Epilepsy, Participation, and Belonging in South African Secondary Schools: Learners’ Accounts Through a Capability Approach

Abstract

Learners with epilepsy experience persistent educational challenges that remain underexplored within inclusive education discourse, particularly in secondary school contexts. Guided by the Capability Approach, this study examines how epilepsy shapes learners’ opportunities to participate meaningfully in schooling and achieve valued educational outcomes. Situated within an interpretivist paradigm, this interpretive qualitative research employed semi-structured interviews with 12 learners diagnosed with epilepsy, recruited from four secondary schools in South Africa. Grounded in learners lived experiences, the data were analysed using reflexive thematic analysis. The findings indicate that seizure episodes disrupt classroom participation and continuity of learning, while stigma and fear of embarrassment constrain learners’ confidence and social inclusion. Recurrent absenteeism, linked to both medical and psychosocial factors, further limits academic engagement and progression. These interconnected challenges restrict learners’ capabilities not only to learn, but also to participate fully and develop a sense of belonging within the school environment. The findings suggest that participants experienced educational disadvantage through the interaction between health-related challenges and contextual barriers rather than through epilepsy alone. It highlights the potential value of inclusive and responsive educational practices that may expand learners’ opportunities for participation and belonging, including enhanced teacher awareness, flexible pedagogical approaches, and psychosocial support. By foregrounding learners’ voices, the study contributes to a more nuanced understanding of how chronic health conditions intersect with inclusive education and calls for systemic efforts to promote meaningful participation and well-being.

1. Introduction

Inclusive education has gained global recognition as a key approach for ensuring equitable access to quality education for all learners, particularly those who experience barriers to learning (Yang et al., 2025). While significant progress has been made in addressing the needs of learners with disabilities, those with chronic health conditions such as epilepsy remain comparatively under-researched within inclusive education discourse (Ainscow, 2020). This is despite the profound ways in which epilepsy, a neurological disorder characterised by recurrent and unpredictable seizures, may shape learners’ educational participation, social inclusion, and academic outcomes (Mbelu, 2025). In many school contexts, the condition remains poorly understood, and institutional responses are often inadequate to support affected learners (Makhado et al., 2024).

Consistent with the Capability Approach, educational disadvantage arises when learners are denied the opportunities and freedoms required to achieve valued educational functionings and participate meaningfully in school life (Gracia-Calandín & Tamarit-López, 2021). The Capability Approach, developed by Sen and extended by Nussbaum, emphasises individuals’ substantive freedoms, or capabilities, to be and do what they have reason to value (Murray, 2024). In the context of education, this includes the ability to attend school consistently, engage meaningfully in classroom activities, form social relationships, and develop a positive sense of self. For learners with epilepsy, these capabilities may be significantly restricted by the interaction between seizure-related disruptions, social stigma, and systemic inadequacies within schooling environments (Lambert et al., 2026).

Empirical studies suggest that learners with epilepsy face a range of interconnected barriers. Seizure episodes may interrupt teaching and learning processes, limiting access to instructional time and affecting academic continuity (Johnson et al., 2021; Lystad et al., 2022; Dreier et al., 2024). The unpredictability of seizures can also generate anxiety and fear, both for learners and their peers, potentially leading to social distancing or exclusion (Alege et al., 2026). Furthermore, stigma and misconceptions surrounding epilepsy often contribute to diminished self-esteem, embarrassment, and reluctance to participate in classroom or social activities (Dzah et al., 2025). These challenges are frequently compounded by absenteeism linked to medical appointments, recovery periods, or fear of experiencing seizures at school, which further constrains learners’ academic engagement and progression (Hassen & Beyene, 2020).

Foregrounding the Capability Approach allows this study to conceptualise these experiences not simply as educational difficulties, but as forms of capability deprivation. In this sense, educational disadvantage extends beyond poor academic performance to include restricted participation, limited agency, and compromised well-being (Motitswe, 2025). This perspective aligns closely with the goals of inclusive education, which emphasise the removal of barriers and the creation of enabling environments that support all learners to participate and thrive (UNESCO, 2020).

Although the educational challenges associated with epilepsy are well documented internationally, less is known about how learners with epilepsy experience participation, learning, and belonging in South African secondary schools. This study addresses this gap by exploring learners’ experiences through the lens of the Capability Approach.

Learners are uniquely positioned to describe how epilepsy shapes their experiences of learning, participation, and belonging in school. While teachers, caregivers, and health professionals provide valuable perspectives, they may not fully capture learners’ lived experiences. The Capability Approach extends beyond identifying barriers by examining how personal, social, and environmental factors shape learners’ opportunities to participate, learn, and achieve valued educational outcomes.

Against this backdrop, this study explores the schooling experiences of learners with epilepsy in a secondary school context, explicitly guided by the Capability Approach. By centring learners’ voices, the study seeks to generate in-depth insights into how epilepsy shapes their participation, self-perception, and academic engagement.

The study was guided by the following research question: how do learners with epilepsy describe the personal, social, and school-level conditions that constrain or enable their opportunities for learning, participation, and belonging within secondary school contexts?

By addressing this question, the study contributes to a deeper understanding of how chronic health conditions intersect with inclusive education. It further highlights the need for responsive educational practices that not only accommodate medical needs but also expand learners’ capabilities, thereby promoting equitable participation and meaningful educational outcomes.

2. Materials and Methods

2.1. Research Design and Approach

This study employed a qualitative approach within an interpretivist paradigm to explore how epilepsy shapes learners’ educational experiences and capabilities. An interpretive qualitative research design was adopted to explore learners’ experiences of schooling with epilepsy. Participants were recruited from four secondary schools to enhance contextual diversity, with the individual learner serving as the unit of analysis. The focus was on shared experiences across participants rather than comparisons between schools.

2.2. Theoretical Framework: The Capability Approach and Educational Inclusion

This study is guided by the Capability Approach, developed by Sen and further extended by Nussbaum, which focuses on individuals’ real freedoms, or capabilities, to achieve valued ways of being and doing (functionings) (Murray, 2024). In educational contexts, this perspective shifts attention from access to schooling alone to learners’ actual opportunities to participate meaningfully and succeed.

The distinction between capabilities and functionings is central. While functionings refer to achieved outcomes such as classroom participation and academic progress, capabilities reflect the genuine opportunities learners have to realise these outcomes (Schweiger, 2025). This distinction is particularly relevant in inclusive education, where equal access does not necessarily result in equitable participation.

For learners with epilepsy, the Capability Approach highlights how educational disadvantage arises not only from the medical condition but from its interaction with contextual factors (Binder & Coad, 2024). These include conversion factors, such as personal factors (seizure severity), social factors (stigma and peer attitudes), and environmental factors (school support and teacher responsiveness), which shape how learners convert resources into meaningful participation (Walker, 2019).

Nussbaum’s central capabilities, including bodily health, emotional well-being, and affiliation, further illuminate how epilepsy may affect learners’ sense of belonging, confidence, and agency within the school environment (Andersson, 2025). Seizures, absenteeism, and stigma can constrain these capabilities, limiting both academic engagement and social inclusion (Kirabira et al., 2020).

The Capability Approach aligns with inclusive education by emphasising the need to remove barriers and create enabling environments (Schweiger, 2025). In this study, it provides a lens for understanding how learners’ opportunities are restricted or supported, thereby framing epilepsy-related challenges as issues of capability deprivation rather than individual deficit.

In this study, access to schooling, instruction, and support services constituted educational resources. Learners’ capabilities to participate, learn, belong, and exercise agency were shaped by personal, social, and environmental conversion factors, including seizure-related challenges, stigma, peer attitudes, and school support arrangements. Functionings referred to achieved outcomes such as attendance, classroom engagement, academic progress, and social participation.

Drawing on Sen and Nussbaum, the study focused on valued opportunities related to affiliation, well-being, and agency. These concepts informed the interpretation of themes rather than functioning as predetermined coding categories.

2.3. Participants and Sampling

Purposive sampling was used to select twelve learners diagnosed with epilepsy, aged between 13 and 18 years. The age range of 13 to 18 years was selected because the study focused on learners enrolled in secondary schools. In the South African education system, secondary schooling spans Grades 8 to 12, with learners generally entering Grade 8 at approximately 13 years of age and completing Grade 12 between 17 and 18 years. Including learners across this age range enabled the study to capture experiences from different stages of secondary schooling while remaining aligned with the study’s focus on educational participation, learning, and belonging in secondary school contexts.

Participants were recruited from four secondary schools selected purposively because they enrolled learners diagnosed with epilepsy. The Department of Basic Education gave permission for the study to be conducted. Eligibility criteria required participants to (a) have a confirmed diagnosis of epilepsy as reported by parents/guardians and documented in school records, (b) be currently enrolled in a secondary school, and (c) be willing to participate in an interview. The study did not independently verify clinical diagnoses through medical records or healthcare providers. Learners who met the inclusion criteria were eligible to participate regardless of seizure frequency or level of control, as the study focused on educational experiences rather than clinical characteristics.

Class teachers assisted in identifying eligible learners; however, participation was voluntary, and learners’ decisions to participate or decline were not disclosed to school staff. Following identification of potentially eligible learners, information sheets and consent documentation were distributed through the schools to learners and their parents or guardians. Teachers’ involvement was limited to identifying learners who met the inclusion criteria and facilitating the distribution of study information. Teachers were not informed of learners’ decisions regarding participation and were not present during the consent process or interviews. This procedure was implemented to minimise any perceived coercion and to protect participant confidentiality. Information sheets written in age-appropriate language were provided to learners and their parents/guardians. Learners aged 18 years provided their own written informed consent, while parental consent and learner assent were obtained for participants under 18. Participation was voluntary, and parental consent did not obligate participation, as learners were given an independent opportunity to decide whether they wished to participate. Recruitment information was shared privately with eligible learners and their parents or guardians. Participation and epilepsy diagnoses remained confidential and were disclosed only to authorised individuals.

No eligible learners withdrew after consenting to participate, and the focus was on learners’ educational experiences rather than clinical characteristics.

The inclusion of multiple schools was intended to provide contextual variation and enhance the diversity of participants’ experiences rather than facilitate school-level comparison. Participant distribution across the four schools was as follows: School A (n = 3), School B (n = 3), School C (n = 3), and School D (n = 3).

Consistent with the interpretivist orientation of the study, twelve purposively selected participants were deemed sufficient for an in-depth exploration of learners’ experiences of schooling with epilepsy. The sample provided variation in age, grade level, and school context across four secondary schools. These schools were purposively selected because they enrolled learners diagnosed with epilepsy, enabling the collection of diverse perspectives relevant to the research question. Sample adequacy was evaluated according to the richness, depth, and relevance of participants’ accounts rather than statistical representativeness or predetermined numerical targets. The participants contributed detailed and information-rich accounts that enabled a nuanced and comprehensive investigation of the research question.

To protect confidentiality, detailed school descriptions are not provided. The participating schools were mainstream public secondary schools located in one district, but different South African educational contexts, including urban and rural settings. The schools served diverse learner populations and varied in terms of available learner-support resources and contextual conditions relevant to inclusive education. These contextual differences were intended to enhance the diversity of learners’ experiences represented in the study rather than facilitate school-level comparisons.

Participant characteristics reported in Table 1 reflect the information collected and considered necessary for understanding the diversity of the sample while protecting confidentiality. Additional clinical characteristics (e.g., seizure type or frequency) and demographic variables were not collected because the study focused on learners’ educational experiences rather than clinical profiles.

Table 1. Participant Characteristics.

Participant	Age Range	Grade	School	Interview Language	Duration of Living with Epilepsy
P1	13–14	Grade 8	School A	English	Several years
P2	15–16	Grade 10	School A	English	Several years
P3	17–18	Grade 11	School A	English	More than 5 years
P4	13–14	Grade 8	School B	English	Several years
P5	14–15	Grade 9	School B	English	Several years
P6	16–17	Grade 10	School B	English	More than 5 years
P7	15–16	Grade 9	School C	English	Several years
P8	16–17	Grade 11	School C	English	More than 5 years
P9	17–18	Grade 12	School C	English	Several years
P10	13–14	Grade 8	School D	English	Several years
P11	15–16	Grade 10	School D	English	More than 5 years
P12	17–18	Grade 12	School D	English	Several years

Note: Participant information is reported in broad categories to protect confidentiality and minimise the risk of deductive disclosure. School identifiers are pseudonyms. The duration of living with epilepsy is reported in aggregated categories rather than exact years. Participants were between 13 and 18 years of age and were enrolled in Grades 8 to 12 at the time of the study.

2.4. Data Collection

Data were gathered between February 2026 and March 2026 using interviews. Interviews were conducted by the researcher, a scholar in inclusive education who had no prior professional or personal relationship with the participating schools or learners. This helped reduce potential power imbalances and encouraged participants to share their experiences openly. Interviews were conducted in a private room at each participating school during times arranged in consultation with school management. Only the researcher and participant were present during the interviews, unless otherwise requested by the participant. Privacy was maintained by conducting interviews away from classrooms and other learners.

Data were collected through semi-structured interviews, allowing for both consistency across participants and flexibility to probe individual experiences (Creswell & Poth, 2018). All interviews were conducted in English, which was the preferred language of the participants. The interview guide was reviewed and piloted prior to data collection to assess the clarity, relevance, and appropriateness of the questions. Minor refinements were made based on the feedback received.

Interviews focused on classroom participation, academic engagement, peer relationships, seizure experiences at school, and perceived support. Each interview lasted approximately thirty to forty-five minutes, was audio-recorded with consent, and was supplemented with brief field notes. Given the sensitive nature of discussing epilepsy-related experiences, participants were informed that they could decline to answer any question, pause the interview, or withdraw at any stage. Procedures were established to manage any seizure occurring during an interview. Interviews were conducted during school hours when designated school personnel were available, and interviews would have been paused immediately if a seizure occurred. No seizure incidents occurred during data collection. Provision was made for referral to available school support services should a participant experience emotional distress.

2.5. Data Analysis

Data were analysed using reflexive thematic analysis following the six-phase approach proposed by Braun and Clarke (2021), namely familiarisation with the data, generation of initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. Interview recordings were transcribed verbatim and imported into NVivo 12 Plus to facilitate the systematic organisation, management, and retrieval of data during the analytical process.

Analysis commenced with repeated reading of transcripts to promote deep familiarisation with participants’ accounts and to identify patterns relevant to the research question. Initial coding was conducted inductively, with codes generated directly from the dataset rather than being predetermined by existing theoretical assumptions. Initial descriptive codes included experiences such as missed lessons, fear of seizures, embarrassment, peer reactions, lack of teacher support, academic catch-up efforts, and help-seeking behaviours. Related codes were grouped into broader categories concerning educational participation, social experiences, support structures, and coping responses. NVivo 12 Plus supported the systematic comparison of codes across participants, enabling the identification of recurring patterns as well as variations in experiences (Jackson & Bazeley, 2019). These categories were subsequently refined into the final themes through iterative review and comparison across participant accounts.

During theme development, some preliminary themes were merged due to conceptual overlap, while others were refined and renamed to better reflect participants’ experiences. Both recurring and less common accounts were retained and examined for their contribution to understanding the phenomenon. The analysis was conducted by the researcher, who maintained detailed analytic memos and reflexive notes throughout the coding and theme-development process. Reflexive notes informed decisions regarding theme boundaries, interpretation of divergent accounts, and consideration of how the researcher’s assumptions might shape analytical interpretations.

Following initial coding, related codes were grouped into broader categories and subsequently developed into candidate themes. These themes were continuously reviewed and refined through an iterative process that involved revisiting the coded extracts and the full dataset to ensure coherence, consistency, and distinctiveness. The analysis sought to capture both shared experiences across participants and contextual nuances within individual accounts. Theme development was guided by the principle of internal homogeneity and external heterogeneity to ensure that each theme reflected a meaningful and analytically distinct aspect of learners’ experiences (Braun & Clarke, 2021).

Although coding was primarily inductive, the Capability Approach informed the interpretive phase of the analysis. Once themes had been developed from participants’ accounts, they were examined in relation to the concepts of educational resources, conversion factors, capabilities, and functionings. This enabled the analysis to move beyond describing challenges associated with epilepsy and to explore how personal, social, and environmental conditions shaped learners’ opportunities to convert available educational resources into valued educational outcomes. An example of the analytical progression involved codes such as fear of seizures, embarrassment, and peer avoidance being grouped into a broader category relating to social experiences, which subsequently contributed to the theme ‘Stigma, Fear, and Social Withdrawal’.

The analysis focused on identifying patterns across participants’ accounts rather than comparing school sites. Consequently, themes were developed from the collective dataset and are presented as shared experiences of learners recruited from different school contexts.

To enhance analytical rigour, coding decisions, theme development, and interpretive insights were documented throughout the analysis process, creating a transparent audit trail. Regular reflection on emerging interpretations further ensured that themes remained grounded in participants’ accounts while allowing for theoretically informed analysis. This process strengthened the credibility and dependability of the findings by demonstrating a clear and systematic progression from raw data to thematic interpretation.

2.6. Trustworthiness

Trustworthiness was enhanced through credibility, dependability, confirmability, and transferability (Ahmed, 2024). Credibility was supported through prolonged engagement with the dataset, repeated review of transcripts, and the inclusion of verbatim quotations. Dependability was strengthened through an audit trail documenting methodological decisions, coding processes, theme development, and revisions made during analysis. Confirmability was supported through reflexive journalling and ongoing comparison of interpretations against participants’ accounts. Transferability was facilitated through detailed descriptions of the research context, participants, and study procedures, enabling readers to assess the applicability of findings to similar settings.

Although participants were recruited from four schools, the study did not seek statistical or contextual representativeness. Rather, sufficient contextual information is provided to allow readers to assess the applicability of the findings to similar educational settings.

2.7. Reflexivity

Reflexivity was an integral component of this study due to the interpretive nature of qualitative research. The researcher is a scholar in the field of inclusive education whose academic interests include understanding the experiences of learners who encounter barriers to learning and participation. This professional background provided valuable insight into issues of inclusion and educational participation; however, it also required ongoing critical reflection to ensure that personal beliefs and assumptions did not unduly influence the research process.

Throughout data collection and analysis, the researcher engaged in continuous reflexive practice to examine how personal experiences, professional knowledge, and theoretical commitments to inclusive education and the Capability Approach might shape interactions with participants and the interpretation of data. A reflexive journal was maintained to document methodological decisions, emerging interpretations, and potential assumptions about learners with epilepsy. These notes were reviewed regularly during analysis to identify and challenge preconceived understandings of the phenomenon under investigation. Attention was given to ensuring that participants’ voices remained central to the analysis. Rather than imposing predetermined explanations on the data, themes were derived from learners’ accounts and subsequently interpreted through the lens of the Capability Approach. This process enabled the researcher to distinguish between participants’ lived experiences and theoretical interpretations. Reflexive engagement throughout the study contributed to transparency, enhanced the credibility of the findings, and supported a more nuanced understanding of how epilepsy shapes learners’ opportunities for participation, learning, and well-being within school contexts.

Reflexive journalling contributed to several analytical decisions, including the refinement of themes, reconsideration of alternative interpretations, and continued attention to participants’ perspectives during interpretation. This process helped ensure that theoretical insights remained grounded in participants’ accounts.

2.8. Ethical Considerations

Ethical clearance was obtained from the relevant institutional body, and permission was granted by participating schools. Permission to conduct the study was also obtained from the relevant education authorities and participating school principals. Written informed consent was obtained from parents or legal guardians, while written assent was obtained from all participating learners prior to data collection. Participation was voluntary, and learners were informed that their decision to participate, decline, or withdraw would have no consequences for their schooling, academic standing, or relationships with teachers and all school staff.

To safeguard confidentiality, interviews were conducted privately, participant identities were replaced with pseudonyms, and potentially identifying contextual details were removed from transcripts and quotations. School names were replaced with broad identifiers to minimise the possibility of deductive disclosure. Procedures were established to respond to participant distress, including pausing interviews, reminding participants of their right to withdraw, and referring learners to appropriate school-based support services where necessary.

Participants’ anonymity and confidentiality were safeguarded using pseudonyms. Participation was voluntary, and learners could withdraw at any stage without penalty.

3. Results

To protect participant anonymity, quotations were reviewed to remove or generalise potentially identifying information while preserving the meaning of participants’ account.

The analysis generated five interrelated themes: disrupted participation and learning continuity, absenteeism and academic strain, stigma and social withdrawal, limited awareness and support, and resilience and coping strategies. As the study was not designed as a comparative analysis of school sites, findings are presented as recurring patterns across learners’ experiences rather than as school-specific themes.

Across these themes, learners’ accounts reveal how seizure experiences, social dynamics, and institutional responses intersect to shape their participation, academic engagement, and well-being. The quotations presented below illustrate participants’ experiences, while the subsequent interpretive comments draw on the Capability Approach to understand how these experiences shaped educational opportunities and outcomes.

Rather than discrete challenges, these themes reflect interconnected processes that constrain or enable learners’ capabilities within the school environment.

3.1. Disrupted Participation and Learning Continuity

A central finding concerns the disruption of classroom participation and continuity of learning caused by seizure episodes and their after-effects. Learners’ narratives indicate that participation is not only interrupted at the moment of a seizure but remains compromised even after the episode due to fatigue, confusion, and difficulty re-engaging with ongoing instruction. For example, one learner explained: “Sometimes I just blank out and when I come back, the teacher is already far ahead. I don’t know what is happening anymore” (Learner A). Similarly, another noted: “After a seizure, I feel tired and confused, so even if I am in class, I am not really learning” (Learner D).

These accounts suggest that being physically present in the classroom does not necessarily translate into meaningful cognitive engagement. The unpredictability of seizures further compounds this challenge by creating a constant sense of uncertainty that undermines concentration. As one learner stated: “I am always worried it can happen anytime, so I can’t fully concentrate” (Learner H).

Taken together, these experiences illustrate how seizure-related disruptions constrain learners’ ability to sustain attention, follow instruction, and participate effectively in classroom activities. This highlights a significant gap between access to schooling and the ability to benefit from it.

From a Capability Approach perspective, learners retained formal access to classroom instruction, but seizure-related personal conversion factors limited their capability to participate meaningfully in learning. Consequently, valued functionings such as sustained classroom engagement, participation in learning activities, and academic progression were frequently disrupted.

3.2. Absenteeism and Academic Strain

Closely linked to disruptions in classroom participation is the issue of absenteeism, which emerged as a recurring and compounding challenge. Learners reported frequent absences due to seizures, medical appointments, recovery periods, and, in some cases, fear of experiencing seizures at school. One learner explained: “I miss school a lot because I have to go to the hospital, and when I come back, I am behind in everything” (Learner B), while another added: “Sometimes I stay at home because I am scared, I might have a seizure at school” (Learner F).

These findings indicate that absenteeism stems not only from health-related requirements but also from anticipatory anxiety.

The cumulative effect of missed instructional time contributes to significant academic strain. Learners described persistent difficulties in catching up and feelings of falling behind their peers. As one participant expressed: “It’s hard to catch up. Even when I try, I feel like I am always behind others” (Learner K).

These experiences suggest that absenteeism disrupts learning trajectories over time, reinforcing academic disadvantage and eroding confidence. The findings therefore highlight absenteeism as a key mechanism through which educational participation and progression are constrained.

These findings suggest that health-related and emotional conversion factors constrained learners’ capability to attend school consistently and benefit from educational resources, resulting in functionings such as interrupted learning and academic difficulties.

3.3. Stigma, Fear, and Social Withdrawal

Beyond academic challenges, learners’ social experiences at school were strongly shaped by stigma and fear of negative judgement. Participants’ accounts reveal a heightened awareness of being perceived as different, which influenced their interactions with peers and willingness to participate in social and classroom activities. For instance, one learner noted: “People look at you differently when they know you have epilepsy. Some think you are strange” (Learner C), while another shared: “I feel embarrassed when it happens in front of others, so I try not to draw attention to myself” (Learner J).

These responses indicate the internalisation of stigma and the anticipation of embarrassment. In some cases, stigma manifested in peer reactions such as fear or avoidance. As one learner explained: “Others are scared when I have a seizure, and they don’t want to come close to me after that” (Learner E). Such experiences contributed to social withdrawal, with learners deliberately limiting their participation in group activities. One participant remarked: “I don’t like group work because I feel like people judge me” (Learner L).

These findings suggest that stigma operates as a powerful social barrier, shaping learners’ sense of belonging and participation. The resulting withdrawal not only affects peer relationships but also limits opportunities for collaborative learning and social development.

Viewed through the Capability Approach, stigma functioned as a social conversion factor that restricted learners’ capability for affiliation and belonging, contributing to reduced participation in educational and social activities.

3.4. Limited Awareness and Support in School Contexts

Learners’ experiences also point to uneven and often inadequate support within school contexts, which further constrains their participation and learning. While some participants described supportive teachers, others highlighted a lack of understanding and inconsistent responses to their needs. As one learner reported: “Some teachers understand and help me, but others don’t know what to do, so they just ignore it” (Learner G). Similarly, another noted: “After a seizure, no one explains the work I missed. I have to figure it out myself” (Learner I). While many participants reported support challenges, experiences varied. Some learners described supportive teachers who assisted after absences or seizures, whereas others perceived support as inconsistent or limited.

Participants described inconsistent teacher responses and limited assistance following seizures or health-related absence, which they interpreted as uneven understanding and support. Several learners indicated that these experiences made it more difficult to regain continuity in learning after missed classroom activities.

Participants also described limited access to tailored support following seizures or periods of absence, which they perceived as making it harder to manage academic demands.

One learner stated: “There is no special help for me. I just have to cope like everyone else” (Learner A), highlighting the lack of tailored interventions.

This indicates that access to schooling is not accompanied by the necessary conditions to support meaningful participation and learning. As a result, learners are often required to navigate complex academic and social demands with minimal institutional support.

Teacher responsiveness and support structures emerged as important environmental conversion factors. Where these were limited, learners experienced reduced opportunities to translate educational resources into meaningful participation and academic progress.

3.5. Learner Agency and Coping Strategies

Despite the challenges identified, learners demonstrated agency through various strategies aimed at managing educational and social challenges associated with epilepsy. These strategies reflected learners’ efforts to exercise agency and maintain participation within school contexts despite epilepsy-related challenges.

Not all participants experienced stigma or support in the same way. Some learners reported positive peer relationships and supportive social networks that helped them manage epilepsy-related challenges at school.

Their accounts reveal various strategies aimed at managing both academic and social demands. Some learners actively sought to build supportive relationships. For example, one participant explained: “I try to tell my close friends what to do when I have a seizure, so I feel safer” (Learner D), while another noted: “I talk to some teachers when I miss work, and that helps a bit” (Learner H). These strategies reflect efforts to create supportive micro-environments within the broader school context. Others described individual coping mechanisms to address academic gaps. One learner explained: “I study more at home to catch up” (Learner F), while another stated: “I try not to give up, even when it is difficult” (Learner K).

Such responses demonstrate determination and perseverance in the face of ongoing challenges. However, while these strategies enable some degree of participation, they do not fully mitigate the structural and social barriers identified in the study. Learners’ reliance on personal coping mechanisms underscores both their agency and the limitations of existing support systems. These findings highlight the importance of strengthening institutional support while recognising learners’ active efforts to navigate their educational experiences.

Collectively, the findings illustrate that epilepsy influences learners’ educational experiences through a combination of health-related disruptions, social barriers, and institutional constraints. While learners demonstrated considerable agency in responding to these challenges, opportunities for meaningful participation remained limited when adequate support structures were absent. Viewed through the Capability Approach, these experiences reflect forms of capability deprivation that affect learners’ opportunities to learn, participate, belong, and achieve within secondary school settings.

These coping strategies demonstrate learners’ agency in seeking to expand their capabilities despite existing constraints. However, individual resilience alone was insufficient to overcome structural and institutional barriers.

Table 2 presents a Capability Approach interpretation of the findings by illustrating how the identified themes relate to conversion factors, capabilities, and educational functionings.

Table 2. Interpretation of Findings through the Capability Approach.

Theme	Analytical Meaning	Illustrative Quotation	Conversion Factor	Capability Affected	Functioning/Outcome
Disrupted Participation and Learning Continuity	Seizure-related challenges interrupted learners’ opportunities to engage meaningfully with learning	“After a seizure, I feel tired and confused…” (Learner D)	Personal (seizures, fatigue, confusion)	Opportunity to learn and participate	Reduced achievement of sustained classroom engagement
Absenteeism and Academic Strain	Health-related absences affected continuity of learning	“I miss school a lot because I have to go to the hospital…” (Learner B)	Personal (recovery periods, anxiety)	Opportunity to attend consistently	Missed work and academic difficulties
Stigma and Social Withdrawal	Peer reactions restricted learners’ sense of belonging	“People look at you differently when they know you have epilepsy…” (Learner C)	Social (stigma, peer attitudes)	Opportunity for affiliation and belonging	Reduced social participation
Limited Awareness and Support	Learners perceived support as inconsistent	“Some teachers understand and help me, but others don’t know what to do…” (Learner G)	Environmental (teacher responsiveness)	Opportunity to receive support	Reduced opportunities to achieve meaningful educational participation
Learner Agency and Coping Strategies	Learners actively sought ways to remain engaged in schooling	“I study more at home to catch up…” (Learner F)	Positive personal/social factors	Opportunity to exercise agency	Continued engagement despite challenges

Note: The table summarises how the empirical themes were interpreted through the Capability Approach by linking participants’ accounts to analytical meanings, conversion factors, capabilities, and functionings. This interpretation highlights how personal, social, and environmental factors shaped learners’ educational opportunities and outcomes.

4. Discussion

4.1. Epilepsy and Capability Constraints in Learning

The findings suggest that the educational implications of epilepsy extend beyond the immediate physiological effects of seizures to encompass broader constraints on learners’ opportunities to engage meaningfully in learning. From a Capability Approach perspective, educational participation should not be assessed solely in terms of school attendance or physical presence in the classroom but rather in relation to learners’ substantive freedoms to benefit from educational processes and achieve valued learning outcomes (Walker, 2020). Although participants remained formally included within mainstream schooling, their experiences indicate that seizure-related disruptions often restricted their capability to sustain concentration, engage in classroom interactions, and maintain continuity in learning.

From a Capability Approach perspective, access to classroom instruction, teachers, and learning materials represents important educational resources. However, seizure-related fatigue, difficulties with concentration, and the unpredictability of seizures function as personal conversion factors that affect learners’ ability to utilise these resources effectively. Consequently, learners’ capabilities to engage meaningfully in learning are restricted, limiting the functioning of sustained classroom participation and academic progress.

This finding reinforces the distinction between educational access and educational participation, a distinction frequently emphasised within inclusive education scholarship (Ainscow, 2020; González-Afonso et al., 2026). The study therefore suggests that inclusion must be understood not merely as placement within mainstream classrooms but as the creation of conditions that enable learners to participate effectively and derive meaningful benefit from educational opportunities. In this regard, epilepsy represents not only a health condition but also a factor that may limit learners’ capability to convert educational resources into valued academic functionings.

4.2. Absenteeism as a Barrier to Educational Participation

The findings further highlight absenteeism as a significant mechanism through which educational inequalities may emerge for learners with epilepsy. Rather than viewing absenteeism simply as a consequence of health-related challenges, the Capability Approach draws attention to how irregular attendance constrains learners’ opportunities to access and utilise educational resources over time. The cumulative nature of missed learning experiences may place learners at a disadvantage relative to their peers, limiting opportunities for academic progression and achievement.

Although schools provide educational resources through teaching, curriculum access, and assessment opportunities, learners who experience recurrent absences are often unable to convert these resources into meaningful educational participation. Health-related demands, recovery periods, and anxiety about experiencing seizures at school operate as conversion factors that constrain learners’ capabilities to remain engaged with learning. As a result, valued functionings such as academic progression, continuity of learning, and successful educational achievement may be compromised.

Importantly, the findings suggest that absenteeism reflects the interaction of both medical and contextual factors. Health-related needs may necessitate absence from school, yet the extent to which learners fall behind appears to be influenced by the availability of support systems that facilitate learning continuity. This observation aligns with previous studies identifying school absence as a critical factor affecting the educational trajectories of learners with chronic health conditions (Jay et al., 2025; Whitley et al., 2026). Consequently, efforts to reduce educational disadvantage should focus not only on attendance but also on ensuring that learners have access to flexible educational support during periods of absence.

4.3. Stigma, Affiliation, and Social Inclusion

A significant contribution of this study lies in illuminating how social perceptions and interpersonal relationships shape the schooling experiences of learners with epilepsy. Within Nussbaum’s framework, affiliation is recognised as a central human capability because it encompasses opportunities to form relationships, experience respect, and participate in social life (Nussbaum, 2011, 2019). The findings suggest that stigma undermines these opportunities by creating conditions in which learners may feel marginalised, misunderstood, or reluctant to engage fully with peers.

The significance of this finding extends beyond social interaction alone. Feelings of belonging and acceptance are closely linked to educational engagement, psychological well-being, and learner participation. Consequently, stigma should be understood not simply as a social challenge but as a barrier to educational inclusion. These findings support previous research demonstrating that negative perceptions of disability and chronic health conditions can limit participation and contribute to exclusionary experiences within mainstream schooling (Shifrer, 2013). Addressing stigma is therefore essential for creating school environments that support both educational participation and holistic well-being.

The Capability Approach highlights that social relationships and opportunities for participation constitute important social resources within schooling environments. Negative peer attitudes, misconceptions about epilepsy, and fear of discrimination act as social conversion factors that limit learners’ capabilities for affiliation, belonging, and social participation. These restrictions may prevent learners from achieving valued functionings such as positive peer relationships, active classroom participation, and a sense of inclusion within the school community.

4.4. School Support as an Environmental Conversion Factor

The findings underscore the importance of school environments in shaping learners’ capabilities. The Capability Approach emphasises that available resources do not automatically translate into valued outcomes; rather, outcomes depend on the presence of conversion factors that enable individuals to utilise these resources effectively (Walker, 2019). In this study, teacher knowledge, responsiveness, and institutional support emerged as important environmental factors influencing learners’ educational experiences.

Teacher support, inclusive policies, and learner-support arrangements can be understood as educational resources that have the potential to expand learners’ opportunities. However, the extent to which these resources translate into meaningful participation depends on environmental conversion factors such as educator knowledge, responsiveness, and institutional support systems. Where these factors are inadequate, learners’ capabilities to learn, participate, and succeed may remain constrained despite their formal access to schooling. This ultimately limits the achievement of valued educational functionings.

Participants’ accounts suggest that perceived variations in educator understanding and support influenced their experiences of participation and achievement.

Where participants perceived support to be limited or inconsistent, they described difficulties in recovering missed learning opportunities and managing epilepsy-related challenges at school. This observation is consistent with inclusive education literature highlighting the critical role of teacher competence, school responsiveness, and inclusive pedagogical practices in promoting equitable participation (Slee, 2018; Motitswe, 2025). The study therefore reinforces the need for professional development initiatives that equip educators with the knowledge and confidence required to support learners living with epilepsy.

4.5. Learner Agency and Capabilities Expansion

Although participants encountered considerable challenges, the study also highlights the active role learners play in navigating constraints within their educational environments. Their efforts to develop supportive peer relationships, seek assistance from teachers, and adopt strategies to maintain academic progress demonstrate important forms of agency. From a Capability Approach perspective, these actions indicate learners’ attempts to expand their own opportunities and achieve valued educational functionings despite existing barriers.

However, the findings also caution against placing responsibility for inclusion solely on learners themselves. While resilience and determination are important personal resources, they cannot fully compensate for structural and institutional shortcomings. Consistent with the Capability Approach, educational inclusion should not depend on individual learners’ capacity to adapt to disabling circumstances but on the ability of schools to create enabling conditions that support participation for all learners (Riddle, 2021; Schweiger, 2025). As such, learner resilience should be viewed as complementary to, rather than a substitute for, institutional support.

Learners’ agency, self-advocacy, and coping strategies can be viewed as personal resources that support participation in school life. These personal resources may strengthen learners’ capabilities by helping them navigate challenges associated with epilepsy. Nevertheless, the achievement of valued functionings such as successful learning, social inclusion, and educational attainment remains dependent on supportive social and institutional conversion factors. Consequently, individual agency alone cannot fully compensate for inadequate educational support structures.

The findings also suggest important interrelationships among the themes. For example, seizure episodes and their after-effects frequently disrupted classroom participation, which contributed to missed learning opportunities and academic strain when learners struggled to access missed work. Similarly, concerns about experiencing seizures in front of peers sometimes contributed to fear of embarrassment and reduced participation in social or classroom activities, limiting opportunities for affiliation and belonging. These interconnected experiences illustrate how personal, social, and environmental factors interacted to shape learners’ educational opportunities.

4.6. Implications for Inclusive Education

Taken together, the findings reinforce the value of the Capability Approach as a framework for understanding educational inclusion among learners with chronic health conditions. Participants’ accounts suggest that educational disadvantage was experienced through the interaction of seizure-related challenges, absenteeism, stigma, and perceived limitations in support within the participating schools.

This perspective challenges deficit-oriented understandings of epilepsy by directing attention towards the social and institutional conditions that enable or constrain learner achievement.

The findings have important implications for policy and practice. Schools should adopt more holistic approaches to inclusion that address both academic and psychosocial dimensions of participation. Such approaches may include enhanced teacher training on epilepsy, structured mechanisms for supporting learners who miss school due to health-related reasons, and initiatives aimed at reducing misconceptions and stigma among peers. Expanding these supports would strengthen learners’ capabilities related to learning, affiliation, agency, and well-being, thereby advancing the broader goals of inclusive education. Ultimately, the study suggests that achieving meaningful inclusion requires educational environments that not only accommodate difference but actively expand learners’ opportunities to flourish.

Implications arising from participants’ accounts include the importance of confidential individual support planning, procedures for supporting learners following seizures or health-related absences, improved access to missed instructional material, teacher preparation for seizure management and post-seizure learning needs, communication among learners, families, educators and support professionals, and flexible learning arrangements where appropriate.

These implications are consistent with the objectives of South Africa’s inclusive education framework (Department of Education, 2001), particularly the emphasis on learner support, barrier removal, and meaningful participation articulated in Education White Paper 6. Participants’ accounts suggest that continued attention is needed to ensure that learners with chronic health conditions can benefit fully from these policy commitments.

The contribution of this study is not to extend the Capability Approach theoretically but to demonstrate its usefulness as a framework for understanding how chronic health conditions interact with personal, social, and environmental conditions to shape learners’ educational opportunities within inclusive secondary school contexts.

5. Conclusions

This study examined how epilepsy shapes learners’ capabilities to participate, learn, and achieve within secondary school contexts. Guided by the Capability Approach, participants’ accounts suggest that educational disadvantage was experienced through the interaction of seizure-related challenges, absenteeism, stigma, and perceived limitations in support within the participating school.

The study contributes to inclusive education scholarship by highlighting how chronic health conditions may restrict learners’ capabilities when adequate support structures are absent. The findings highlight the need for inclusive educational practices that not only provide access but also broaden learners’ capabilities and freedoms to participate meaningfully and flourish within school environments.

By distinguishing between resources, conversion factors, capabilities, and functionings, the Capability Approach provided a deeper understanding of how educational disadvantage emerges through the interaction between health-related challenges and school contexts rather than from epilepsy alone.

These findings should be understood as reflecting learners’ experiences and perceptions within the participating schools rather than objective assessments of teacher competence, school policies, or support systems.

Addressing stigma, strengthening teacher awareness and preparedness, and providing structured academic and psychosocial support may help create more inclusive and enabling school environments. Such efforts can enhance learners’ capabilities, agency, and well-being, ensuring that learners with epilepsy are not only present in schools but are supported to participate fully and thrive.

6. Limitations of the Study

The findings capture learners’ lived experiences of schooling in the participating secondary schools and are intended to generate contextually grounded insights that may be transferable to similar settings, rather than statistically representative conclusions.

The focus was on understanding how participants made meaning of their experiences of learning, participation, and belonging while living with epilepsy, which is consistent with the interpretivist orientation of the study.

Moreover, the study focused exclusively on learners’ perspectives. Incorporating the views of teachers, parents, caregivers, and school leaders could have enriched understanding of the systemic factors affecting participation and support. Future research should adopt a multi-stakeholder approach to provide a more comprehensive understanding of the educational experiences of learners with epilepsy.

Furthermore, the study relied exclusively on learners’ perspectives and did not independently verify clinical characteristics, teacher practices, school policies, support arrangements, or academic outcomes. Future studies could incorporate the perspectives of educators, families, school leaders, and health professionals to examine complementary dimensions of support and institutional practice.

Participants were recruited purposively from four schools and volunteered to participate, which may have influenced the experiences represented. Clinical differences among participants were not examined, and the cross-sectional design captured experiences at a single point in time. The findings are intended to provide transferable insights rather than statistically generalisable conclusions.

Lastly, the study was conducted with learners recruited from four secondary schools and was intended to generate in-depth insights rather than statistically representative findings. As such, the findings are contextually situated within the participating school settings and should not be regarded as representative of all South African secondary schools.