Indigenous Dream Interpretation and Caregiver Help-Seeking Delay in Ghanaian Epilepsy Households: A Factorial Survey on Seizure Etiology Attribution

Caregivers in Ghanaian epilepsy households often delay biomedical help-seeking after a first seizure, and indigenous dream interpretation has been proposed as a contributing factor. A vignette design crossed three factors—dream content (ancestral warning, spiritual attack, no dream), dream interpreter status (senior family elder, Pentecostal pastor, no interpreter), and seizure phenomenology (convulsive, non-convulsive)—yielding twelve vignettes rated by 384 caregivers. The primary outcome was stated delay in seeking biomedical care. Analysis used multilevel regression with random intercepts for caregiver and vignette. Dream content attributed to spiritual attack increased stated delay by 2.4 days relative to no dream (95% CI 1.7–3.1), and interpreter status moderated this effect: the delay was 1.3 days longer when a Pentecostal pastor rather than a senior family elder interpreted the dream (95% CI 0.4–2.2). Non-convulsive phenomenology reduced delay by 0.9 days (95% CI 0.3–1.5). The results support a mechanism in which dream-based spiritual attribution, mediated by interpreter authority, raises the perceived efficacy of ritual before biomedical consultation.