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Original Article
5 (
4
); 93-98
doi:
10.25259/JISH_2_2022

A survey to assess awareness about intellectual disability disorder in students studying homoeopathy

Bakson Homoeopathic Medical College and Hospital, Greater Noida, Uttar Pradesh, India
Central Council for Research in Homoeopathy, Delhi, India
Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Department of Pediatrics, Bakson Homoeopathic Medical College and Hospital, Greater Noida, India
Corresponding author: Mehak Gupta, Independent Researcher, B2/001 RPS Savana Sector 88, Faridabad, Haryana - 121002, India. mehakgupta.012@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Gupta M, Taneja D, Salklan MM, Gontiya R. A survey to assess awareness about intellectual disability disorder in students studying homoeopathy. J Intgr Stand Homoeopathy 2022;5:93-8.

Abstract

Objectives:

Students in homoeopathic colleges must be oriented towards intellectual disability (intellectual developmental disorder – ID/IDD) from the homoeopathic and medical perspectives; moreover, they should have a basic understanding of the social, ethical and legal implications of this condition. The objective of this study was to identify the knowledge, attitudes and level of awareness of homoeopathic students regarding IDDs using a standardised questionnaire.

Materials and Methods:

A survey of undergraduate and postgraduate students of Bakson Homoeopathic Medical College, Greater Noida was undertaken using NIMH – GEM questionnaire. Responses to the 30 statements in the questionnaire were calculated to determine the overall mean score, which was compared between sexes and the graduate and postgraduate levels. Responses to individual questions were analysed to identify the areas of low knowledge and awareness.

Results:

A total of 143 undergraduate and postgraduate students participated; 30 were male and 113 were female. The mean participant score was 6.22 +3.18 (95% confidence interval 5.69–6.75), suggesting a good level of awareness among the students. Significantly, a higher score was seen in the male students than in the female students. There was no significant difference between the scores of undergraduate and postgraduate students.

Conclusion:

While most students have a high level of understanding and awareness of IDD, certain areas from the rehabilitation perspective need to be explored further, specifically relating to the extent of independent activity that patients with IDD can attain with rehabilitation and care.

Keywords

Attitude
Knowledge
Intellectual disability disorders
Homoeopathic students
NIMH – GEM questionnaire

INTRODUCTION

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V), ‘Intellectual Disability (Intellectual Developmental Disorder) (ID/IDD) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social and practical domains’.[1]

The previously used term mental retardation was replaced by the term intellectual disability in the DSM V and the ICD 11 classifications to Disorders of Intellectual Development. This change was necessitated by the pejorative, negative and pessimistic connotations of the terms mental retardation, arrested mind development, idiocy, imbecility and mental deficiency, all of which were used previously. The use of the term intellectual is also in line with the current definition of the construct of intelligence encompassing a wide range of cognitive abilities, adaptive function and new learning abilities; this description has therefore gained wider acceptance with professionals, lay individuals and most health policy officials worldwide.[2]

Over time, numerous changes have occurred in the management and care of individuals with IDDs. With the growing awareness in this area, the roles of special educators, therapists and medical service providers have also been refined and made more inclusive. Medical treatment of disabilities is a lesser explored area, both in conventional and complementary and alternative medicine systems. The main focus of intervention is rehabilitation and special education. Parents often approach practitioners of conventional as well as complementary and alternative systems. Very often, faith healers are consulted as well.

Clinical evidence supports the role of homoeopathy in the treatment of ID/IDD. Studies state that, with homoeopathy, existing symptoms such as restlessness, irritability, anger and behavioural problems including threatening and attacking others and physical symptoms such as stammering, enuresis and others can be controlled and medicines can prevent further worsening of the symptoms.[3-8]

Homoeopathic colleges in India provide education and training for 5 years; their syllabi include the study of subjects of modern medicine along with those of homoeopathy. During undergraduate studies, the subject of the practice of medicine introduces students to pre-clinical and clinical subjects. This also includes the subject of paediatrics. IDD is introduced at the graduate level and further discussed at the postgraduate level. These students later become homoeopathic practitioners and play major roles in providing healthcare services at the primary, secondary and tertiary levels, including integrated care.

For homoeopathic physicians to provide treatment and support to persons with IDD, they need to understand the condition from not only the medical and homoeopathic perspectives but also the social, ethical and legal aspects. The attitude of students in homoeopathic medical colleges towards IDD and specifically people with IDD deserves considerable attention considering their potential role as future homoeopathic practitioners and family physicians. This survey was, therefore, undertaken to assess the knowledge and attitudes of the students towards ID/IDD as well as their level of awareness and misconceptions about the condition from a sociocultural perspective.

MATERIAL AND METHODS

Design

A cross-sectional survey was conducted at Bakson Homoeopathic Medical College, Hospital and Research Centre, Greater Noida, Uttar Pradesh.

Survey sample

A student seminar on ID/IDD was organised, where postgraduate (MD[Hom]) and final year undergraduate students (Bachelor of Homoeopathic Medicine and Surgery) were expected to be present as a part of the curricular activities. The participants of this seminar were invited to participate in the study, before starting the seminar. Participation in the survey was purely voluntary and only the students who provided their consent to participate in the study were included in the study.

Questionnaire

A questionnaire has been developed by the erstwhile National Institute of Mentally Handicapped (presently, the National Institute for Empowerment of Persons with Multiple Disabilities, Secunderabad) called NIMH-GEM for the assessment of the level of awareness about mental retardation.[9] The scale is sensitive to record misinformation and misconceptions held by the general community concerning the sociocultural conditions prevalent in India. The scale has reportedly been used in various studies, but no survey on the level of awareness in homoeopathic students on this questionnaire is reported.[10-13]

Description of the tool

The NIMH-GEM questionnaire has 30 items divided into three sections, namely, general information (G), aetiology (E) and management (M). The items are stated in the form of a statement and the respondent is expected to indicate whether they agree (yes) with the statement or not (no). If the respondent agrees with the statement, they must answer by making a circle with a pen/pencil on ‘yes’. If the respondent does not agree with the statement, they must encircle ‘no’. The items are not in any particular order. There are 11 items in the category of general information, nine on aetiology and ten on management aspects. Items 1–11 identify misconceptions related to general information on mental retardation, items 12– 20 on aetiology and items 21–30 on the management of mental retardation. The English language version of the NIMHGEM questionnaire was used in the survey. Each statement is awarded a score of 1 in the direction of misconception or a lower level of awareness. The higher the scores, the greater the misconceptions regarding ID/IDD. The terminology used in the questionnaire is mental retardation as against the currently used term ID/IDD. This term was retained as it is and no change was made in the original questionnaire.

Data collection

The purpose of the survey was explained to all participating students. The participants were informed about the value of their participation and were requested to take the survey seriously and respond to the items honestly and thoughtfully. The participants were reminded not to leave any items blank. After the survey, the questionnaires were sealed in a packet labelled ‘IDD Awareness’ and the number of respondents was marked on the envelope.

The participant’s identity was kept confidential and mentioning the participant’s name was not mandatory. All responses were coded and individual responses were entered into a data sheet by an independent research student who was not associated with the college. The coded data sheet was shared with the rest of the researchers from the college. The participants’ identities were also kept confidential during the analysis and presentation of the data.

Data analysis

The ‘yes/no’ responses to each statement were counted. The response in the direction of misconception was scored as 1 and the response not in direction of misconception was scored as 0. No response or blanks were also included in the direction of misconception and scored as 1. The total score was calculated for each participant. The mean and standard deviation of scores were identified and compared using an independent t-test based on sex and qualification.

RESULTS

A total of 143 undergraduate and postgraduate students participated in the survey; 30 were male and 113 were female. One participant who did not mention their age, sex and year of study was excluded from the analysis. The participants needed approximately 10 min to fill out the questionnaire. The baseline characteristics of the participants are detailed in [Table 1].

Table 1:: Baseline parameters of included participants.
Parameter (n=142) Value
Age (in years) (Mean+SD) 23.51+2.86
Male sex (n) 30
Female sex (n) 112
Undergraduate final year students (n) 92
Postgraduate students (n) 50

The responses received from the students are detailed in [Table 2]. The awareness was minimum regarding whether ID is a mental illness, whether children with convulsive disorders also have ID and if ID patients can lead a normal life.

Table 2:: Responses received.
S. No. Questions* Yes No No reply
n % n % n %
1. The problem of mental retardation is found only in children 8 5.63 133 93.66 1 0.70
2. Individual differences exist among mentally retarded persons 111 78.16 25 17.60 6 4.22
3. Mental retardation is an Infectious disease 2 1.40 139 97.9 1 0.70
4. Some of the persons with mental retardation can be as energetic as normal persons. 127 89.43 14 9.85 1 0.70
5. Persons with mental retardation are able to manage themselves to some degree 121 85.21 19 13.4 2 1.40
6. Mental retardation is mental illness 78 54.92 60 42.25 4 2.81
7. Persons with mental retardation can be fully cured 35 24.64 101 71.12 6 4.22
8. Most of the mentally retarded individuals can become capable of helping other persons in simple tasks 106 74.64 34 23.94 2 1.40
9. As the mentally retarded child grows up he would gradually become normal 26 18.30 109 76.76 7 4.92
10. Persons with mental retardation usually remain unhappy 18 12.7 122 85.91 2 1.40
11. The problem of mental retardation does not exist in our society 11 7.74 126 88.73 5 3.52
12. The condition of mental retardation may not always be transmitted from parents to children but can also be caused by factors during pregnancy, after birth, during childhood or adolescence. 137 96.5 4 2.81 1 0.70
13. Mental retardation is due to fate or karma 5 3.52 132 92.95 5 3.52
14. Children suffering from fits may not suffer from mental retardation 62 43.66 75 52.81 5 3.52
15. A child with mental retardation is born due to the sins of parents 6 4.22 130 91.54 6 4.22
16. Mentally retarded individuals are disobedient 29 20.42 109 76.76 4 2.81
17. Mental retardation is due to black magic or spells 1 0.70 138 97.2 3 2.11
18. Mental retardation is caused as an effect to lunar eclipse at the time of pregnancy or birth of the child. 25 17.60 108 76.05 9 6.33
19. Accidents, high fever, fits and causing brain damage in childhood may cause mental retardation 123 86.61 15 10.56 4 2.81
20. Malnutrition in pregnant women can cause mental retardation 130 91.54 11 7.74 1 0.70
21. Medicines only can cure mental retardation 10 7.04 125 88.02 7 4.92
22. The mentally retarded individuals require continuous training to learn various simple activities. 130 91.54 9 6.33 3 2.11
23. Marriage can cure a persons with mental retardation 3 2.11 138 97.18 1 0.70
24. Many of the persons with mental retardation are capable of looking after their basic needs. 98 69.01 39 27.46 5 3.52
25. Traditional healers and poojaries can cure mentally retarded persons 6 4.22 135 95.07 1 0.70
26. The only solution to the problem of mentally retarded person is to put him in a residential school/hostel 4 2.81 132 92.95 6 4.22
27. Involvement of the parents is essential in the training of the child with mental retardation 137 96.47 1 0.70 4 2.81
28. Mentally retarded individuals will not improve without any amount of training 89 62.7 48 33.80 5 3.52
29. A mentally retarded individual can become as capable as a normal individual 86 60.56 54 38.02 2 1.40
30. Love alone will not benefit a mentally retarded individual 103 72.53 38 26.76 1 0.70
The original survey terminology retained as it is

Comparison of scores based on sex and qualification level is shown in Table 3.

Table 3:: Comparison of scores on the basis of sex.
Characteristic N Mean±SD CI T value P-value
Female students 112 5.95±2.99 2.08 0.04
Male students 30 7.27±3.40

A significantly higher score was seen in the male students in the direction of misconceptions, implying a comparatively lower level of awareness from social perspectives. Although there was no significant difference between the scores of undergraduate (6.50±3.35) and postgraduate students (5.72±2.60), a higher score in the graduate students implies a lower level of awareness [Table 4].

Table 4:: Comparison of scores based on qualification level.
Characteristic N Mean±SD f value P-value
Undergraduates 92 6.50±3.35 1.057 0.350
Postgraduates 1st year 33 5.82±2.51
Postgraduates 2nd year 17 5.53±2.85

The overall misconception score was 6.22 ± 3.18 (95% confidence interval 5.69–6.75) suggesting a good level of awareness among the students.

DISCUSSION

The study identifies that while students have a high level of understanding and awareness of ID/IDD, certain areas from the rehabilitation perspective need to be explored further, particularly issues such as the extent of improvement or autonomy that can be achieved in the intellectually disabled after proper rehabilitative measures. The college posts its students to outpatient departments (OPDs) and peripheral OPDs, where ID/IDD cases are present occasionally. The college also posts its students at the National Institute for Empowerment of Persons with Intellectual Disabilities, Noida, an institute autonomous under the Ministry of Social Justice and Empowerment for undertaking MD thesis work, which provides integrated settings of care with psychological assessment, medical treatment and rehabilitation. The faculty, therefore, is well aware of the diagnostic constraints, management modalities and common misconceptions reported by the parents.

The incidence of ID/IDD is 1–2%, varying with age, region and socioeconomic status.[14] However, the condition is frequently poorly understood and misdiagnosed; affected children and their families are often at a loss for accessibility and availability of healthcare and rehabilitative services.[15]

Homoeopathic training in India covers both the modern understanding of the disease condition as well as its understanding in terms of homoeopathic principles and philosophy. Barring the methodology for choice of prescription, the overall management and assessment of condition and prognosis remain the same across systems. Several studies report that homoeopathy in conjunction with rehabilitative therapies has reduced distressing symptoms; homoeopathy has thus been identified as a useful alternative to relieve associated pathologies.[3-6] Occasional case reports of ID and studies on related conditions such as autism spectrum disorder and attention deficit hyperactivity disorder also state that patients frequently seek homoeopathic treatment.[3,7,8,16-31]

However, homoeopathic educational training usually does not cover various aspects of rehabilitation and special education, which is best left to the specialists in the concerned field. Further, homoeopathic practitioners need to be aware of the common sociocultural misconceptions regarding ID/IDD, such as it being caused by black magic or fate, whether it is contagious, or if those with ID/IDD can be ‘cured’ and become normal with treatments, or marriage or childbirth, etc. Homoeopathic practitioners must be adequately trained regarding the management of the social implications of ID/IDD as well. Practitioners, therefore, need to identify their misconceptions about ID/IDD and seek means of overcoming these in an effort to provide quality and compassionate service to their patients. The student years, therefore, provide the right opportunity to understand this aspect, where appropriate training can be imparted; thus, students are better prepared as practitioners to deal with the condition medically and socially and can guide the caregivers accordingly.

To the best of our knowledge, this is the first study identifying sociocultural awareness regarding ID/IDD among homoeopathic students. While studying the clinical aspects of this condition is important, it is equally important to understand the misconceptions, myths and stigma associated with the same. Practitioners need to educate caregivers about the condition, guide them regarding rehabilitative therapies and allay any myths and concerns.

One limitation of the study was that it was performed on a small sample of students from one college. The survey was conducted only with the students who were scheduled to attend the seminar on ID; other students, like those posted in the OPDs or the wards, were not included.

Recommendation

Homoeopathic colleges can organise training and interactions for their students, inviting experts from other fields such as psychology, physiotherapy, occupational therapy and special education so that the students are apprised of the advances in the field. This will enable them to explore options for integrated care for patients with ID and come up with an optimum treatment in a socially and legally responsible manner.

CONCLUSION

The surveyed sample of students had a good level of awareness about ID. However, further understanding of sociocultural aspects needs to be enhanced and myths and misconceptions related to the conditions need to be allayed, specifically those related to the capacity for self-care and independence that patients with ID can attain with rehabilitation and care.

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Conflicts of interest

There are no conflicts of interest.

Financial support and sponsorship

Nil.

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