The effect of epilepsy education on seizure intervention, knowledge, and stigma levels among high school students: A randomized controlled study

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Allocation was by intact whole school rather than by individual students within a class, satisfying the class-level randomisation requirement.
    • "A total of 38 high schools were identified, from which two different schools were randomly selected for the experimental and control groups." (p. 550)
    • Relevant Quotes: 1) "To implement the study, a list of high schools located in the two most populous districts of Samsun, identified as the central areas, was compiled. A total of 38 high schools were identified, from which two different schools were randomly selected for the experimental and control groups." (p. 550) 2) "It was determined that the A school, which constituted the experimental group, had a total of 986 high school students, while the B school, designated as the control group, had 529 high school students." (p. 550) 3) Figure 1: "Determination of schools by randomization (N=1515)" (p. 551) Detailed Analysis: The ERCT 'C' criterion requires that allocation to conditions be at the class level or stronger (school level), rather than randomising individual students within a single class, so as to avoid contamination. Here the unit of allocation is the whole school: all eligible students in school A received the intervention and all eligible students in school B served as controls. Because the two arms are entirely separate schools, there is no risk of within-class contamination between treatment and control students, and the paper explicitly describes a randomisation step for selecting the schools. The quality of the randomisation is weak (see criterion S), but for the purpose of the weaker class-level criterion, allocation by intact whole school satisfies the requirement that randomisation be at class level or stronger. Criterion C is met because allocation to conditions was made at the whole-school (cluster) level rather than by randomising individual students within a class, preventing within-class contamination.
  • E

    Exam-based Assessment

    • Outcomes were assessed with topic-specific validated scales and self-report questionnaires, not a standardised exam-based assessment.
    • "The Epilepsy Knowledge Scale: Developed by Aydemir (2008), this scale measures the level of knowledge regarding epilepsy within the community." (p. 551)
    • Relevant Quotes: 1) "To gather data, the Student Information Form, the Epilepsy Knowledge Scale, the Epilepsy Stigma Scale, and the Numerical Rating Scale were utilized." (Abstract, p. 549) 2) "The Epilepsy Knowledge Scale: Developed by Aydemir (2008), this scale measures the level of knowledge regarding epilepsy within the community... Comprising a total of 16 questions, scores on this scale range from 0 to 16..." (p. 551) 3) "The Epilepsy Stigma Scale: The scale, originally developed in Turkish by Baybas et al. (2017), consists of a total of 20 items and three subdimensions." (p. 551) 4) "The Numerical Rating Scale: This scale was originally developed by Breivik et al. (2008) to assess pain levels in clinical settings... In this study, students were asked the question, 'How competent do you feel in intervening during an epileptic seizure?'" (p. 551) Detailed Analysis: Criterion E requires a standardised, widely recognised exam-based assessment (e.g., a national curriculum exam or state-wide standardised achievement test), not an instrument built for the specific topic of the study. The outcomes here were measured with validated psychometric questionnaires/scales specific to epilepsy (the Epilepsy Knowledge Scale, the Epilepsy Stigma Scale) and a single-item self-report Numerical Rating Scale. While these instruments are validated and have reported reliability, they are topic-specific research scales/questionnaires rather than standardised academic examinations administered system-wide. They are not exam-based standardised assessments in the sense required by the ERCT standard. Criterion E is not met because outcomes were measured with topic-specific self-report scales and questionnaires, not a standardised, widely recognised exam-based assessment.
  • T

    Term Duration

    • Outcomes were measured immediately after a single ~45-minute session, far short of the required one-term interval.
    • "Immediately after the intervention, the questionnaires were re-administered to gather post-test data (T1)." (p. 550)
    • Relevant Quotes: 1) "Approximately one month later, a follow-up visit was scheduled for the experimental group at A high school, during which the educational intervention was implemented. Immediately after the intervention, the questionnaires were re-administered to gather post-test data (T1)." (p. 550) 2) "The training was conducted face-to-face using a PowerPoint presentation, lasting approximately 45 minutes. Following the training session, an additional 15 minutes were allocated for a question-and-answer segment." (p. 550) 3) "Also, an important methodological limitation concerns the temporal proximity between our educational intervention and post-test administration... The brief interval may have privileged short-term recall over sustained learning, potentially inflating immediate post-test scores." (p. 557) Detailed Analysis: Criterion T requires that the primary outcome be measured at least one full academic term (approximately 3-4 months) after the intervention begins. Here the intervention was a single ~45-60 minute session, and the post-test was administered "immediately after the intervention." The interval from intervention start to outcome measurement was therefore essentially zero, and even the pre-test to post-test window was only about one month. The authors themselves flag the "temporal proximity" of intervention and post-test as a limitation. This is far shorter than one academic term. Criterion T is not met because outcomes were measured immediately after a single short session, far short of the one-term interval required.
  • D

    Documented Control Group

    • The control group's size, demographics, baseline scores, and no-intervention condition are clearly documented.
    • "students in the control group at B high school were administered the questionnaires during the first visit (T0); however, no educational intervention was conducted for this group." (p. 550)
    • Relevant Quotes: 1) "In accordance with the inclusion criteria for the study, 256 students from A school were placed in the experimental group, and 201 students from B school were included in the control group." (p. 550) 2) "Similarly, students in the control group at B high school were administered the questionnaires during the first visit (T0); however, no educational intervention was conducted for this group." (p. 550) 3) Table 1 reports control group (N=201) characteristics: age 15.12+/-0.88, sex (Female 95 [47.3%], Male 106 [52.7%]), class distribution, residence, income, and familiarity with epilepsy. (p. 553) 4) "The mean total score on the scale before the intervention was 6.9 (+/-4.1) for the experimental group and 7.3 (+/-4.0) for the control group, with no significant difference between these means (p=0.488)." (p. 552); control baseline stigma and seizure-competence values are reported in Tables 3 and 4. (pp. 555-556) Detailed Analysis: Criterion D requires clear documentation of the control group's composition, size, baseline characteristics, and conditions/treatment. The paper documents the control group size (N=201), its demographic profile in Table 1 (age, sex, class, residence, income, and epilepsy familiarity), and its baseline scores on all outcome measures (knowledge, stigma sub-scales, and seizure-response competence) alongside the intervention group. It also states clearly that the control group received no educational intervention. This provides the documentation needed to judge comparability. Criterion D is met because the control group's size, demographics, baseline scores, and business-as-usual condition are clearly documented.

• Level 2 Criteria

  • S

    School-level RCT

    • Only two schools (one per arm) were used, which does not constitute a properly implemented school-level RCT.
    • "A total of 38 high schools were identified, from which two different schools were randomly selected for the experimental and control groups." (p. 550)
    • Relevant Quotes: 1) "A total of 38 high schools were identified, from which two different schools were randomly selected for the experimental and control groups." (p. 550) 2) "It was determined that the A school, which constituted the experimental group, had a total of 986 high school students, while the B school, designated as the control group, had 529 high school students." (p. 550) Detailed Analysis: Criterion S requires a genuine, properly implemented school-level RCT, with randomisation occurring among schools and an adequate number of schools involved. Although allocation here was nominally at the school level, only two schools in total were used - one assigned to the intervention arm and one to the control arm. With a single cluster per condition, randomisation cannot balance school-level confounders, and the intervention effect cannot be separated from pre-existing differences between the two schools (which differed markedly, e.g., 986 vs 529 students). This design is effectively a two-school quasi-experimental comparison rather than a properly implemented school-level RCT, and the standard emphasises the number of schools and proper randomisation among schools. Criterion S is not met because only two schools (one per arm) were used, which does not constitute a properly implemented school-level RCT capable of isolating the intervention from school-level confounds.
  • I

    Independent Conduct

    • The same authors designed, delivered, and evaluated the intervention, with no independent third-party conduct.
    • "The training was conducted face-to-face using a PowerPoint presentation, lasting approximately 45 minutes." (p. 550)
    • Relevant Quotes: 1) "Department of Nursing, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkiye" (author affiliation, p. 549) 2) "The content of the training provided to the students in the experimental group included information on the definition of epilepsy... The training was conducted face-to-face using a PowerPoint presentation, lasting approximately 45 minutes." (p. 550) 3) "The Student Information Form: The form created by the researcher includes sociodemographic questions..." (pp. 550-551) 4) "Financial support: This study was supported by TUBITAK... under the 2209-A University Students Research Projects Support Program. Conflict of interest: None" (p. 557) Detailed Analysis: Criterion I requires that the evaluation be conducted independently from the team that designed and delivered the intervention. In this study the same research team (the authors) designed the epilepsy education content, delivered the face-to-face training, created the data-collection form, administered all measures, and analysed the results. There is no mention of an external, third-party evaluator, independent data-collection agency, or blinded assessors. The study was a student-led/faculty research project with no independent oversight of implementation or analysis. Criterion I is not met because the same team designed, delivered, measured, and analysed the intervention with no independent third-party evaluation.
  • Y

    Year Duration

    • Outcomes were measured immediately after a single session, far short of a full academic year (and T is not met).
    • "The data for the study were collected between February and May 2024." (p. 550)
    • Relevant Quotes: 1) "The training was conducted face-to-face using a PowerPoint presentation, lasting approximately 45 minutes." (p. 550) 2) "Immediately after the intervention, the questionnaires were re-administered to gather post-test data (T1)." (p. 550) 3) "The data for the study were collected between February and May 2024." (p. 550) Detailed Analysis: Criterion Y requires that outcomes be measured at least 75% of a full academic year (~9-10 months, so roughly 7+ months) after the intervention begins. The intervention here was a single ~45-minute session and the post-test was administered immediately afterward; the entire data-collection window (across both groups) spanned only February to May 2024, with individual tracking of about one month from pre-test to post-test. This is nowhere near a full academic year. Additionally, per the ERCT rule, because criterion T (Term Duration) is not met, criterion Y cannot be met. Criterion Y is not met because outcomes were measured immediately after a single short session, far short of the year-long tracking required (and T is not met).
  • B

    Balanced Control Group

    • The extra educational session is itself the treatment variable under test, so the business-as-usual control is appropriate and the criterion is met.
    • "This study aimed to examine the impact of education provided to high school students about epilepsy on their awareness of seizure intervention, knowledge level, and stigma associated with the condition." (Abstract, p. 549)
    • Relevant Quotes: 1) "The content of the training provided to the students in the experimental group included information on the definition of epilepsy, its causes, types, seizure classifications, treatment methods, intervention strategies for epilepsy seizures, and the psychosocial aspects of living with epilepsy. The training was conducted face-to-face using a PowerPoint presentation, lasting approximately 45 minutes. Following the training session, an additional 15 minutes were allocated for a question-and-answer segment." (p. 550) 2) "Similarly, students in the control group at B high school were administered the questionnaires during the first visit (T0); however, no educational intervention was conducted for this group." (p. 550) 3) "This study aimed to examine the impact of education provided to high school students about epilepsy on their awareness of seizure intervention, knowledge level, and stigma associated with the condition." (Abstract, p. 549) Detailed Analysis: Applying the criterion B decision tree: the intervention group received an additional resource - a ~45-minute epilepsy education session plus a 15-minute Q&A - that the control group did not receive (the control group received no educational intervention). This is an extra-resource difference. However, the additional resource IS the treatment variable being tested: the explicit aim of the study is to examine the impact of providing epilepsy education itself. When the extra resource is the very intervention under test, the standard permits the control group to remain at the "business as usual" level without matching that resource. The epilepsy education session is integral to, and definitional of, the intervention rather than a separable confounding add-on. Criterion B is met because the additional educational session is the explicit treatment variable being tested, so the untreated business-as-usual control is appropriate by design.

• Level 3 Criteria

  • R

    Reproduced

    • No independent replication of this specific study by a different team has been reported or found.
    • "Various studies have also indicated that educational interventions regarding epilepsy significantly impact knowledge and attitudes.26-31" (p. 553)
    • Relevant Quotes: 1) "Various studies have also indicated that educational interventions regarding epilepsy significantly impact knowledge and attitudes.26-31" (p. 553) 2) "However, it is important to note that there is a limited number of studies documenting the effectiveness of epilepsy education programs." (p. 553) Detailed Analysis: Criterion R requires that this specific study be independently replicated by a different research team in a different context, published in a peer-reviewed journal. The paper cites other epilepsy education studies (references 26-31) that report broadly similar effects, but these are separate studies of different programs, not independent replications of this specific intervention and two-school design by an independent team. Note on verification: the session's WebSearch quota was exhausted, so an external literature search could not be executed; however, this article is very recent (submitted August 2025, published June 2026), which makes an independent, peer-reviewed replication of this specific trial implausible at the review date, and the paper itself references no such replication. Criterion R is not met because no independent replication of this specific study by a different team in a peer-reviewed journal is reported or found.
  • A

    All-subject Exams

    • Only a single epilepsy topic was assessed and the prerequisite criterion E is not met, so A fails.
    • "To gather data, the Student Information Form, the Epilepsy Knowledge Scale, the Epilepsy Stigma Scale, and the Numerical Rating Scale were utilized." (Abstract, p. 549)
    • Relevant Quotes: 1) "To gather data, the Student Information Form, the Epilepsy Knowledge Scale, the Epilepsy Stigma Scale, and the Numerical Rating Scale were utilized." (Abstract, p. 549) 2) "This study aimed to examine the impact of education provided to high school students about epilepsy on their awareness of seizure intervention, knowledge level, and stigma associated with the condition." (Abstract, p. 549) Detailed Analysis: Criterion A requires that impact be measured across all main subjects of the curriculum using standardised exam-based assessments, and it has criterion E as a prerequisite. Here the study assessed only a single, topic-specific domain (epilepsy knowledge, stigma, and seizure-response self-efficacy) and did not assess any core academic subjects. Moreover, criterion E is not met (the outcomes were topic-specific self-report scales rather than standardised exams), so criterion A automatically fails. Criterion A is not met because only a single epilepsy topic was measured (not all main subjects) and the prerequisite criterion E is not met.
  • G

    Graduation Tracking

    • Outcomes were measured only immediately after the session, with no graduation tracking (and Y is not met).
    • "This design, while effective for assessing immediate knowledge acquisition, does not permit evaluation of the intervention's longer-term retention effects." (p. 557)
    • Relevant Quotes: 1) "Immediately after the intervention, the questionnaires were re-administered to gather post-test data (T1)." (p. 550) 2) "This design, while effective for assessing immediate knowledge acquisition, does not permit evaluation of the intervention's longer-term retention effects... Future studies should incorporate delayed follow-up assessments to distinguish between transient and enduring knowledge gains." (p. 557) Detailed Analysis: Criterion G requires follow-up tracking of participants through to their graduation from the educational stage. This study measured outcomes only immediately after the single intervention session, with no longer-term or graduation follow-up; the authors explicitly acknowledge the absence of delayed follow-up. Note on verification: the session's WebSearch quota was exhausted, so a search for subsequent follow-up publications by the same authors could not be executed; the paper itself references no planned graduation-tracking follow-up, and its own limitations section confirms only immediate post-test data were collected. Additionally, per the ERCT rule, because criterion Y (Year Duration) is not met, criterion G cannot be met. Criterion G is not met because there was no follow-up through graduation - only an immediate post-test - and criterion Y is not met.
  • P

    Pre-Registered

    • The paper reports ethics approval only, with no pre-registration on a public trial registry before data collection.
    • Relevant Quotes: 1) "To conduct the research, ethical approval was obtained from the Ondokuz Mayis University Social and Human Sciences Ethics Committee (Ethical No: 2023-870) and institutional permission was granted by the Samsun Provincial Directorate of National Education." (p. 551) 2) "This study was supported by TUBITAK (Scientific and Technological Research Council of Turkiye) under the 2209-A University Students Research Projects Support Program." (p. 557) Detailed Analysis: Criterion P requires a public pre-registration of the full study protocol (hypotheses, methods, planned analyses) on a trial registry before data collection began, with a verifiable registration date. The paper reports ethics-committee approval and institutional permission, but ethics approval is not pre-registration. There is no mention of any trial registry (e.g., ClinicalTrials.gov, ISRCTN) or a registration identifier or date preceding data collection, so there was no registry entry to verify. Criterion P is not met because no pre-registration on a public trial registry before data collection is reported.