.

Neuman, W.L., 2016. Understanding research. Pearson.

Noble, A.J., Robinson, A., Snape, D. and Marson, A.G., 2017. ‘Epileptic’,‘epileptic person’or ‘person with epilepsy’? Bringing quantitative and qualitative evidence on the views of UK patients and carers to the terminology debate. Epilepsy & Behavior, 67, pp.20-27.

Otte, W.M., Nhaga, A.A., Tchuda, D.L., Abna, B., Sander, J.W. and van der Maas, F., 2013. Understanding of and attitudes towards people with epilepsy among community-based rehabilitation volunteers in Guinea-Bissau. Epilepsy & Behavior, 28(2), pp.196-200.

Panneerselvam, R., 2014. Research methodology. PHI Learning Pvt. Ltd..

Ridsdale, L., Philpott, S.J., Krooupa, A.M. and Morgan, M., 2017. People with epilepsy obtain added value from education in groups: results of a qualitative study. European journal of neurology, 24(4), pp.609-616.

Silverman, D. ed., 2016. Qualitative research. Sage.

Snape, D.A., Morgan, M., Ridsdale, L., Goodacre, S., Marson, A.G. and Noble, A.J., 2017. Developing and assessing the acceptability of an epilepsy first aid training intervention for patients who visit UK emergency departments: A multi-method study of patients and professionals. Epilepsy & Behavior, 68, pp.177-185.

Taylor, S.J., Bogdan, R. and DeVault, M., 2015. Introduction to qualitative research methods: A guidebook and resource. John Wiley & Sons.

Teferi, J. and Shewangizaw, Z., 2015. Assessment of knowledge, attitude, and practice related to epilepsy: A Community-based Study. Neuropsychiatric disease and treatment, 11, p.1239.