Impact of Tele-Nursing on Maternal Self-Efficacy and Anxiety in Post-Discharge Epilepsy Care: an interventional study

Impact of Tele-Nursing on Maternal Self-Efficacy and Anxiety in Post-Discharge Epilepsy Care: an interventional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Tele-Nursing on Maternal Self-Efficacy and Anxiety in Post-Discharge Epilepsy Care: an interventional study Marzieh Seif, Mohammad reza Khodahakhshi, Reyhaneh Roozbahani, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5426721/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Apr, 2025 Read the published version in European Journal of Pediatrics → Version 1 posted 10 You are reading this latest preprint version Abstract Purpose Epilepsy is one of the most common neurological disorders and one of the chronic childhood diseases that affects many children every year. Therefore, the present study was conducted with the aim of determining the effect of tele-nursing after discharge on the self-efficacy and anxiety of mothers with children with epilepsy. Methods In this experimental study, 90 mothers of children with epilepsy were selected by available sampling method and then randomly divided into two control and intervention groups. Demographic information questionnaire, Spielberger anxiety questionnaire and caregiver self-efficacy questionnaire were used to collect data. The intervention group was trained by telephone in the form of 10 telephone calls at regular intervals during two months. Data collected was analyzed using SPSS version 16. Results The results showed that the two control and intervention groups were similar in terms of mother's age, gender, mother's occupation, and parents' education. In addition, the anxiety scores of the two groups were similar before the intervention, and after the intervention the two groups had a statistically significant difference (P < 0.001). In terms of the self-efficacy score, the two groups had a statistically significant difference after the intervention (P < 0.001). Conclusion Tele-nursing after discharge caused a significant decrease in anxiety and increased self-efficacy of mothers in taking care of their children, therefore, it is recommended to use a comprehensive program in the form of tele-nursing according to parents' educational needs and wishes. Epilepsy Telenursing anxiety Self-Efficacy Introduction Epilepsy is one of the most common neurological disorders and is considered a chronic childhood disease, characterized by two or more unprovoked seizures in the nervous system ( 1 ). Although epilepsy occurs in all age groups, its prevalence is higher in children and the elderly ( 2 ). Out of the 65 million people with epilepsy worldwide, 10.5 million are under the age of 15 ( 3 , 4 ). It is estimated that one in every 100 children is at risk of developing epilepsy and being hospitalized. Seizures are consistently one of the most common reasons for pediatric hospitalizations. Despite this, studies have shown that approximately 10% of children with epilepsy are re-hospitalized within 30 days of discharge ( 5 ). Among chronic diseases, epilepsy poses a unique challenge for both the patient and their family ( 6 ). Despite advancements in controlling epilepsy, those affected still face numerous issues. On one hand, there are physical problems, and on the other, these patients confront various psychosocial issues. A childhood onset of epilepsy has a significant impact on family functioning. From the parents' perspective, a diagnosis of epilepsy in their child is a potential source of insecurity and a threat to their child's health ( 7 ). Fears of intellectual disability, death during seizures, deprivation of basic social rights in the future, discrimination, negative societal attitudes, and the social stigma associated with this disease are among the problems faced by both parents and the child ( 8 ). Although most families strive to return to a normal family life and minimize epilepsy's impact on their lives, some families face challenges that can lead to isolation, limited family activities, and changes in family lifestyle ( 9 ). One of the challenges faced by mothers of children with chronic illnesses, which can impact the disease process and its management, is low self-efficacy ( 10 ). According to definitions, self-efficacy refers to an individual's belief in their ability to perform a specific behavior ( 11 ). Based on Bandura's theory, self-efficacy includes an individual's confidence to perform self-care tasks successfully, thereby achieving desired outcomes. Researchers believe that a sense of self-efficacy is one of life's most important cognitive abilities, developed through overcoming challenges and consistently performing behaviors. It can be enhanced through programs designed to meet the needs of patients. Low self-efficacy reduces an individual's motivation to adhere to medical advice, worsens disease prognosis, and creates feelings of helplessness. Conversely, increased self-efficacy reduces anxiety in both the child and parent and increases physical and psychological well-being ( 12 ). On the other hand, families with a sick child, compared to other families, experience more limitations in life and mental health problems such as anxiety ( 13 ). A child's chronic illness and hospitalization impact the psychological state of all family members, especially mothers, leading to high levels of stress, anxiety, depression, and guilt ( 14 ). Factors such as lack of social support, financial difficulties, and marital problems exacerbate these adverse conditions; therefore, parents of children with epilepsy have a high risk of developing anxiety ( 15 ). Anxiety is the most common psychological reaction to stressors and is described as an unpleasant emotion often characterized by words like worry, tension, and fear ( 16 ). According to Kaplan, anxiety is a warning of an imminent, unknown, and internal danger that enables an individual to take action to cope with the threat ( 17 ). Parental anxiety not only affects the parents' physical, psychological, and social health but also impacts the child's condition and can interfere with the treatment process ( 13 ). Given the chronic nature and extensive consequences of epilepsy, individuals with this condition require ongoing education and support to maintain optimal health ( 18 ). Studies have shown that family-centered care can increase feelings of control over disease management, reduce anxiety, improve clinical decision-making, enhance follow-up care, recognize family abilities and capacity, and improve communication among healthcare team members ( 14 , 19 ). To provide this care, various methods can be used, one of which is tele-education. Tele-education is a planned learning process where learning and teaching typically occur in separate environments. In tele-education, communication between the instructor and learner can be through radio, television, telephone, or the internet and social networks ( 20 ). Among tele-education tools, the telephone is a device that is accessible to most people. The use of the telephone in providing care is effective in reducing costs and facilitating access to care, increasing patients' psychological safety, and improving the relationship between patients and care providers. This technique saves time for families and patients, allowing that time to be used for tele-education, and patients do not need to travel long distances. This not only reduces treatment costs but also decreases the workload and time spent by nurses ( 21 ). Given their unique position in interacting with family members, nurses play a crucial role in empowering family members by providing necessary knowledge, skills, and support ( 10 ). Although patient education during hospitalization and discharge is considered an important nursing intervention, it is insufficient for chronic diseases and requires further follow-up. Currently, the use of tele-nursing enables nurses to perform tasks such as patient monitoring, education, data collection, nursing interventions, pain control, and family support ( 22 ). According to the definition, tele-nursing refers to the use of telecommunication technology in nursing to enhance care, improve the relationship between the patient and care providers, and eliminate barriers related to time and place ( 23 ). Given the importance of education as a key factor in achieving health goals, and emphasizing the role of nurses as key individuals in planning and implementing discharge education as well as monitoring the continuity of care after discharge, having a comprehensive educational program can be very helpful ( 14 ). This educational program can contribute to the patient's health, control of complications, recognition of family abilities, and reduction of their psychological burden ( 24 ). Among these methods, tele-nursing is one of the most effective and economical methods that is expanding worldwide every day ( 18 ). Although numerous studies have examined the effects of this method on various diseases, it is worth noting that no relevant research has been found among the studies conducted in the country that examined the effect of post-discharge tele-nursing on the self-efficacy and anxiety of mothers of children with epilepsy. This is a strong reason for the necessity of the present study; it is hoped that this research will provide a suitable scientific and practical guide for these patients. Methods This study is a pre-test-post-test experimental research conducted in the Pediatric Neurology Department of Ba'ath Hospital, Hamadan in 2023. The inclusion criteria for the study included: consent to participate in the study, having the ability to read and write for the mother, the mother having access to a smartphone and the Ita or Telegram software, confirmation of the diagnosis by the treating physician, at least one month having passed since the diagnosis, the patient taking at least one anti-epileptic drug, and no history of other chronic physical or mental illnesses or intellectual disability. The exclusion criteria included: unwillingness to participate in the study, development of an adverse event during the research for the patient such as hospitalization and contracting another disease, poor physical and mental condition of the patient, not participating in telephone sessions, and incomplete completion of questionnaires. Initially, individuals who met the inclusion criteria were identified using a convenience sampling method, and the procedure was explained to them. After completing the informed consent form and questionnaires, a block randomization method with a block size of 4 was used to randomly assign participants to the control and intervention groups. To determine the sample size, based on the study by Souleti and colleagues ( 14 ) and considering the main objective of the study, the sample size was calculated using the following formula. Considering an alpha error of 5% and a power of 90% and according to the study by Souleti and colleagues, which considered the standard deviation of anxiety scores to be 4.77 in both the intervention and control groups, and considering a minimum mean difference of 3.46 and considering a 10% possible sample loss, the sample size for each group was calculated to be 45 people. Data Collection Tools 1. Demographic Questionnaire : This questionnaire consisted of two parts, an informed consent form and questions about the child's age, diagnosis, duration of illness, doctor's name and place of residence, parents' age, education, and occupation, family history of epilepsy and seizures, other illnesses, dietary status, sleep, and physical activity of the child, the child's academic status, access to a smartphone, medications taken by the child, the mother's knowledge of epilepsy, medications, and the mother's educational needs. This form was completed by interviewing the mother and referring to the child's medical records. The form was developed by the researchers using similar studies ( 10 ) and in line with the literature, and includes items whose effect on the research was monitored. 2. Spielberger State-Trait Anxiety Inventory (STAI) : This questionnaire was developed in 1973 by Spielberger and colleagues. The questionnaire consists of 40 items and separate self-report scales to measure state and trait anxiety. Trait anxiety refers to the relatively stable and enduring aspects of anxiety, while state anxiety is the individual's current feelings at the time of responding ( 16 ). In this study, only the state anxiety part was considered, according to the study by Chakari and colleagues ( 25 ). This part includes 20 items. Ten questions are directly and ten questions ( 20 , 19 , 16 , 15 , 11 , 10 , 8 , 5 , 2 , 1 ) are inversely in the form of a 4-point Likert scale: not at all ( 1 ), somewhat ( 2 ), very much ( 3 ), very much ( 4 ). The minimum score is 20 and the maximum score is 80. A score of ( 20 – 31 ) indicates mild anxiety, (32–42) low to moderate anxiety, (42–53) moderate anxiety, (54–64) relatively severe anxiety, (65–75) severe anxiety, and a score of 76 and above indicates very severe anxiety ( 26 ). The reliability and validity of the Thai version of this questionnaire were examined and confirmed in 2007 by Ketalay ( 27 ). In the present study, the reliability of the questionnaire was determined using the internal consistency method, whereby the tool was completed by 10 mothers in one session and then its Cronbach's alpha was calculated as 0.78. 3. Parental Self-Efficacy Scale (RCSES) : The Parental Self-Efficacy Scale consists of 35 questions and 5 dimensions that measure mothers' self-efficacy in the areas of information about the disease, seeking support, responding to the child's inappropriate behavior, moderating the mother's mood, and managing disease care. Each item is rated from 0 to 100, with higher scores indicating higher self-efficacy. The self-efficacy scale is a standardized questionnaire with global validity and reliability. The reliability of this questionnaire was obtained by Zhang in 2010 by calculating Cronbach's alpha coefficient for the entire instrument and each of its dimensions at 80% (28). The validity and reliability of the Persian version of the questionnaire were evaluated by Gholami and colleagues (2016). The four-week test-retest reliability was calculated for the entire instrument and each of its dimensions from 64–85% ( 29 ). In the present study, the reliability of the questionnaire was determined using the internal consistency method, whereby the tool was completed by 10 mothers in one session and then its Cronbach's alpha was calculated as 0.80. Procedure After obtaining permission from the research ethics committee and a referral letter from Hamedan University of Medical Sciences and obtaining the consent of the Ba'ath Hospital officials, the researcher went to the relevant department and started sampling. First, individuals who met the inclusion criteria were identified using a convenience sampling method, and the research method was explained to them. After obtaining the consent of the research units and completing the informed consent form, the questionnaires were given to them and collected after completion. Then, a 4-block randomized block allocation was used to randomly assign them to the control and intervention groups. Patients in the intervention and control groups were selected simultaneously in the specified time frame and received routine discharge training by the nurse after discharge. Then, the patients in the intervention group received 10 training sessions over the phone over a two-month period, with a 6-day interval between each session. The educational content used in the telephone sessions was prepared based on the study by Mousavi and colleagues (2020) ( 18 ) and approved by a child neurologist. The duration of the phone call was 15 minutes based on a similar study conducted in this area ( 8 ). During each phone call, the content of the conversation, the number of times, and the time of the calls were recorded in a standardized form. Thus, all the educational content of the planned program was taught to all patients in the intervention group at a specific time and in the same way. Also, at the end of each session, the day and time of the next call with the patient were coordinated. In case of any problems or specialized questions, a child neurologist was consulted. After the end of the intervention, in order to reduce the cost and travel of the research units, the self-efficacy and anxiety questionnaires were sent online via the Eitaa or Telegram software to both groups and completed again. It should be noted that during the study, no educational intervention was performed by the researcher for the patients in the control group and, in order to maintain ethical considerations, at the end of the study, the educational content was provided to the patients in this group in the form of an electronic booklet. Data Analysis Data collected was analyzed using SPSS version 16. The Kolmogorov-Smirnov test was used to assess the normality of variables. Quantitative variables were reported as mean and standard deviation, and qualitative variables were reported as frequency and percentage. Independent t-tests were used to compare scores between the intervention and control groups. Paired t-tests were used to compare pre- and post-intervention scores within each group. The level of significance for all tests was set at 5%. Results The study results indicated that in the control group, 48.9% of children were girls and 51.1% were boys, and in the intervention group, 44.4% of children were girls and 55.6% were boys. The mean age of children in the control group was 10 years and, in the intervention group was 6 years. Additionally, the mean age of mothers in the control group was 34 years and in the intervention group was 33 years, and the mean age of fathers in the control group was 43 and in the intervention group was 37 years. There was a statistically significant difference between the control and intervention groups in terms of child's age and father's age (P < 0.001). On the other hand, in the control group, 62.1% of mothers and 63.2% of fathers had an elementary or middle school education, while in the intervention group, 47.8% of mothers and 60% of fathers had an elementary or middle school education. Also, in the control group, 93.3% of mothers were housewives and 71.4% of fathers were self-employed. Similarly, in the intervention group, 97.8% of mothers were housewives and 78% of fathers were self-employed. There was a statistically significant difference between the control and intervention groups in terms of father's occupation (P < 0.001). Results from the demographic questionnaire showed that the control and intervention groups were similar, and only differed significantly in terms of sufficient nighttime sleep (P < 0.001) (Table 1 ). Based on independent and paired t-tests, the mean anxiety score at the pre-test was 53.51 in the control group and 53.16 in the intervention group. Additionally, the mean anxiety score at the post-test was 53.27 in the control group and 47.96 in the intervention group. As a result, in terms of anxiety scores, the two groups were similar before the intervention, but after the intervention, there was a statistically significant difference between the two groups (P < 0.001). On the other hand, the mean caregiver self-efficacy score at the pre-test was 207.78 in the control group and 233.24 in the intervention group. Additionally, the mean caregiver self-efficacy score at the post-test was 207.27 in the control group and 224.44 in the intervention group. As a result, in terms of self-efficacy scores, there was a statistically significant difference between the two groups after the intervention (P < 0.001) (Table 2 ). Table 1 Frequency of history of the study participants Items Group P value Control Intervention N (%) N (%) Family history of epilepsy Yes 8 (17.8) 17 (37.8) 0.059 No 37 (82.2) 28 (62.2) Having a special diet or food restriction Yes 5 (11.1) 0 (0.0) 0.056 No 40 (88.9) 45 (100.0) Having physical activity appropriate for age Yes 27 (62.8) 26 (57.8) 0.668 No 16 (37.2) 19 (42.2) Having a satisfactory educational status Yes 20 (55.6) 13 (48.1) 0.616 No 16 (44.4) 14 (51.9) Getting enough sleep at night Yes 33 (75.0) 45 (100.0) 0.001 No 11 (25.0) 0 (0.0) Discontinue treatment without a doctor's order Yes 2 (4.7) 2 (4.4) 0.963 No 41 (95.3) 43 (95.6) Knowledge of children's medications and their side effects Yes 12 (28.6) 17 (37.8) 0.363 No 30 (71.4) 28 (62.2) Table 2 Comparison of anxiety and caregiver self-efficacy scores in two groups Group P value Control Control Mean ± SD Mean ± SD Anxiety score (pre-test) 53.51 ± 9.50 53.16 ± 7.63 0.845 Anxiety score (Post-test) 53.27 ± 8.21 47.96 ± 4.73 0.001 caregiver self-efficacy score (pre-test) 207.78 ± 45.07 233.24 ± 57.24 0.021 caregiver self-efficacy score (post-test) 207.27 ± 32.20 224.44 ± 29.16 0.001 Discussion This study aimed to determine the impact of post-discharge tele-nursing on the self-efficacy and anxiety levels of mothers with children diagnosed with epilepsy who were hospitalized in the pediatric ward of Ba'ath Educational and Therapeutic Center in Hamedan. The results revealed that the anxiety and self-efficacy scores of the two groups were similar before the intervention, but after the intervention, there was a significant statistical difference between the two groups, indicating a positive impact of nursing education and follow-up via telephone in reducing anxiety and increasing self-efficacy in mothers. Parents, especially mothers of children with epilepsy, due to the chronic nature of this disease, face numerous care challenges such as how to manage the frequency and severity of seizures, physical, social, and psychological problems, as well as common questions about seizure control through various medications and their side effects, diet, and surgery ( 10 ). Therefore, these patients, especially their parents, require extensive educational interventions. Regular follow-up and tele-nursing education, which provides up-to-date and scientific information about the disease, and whose professional mission is care, can be effective in early detection of disease complications and timely informing parents of the existence of complications so that appropriate treatment can be provided. In fact, tele-nursing, as an essential part of healthcare services, helps patients and their families to actively participate in the treatment process and successfully manage chronic diseases ( 12 ). In line with this, the results of Golati and colleagues' study (2022) also showed that compared to face-to-face consultations with a physician, a neurology nurse trained for telephone consultations and follow-ups can identify many events that require urgent medical attention, such as the occurrence of a sudden seizure or a severe adverse event, and provide necessary training. In fact, nurses managed more than half of the phone calls without the need for a physician. The use of a nursing hotline can help physicians allocate more time to children with epilepsy and provide better care to these patients ( 30 ). Similarly, in Bahrani and colleagues' study (2017), although the number of sudden seizures and self-reported periods of non-adherence to anti-epileptic drugs (AEDs) in patients with epilepsy was similar in both the telephone consultation and face-to-face consultation groups, the financial cost in the telephone consultation group, especially for those living farther from the clinic, was significantly lower. Overall, patients were very satisfied with telephone consultations ( 31 ). The results of a study by Reihany and colleagues (2014) were also consistent with the present study and showed that an empowerment and follow-up program by telephone for 1.5 months could increase care self-efficacy in mothers of children with epilepsy. They believe that parents of children with epilepsy, as individuals at risk of a disease that is referred to as a hidden disease, experience a great deal of stress. Therefore, interventions such as implementing an empowerment program will help them increase their knowledge about the disease and improve their ability to manage care and self-efficacy in this area ( 10 ). In Klotz and colleagues' study (2021), some children with epilepsy and their families experienced a worsening of their health condition and an increase in the number of seizures during the COVID-19 pandemic. The results of their study showed that telemedicine can be beneficial in managing epilepsy and reducing parental anxiety. They stated that the use of telemedicine in children with epilepsy is a valuable care alternative for both patients and healthcare providers and is likely to continue even after the COVID-19 pandemic ( 32 ). Although the results of Huang and colleagues' study (2023), which used WeChat as a method for remote follow-up, showed that continued care after discharge, whether routine in the control group or remote-based on WeChat, reduced caregiver burden and negative emotions such as anxiety and depression in parents of children with epilepsy, indicating the usefulness of ongoing nursing care after discharge, but the scores related to caregiver burden, anxiety, and stress in the WeChat group were significantly lower than the control group, which is consistent with the present study ( 33 ). Given the limited number of studies that have yielded somewhat similar results to this research, we will now discuss several studies conducted in the field of tele-nursing for other chronic diseases. In a study by Samimi and colleagues (2017), the effectiveness of telephone-based tele-nursing methods in strengthening self-care support systems for children with chronic diseases such as type 2 diabetes was confirmed. They believe that this type of educational method is more effective and convenient for patients who cannot access healthcare facilities due to geographical factors ( 34 ). Amer and colleagues (2022) also concluded in their study that remote nursing intervention (tele-nursing) is a significant method of providing healthcare and has a positive impact on the health outcomes of children with rheumatoid arthritis and increases caregiver satisfaction, especially after the start of the COVID-19 pandemic ( 35 ). Additionally, the results of the study by Shamsizadeh and colleagues (2021) showed that nursing education and follow-up by telephone in the intervention group, compared to the control group, led to improved self-efficacy in diabetes management among patients. Furthermore, self-efficacy in diabetes management was significantly higher two months after the intervention compared to one month after the intervention. They believe that the use of methods such as tele-nursing by experienced and skilled individuals can, in addition to increasing trust and communication between the patient and nurse, lead to the transfer of useful and relevant information ( 36 ). Eskandari and colleagues (2020) found in their study that empowering families through telephone follow-up by nurses for patients with mental disorders can be an effective method for improving medication adherence and reducing readmissions ( 37 ). However, in a study by Solati and colleagues (2019), despite the effectiveness of family-centered education through tele-nursing in reducing depression and stress in mothers of children after bone marrow transplantation, it did not significantly reduce anxiety ( 14 ). This is not consistent with the results of the present study, which could be due to the nature of the disease and the treatment process. Given the results of numerous studies and the results of the present study, since most patients with epilepsy spend most of their time outside of clinics and hospitals, it is important that care extends beyond such centers and covers their entire lives. This approach can only be effective if appropriate policies are developed for implementing educational programs and follow-up interventions through hospital staff, especially nurses ( 38 ). Interventions such as tele-nursing, due to being low-cost, safe, and effective, can support mothers of these children and improve the quality of their specialized care. Limitations One limitation of the present study was that participants may have received education from other sources such as the internet in addition to the research training program. Since the present study only relied on telephone-based education, it is recommended to investigate the impact of other follow-up methods in patients with epilepsy, such as the internet and social media. Conclusion The results of this study showed that post-discharge tele-nursing significantly reduced anxiety and increased self-efficacy in mothers caring for their children. Therefore, the use of a comprehensive program in the form of tele-nursing tailored to the needs and educational requirements of parents can improve the mental health of parents, save on transportation costs, and increase parents' ability to manage their child's disease. Declarations Funding The Research Vice-Chancellor of Hamadan University of Medical Sciences supported researchers in obtaining research permits. It had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing interests The authors have no relevant financial or non-financial interests to disclose. Authors’ contributions Marzieh Seif, Maryam Dehghani and Mohammad reza Khodahakhshi wrote the manuscript draft, Reyhaneh Roozbahani, Hamideh Hakimi, and Afshin Fayyazi designed the study. Reyhaneh Roozbahani, Marzieh Seif collected data and Hadi Ranjbar Conducted the analysis Marzieh Seif, Maryam Dehghani, Hamideh Hakimi and Afshin Fayyazi revised it critically for important intellectual content. All authors read and approved the final manuscript. Ethics approval The Ethics Committee of Hamadan University of Medical Sciences approved the project (IR.UMSHA.REC.1402.332). To assure the ethical considerations are observed, the study was performed in accordance with the relevant guidelines and regulations. Written informed consent for participation was obtained from each participant after full disclosure of the aim of the study. The researcher assures them that their information will be confidential. Their anonymity was preserved in all stages of the research. Consent to participate Written informed consent was obtained from the parents. Consent to publish The authors affirm that human research participants provided informed consent for publication of the results. Availability of data and materials We confirm that all data generated or analyzed during this study are included in this published article. Acknowledgements The authors would like to thank the deputy of research of Hamadan University of medical science for approving and providing financial support for this research project. Also, would like to thank participants for their valuable time. References Fine A, Wirrell EC. Seizures in children. Pediatrics in Review. 2020;41(7):321-47. Hockenberry MJ, Wilson D. 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Talebi S, Ganjlo J, Rakhshani M, Asghari S. Comparison the effect of orientation program used by visual concept map and face to face method on fear and anxiety of children. Iran J Pediatr Nurs. 2015;1(4):32-44. Kathalae D. An intervention to reduce anxiety/fear in hospitalized Thai school age children: State University of New York at Buffalo; 2007. Zhang S-Y. Measurement and correlates of caregiver self-efficacy amongst family caregivers of persons with dementia living in Shanghai, China: Queensland University of Technology; 2010. Gholami S, Reyhani T, BeyraghiToosi M, Behnam Vashani H. Effect of an Empowerment Program on Self-Efficacy of Epileptic Child's Mothers in Psychological Adaptation, Gaining Support and Receiving Information. The Horizon of Medical Sciences. 2016;22(4):299-306. Gulati S, Shruthi N, Panda PK, Sharawat IK, Josey M, Pandey RM. Telephone-based follow-up of children with epilepsy: Comparison of accuracy between a specialty nurse and a pediatric neurology fellow. Seizure. 2020;83:98-103. Bahrani K, Singh MB, Bhatia R, Prasad K, Vibha D, Shukla G, et al. Telephonic review for outpatients with epilepsy—A prospective randomized, parallel group study. Seizure. 2017;53:55-61. Klotz KA, Borlot F, Scantlebury MH, Payne ET, Appendino JP, Schönberger J, et al. Telehealth for children with epilepsy is effective and reduces anxiety independent of healthcare setting. Frontiers in pediatrics. 2021;9:642381. Huang X, Kang Y, Wang M, Liu Q, Wang F, Zeng M. WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy: A randomized controlled study. Medicine. 2023;102(25):e34070. Samimi Z, Talakoub S, Ghazavi Z. Effect of telephone follow-up by nurses on self-care in children with diabetes. Iranian journal of nursing and midwifery research. 2018;23(1):26. Mostafa Amer H, S Elzyen E, A Zayed D, H Salama A. Effect of Tele Nursing on Health Outcomes of Children with Rheumatic Arthritis and Satisfaction of Their Caregivers during Covid-19 Pandemic. Egyptian Journal of Health Care. 2022;13(2):1855-73. Shamsizadeh M, Shaadi S, Mohammadi Y, Borzou SR. The effects of education and telephone nurse follow-up (tele-nursing) on diabestes management self–efficacy in patients with type 2 diabetic referred to Hamadans Diabetes Center in 2018. Avicenna Journal of Nursing and Midwifery Care. 2021;29(2):81-90. Eskandari Z, DashtBozorgi B, Fakhri A, Latifi SM. The effect of Family-based Model Education with Telephone Follow-up on Drug Adherence and Re-hospitalization of Patients with Mental Disorders. Iranian Journal of Psychiatric Nursing (IJPN) Original Article. 2021;9(1). Arab M, Bagheri E. Comparison of the effect of educational intervention based on adult learning theory and telenursing on self-management among epileptic patients. Journal of Research and Health. 2016;6(5):522-9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 Apr, 2025 Read the published version in European Journal of Pediatrics → Version 1 posted Editorial decision: Revision requested 08 Dec, 2024 Reviews received at journal 25 Nov, 2024 Reviews received at journal 24 Nov, 2024 Reviewers agreed at journal 15 Nov, 2024 Reviewers agreed at journal 13 Nov, 2024 Reviewers agreed at journal 13 Nov, 2024 Reviewers invited by journal 13 Nov, 2024 Editor assigned by journal 13 Nov, 2024 Submission checks completed at journal 13 Nov, 2024 First submitted to journal 10 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5426721","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":382222386,"identity":"edead7f8-b7a8-4fc2-86e5-7809f55f893d","order_by":0,"name":"Marzieh Seif","email":"","orcid":"","institution":"Nahavand School of Allied Medical Sciences, Hamadan University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Marzieh","middleName":"","lastName":"Seif","suffix":""},{"id":382222388,"identity":"ca7171aa-6867-41ca-b00b-049ac781d939","order_by":1,"name":"Mohammad reza Khodahakhshi","email":"","orcid":"","institution":"Hamadan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"reza","lastName":"Khodahakhshi","suffix":""},{"id":382222390,"identity":"280a44cd-b42d-42cc-9c2f-9fec2072a060","order_by":2,"name":"Reyhaneh Roozbahani","email":"","orcid":"","institution":"Nahavand School of Allied Medical Sciences, Hamadan University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Reyhaneh","middleName":"","lastName":"Roozbahani","suffix":""},{"id":382222393,"identity":"8b01eb85-41db-4c09-81c8-14205e9501e9","order_by":3,"name":"Maryam Dehghani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYPACZgZ+ZsaGAx+ATDZ2YrVItjc3PpwB0sJMrBaDM8ebjXkgbPxAt/3sM4mfOdYMDDcS26Rtfm2T52NmYPzwMQe3FrMz6WaSvdvSGRhnALXk9t02bGNmYJacuQ2PlgNpbBK82w4zMEuAtPTcZgRqYWPmxafl/DM2yb9ALWwgLZY9t+0Ja7mRxiYNsoWH52CzMcOP24lEaHnGbC27LZ1Hgr2x8WFvw+3kNmbGZvx+OZ/GePPtNms5+8PsDw78+HPbdn5788EPH/FoAQIWCSABjhEGxjYw2YBXPRAwf0Cw/xBSPApGwSgYBSMRAACOB1ABlDpeLwAAAABJRU5ErkJggg==","orcid":"","institution":"Zeyinab (P.B.U.H), Guilan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Dehghani","suffix":""},{"id":382222396,"identity":"ad2dff89-6380-4fc0-ae65-14b10321b911","order_by":4,"name":"Hamideh Hakimi","email":"","orcid":"","institution":"Faculty of Nursing and Midwifery, Qazvin University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Hamideh","middleName":"","lastName":"Hakimi","suffix":""},{"id":382222397,"identity":"e342edac-36b7-4cea-bb34-09c74156ef70","order_by":5,"name":"Hadi Ranjbar","email":"","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hadi","middleName":"","lastName":"Ranjbar","suffix":""},{"id":382222398,"identity":"e4e69b13-10e6-4a6a-921a-f54ef04f8ad1","order_by":6,"name":"Afshin Fayyazi","email":"","orcid":"","institution":"Hamadan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Afshin","middleName":"","lastName":"Fayyazi","suffix":""}],"badges":[],"createdAt":"2024-11-10 15:38:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5426721/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5426721/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00431-025-06111-x","type":"published","date":"2025-04-08T16:04:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80558146,"identity":"7ac7e4e3-ad85-49d4-8837-6e78356fefb2","added_by":"auto","created_at":"2025-04-14 16:08:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":597840,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5426721/v1/19fbf31b-61f9-49e8-907c-06a5d8419ceb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Tele-Nursing on Maternal Self-Efficacy and Anxiety in Post-Discharge Epilepsy Care: an interventional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEpilepsy is one of the most common neurological disorders and is considered a chronic childhood disease, characterized by two or more unprovoked seizures in the nervous system (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although epilepsy occurs in all age groups, its prevalence is higher in children and the elderly (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Out of the 65\u0026nbsp;million people with epilepsy worldwide, 10.5\u0026nbsp;million are under the age of 15 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). It is estimated that one in every 100 children is at risk of developing epilepsy and being hospitalized. Seizures are consistently one of the most common reasons for pediatric hospitalizations. Despite this, studies have shown that approximately 10% of children with epilepsy are re-hospitalized within 30 days of discharge (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong chronic diseases, epilepsy poses a unique challenge for both the patient and their family (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Despite advancements in controlling epilepsy, those affected still face numerous issues. On one hand, there are physical problems, and on the other, these patients confront various psychosocial issues. A childhood onset of epilepsy has a significant impact on family functioning. From the parents' perspective, a diagnosis of epilepsy in their child is a potential source of insecurity and a threat to their child's health (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Fears of intellectual disability, death during seizures, deprivation of basic social rights in the future, discrimination, negative societal attitudes, and the social stigma associated with this disease are among the problems faced by both parents and the child (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Although most families strive to return to a normal family life and minimize epilepsy's impact on their lives, some families face challenges that can lead to isolation, limited family activities, and changes in family lifestyle (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne of the challenges faced by mothers of children with chronic illnesses, which can impact the disease process and its management, is low self-efficacy (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). According to definitions, self-efficacy refers to an individual's belief in their ability to perform a specific behavior (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Based on Bandura's theory, self-efficacy includes an individual's confidence to perform self-care tasks successfully, thereby achieving desired outcomes. Researchers believe that a sense of self-efficacy is one of life's most important cognitive abilities, developed through overcoming challenges and consistently performing behaviors. It can be enhanced through programs designed to meet the needs of patients. Low self-efficacy reduces an individual's motivation to adhere to medical advice, worsens disease prognosis, and creates feelings of helplessness. Conversely, increased self-efficacy reduces anxiety in both the child and parent and increases physical and psychological well-being (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, families with a sick child, compared to other families, experience more limitations in life and mental health problems such as anxiety (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A child's chronic illness and hospitalization impact the psychological state of all family members, especially mothers, leading to high levels of stress, anxiety, depression, and guilt (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Factors such as lack of social support, financial difficulties, and marital problems exacerbate these adverse conditions; therefore, parents of children with epilepsy have a high risk of developing anxiety (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Anxiety is the most common psychological reaction to stressors and is described as an unpleasant emotion often characterized by words like worry, tension, and fear (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). According to Kaplan, anxiety is a warning of an imminent, unknown, and internal danger that enables an individual to take action to cope with the threat (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Parental anxiety not only affects the parents' physical, psychological, and social health but also impacts the child's condition and can interfere with the treatment process (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the chronic nature and extensive consequences of epilepsy, individuals with this condition require ongoing education and support to maintain optimal health (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Studies have shown that family-centered care can increase feelings of control over disease management, reduce anxiety, improve clinical decision-making, enhance follow-up care, recognize family abilities and capacity, and improve communication among healthcare team members (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). To provide this care, various methods can be used, one of which is tele-education. Tele-education is a planned learning process where learning and teaching typically occur in separate environments. In tele-education, communication between the instructor and learner can be through radio, television, telephone, or the internet and social networks (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Among tele-education tools, the telephone is a device that is accessible to most people. The use of the telephone in providing care is effective in reducing costs and facilitating access to care, increasing patients' psychological safety, and improving the relationship between patients and care providers. This technique saves time for families and patients, allowing that time to be used for tele-education, and patients do not need to travel long distances. This not only reduces treatment costs but also decreases the workload and time spent by nurses (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven their unique position in interacting with family members, nurses play a crucial role in empowering family members by providing necessary knowledge, skills, and support (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Although patient education during hospitalization and discharge is considered an important nursing intervention, it is insufficient for chronic diseases and requires further follow-up. Currently, the use of tele-nursing enables nurses to perform tasks such as patient monitoring, education, data collection, nursing interventions, pain control, and family support (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). According to the definition, tele-nursing refers to the use of telecommunication technology in nursing to enhance care, improve the relationship between the patient and care providers, and eliminate barriers related to time and place (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the importance of education as a key factor in achieving health goals, and emphasizing the role of nurses as key individuals in planning and implementing discharge education as well as monitoring the continuity of care after discharge, having a comprehensive educational program can be very helpful (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This educational program can contribute to the patient's health, control of complications, recognition of family abilities, and reduction of their psychological burden (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Among these methods, tele-nursing is one of the most effective and economical methods that is expanding worldwide every day (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Although numerous studies have examined the effects of this method on various diseases, it is worth noting that no relevant research has been found among the studies conducted in the country that examined the effect of post-discharge tele-nursing on the self-efficacy and anxiety of mothers of children with epilepsy. This is a strong reason for the necessity of the present study; it is hoped that this research will provide a suitable scientific and practical guide for these patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study is a pre-test-post-test experimental research conducted in the Pediatric Neurology Department of Ba\u0026apos;ath Hospital, Hamadan in 2023. The inclusion criteria for the study included: consent to participate in the study, having the ability to read and write for the mother, the mother having access to a smartphone and the Ita or Telegram software, confirmation of the diagnosis by the treating physician, at least one month having passed since the diagnosis, the patient taking at least one anti-epileptic drug, and no history of other chronic physical or mental illnesses or intellectual disability. The exclusion criteria included: unwillingness to participate in the study, development of an adverse event during the research for the patient such as hospitalization and contracting another disease, poor physical and mental condition of the patient, not participating in telephone sessions, and incomplete completion of questionnaires. Initially, individuals who met the inclusion criteria were identified using a convenience sampling method, and the procedure was explained to them. After completing the informed consent form and questionnaires, a block randomization method with a block size of 4 was used to randomly assign participants to the control and intervention groups.\u003c/p\u003e\n\u003cp\u003eTo determine the sample size, based on the study by Souleti and colleagues (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e) and considering the main objective of the study, the sample size was calculated using the following formula. Considering an alpha error of 5% and a power of 90% and according to the study by Souleti and colleagues, which considered the standard deviation of anxiety scores to be 4.77 in both the intervention and control groups, and considering a minimum mean difference of 3.46 and considering a 10% possible sample loss, the sample size for each group was calculated to be 45 people.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Demographic Questionnaire\u003c/strong\u003e: This questionnaire consisted of two parts, an informed consent form and questions about the child\u0026apos;s age, diagnosis, duration of illness, doctor\u0026apos;s name and place of residence, parents\u0026apos; age, education, and occupation, family history of epilepsy and seizures, other illnesses, dietary status, sleep, and physical activity of the child, the child\u0026apos;s academic status, access to a smartphone, medications taken by the child, the mother\u0026apos;s knowledge of epilepsy, medications, and the mother\u0026apos;s educational needs. This form was completed by interviewing the mother and referring to the child\u0026apos;s medical records. The form was developed by the researchers using similar studies (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e) and in line with the literature, and includes items whose effect on the research was monitored.\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e2. Spielberger State-Trait Anxiety Inventory (STAI)\u003c/strong\u003e: This questionnaire was developed in 1973 by Spielberger and colleagues. The questionnaire consists of 40 items and separate self-report scales to measure state and trait anxiety. Trait anxiety refers to the relatively stable and enduring aspects of anxiety, while state anxiety is the individual\u0026apos;s current feelings at the time of responding (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). In this study, only the state anxiety part was considered, according to the study by Chakari and colleagues (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e). This part includes 20 items. Ten questions are directly and ten questions (\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) are inversely in the form of a 4-point Likert scale: not at all (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e), somewhat (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e), very much (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e), very much (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). The minimum score is 20 and the maximum score is 80. A score of (\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e) indicates mild anxiety, (32\u0026ndash;42) low to moderate anxiety, (42\u0026ndash;53) moderate anxiety, (54\u0026ndash;64) relatively severe anxiety, (65\u0026ndash;75) severe anxiety, and a score of 76 and above indicates very severe anxiety (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eThe reliability and validity of the Thai version of this questionnaire were examined and confirmed in 2007 by Ketalay (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e). In the present study, the reliability of the questionnaire was determined using the internal consistency method, whereby the tool was completed by 10 mothers in one session and then its Cronbach\u0026apos;s alpha was calculated as 0.78.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Parental Self-Efficacy Scale (RCSES)\u003c/strong\u003e: The Parental Self-Efficacy Scale consists of 35 questions and 5 dimensions that measure mothers\u0026apos; self-efficacy in the areas of information about the disease, seeking support, responding to the child\u0026apos;s inappropriate behavior, moderating the mother\u0026apos;s mood, and managing disease care. Each item is rated from 0 to 100, with higher scores indicating higher self-efficacy. The self-efficacy scale is a standardized questionnaire with global validity and reliability. The reliability of this questionnaire was obtained by Zhang in 2010 by calculating Cronbach\u0026apos;s alpha coefficient for the entire instrument and each of its dimensions at 80% (28). The validity and reliability of the Persian version of the questionnaire were evaluated by Gholami and colleagues (2016). The four-week test-retest reliability was calculated for the entire instrument and each of its dimensions from 64\u0026ndash;85% (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e). In the present study, the reliability of the questionnaire was determined using the internal consistency method, whereby the tool was completed by 10 mothers in one session and then its Cronbach\u0026apos;s alpha was calculated as 0.80.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eProcedure\u003c/h2\u003e\n \u003cp\u003eAfter obtaining permission from the research ethics committee and a referral letter from Hamedan University of Medical Sciences and obtaining the consent of the Ba\u0026apos;ath Hospital officials, the researcher went to the relevant department and started sampling. First, individuals who met the inclusion criteria were identified using a convenience sampling method, and the research method was explained to them. After obtaining the consent of the research units and completing the informed consent form, the questionnaires were given to them and collected after completion. Then, a 4-block randomized block allocation was used to randomly assign them to the control and intervention groups. Patients in the intervention and control groups were selected simultaneously in the specified time frame and received routine discharge training by the nurse after discharge. Then, the patients in the intervention group received 10 training sessions over the phone over a two-month period, with a 6-day interval between each session. The educational content used in the telephone sessions was prepared based on the study by Mousavi and colleagues (2020) (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e) and approved by a child neurologist. The duration of the phone call was 15 minutes based on a similar study conducted in this area (\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e). During each phone call, the content of the conversation, the number of times, and the time of the calls were recorded in a standardized form. Thus, all the educational content of the planned program was taught to all patients in the intervention group at a specific time and in the same way. Also, at the end of each session, the day and time of the next call with the patient were coordinated. In case of any problems or specialized questions, a child neurologist was consulted. After the end of the intervention, in order to reduce the cost and travel of the research units, the self-efficacy and anxiety questionnaires were sent online via the Eitaa or Telegram software to both groups and completed again. It should be noted that during the study, no educational intervention was performed by the researcher for the patients in the control group and, in order to maintain ethical considerations, at the end of the study, the educational content was provided to the patients in this group in the form of an electronic booklet.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eData Analysis\u003c/h2\u003e\n \u003cp\u003eData collected was analyzed using SPSS version 16. The Kolmogorov-Smirnov test was used to assess the normality of variables. Quantitative variables were reported as mean and standard deviation, and qualitative variables were reported as frequency and percentage. Independent t-tests were used to compare scores between the intervention and control groups. Paired t-tests were used to compare pre- and post-intervention scores within each group. The level of significance for all tests was set at 5%.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study results indicated that in the control group, 48.9% of children were girls and 51.1% were boys, and in the intervention group, 44.4% of children were girls and 55.6% were boys. The mean age of children in the control group was 10 years and, in the intervention group was 6 years. Additionally, the mean age of mothers in the control group was 34 years and in the intervention group was 33 years, and the mean age of fathers in the control group was 43 and in the intervention group was 37 years. There was a statistically significant difference between the control and intervention groups in terms of child's age and father's age (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). On the other hand, in the control group, 62.1% of mothers and 63.2% of fathers had an elementary or middle school education, while in the intervention group, 47.8% of mothers and 60% of fathers had an elementary or middle school education. Also, in the control group, 93.3% of mothers were housewives and 71.4% of fathers were self-employed. Similarly, in the intervention group, 97.8% of mothers were housewives and 78% of fathers were self-employed. There was a statistically significant difference between the control and intervention groups in terms of father's occupation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eResults from the demographic questionnaire showed that the control and intervention groups were similar, and only differed significantly in terms of sufficient nighttime sleep (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBased on independent and paired t-tests, the mean anxiety score at the pre-test was 53.51 in the control group and 53.16 in the intervention group. Additionally, the mean anxiety score at the post-test was 53.27 in the control group and 47.96 in the intervention group. As a result, in terms of anxiety scores, the two groups were similar before the intervention, but after the intervention, there was a statistically significant difference between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). On the other hand, the mean caregiver self-efficacy score at the pre-test was 207.78 in the control group and 233.24 in the intervention group. Additionally, the mean caregiver self-efficacy score at the post-test was 207.27 in the control group and 224.44 in the intervention group. As a result, in terms of self-efficacy scores, there was a statistically significant difference between the two groups after the intervention (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of history of the study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c7\" namest=\"c6\" rowspan=\"3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily history of epilepsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e17 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c7\" namest=\"c6\" rowspan=\"2\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (82.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e28 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHaving a special diet or food restriction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c7\" namest=\"c6\" rowspan=\"2\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHaving physical activity appropriate for age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e26 (57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c7\" namest=\"c6\" rowspan=\"2\"\u003e \u003cp\u003e0.668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e19 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHaving a satisfactory educational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e13 (48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c7\" namest=\"c6\" rowspan=\"2\"\u003e \u003cp\u003e0.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14 (51.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGetting enough sleep at night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e11 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiscontinue treatment without a doctor's order\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c7\" namest=\"c6\" rowspan=\"2\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (95.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e43 (95.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKnowledge of children's medications and their side effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e17 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c7\" namest=\"c6\" rowspan=\"2\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e28 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of anxiety and caregiver self-efficacy scores in two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety score (pre-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.51\u0026thinsp;\u0026plusmn;\u0026thinsp;9.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.16\u0026thinsp;\u0026plusmn;\u0026thinsp;7.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety score (Post-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecaregiver self-efficacy score (pre-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e207.78\u0026thinsp;\u0026plusmn;\u0026thinsp;45.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e233.24\u0026thinsp;\u0026plusmn;\u0026thinsp;57.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecaregiver self-efficacy score (post-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e207.27\u0026thinsp;\u0026plusmn;\u0026thinsp;32.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e224.44\u0026thinsp;\u0026plusmn;\u0026thinsp;29.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to determine the impact of post-discharge tele-nursing on the self-efficacy and anxiety levels of mothers with children diagnosed with epilepsy who were hospitalized in the pediatric ward of Ba'ath Educational and Therapeutic Center in Hamedan. The results revealed that the anxiety and self-efficacy scores of the two groups were similar before the intervention, but after the intervention, there was a significant statistical difference between the two groups, indicating a positive impact of nursing education and follow-up via telephone in reducing anxiety and increasing self-efficacy in mothers. Parents, especially mothers of children with epilepsy, due to the chronic nature of this disease, face numerous care challenges such as how to manage the frequency and severity of seizures, physical, social, and psychological problems, as well as common questions about seizure control through various medications and their side effects, diet, and surgery (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Therefore, these patients, especially their parents, require extensive educational interventions. Regular follow-up and tele-nursing education, which provides up-to-date and scientific information about the disease, and whose professional mission is care, can be effective in early detection of disease complications and timely informing parents of the existence of complications so that appropriate treatment can be provided. In fact, tele-nursing, as an essential part of healthcare services, helps patients and their families to actively participate in the treatment process and successfully manage chronic diseases (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn line with this, the results of Golati and colleagues' study (2022) also showed that compared to face-to-face consultations with a physician, a neurology nurse trained for telephone consultations and follow-ups can identify many events that require urgent medical attention, such as the occurrence of a sudden seizure or a severe adverse event, and provide necessary training. In fact, nurses managed more than half of the phone calls without the need for a physician. The use of a nursing hotline can help physicians allocate more time to children with epilepsy and provide better care to these patients (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Similarly, in Bahrani and colleagues' study (2017), although the number of sudden seizures and self-reported periods of non-adherence to anti-epileptic drugs (AEDs) in patients with epilepsy was similar in both the telephone consultation and face-to-face consultation groups, the financial cost in the telephone consultation group, especially for those living farther from the clinic, was significantly lower. Overall, patients were very satisfied with telephone consultations (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The results of a study by Reihany and colleagues (2014) were also consistent with the present study and showed that an empowerment and follow-up program by telephone for 1.5 months could increase care self-efficacy in mothers of children with epilepsy. They believe that parents of children with epilepsy, as individuals at risk of a disease that is referred to as a hidden disease, experience a great deal of stress. Therefore, interventions such as implementing an empowerment program will help them increase their knowledge about the disease and improve their ability to manage care and self-efficacy in this area (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Klotz and colleagues' study (2021), some children with epilepsy and their families experienced a worsening of their health condition and an increase in the number of seizures during the COVID-19 pandemic. The results of their study showed that telemedicine can be beneficial in managing epilepsy and reducing parental anxiety. They stated that the use of telemedicine in children with epilepsy is a valuable care alternative for both patients and healthcare providers and is likely to continue even after the COVID-19 pandemic (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Although the results of Huang and colleagues' study (2023), which used WeChat as a method for remote follow-up, showed that continued care after discharge, whether routine in the control group or remote-based on WeChat, reduced caregiver burden and negative emotions such as anxiety and depression in parents of children with epilepsy, indicating the usefulness of ongoing nursing care after discharge, but the scores related to caregiver burden, anxiety, and stress in the WeChat group were significantly lower than the control group, which is consistent with the present study (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the limited number of studies that have yielded somewhat similar results to this research, we will now discuss several studies conducted in the field of tele-nursing for other chronic diseases. In a study by Samimi and colleagues (2017), the effectiveness of telephone-based tele-nursing methods in strengthening self-care support systems for children with chronic diseases such as type 2 diabetes was confirmed. They believe that this type of educational method is more effective and convenient for patients who cannot access healthcare facilities due to geographical factors (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Amer and colleagues (2022) also concluded in their study that remote nursing intervention (tele-nursing) is a significant method of providing healthcare and has a positive impact on the health outcomes of children with rheumatoid arthritis and increases caregiver satisfaction, especially after the start of the COVID-19 pandemic (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Additionally, the results of the study by Shamsizadeh and colleagues (2021) showed that nursing education and follow-up by telephone in the intervention group, compared to the control group, led to improved self-efficacy in diabetes management among patients. Furthermore, self-efficacy in diabetes management was significantly higher two months after the intervention compared to one month after the intervention. They believe that the use of methods such as tele-nursing by experienced and skilled individuals can, in addition to increasing trust and communication between the patient and nurse, lead to the transfer of useful and relevant information (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEskandari and colleagues (2020) found in their study that empowering families through telephone follow-up by nurses for patients with mental disorders can be an effective method for improving medication adherence and reducing readmissions (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e37\u003c/span\u003e). However, in a study by Solati and colleagues (2019), despite the effectiveness of family-centered education through tele-nursing in reducing depression and stress in mothers of children after bone marrow transplantation, it did not significantly reduce anxiety (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This is not consistent with the results of the present study, which could be due to the nature of the disease and the treatment process. Given the results of numerous studies and the results of the present study, since most patients with epilepsy spend most of their time outside of clinics and hospitals, it is important that care extends beyond such centers and covers their entire lives. This approach can only be effective if appropriate policies are developed for implementing educational programs and follow-up interventions through hospital staff, especially nurses (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Interventions such as tele-nursing, due to being low-cost, safe, and effective, can support mothers of these children and improve the quality of their specialized care.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eOne limitation of the present study was that participants may have received education from other sources such as the internet in addition to the research training program. Since the present study only relied on telephone-based education, it is recommended to investigate the impact of other follow-up methods in patients with epilepsy, such as the internet and social media.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study showed that post-discharge tele-nursing significantly reduced anxiety and increased self-efficacy in mothers caring for their children. Therefore, the use of a comprehensive program in the form of tele-nursing tailored to the needs and educational requirements of parents can improve the mental health of parents, save on transportation costs, and increase parents' ability to manage their child's disease.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Research Vice-Chancellor of Hamadan University of Medical Sciences supported researchers in obtaining research permits. It had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Marzieh Seif,\u0026nbsp;Maryam Dehghani\u003csup\u003e\u0026nbsp;\u003c/sup\u003eand\u0026nbsp;Mohammad reza Khodahakhshi\u003csup\u003e\u0026nbsp;\u003c/sup\u003ewrote the manuscript draft,\u0026nbsp;Reyhaneh Roozbahani,\u0026nbsp;Hamideh Hakimi, and Afshin Fayyazi\u003csup\u003e\u0026nbsp;\u003c/sup\u003edesigned the study.\u0026nbsp;Reyhaneh Roozbahani,\u0026nbsp;Marzieh Seif\u0026nbsp;collected data and\u0026nbsp;Hadi Ranjbar\u0026nbsp;Conducted the analysis\u0026nbsp;Marzieh Seif,\u0026nbsp;Maryam Dehghani,\u0026nbsp;Hamideh Hakimi\u0026nbsp;and Afshin Fayyazi\u003csup\u003e\u0026nbsp;\u003c/sup\u003erevised it critically for important intellectual content. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of Hamadan University of Medical Sciences approved the project (IR.UMSHA.REC.1402.332). To assure the ethical considerations are observed, the study was performed in accordance with the relevant guidelines and regulations. Written informed consent for participation was obtained from each participant after full disclosure of the aim of the study. The researcher assures them that their information will be confidential. Their anonymity was preserved in all stages of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the parents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that human research participants provided informed consent for publication of the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe confirm that all data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the deputy of research of Hamadan University of medical science for approving and providing financial support for this research project. Also, would like to thank participants for their valuable time.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFine A, Wirrell EC. Seizures in children. Pediatrics in Review. 2020;41(7):321-47.\u003c/li\u003e\n\u003cli\u003eHockenberry MJ, Wilson D. Wong\u0026apos;s nursing care of infants and children-E-book: Elsevier Health Sciences; 2018.\u003c/li\u003e\n\u003cli\u003eİşler A, Turan FD, G\u0026ouml;z\u0026uuml;m S, \u0026Ouml;ncel S. Complementary and alternative approaches used by parents of children with epilepsy on epilepsy management. Epilepsy \u0026amp; Behavior. 2014;32:156-61.\u003c/li\u003e\n\u003cli\u003eSmith A, McKinlay A, Wojewodka G, Ridsdale L. A systematic review and narrative synthesis of group self-management interventions for adults with epilepsy. BMC neurology. 2017;17(1):1-10.\u003c/li\u003e\n\u003cli\u003eKessler SK, Blank LJ, Glusman J, Thibault D, Massey S, Abend NS, et al. 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Effect of an empowerment program on management of care related self-efficacy of epileptic child\u0026apos;s mother. Journal of North Khorasan University of Medical Sciences. 2017;8(4):655-64.\u003c/li\u003e\n\u003cli\u003eMarks R, Allegrante JP. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part II). Health promotion practice. 2005;6(2):148-56.\u003c/li\u003e\n\u003cli\u003eMadadkar Dehkordi S, Noorian K. The effect of multimedia education and telephone follow-up of patients and families on self-efficacy of patients with myocardial infarction. Scientific Journal of Nursing, Midwifery and Paramedical Faculty. 2021;7(2):12-22.\u003c/li\u003e\n\u003cli\u003eReilly C, Atkinson P, Memon A, Jones C, Dabydeen L, Das KB, et al. Symptoms of depression, anxiety, and stress in parents of young children with epilepsy: a case controlled population-based study. Epilepsy \u0026amp; Behavior. 2018;80:177-83.\u003c/li\u003e\n\u003cli\u003eSolati H, Sahebalzamani M, Adhami Moghadam F. Effect of Family-Based Care Training by Tele-nursing on Emotional Reactions in Mothers of Children with Bone Marrow Transplantation. Journal of Mazandaran University of Medical Sciences. 2021;30(192):156-61.\u003c/li\u003e\n\u003cli\u003eG\u0026ouml;kg\u0026ouml;z-Durmaz F, Cihan FG, Uzun M, Kutlu R. Mental health problems in children with uncomplicated epilepsy; relation with parental anxiety. Turkish Journal of Pediatrics. 2016;58(3).\u003c/li\u003e\n\u003cli\u003eSadeghian E, Seif M, Khalili A. The effect of preparation for hospitalization on school-age children\u0026rsquo;s anxiety during admission at Hamadan Besat educational hospital. Avicenna Journal of Nursing and Midwifery Care. 2019;27(3):149-55.\u003c/li\u003e\n\u003cli\u003eSadock BJ. Kaplan \u0026amp; Sadock\u0026apos;s synopsis of psychiatry: behavioral sciences/clinical psychiatry. 7ed, editor: Lippincott williams \u0026amp; wilkins; 2015.\u003c/li\u003e\n\u003cli\u003eMousavi SK, Kamali M, Azizkhani H. The effect of patient education and nurse-led telephone follow-up (tele nursing) on quality of life in patients with epilepsy. Journal of Nursing Education (JNE). 2020;9(4).\u003c/li\u003e\n\u003cli\u003eRafeifar S, Ahmadzadehasl M, Sharifi M. Comprehensive system of health education to patients. Tehran, Iran: Pazhouheshgarane-Bedoun-e-Marz Institute Pub. 2005.\u003c/li\u003e\n\u003cli\u003eKhodadadi S, Azarbarzin M. Telehealth for Arterial Diseases : the role of in-person and distance learning consultations- Rewiew article. h Nursing of Journal Iranian 2023;18(5):23-32.\u003c/li\u003e\n\u003cli\u003eKhodaparast M, Rahani T, Sadeghi T, Boskabadi H, Yavari M. The Effect of Training Through Telenursing and Multimedia on the Success of Lactation in Preterm Infants After Discharge. Journal of North Khorasan University of Medical Sciences. 2018;10(2):13-20.\u003c/li\u003e\n\u003cli\u003eKhodaveisi M, Chaghazardi N, Pakrad F, Tapak L, Safarpoor G. The Effect Of Post-Discharge Telephone Follow-Up (Telenursing) On Symptoms, Complications, And Readmission Of Patients After Coronary Artery Bypass Graft Surgery In Hamadan. Nursing And Midwifery Journal. 2020;18(6):436-46.\u003c/li\u003e\n\u003cli\u003eKaveh Savadkooh O, Zakerimoghadam M, Gheyasvandian S, Kazemnejad A. Effect of self-management program on self-efficacy in hypertensive patients. Journal of Mazandaran University of Medical Sciences. 2012;22(92):19-28.\u003c/li\u003e\n\u003cli\u003eSenobari M, Dehghan Nayeri N, Mehran A, Shirazi M, Rahimi Kian F. Evaluation of the effect of discharge education on neonatal outcomes in women with gestational diabetes. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2014;17(129):10-7.\u003c/li\u003e\n\u003cli\u003eChakeri A, Jalali E, Ghadi MR, Mohamadi M. Evaluating the effect of nurse-led telephone follow-ups (tele-nursing) on the anxiety levels in people with coronavirus. Journal of Family Medicine and Primary Care. 2020;9(10):5351.\u003c/li\u003e\n\u003cli\u003eTalebi S, Ganjlo J, Rakhshani M, Asghari S. Comparison the effect of orientation program used by visual concept map and face to face method on fear and anxiety of children. Iran J Pediatr Nurs. 2015;1(4):32-44.\u003c/li\u003e\n\u003cli\u003eKathalae D. An intervention to reduce anxiety/fear in hospitalized Thai school age children: State University of New York at Buffalo; 2007.\u003c/li\u003e\n\u003cli\u003eZhang S-Y. Measurement and correlates of caregiver self-efficacy amongst family caregivers of persons with dementia living in Shanghai, China: Queensland University of Technology; 2010.\u003c/li\u003e\n\u003cli\u003eGholami S, Reyhani T, BeyraghiToosi M, Behnam Vashani H. Effect of an Empowerment Program on Self-Efficacy of Epileptic Child\u0026apos;s Mothers in Psychological Adaptation, Gaining Support and Receiving Information. The Horizon of Medical Sciences. 2016;22(4):299-306.\u003c/li\u003e\n\u003cli\u003eGulati S, Shruthi N, Panda PK, Sharawat IK, Josey M, Pandey RM. Telephone-based follow-up of children with epilepsy: Comparison of accuracy between a specialty nurse and a pediatric neurology fellow. Seizure. 2020;83:98-103.\u003c/li\u003e\n\u003cli\u003eBahrani K, Singh MB, Bhatia R, Prasad K, Vibha D, Shukla G, et al. Telephonic review for outpatients with epilepsy\u0026mdash;A prospective randomized, parallel group study. Seizure. 2017;53:55-61.\u003c/li\u003e\n\u003cli\u003eKlotz KA, Borlot F, Scantlebury MH, Payne ET, Appendino JP, Sch\u0026ouml;nberger J, et al. Telehealth for children with epilepsy is effective and reduces anxiety independent of healthcare setting. Frontiers in pediatrics. 2021;9:642381.\u003c/li\u003e\n\u003cli\u003eHuang X, Kang Y, Wang M, Liu Q, Wang F, Zeng M. WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy: A randomized controlled study. Medicine. 2023;102(25):e34070.\u003c/li\u003e\n\u003cli\u003eSamimi Z, Talakoub S, Ghazavi Z. Effect of telephone follow-up by nurses on self-care in children with diabetes. Iranian journal of nursing and midwifery research. 2018;23(1):26.\u003c/li\u003e\n\u003cli\u003eMostafa Amer H, S Elzyen E, A Zayed D, H Salama A. Effect of Tele Nursing on Health Outcomes of Children with Rheumatic Arthritis and Satisfaction of Their Caregivers during Covid-19 Pandemic. Egyptian Journal of Health Care. 2022;13(2):1855-73.\u003c/li\u003e\n\u003cli\u003eShamsizadeh M, Shaadi S, Mohammadi Y, Borzou SR. The effects of education and telephone nurse follow-up (tele-nursing) on diabestes management self\u0026ndash;efficacy in patients with type 2 diabetic referred to Hamadans Diabetes Center in 2018. Avicenna Journal of Nursing and Midwifery Care. 2021;29(2):81-90.\u003c/li\u003e\n\u003cli\u003eEskandari Z, DashtBozorgi B, Fakhri A, Latifi SM. The effect of Family-based Model Education with Telephone Follow-up on Drug Adherence and Re-hospitalization of Patients with Mental Disorders. Iranian Journal of Psychiatric Nursing (IJPN) Original Article. 2021;9(1).\u003c/li\u003e\n\u003cli\u003eArab M, Bagheri E. Comparison of the effect of educational intervention based on adult learning theory and telenursing on self-management among epileptic patients. Journal of Research and Health. 2016;6(5):522-9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Epilepsy, Telenursing, anxiety, Self-Efficacy","lastPublishedDoi":"10.21203/rs.3.rs-5426721/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5426721/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eEpilepsy is one of the most common neurological disorders and one of the chronic childhood diseases that affects many children every year. Therefore, the present study was conducted with the aim of determining the effect of tele-nursing after discharge on the self-efficacy and anxiety of mothers with children with epilepsy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this experimental study, 90 mothers of children with epilepsy were selected by available sampling method and then randomly divided into two control and intervention groups. Demographic information questionnaire, Spielberger anxiety questionnaire and caregiver self-efficacy questionnaire were used to collect data. The intervention group was trained by telephone in the form of 10 telephone calls at regular intervals during two months. Data collected was analyzed using SPSS version 16.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results showed that the two control and intervention groups were similar in terms of mother's age, gender, mother's occupation, and parents' education. In addition, the anxiety scores of the two groups were similar before the intervention, and after the intervention the two groups had a statistically significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In terms of the self-efficacy score, the two groups had a statistically significant difference after the intervention (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eTele-nursing after discharge caused a significant decrease in anxiety and increased self-efficacy of mothers in taking care of their children, therefore, it is recommended to use a comprehensive program in the form of tele-nursing according to parents' educational needs and wishes.\u003c/p\u003e","manuscriptTitle":"Impact of Tele-Nursing on Maternal Self-Efficacy and Anxiety in Post-Discharge Epilepsy Care: an interventional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-02 16:35:12","doi":"10.21203/rs.3.rs-5426721/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-08T11:08:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-25T09:10:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-24T07:15:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213367736697179982183596153909097427649","date":"2024-11-15T18:00:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64288954826165696389755730772221650418","date":"2024-11-13T21:02:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72519552056218309959209827953338277186","date":"2024-11-13T19:23:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-13T15:34:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-13T15:21:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-13T14:59:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Pediatrics","date":"2024-11-10T15:31:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"cd8804d3-eebf-42a2-b874-5709b5050bd9","owner":[],"postedDate":"December 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-14T16:06:10+00:00","versionOfRecord":{"articleIdentity":"rs-5426721","link":"https://doi.org/10.1007/s00431-025-06111-x","journal":{"identity":"european-journal-of-pediatrics","isVorOnly":false,"title":"European Journal of Pediatrics"},"publishedOn":"2025-04-08 16:04:50","publishedOnDateReadable":"April 8th, 2025"},"versionCreatedAt":"2024-12-02 16:35:12","video":"","vorDoi":"10.1007/s00431-025-06111-x","vorDoiUrl":"https://doi.org/10.1007/s00431-025-06111-x","workflowStages":[]},"version":"v1","identity":"rs-5426721","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5426721","identity":"rs-5426721","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}