A Study to Assess the Knowledge and Attitude
A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE
REGARDING HIV INFECTION AMONG ADOLESCENTS IN A
SELECTED SCHOOL, AT BANGALORE
M.Sc. Nursing Dissertation Protocol submitted to
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.
By
MS. PREEJA K KRISHNAN
M.Sc NURSING 1ST YEAR
2009-2011
Under the Guidance of
HOD, Department of Peadiatric Nursing
KTG College of Nursing
Hegganahalli Cross
Vishwaneedam Post
Magadi Road
Bangalore –91
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA
CURRICULAM DEVELOPMENT CELL
CONFORMATION FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Registration number :
Name of the candidate:Ms. Preeja K Krishnan
Address:Hegganahalli cross, Vishwaneedam Post
Magadi Road, Bangalore-91.
Name of the institution:KTG college of nursing
Course of study and subject:M.Sc Nursing in Pediatric Nursing
.
Date of admission to course:15-05-2009
Title of the topic: A study to assess the knowledge and
attitude regarding HIV infection among adolescents in a selected School, at Bangalore
Brief resume of the intended work : Attached
Signature of the student:
Guide Name:
.
Remarks of the guide:
Signature of the guide:
Co-guide name:
Signature of co-guide:
HOD name:
Signature of HOD :
Principal Name :Mr. Biju Ramachandran
Principal Mobile No: 09845144754
Principal E-mail ID:
Remarks of the Principal:
Principal signature:
rAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,kARNATAKA, bANGALORE
aNNEXURE-ii
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1 / name of the candidate
and address / ms.preeja .k. krishnan
1 year M.Sc. nursing,
ktg college of nursing
hegganahalli cross vishwaneedam post, magadi road,bangalore-91
2 / name of the institution / ktg college of nursing
hegganahalli cross vishwaneedam post, magadi road bangalore-91
3 / course of study and subject / M.sc nursing PAEDIATRIC NURSING
(CHILD HEALTH NURSING)
4 / date of admission to the course / 15th May 2009
5 / title of the topic:
“a STUDY TO ASSESS THE KNOWLEDGE AND
ATTITUDE REGARDING HIV INFECTION AMONG
ADOLESCENTS IN A SLECTED, AT
BANGALORE.”
6. / BRIEF RESUME OF THE INTENDED WORK:INTRODUCTION
“Sometimes I have terrible feeling that, I am dying-
not from the virus, but from the untouchable”
-Amanda Heggs
Acquired immuno deficiency syndrome (AIDS) is a disease of human immune system caused by HIV, the condition progressively reduces the effectiveness of immune system and leaves the individuals susceptible to opportunistic infections and tumors. Although the progress has been made in treating the HIV infection and AIDS, the epidemic remains a critical public issue in all the communities across the country and around the world. Prevention, early detection and ongoing treatment remain important aspects of the care for the people with HIV infection and AIDS.1
Since AIDS was first recognized more than 20years of age, remarkable progress has been made in improving the quality and duration of life for the people with HIV infection. During the first decade this progress was associated with the recognition of the opportunistic disease process more effective therapies for the complications and the introduction of the prophylaxis against the common opportunistic infections. The second decade witnessed the progress in the development of Highly Active Anti Retroviral Therapies as well as continuing in the treatment of opportunistic infection. The third decade has focused on the issues of adherence to the therapy development of the second generation medication to treat HIV infection and continued pressure to develop a vaccine.2
The use of tobacco, alcohol & drug is increasing among adolescents. This may be a result of their attempting to cope with many changes that occur in the transitional period. In addition, peer pressure also one of the most important factors for many bad habits it is important for health care providers to make information available concerning the risk in using these addictive substances. Communication with the adolescent facilitates establishment of a trusting, productive relationship Information should be made available regarding preventive measures, the need for recognition of symptoms, treatment and the follow up of concepts. The nurse should routinely provide this information even if the adolescent is hesitant to ask. The nurse should also provide information about how to prevent HIV Infection.3
Primary prevention efforts through effective educational programs are vital for control and prevention. Nurse has an important role in the aspect of promotion of health and prevention of disease. Effective educational programs have been initiated to educate the public regarding safer sexual practices to decrease the risk of transmission. People who are HIV Positive or use injection drugs should be instructed not to donate blood or share the drug equipment with others. The provision of pre and post test information, counseling and support for pregnant women is vitally important and should be undertaken by specialist, counselors or midwives who have receive appropriate training. Despite all these HIV infection is spreading widely.4
6.1 / NEED FOR THE STUDY Although progress has been made in treating HIV infection and AIDS, the epidemic remains a critical public health issue in all communities across the and around the world. Prevention, early education, and ongoing treatment remain important aspects of care for people with HIV Infection and AIDS.5
World wide AIDS kills more than 8,000 people everyday, one person every seconds (UN AIDS). Now a days as a result of modernization and urbanization the HIV infection is spreading widely, and now the adolescents is a risk group for getting the infection due to their ignorance and carelessness. Today an estimated 34-36 million people are living with HIV or AIDS, 3million in 2007 alone. The cumulative numbers of AIDS cases in the country has raised to 86028 by August 21st 2008.This includes 62050 males and 23978 females. 1799 new cases of AIDS were detected in the month of August 2008.6
India is one of the largest and most populated countries in the world, with over the billion inhabitants. Of this number, it is estimated that around 2.3 million people are currently living with HIV. In 2006 UNAIDS estimated that there were 5.6 million people living with HIV in India. In 2007 it was estimated that 33.2million people lived with the disease worldwide and that AIDS had killed an estimated 2.1 million people including 333,000 children. Over the quarters of these deaths occurred in Sub Saharan Africa.7
INCIDENCE
SL.NO / NAME OF STATES / YEAR / % OF INCIDENCE
1 / Andhra Pradesh / 2006-2007 / 1.26-1.0
2 / Goa / 2007-2008 / 0.18 & 5.6-3.81
3 / Karnataka / 2003-2006 -2007 / 1.0-5.0-17.6
4 / Maharashtra / 2007 / 0.5, 18 (among female sex workers) 24 (among injecting drug users)
12 (among injecting drug users)
5 / Tamilnadu / 1995-1997-2007 / 1.25-0.25-16.8
6 / Manipur / 1980-2007 / 17.9-01
7 / Mizoram / 2007 / 0.75
8 / Nagaland / 2003-2007 / 8.43-1.91,
0.60 & 3.42
HIV epidemic in Central Indian: The occurrence of HIV infection increased from nil in 1986 to 19.9% in 2003. The HIV seropositivity was higher in males (6.9) % than in females (3.3%). Highest prevalence was seen in the age group of 25-29years in both males and females. 8
The study was conducted on Demographic & clinical profile of HIV infected children accessing care at Chennai. The results were showed that 1,768 new pediatric patients access care from 2002 to 2004. Children aged less than 5 years were 49.9%. 1115 children had (63%) tuberculosis. Significantly, 14.9 and 20.6% children had extra-pulmonary TB and disseminated TB respectively. Lower (15.2%), oral/esophageal candidiasis (13.5%), wasting (6.1%) and diarrhoeal disorders (3.5%) were the common clinical.9The study was conducted on Prevalence of orphans among HIV infected children-a preliminary study from a pediatric HIV centre in Western India. The results were Fifty nine (40%) HIV-infected children were orphans. In 28 children (19%), father had died: in 20 children (13.6%), mother had died; in 11 children (7.5%) both parents had died and in 2 children (1.4%), parents death status was not known. Cause of death was AIDS in 19 parents (38%) and TB in 21 parents (42%).10
One of the important problem in the community is HIV infection. Adolescents are more vulnerable to get HIV infection due to peer group influence. So they will have the habit of alcoholism, drug addiction, homosexual activities etc. Through the mass media also they are getting information regarding HIV infection. Even the incidence rate is higher among adolescents. So the investigator is very much interested in doing the research in this topic.3
6.2 / REVIEW OF LITERATURE
Reviewing the existing literature is critical step in the research process. The literature consist of all written sources relevant to the topic selected. Review of literature is an extensive, exhaustive and unpublished material relevant to the topic.
In our country there is large number of persons suffered with HIV. It is a fact that the HIV transmission occurs not only through false sexual practices but also by various other methods like usage of same syringes and needles, through unscreened blood transfusion etc.6
The review of literature which support this study are given below:
The study was conducted on “Undiagnosed HIV Prevalence among Adults and Adolescents in the United States.” An estimated 1,106,400 adults/adolescents (95% confidence interval=1,056,400-1,156,400) were living with HIV in the United States at the end of 2006; overall, 21.0% (232,700; 95% confidence interval=221,200-244,200) were undiagnosed. Whites had the lowest percentage undiagnosed (18.8%) compared with Hispanics/Latinos (21.6%), blacks/African Americans (22.2%), American Indians/Alaska natives (25.8%) and Asians/Pacific Islanders (29.5%; all P<0.001). Persons with a behavioral risk of injection drug use (IDU) had the lowest percentage undiagnosed (female IDU:13.7% and male IDU:14.5%): men exposed through heterosexual contact had the highest (26.7%) followed by men who have sex with men (23.5%).14
The study was conducted “on knowledge of adolescents towards HIV infection.” Sample size is 900. Random sampling technique was chosen for the study. Result showed that majority are aware about the prevention of transmission of HIV infection.11
The Study was conducted on “Time trends of pediatric HIV infection in North India”. Time trends were ascertained over a 15-year period to assess the impact of information, education and communication programme launched by National AIDS Control Organization. Data indicates that the total number of HIV positive cases increased 10-fold over the last 10 years. During 1991, 41 cases were recorded; the number increased to 439in year 2001, and 574 in 2004 (r=0.98). A similar t rend was observed in the pediatric age group. During the initial 5years i.e., 1987 to 1992 only 7 pediatric cases were documented positive while the number increased to 45 in the year 2001 to 64 in the year 2004 with a cumulative figure of 323 children.15
The study was conducted “to assess the current knowledge about HIV epidemiology and safe sexual behavior among adolescents at Nepal.” Sample size is 1800. The result showed that the 69% of adolescents were aware about the safe sexual behavior.11
The study was conducted on “knowledge regarding HIV prevention interventions in the adolescent girls at rural and urban areas of Gujarat,” sample size is 800. Result showed that about 64% of the girls are aware about the preventive interventions.12
The study was conducted on “knowledge of young people regarding HIV infection” at Calcutta and sample size is 1200. The result showed that the 78% of the risk group were not aware about the proper prevention of HIV infection.13
The study was conducted on “HIV Risk Reduction among Detained Adolescents”. 484detaind adolescents received 1 of 3 group-based interventions and the result was condom-use behavior measured as frequency of condom use during sex (ranging from never to always) decreased over time, although the GPI and GPI+GMET interventions mitigated this tendency at the 3-, 6- and 9-month follow-up assessments. Although both active interventions were significantly more successful than the GINFO condition; and the pattern of effects favored the GPI+GMET, there were no statistically significant differences between the GPI and GPI+GMET interventions.16
The study was conducted on “Characteristics of sexual behavior in Spanish adolescents”. Participants were 1.279 male and female adolescents. The result was males and females were different according to the type of partner at the last sexual intercourse: 63.0% of males had a steady partner compared to 90.5% of females (p<0.01). The mean number of sexual partners during the last 12 months was higher in males than in females (M=2.1 and M=1.5 partners, for males and females, respectively, p<0.01). 50.0% of males had sexual intercourse under the effects of drugs versus 39.3% of females (p<0.01).17
The study was conducted on “Preliminary efficacy of a comprehensive HIV prevention intervention for abstinent adolescent girls”. 54 sexually abstinent girls were taken for the study. The intervention resulted in a large effect for information (d=1.11); small to large effects for the motivational measures (d=.34-.88), and a moderate effect for a measures of behavioral skills (d=.67). The results indicate that antecedents of sexual risk behavior change were improved by a gender-specific theoretically guided intervention.18
6.3
6.4 / All these reviews throw light over the fact that the knowledge about HIV is necessary. This concept is strongly supported by the situation that, up to this there is no way to get rid from AIDS if once affected. Therefore prevention is the only remedy to avoid AIDS.
STATEMENT OF THE PROBLEM
“A study to assess the knowledge and attitude regarding H.I.V. infection among adolescents in a selected school, at Bangalore”OBJECTIVE OF STUDY
The objectives of the study are .to assess the knowledge of adolescents regarding the HIV infections.
to assess the attitude of adolescents regarding the HIV infections.
to compare the knowledge ad attitude of adolescents regarding the HIV infections.
to find the association between the knowledge of adolescents regarding the HIV infection with selected demographic variables (age, sex, education parents education, place of residence, occupation of the father).
to find the association between the attitude of adolescents regarding the HIV infection with selected demographic variables (age, sex, education, parents education, place of residence, occupation of the father).
6.5
6.6
6.7
6.8
6.9
7.0 / HYPOTHESIS
The hypothesis will be tested at 0.05 level of significance.
H1: There will be significant association between the knowledge and attitude regarding HIV infection among adolescents.
H2: There will be significant association between the knowledge regarding HIV infection among adolescents with selected demographic variables (age, sex, education, parents education, place of residence, occupation of the father).
H3: There will be significant association between the attitude regarding HIV infection among adolescents with selected demographic variables (age, sex, education, Parents education, place of residence, occupation of the father).
OPERATIONAL DEFINITIONS:
KNOWLEDGE
“Knowledge is the information or the awareness gained through the experience or education”.ATTITUDE
“An attitude is any belief or opinion that includes and evaluation of some object, person or event along a continuum from negative to positive”.
ADOLESCENTS
“Adolescent refers to the age group between 12 and 15 years”.HIV INFECTION
“HIV refers to the extreme end of the spectrum of disease caused by Human Immune Deficiency virus and impairs the bodies’ cellular immune system”.ASSUMPTIONS:
Adolescents will have knowledge regarding HIV infection.
Adolescents will have a positive attitude regarding HIV infection.
Adolescents will take the preventive measures in the aspect of HIV prevention.
DELIMITATION:
The study is delimited to:
Between the age group of 12 and 15 years.
Study period limited to 4 weeks.
PROJECTED OUTCOME:
The present study will help the Adolescents to understand about HIV infection and hence to decrease the occurrence of HIV infection.
MATERIALS AND METHODS:
7.1 SOURCE OF DATA
7.1.1RESEARCH DESIGN
Descriptive design will be used for this study.
RESEARCH APPROACH
Survey approach will be used for this study.
7.1.2 SETTING:
The selected setting is K.T.G high school, Bangalore. It is 1 km away from the college
7.1.3 POPULATION:
The populations selected are adolescents between the age of 12 and 15 years.
7.2. METHOD OF COLLECTION OF DATA
Interview will be conducted between 9 am to 2 pm. Data will be collected from 5 samples per day. The duration of the study will be 4 weeks. The duration of 30 minutes will be spent per each subject.
7.2.1 SAMPLING TECHNIQUE:
Convenient sampling will be used for this study.
7.2.2 SAMPLE SIZE:
The sample size is 60.
7.3
7.4 / 7.2.3INCLUSION CRITERIA FOR SAMPLING:
The criteria for the sample selection are adolescents who are:
♣ between the age group of 12 and 15 years.
♣ willing to participate in the study.
♣ those who are knowing Kannada and English.
7.2.4EXCLUSION CRITERIA FOR SAMPLING:
♣ those who are sick.
♣ age group below 12 years.
7.2.5 INSTRUMENT INTENDED TO BE USED:
SELECTION OF TOOL:
This consists of 3 parts.
PART-1
Consist of demographic variables such as age, sex, education, parent’s education, place of residence, and occupation of the father.
PART-1I
Questionnaire will be used to assess the knowledge.
25 questions will be used.
PART-1II
Questionnaire will be used to assess the attitude 20 questions
will be used
SCORING PROCEDURE:
For Answers. If answer is Yes - 1
If answer is NO - 0
7.2.6 DATA COLLECTION METHOD:
Prior Permission will be obtained by the significant authorities and
from the subjects. The investigator will use questionnaires to assess the knowledge and attitude regarding HIV infection among adolescents. Interview will be conducted between 9am to 2 pm. Data will be collected from 5 samples per day. The duration of the study will be 4 weeks. The duration of 30 minutes will be spent per each subject.
7.2.7 PILOT STUDY:
Six samples will be selected and study will be conducted to find out the
Feasibility.
7.2.8 DATA ANALYSIS PLAN
Descriptive statistics such as mean standard deviation will be used for assessing the knowledge and attitude. Inferential statistics such as chi-square and t test will be used to compare with demographical variables.DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS
--YES—
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?
YES, ethical clearance will be obtained from the Research Committee of K.T.G College of Nursing.
Consent was taken from the head of school and study subjects before collection of data.