Response to the Comments on “Effect of a Video-Assisted Teaching Program About ECT on Knowledge and Attitude of Caregivers of Patients With Major Mental Illness”

Abstract

Response to the Comments on “Effect of a VideoAssisted Teaching Program About ECT on Knowledge and Attitude of Caregivers of Patients With Major Mental Illness” We thank the authors of the above comments for their interest in and time spent reading our published article1 and raising certain issues to which we would like to respond. One of the issues raised was regarding the choice of the article for sample-size calculation. Though we accept that it is ideal to choose a study employing the same methodology, when there is no precisely comparable study in the literature, basing the calculation on studies that are comparable in terms of methodology and outcomes is an accepted practice. In the study conducted by Kheiri et al.,2 the effect of focused lectures and booklet-based education on knowledge and attitude towards electroconvulsive therapy (ECT) was assessed among Iranian nurses and patient relatives. Both the studies involved a similar study population (relatives of a patient with major mental illness), adopted a similar methodology (targeted educational intervention), and assessed similar outcomes (knowledge and attitude towards ECT). We powered the sample to detect a minimum difference of 2.5 units before and after the intervention. This value reflected the combined judgment of the investigators, and it referred to the change in total scores.1 We do agree that there is a probability of selection bias in our study. Nevertheless, the baseline knowledge and attitude scores were still on the lower side for the included subjects; this was notwithstanding the routine pre-ECT counselling provided to the patient relatives before obtaining consent. This counselling involves a simple explanation about how brief seizures will be intentionally triggered following application of small electrical currents to the brain while under anesthesia and preprocedural instructions to the patient’s caregivers about keeping the patient nil per oral from the previous night. However, this is not a structured explanation and does not involve the use of audio–visual aids. This study’s findings have helped us identify the lacunae in our clinical practice, and the video-assisted intervention used in this study is now increasingly used in our clinical setup. The baseline level of knowledge of the caregivers about ECT, to which the pre-ECT discussion would have contributed, is presented in Table 12; most items showed a significant difference after the intervention. The majority of the sample was employed (82.5%) and educated at or above the higher secondary school level (52.5%); 30% of the sample had received only primary schooling, while 17.5% were educated till high school. The study results may, therefore, be generalized to such a population only. We did not formally assess the socioeconomic status of the participants.