Epilepsy & Behavior 129 (2022) 108527Contents lists available at ScienceDirect
Epilepsy & Behavior
journal homepage: www.elsevier .com/locate /yebehMeanings of quality of life among people living with epilepsy in Ghana;
a qualitative exploratory study⇑ Corresponding author.
E-mail addresses: dadeegbe@ug.edu.gh (D.A. Deegbe), amme.tshabalala@wits.ac.
za (A.M. Tshabalala), laziato@ug.edu.gh (L. Aziato), Daleen.Casteleijn@wits.ac.za (D.
Casteleijn).
https://doi.org/10.1016/j.yebeh.2021.108527
1525-5050/
 2021 Published by Elsevier Inc.David Atsu Deegbe a, Amme Mardulate Tshabalala b,⇑, Lydia Aziato c, Daleen Casteleijn d
aDepartment of Mental Health Nursing, School of Nursing and Midwifery, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
bDepartment of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa
cDepartment of Adult Health, School of Nursing and Midwifery, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
dDepartment of Occupational Therapy, School of Therapeutic Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa
a r t i c l e i n f o a b s t r a c tArticle history:
Received 2 September 2021
Revised 20 December 2021
Accepted 20 December 2021
Available online 12 February 2022
Keywords:
Meaning
Quality of life
People Living with Epilepsy
GhanaPurpose: The purpose of this study was to explore the meanings of quality of life among people living
with epilepsy (PLWE) in Ghana.
Methods: An exploratory-qualitative study design was adopted. Face-to-face in-depth interviews, using a
semi-structured interview guide, were conducted on 15 PLWE who were purposively selected for the
study. The interviews were audio recorded and transcribed verbatim. The content analysis approach
was then used to analyze the data.
Results: Four themes – ‘‘acceptance”, ‘‘support”, ‘‘seizure control”, and ‘‘self-reliance” emerged from the
study as meanings of Quality of life (QoL). Quality of life meant unconditional acceptance from family,
friends, acquaintances at home, school, and work, and by the public despite epilepsy. Receiving support
in the form of protection from injury during a seizure, financial assistance to meet individual and family
demands, emotional warmth, and spiritual support through prayers and encouragement, was QoL for
PLWE. Achievement of control over seizures and being self-reliant in terms of selfcare and daily activities
in addition to having some form of financial independence meant QoL.
Conclusion: Meanings of quality of life among PLWE is associated with being accepted and supported by
family and friends as well as being in control of seizures and attaining a status of independence.

 2021 Published by Elsevier Inc.1. Introduction
Quality of life is a broad term encompassing not just the
absence of disease, but an individual’s perception of his or her posi-
tion in life within the perspective of one’s culture and value sys-
tem, goals, expectations, and concerns about health [1]. Patients
with epilepsy are at increased risk of poor Quality of Life (QoL).
This is due to the chronic and debilitating nature of the condition
[2]. Increased seizure severity has also been reported to signifi-
cantly reduce the QoL of People Living with Epilepsy (PLWE) in
most sub-Saharan countries [3–5]. The debilitating nature of epi-
lepsy interferes with school, work, and activities of daily living
among PLWE [5,6] with a ripple effect on reducing the QoL of PLWE
[7]. Although adherence to antiepileptic treatment has been foundto provide some form of control over seizures [8], the side effects of
these medications negatively affect their QoL [7,9].
Increasingly, studies on epilepsy are focusing on patient-
reported wellbeing and psychosocial outcomes compared to the
traditional clinical health outcomes such as effectiveness of
antiepileptic medications [10–12]. Studies in sub-Saharan coun-
tries such as Uganda [13], South Africa [14], Sudan [15], and Zam-
bia [16] have used both disease-specific and generic QoL tools to
assess the quality of life among PLWE. Despite a high prevalence
of active epilepsy in sub-Saharan Africa, estimated to affect 4.4
million people [17], none of these studies have explored the mean-
ing of QoL among PLWE. [18,19]. In 2018, Ghana had approxi-
mately 22,171 people diagnosed with epilepsy [20]; however,
most cases of epilepsy remain unreported. Persons diagnosed with
epilepsy in Ghana are treated with contempt and avoided by those
around them [6]. These negative public attitudes of avoidance and
rejection of PLWE due to the stigma associated with epilepsy, is not
only among Ghanaians [6] but, common in other sub-Saharan
countries in Africa [21–23]; and contributes to low QoL among
PLWE [24]. People living with epilepsy invariably need support
David Atsu Deegbe, Amme Mardulate Tshabalala, L. Aziato et al. Epilepsy & Behavior 129 (2022) 108527from family, friends, and others to cope with these challenges. In
Ghana, church members and family members play an active role
in supporting PLWE financially in order for them to survive [8].
The show of love and emotional warmth for PLWE give them peace
of mind, makes them less anxious, and improves their QoL [25].
Acceptance of PLWE depends on people’s knowledge about epi-
lepsy and the willingness to understand people living with epi-
lepsy [7].
The negative impact of epilepsy [5,6] on the QoL of PLWE [24]
cannot be underestimated. In order to promote the QoL of PLWE
there is a need to understand, further, what quality of life means
to the person living with epilepsy. The aim of this study was to
explore the meaning of QoL from the perspective of PLWE, which
is key to expanding the knowledge base on the concept of QoL
among PLWE in Ghana.2. Methods
2.1. Research design
This study employed a qualitative exploratory design to explore
the meaning of QoL among PLWE in Ghana. The design aided the
researchers in gaining an in-depth understanding of meanings
from the experiences of participants [26].2.2. Study population and sample
The study population comprised PLWE in Ghana with no
comorbid mental illness or mental sub-normality. Fifteen PLWE
participated in the study, which ensured satisfactory personal
involvement by the researcher [27]. Purposive sampling was used
to select only participants who were 18 years old and above. The
identification and selection of participants were done in consulta-
tion with the community mental health workers in the Greater
Accra Region of Ghana. Arrangements were made to interview par-
ticipants who agreed to participate in the study at places of their
choice, including their homes, churches, workplaces, and some
offices of the community mental health workers.2.3. Data collection
Written consent was sought from participants to conduct and
record participant interviews. A semi-structured interview guide
was used to conduct face-to-face, individual, in-depth interviews
with participants. One main question was asked with probes:
‘‘What does quality of life mean to you?”. The interviews lasted
45 to 60 minutes, were audiotaped and field notes were taken.2.4. Data analysis
Data analysis was conducted concurrently with the interviews.
All interviews were transcribed verbatim. Interview transcripts
were read several times to obtain full understanding of partici-
pants’ accounts. The content analysis approach of preparation,
organisation, and reporting of results [28] was used to analyze data
using the MAXQDA qualitative data analysis software. Coding and
categorization of data [28] were carried out and verified by the sec-
ond author, and the third author serving as an adjudicator in the
event of any discrepancy. The results were described based on
the content of the categories of the phenomenon under study in
the reporting phase. Data from field notes were also reviewed
and added up to the results to enhance the meaning of the infor-
mation gathered. Segments of data that best suited the themes
identified were sorted appropriately and used to support findings.2
Identification codes were used instead of participants’ names to
ensure anonymity.
2.5. Methodological rigor
The trustworthiness criteria recommended by Lincoln and Guba
[29] were employed in this study. To ensure credibility, the
researcher through his experience with caring for PLWE had pro-
long engagement during each interview. Participants were also
given the opportunity to see the final report to verify correct rep-
resentation of their views [30]. Dependability was ensured through
detail reporting of the processes involved in the study [31]. Inde-
pendent co-coding of data was also done by the second author
and results compared. Credibility and dependability were also
met through triangulation of data sources (combination of field
notes and interviews) [31] and, the use of probes during the qual-
itative interviews. A detail description of the research setting, the
participants and methods involved were also presented to ensure
confirmability and transferability [31].
2.6. Ethics
Ethical approval for the study was obtained from the Postgrad-
uate and Human Research Ethics Committee (Medical) of the
University of the Witwatersrand (M180946) and the Ghana Health
Service Research Ethics Review Committee (GHS-ERC004/12/18).
3. Results
The results consist of a description of the demographic charac-
teristics of participants and thematic presentation of the findings
supported by verbatim quotes. The interviews ended with the fif-
teenth participant after data saturation was achieved. Identifica-
tion codes (1F1, 2F2, 3 M1, 4 M2. 5F3, 6 M3, 7 M4, 8 M5, 9 M6,
10 M7, 11 M8, 12F4, 13F5, 14F6, 15 M9) were used, instead of
the respondents’ real names, to conceal their identity.
3.1. Demographic characteristic of participants
A sample of fifteen PLWE (n = 15), comprising six females (40%)
and nine males (60%), aged from 20 to 56 years, participated in the
study. Five participants (40%) had tertiary level education and two
(13.3%) had basic level education. Three participants were self-
employed while, one was a private employee. Thirteen of them
were Christians and 11 were single. Among them, eight had lived
with epilepsy not more than 10 years and three have had epilepsy
for 22 to 28 years (Table 3.1).
The findings from the study are described under four themes
namely; ‘‘support”, ‘‘acceptance”, ‘‘seizure control”, and ‘‘self-
reliance”, with their corresponding 14 sub-themes (Table 3.2).
3.2. Support
Among the PLWE, QoL meant receiving support from family,
friends, and significant others. These included physical, emotional,
financial, and spiritual support.
3.2.1. Physical support
Physical support comprised support provided to PLWE in the
form of first aid or assistance from bystanders or from teachers
in school during seizures, in order to protect them from injury
and suffocation.
‘. . . they have to help anybody living with epilepsy that gets an
attack by holding them up and protect them from getting injured’.
(1F1)
David Atsu Deegbe, Amme Mardulate Tshabalala, L. Aziato et al. Epilepsy & Behavior 129 (2022) 108527
Table 3.1
Socio-demographic characteristics of participants (n = 15).
No Code Sex Age (Years) Level of Education Marital Status Employment Status Religion Duration of Illness (Years)
1. 1F1 Female 42 Secondary Married Unemployed Christian 28
2. 2F2 Female 27 Tertiary Single Unemployed Christian 22
3. 3M1 Male 23 Secondary Single Unemployed Christian 18
4. 4M2 Male 52 Secondary Married Self Employed Christian 13
5. 5F3 Female 41 Basic Married Unemployed Muslim 10
6. 6M3 Male 56 Secondary Single Unemployed Christian 38
7. 7M4 Male 22 Secondary Single Private Employee Christian 22
8. 8M5 Male 21 Tertiary Single Student Christian 8
9. 9M6 Male 35 Tertiary Married Unemployed Christian 8
10. 10M7 Male 20 Tertiary Single Student Muslim 1
11. 11M8 Male 32 Basic Single Unemployed Christian 12
12. 12F4 Female 32 Secondary Single Unemployed Christian 8
13. 13F5 Female 28 Tertiary Single Student Christian 5
14. 14F6 Female 30 Secondary Single Self Employed Christian 8
15. 15M9 Male 32 Secondary Single Self Employed Christian 10
Table 3.2
Themes and sub-themes.
Themes Sub-themes
Support (1) Physical support
(2) Emotional support
(3) Financial support
(4) Spiritual support
Acceptance (1) Acceptance from partner
(2) Acceptance by friends
(3) Acceptance by family
(4) Acceptance at work
(5) Acceptance from general population
Seizure control (1) Nature of seizures
(2) Medication
(3) Disease outcome
Self-reliance (1) Economic self-reliance
(2) Self-care‘The teachers also have to assist by giving some first aid because
during an attack . . .’ (13F5)
One participant was satisfied with the way his family constantly
provided physical support and protection for him during seizures.
‘To my family . . . anytime I get the seizure, they are the people who
protect me form injury and hold me up and tell me what hap-
pened.’ (9M6)3.2.2. Emotional support
Quality of life meant receiving love, a show of concern and emo-
tional warmth from others. Having the reassurance that someone
will be there to provide care or assistance during a seizure episode
also gave them some emotional comfort.
‘. . . knowing that someone will care for me when I have a seizure
makes me feel ok.’ (13F5)
Being reassured, counseled, pampered, and talked to in a nice
and respectable way by their wives meant QoL for two male partic-
ipants who were married.
‘Maybe I would like my wife to talk to me nicely or pamper me after
the seizure.’ (11 M8)3.2.3. Financial support
Financial support for upkeep of self and family and to cater for
one’s needs meant QoL to PLWE.3
‘I want help with money so that I can take care of myself and my
family.’ (6 M3)
Two participants mentioned that they wish to have financial
support to buy medicines to treat their epilepsy through sponsor-
ship from government or from any philanthropist.
‘I would be happy if government helps us out a bit there with some
sponsorship. . . to help and perhaps buy some of my drugs’. (12F4)
‘I’ll be very glad if we get help not only from our families but from
others in the form of small funds . . . I will like it.’ (7M4)3.2.4. Spiritual support
Spiritual encouragement and support in terms of prayers were
linked to QoL among PLWE.
‘When I go to church, I pray. My husband always encourages me
. . .. So, I am praying and waiting for the day God will actually heal
me.’ (1F1)
Other participants indicated that being in a good relationship
with God, having a fulfilling spiritual life and being able to pray
were satisfying moments that represented QoL. It also served as
a means of connection to God for healing.
‘. . . I can pray to God anywhere at any point, . . . I am satisfied that I
have a fulfilling life with God.’ (14F6)
‘My spiritual aspect too is very important. . . so that God will help
me through my prayers.’ (3M1)3.2.5. Acceptance
Quality of life was associated with being accepted by family,
friends, colleagues, and acquaintances as a person, irrespective of
one’s epilepsy status.
3.2.5.1. Acceptance from partner. Unconditional acceptance and get-
ting attention from a partner were stated as attributes of QoL.
‘To me quality of life is when the person (partner) is not rejecting
me when I come to her because of the situation I am in.’ (10M7)
Being accepted by the family of the partner or being able to
marry was satisfying for PLWE and represented QoL for them.
‘. . . my husband to be is scared to sit his mum down and say this is
what my wife to be is going through; and it’s scary . . . She might
even decide . . .. you are not going to be a part of their family.’
(12F4)
‘It’s nice and satisfying to marry. If you stayed all your life and you
didn’t marry it will be very uncomfortable.’ (6M3)
David Atsu Deegbe, Amme Mardulate Tshabalala, L. Aziato et al. Epilepsy & Behavior 129 (2022) 1085273.2.5.2. Acceptance by friends. Participants expressed frustration
and heartbreak at instances where people withdraw from them
because of their condition (epilepsy).
‘. . . And it is heart breaking to know that because somebody knows
this is what is wrong with you, they have withdrawn from you.’
(2F2)
Being welcome and accepted by friends despite epilepsy was
QoL to the PLWE.
‘Despite my state, I want them (friends) to come around me
because the more they come around me, the more I feel that I
am at home.’ (8M5)3.2.5.3. Acceptance by family. Quality of life also meant having a
family that cares, recognizes, and accepts one as a family member
irrespective of the diagnosis of epilepsy.
‘Okay, if you say quality of life, to me it means all the family show-
ing you love by accepting you as you are. . .’ (12F4)
Quality of life meant not being regarded as a burden to the fam-
ily because of epilepsy but, rather to live in harmony with ones’
family.
‘In the past when I have seizures people think that I am a burden to
the family. The family members start to neglect me. But . . .. I should
be living in harmony with my family.’ (8M5)3.2.5.4. Acceptance at work. Participants, particularly those work-
ing, perceived quality of life as being able to get along with col-
leagues at work, and employers listening to them, and treating
them as any other person.
‘They (colleagues and employers) should treat me as every other
normal person without fear because, there is nothing to be afraid
of at the end of the day. Just treat me as you would treat somebody
who is not living with epilepsy.’ (2F2)3.2.5.5. Acceptance from general population. Quality of life meant
not bothering about when or where a seizure episode might occur
in public without fear of being stigmatized and people relating
with PLWE just like any other person.
‘Quality of life would be having to live without looking over your
shoulder, knowing that you can have a seizure anywhere and
nobody would use it against you and there would be no stigma. . .’
(14F6)
‘All that I want to say is that people should see us as normal people
. . .’ (7M4)3.2.6. Seizure control
Control of seizures comprised control of the frequency and
severity of the seizures, having access to quality medications for
the treatment of seizures in addition to the control or cure of
seizures.
3.2.6.1. Nature of seizures. For some participants, having less severe
seizures and less frequent seizures of not more than six times a
year were described as determinants of quality of life.
‘‘I’m okay if it at comes least ones every two or three months.”
(2F2)
‘‘Okay, I think the attack going away for about three, four to five
months for me to see that it’s fading away is what will really make
me happy.” (1F1)4
The participants explained that quality of life meant having
milder seizures without any injuries despite epilepsy. They
expressed satisfaction with seizures with minimal or no falls.
‘‘I want it come such that I will not fall down and hurt myself. Not
falling down and getting injured.” (12F4)3.2.6.2. Medication. A few participants reiterated they will be hap-
pier and more satisfied if they had continuous access to antiepilep-
tic medicines that were effective and also affordable.
‘‘I always want to have access to the medicine. If every day I get
access to it and take it every day as prescribed by the doctor.”
(7M4)
‘‘For me I want just medication that I can live on that can take
away this sickness.” (9M6)
To others quality of life was associated with having access to
quality antiepileptic medication with minimal or less side effects.
‘‘I think finding a medication that is suitable and has a very mini-
mal side effect for this condition will be satisfying for me.” (2F2)3.2.6.3. Disease outcome. Quality of life was described as expecta-
tions for cure from seizures and the reassurance of no risk of trans-
mission of epilepsy to their children.
‘‘I want to be healed . . . If I could get healed, I’ll be very happy.”
(6M3)
‘‘I will be happy that my children to be born will not carry the ill-
ness.” (3M1)
Quality of life meant being physically fit and seizures not inter-
rupting with work and academic activities among PLWE.
‘‘I expect that I will live a healthy life . . . because this is the reason, I
am not able to advance in my education. . . I want to be strong,
healthy and have work doing.” (3M1)3.2.7. Self-reliance
To be self-reliant was perceived as a determinant of quality of
life for the participants. The sub-themes under self-reliance were
economic self-reliance and self-care.
3.2.7.1. Economic self-reliance. Quality of life meant gainful employ-
ment, less stressful work, and the ability to meet personal financial
needs.
‘‘So, . . .. I will be satisfied to work and make money to take care of
myself.” (1F1)
‘‘I don’t need to stress myself too much with work to prevent it (sei-
zures) from occurring. . . .Our employers should provide suitable
and less stressful environment to prevent it from occurring or
reduce the severity.” (7M4)
Secondly, being in the position to provide for one’s family’s
financial needs was seen as a fulfilling state of quality life for
PLWE.
‘‘I would love that I could work and bring money home . . . to help
the family.” (1F1)3.2.7.2. Self-care. Participants described quality of life as being able
to carry out activities of daily living independently, and to move
around without the need for an escort or someone watching out
for the person.
David Atsu Deegbe, Amme Mardulate Tshabalala, L. Aziato et al. Epilepsy & Behavior 129 (2022) 108527‘‘At first, I couldn’t go out alone to buy something without anybody
escorting me but now, I am happy I can do things on my own.”
(1F1)
Secondly, quality of life meant having some form of self-control
where one is able to sense impending seizures and avoid any injury
by getting to a safe place before the seizures begin.
‘‘This is when before an attack, I can tell and be able to control it. . .
Like I can control myself during an attack and know when to stand
or sit somewhere safe.” (3M1).4. Discussion
Among PLWE, QoL means receiving physical and emotional sup-
port from family, friends and others. Injuries are sometimes asso-
ciated with seizures as some PLWE fall unconscious and injure
themselves in the process [6]. Therefore, physical support is con-
sidered as positively contributing to the QoL of PLWE. At school,
PLWE prefer teachers to act as role models in protecting them from
injury and preserving their dignity. This is because in school, teach-
ers wield powerful influence to change the way classmates treat
another with epilepsy [7]. Emotional support in the form of coun-
seling, reassurance, and the expression of love and continual sup-
port from spouses and family members, meant QoL for the
participants. Similarly, Lu et al. [25] found that the show of love
and emotional warmth for PLWE in China gave them peace of
mind, reduces anxiety, and improves their QoL. Receiving emo-
tional support is likely to relieve any feelings of depression, which
is known to be a key predictor of poor QoL among PLWE [24,32].
Financial support from family and friends in addition to spiri-
tual support are some of the aspects that were expressed by partic-
ipants as helping PLWE to live a meaningful and happy life. In
Ghana, some church members and family members are known to
play active role in supporting PLWE financially for them to cope
with living with epilepsy [8]. This underscores the importance of
financial stability in the meaning of quality of life for PLWE. Some
participants perceived spiritual support in terms of prayers and
hope in God for healing as important in the quality of their lives
and living with epilepsy. These spiritual activities are some of
the known coping strategies adopted by PLWE in Ghana [8]. These
spiritual coping measures confirm the belief in Ghana and sub-
Saharan Africa that epilepsy has a spiritual cause [6,33]. Partici-
pants in this study considered quality of life as being recognized
and accepted unconditionally as a person and not seen as a person
with ‘‘epilepsy”. This is demonstrated in studies in Japan [34] and
Tunisia [35] where acceptance of disability of PLWE contributed to
higher QoL among PLWE (p < 0.01). Being rejected by a partner and
the family of the partner makes it difficult for the PLWE to estab-
lish a stable love relationship. This negatively affects their mood
and further contributing to low QoL [24].
In this study, PLWE expressed feelings of not being accepted at
work, being disrespected and in some instances, being laid-off
work. Behaviors of such people or employers who disassociate
themselves from PLWE, mirror the misconceptions and myths
around epilepsy in Ghana and other sub-Saharan countries
[6,36,37]. The rejection of PLWE at the workplace may be linked
to disruptions that seizure episodes may cause [6]. Instead of treat-
ing PLWE badly and laying them off from work, employees and co-
workers should rather create a welcoming environment for PLWE
and show some interest in their treatment to improve their QoL.
Therefore, acceptance is an essential component of adaptation
among PLWE, which is required to attain good QoL [7].
Seizure severity and seizure impact have significantly negative
correlation with QoL of PLWE [3–5]. In this study, QoL meant hav-
ing the frequency and severity of seizures under control. To achieve5
this requires strict adherence and commitment to antiepileptic
treatment regimen [8]. Ease of access to quality antiepileptic med-
ication was also considered as QoL by PLWE. However, access to
quality antiepileptic medications is affected by financial con-
straints and inadequate insurance cover for antiepileptic medica-
tions. The low health insurance cover is likely to increase out of
pocket hospital expenditure, which is known to reduce QoL [38].
To others, QoL means having antiepileptic medication with mini-
mal side effects because the side effects negatively affect the QoL
of PLWE [7,9].
The expectation to be physically healthy, and not experience
seizures any longer, was important in the meaning of the quality
living for PLWE. This confirms findings of Deegbe et al. [6] that
PLWE in Ghana have expectations for cure. However, some of these
hopes are shattered because significant improvement in seizure
control is not apparent, after long periods of treatment. According
to Deegbe et al. [8], achievement of seizure control elicits feelings
of happiness and reduces anxiety. In the absence of complete cure,
PLWE expect their seizures to be under control so that episodes of
seizures do not affect their work, schooling, and other activities.
This is because seizures are known to interfere with work, school-
ing, and activities of daily living while engendering negative emo-
tions among PLWE [5,6].
Furthermore, quality of life for PLWE means to be self-reliant
financially and independently carry out activities of daily living.
Fulfilling the need to also provide for one’s family was QoL for
the PLWE. However, these desires are hampered by negative atti-
tudes that have contributed to unemployment among PLWE in
many SSA countries including Ghana [39] and Nigeria [40].5. Conclusion
The findings from this study have contributed to understanding
the meaning of QoL among PLWE in Ghana. Being accepted and
receiving support from relatives and the community members
meant QoL to PLWE in Ghana. Expectations of support to improve
the QoL of the PLWE, in the form of protection from injury during
seizures, financial assistance, emotional warmth, and spiritual sup-
port, points to the need for a multidisciplinary approach to the care
of PLWE. There is also the need for community mental health
nurses to engage family members of PLWE and community mem-
bers in education, first aid training, and sensitization programs on
epilepsy in order to create more awareness of the need to support
PLWE. In addition, the achievement of control over seizures was
identified as quality life to the PLWE, which underscores the need
for effective epilepsy treatment interventions to control seizures.
Therefore, the Ghana Health Service must ensure easy and regular
access to quality and effective antiepileptic medications that have
fewer side effects, to reduce the severity and frequency of seizures,
if not a complete cure from seizures.6. Limitation
The subjective nature of qualitative approaches in research
makes is difficult for researchers to be objective. However, co-
coding and triangulation of data sources helped to ensure objectiv-
ity in the study.Declaration of Competing Interest
The authors declare that they have no known competing finan-
cial interests or personal relationships that could have appeared
to influence the work reported in this paper.
David Atsu Deegbe, Amme Mardulate Tshabalala, L. Aziato et al. Epilepsy & Behavior 129 (2022) 108527Acknowledgements
This work received postgraduate merit award from the financial
aid and scholarships office and a Faculty Research Committee Indi-
vidual Grant from the University of the Witwatersrand, Johannes-
burg, South Africa. These sources of funding did not have any effect
on the purpose of this research, neither did the funding bodies
influence the research method and the preparation of this
manuscript.
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