# From Hesitation to Confidence: Shifting Parental Attitude and Perception Toward Ketogenic Diet in Treating Children With Drug-Resistant Epilepsy

## TL;DR

A new questionnaire was developed to assess and improve parents' attitudes toward using ketogenic diets for children with drug-resistant epilepsy.

## Contribution

The study introduces and validates the first questionnaire to systematically evaluate parental perceptions of ketogenic diets in treating drug-resistant epilepsy.

## Key findings

- Parental understanding, perceived effectiveness, and motivation significantly improved after a three-month intervention.
- Concerns about side effects, financial burden, and long-term adherence decreased significantly.
- The questionnaire showed high internal consistency and positively impacted child quality of life and peer influence.

## Abstract

Background: Managing drug-resistant epilepsy (DRE) in children through ketogenic diets (KD) is a promising therapeutic approach. Parental perceptions significantly influence adherence and outcomes of KD; however, to date, no validated tool exists to evaluate these perceptions systematically. This study presents a novel approach by developing and validating the first questionnaire to assess parental perceptions of KD in a clinical setting. The aim of this study was to develop and evaluate changes in parental perceptions and attitudes toward KD before and after a structured intervention, addressing domains such as awareness, perceived effectiveness, compliance, concerns, and social and financial influences.

Methodology: A pre- and post-intervention study was conducted among 30 parents of children with drug-resistant epilepsy aged one month to five years. Structured educational sessions, counseling, and resource distribution were provided over three months. Parental perceptions were assessed using validated questionnaires at baseline and post-intervention. The internal consistency of the domains was analyzed using Cronbach's alpha, with values ≥0.70 deemed acceptable. Paired t-tests compared pre- and post-intervention scores, with statistical significance set at p < 0.05. The developed questionnaire has been duly registered by the Copyright Office of the Government of India and is copyright-protected. The study was approved by the Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai (reference number: IEC/24MAR/185/09).

Results: Post-intervention, significant improvements were observed in parental understanding (mean: 5.000 ± 0.000 versus 2.167 ± 1.02; p < 0.001), perceived effectiveness (4.700 ± 0.915 versus 2.967 ± 0.513; p < 0.001), and motivation (4.533 ± 0.698 versus 3.267 ± 0.521; p < 0.001). Concerns about side effects, financial burden, and long-term adherence decreased significantly (p < 0.001). Cronbach's alpha demonstrated high internal consistency across domains (α ≥ 0.719). Positive impacts on child quality of life and reduced peer influence were also noted.

Conclusion: Structured education and support significantly improved parental perceptions, alleviating barriers to KD adherence. The validated questionnaire serves as a robust clinical tool for assessing and addressing parental perceptions, enabling tailored interventions to enhance KD efficacy and optimize outcomes in children with refractory epilepsy.