RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Ms. ANNEPU RAJULAMMA

I year M.Sc Nursing

Community Health Nursing

Year 2008-2009.

PADMASHREE INSTITUTE OF NURSING

NAGARBHAVI,

BANGALORE-560 072.

RAJIV GANDHI UNIVERSITYOF HEALTHSCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / Ms. ANNEPU RAJULAMMA
First year M.ScNursing,
Padmashree Institute of Nursing,
Nagarbhavi Circle,
Bangalore- 560072.
2. / NAME OF THE INSTITUTION / Padmashree Institute of Nursing
3. / COURSE OF THE STUDY AND SUBJECT / M.Sc Nursing,
Community Health Nursing
4. / DATE OF ADMISSION TO THE COURSE / 30-06-2008.
5. / TITLE OF THE STUDY / Assessment of effectivness of structured teaching programme on leprosy rehabilitative measures among leprosy patients.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

Leprosy also known as Hansen’s diseases is a chronic infectious disease that primarily affects the skin, the peripheral nerves, the upper respiratory tract, and the eyes. The causative agent is an acid –fast bacterium, Mycobacterium Leprae. First identified in 1873 by the Norwegian physician, Gerhard Henrik Armauer Hansen.1

In 1991, the world health organization and its member’s states committed themselves to eliminate leprosy as a public health problem by the year 2000.At the end of the year 2000, the deadline of the programme, 597,232 leprosy cases were registered for the treatment and 719,330 cases were newly detected in the world. The prevalence rate at the global level was below 1case per 10,000 persons. There have been 690,830 newly detected patients in 2001.According to official reports received during 2008 from 118 countries and territories, the global registered prevalence of leprosy at the begning of 2008 stood at 212,802 cases.2

Studies have indicated that mortality rate among lepromatous patients can be the direct cause of death unlike many other people disabled with leprosy. As a part of prevalence of effective leprosy control and preventing deformities is early detection and prompt treatment is one of the essential step, and second step is rehabilitation of those patients who are having deformities either special accessories or corrective surgical procedures have to be under taken.3

WHO recommends a protocol of Multidrug therapy (MDT), which effectively controls the disease, hence contributing to the global elimination programme. Early detection of leprosy and treatment by MDT are the most important step in preventing deformities and disabilities. Social and vocational rehabilitation are integral component for the leprosy patients.4

In an analysis of the study on leprosy, reported that 21%to45% of all persons affected by the disease deteriorated economically. The dilemma is to identify who among leprosy affected persons need community-based rehabilitation to address the economic and other psychosocial impact of the illness.5

The basic concepts behind rehabilitation are that the persons affected with leprosy should be restored back to the normal social life or as near as possible. Rehabilitation in field of leprosy requires greater efforts than the rehabilitation in other types of disabled persons because the question of social acceptances does not arises in non-leprosy disabled persons. In the case of orthopaedically handicapped or blind or deaf persons their stay with the family is not prejudiced as in the case of leprosy patients. This is due to stigma attached to the disease. Therefore, one of the essential requirements is socioeconomic rehabilitation in the community for social acceptance of the leprosy cured persons through advocacy methods.

A few non-governmental agencies are rendering organized socioeconomic rehabilitation services to the affected persons by assessing their needs and at the same time helping them to bring lasting benefits. Members of the International Federation of AntiLeprosy Association (ILEP) are showing keen interest in the socio economic rehabilitation and those organizations. According to ILEP guidelines, the approaches to socioeconomic rehabilitation can be based on the following:

  1. Recognition of the impact of leprosy individual; in other words its physical, psychological, social and economic effects.
  2. Responsiveness to the concern of the individuals affected by leprosy. This requires approaches that restore dignity and empowerment.
  3. Sensitivity to the concerns of the families and communities affected by leprosy. Members of the community have an important role to play in rehabilitation.

Strategies with some key principles to enable people with disabilities to participation the whole range of human activities. These principles include participation, equity, self-advocacy, facilities and partnership sustainability.6

Rehabilitation required for people with leprosy related disabilities includes physiotherapy, orthopedic services, occupational therapy and reconstructive surgery and socioeconomic rehabilitation. Rehabilitation activities includes vocational training, integrated education of children’s affected by the leprosy, micro finance and business, creation schemes, provision or improvement of appropriate housing and advocacy at various levels involving a variety of media. The strategies are implementing most of the services.7

The community-based approach assumes that the people with disabilities are able to work together to organize their own lives and their own development, drawing their active involvement and support of their family and local community. The scope and complexity of community-based rehabilitation is close co-operation and communication with prevention of disabilities and those involved in promoting social and economic well.2

In the development of community based rehabilitation and leprosy rehabilitation five different related forces are identified that influences the further conceptualization of rehabilitation in the community. These are:

  1. From an individual to a social approach
  2. Steering of process by the persons with a disabilities
  3. Focus on improving livelihood of people with disabilities
  4. Demand for evidenced based practice

Rehabilitation in the field of leprosy requires greater efforts than the rehabilitation in other types of disabled persons. In case of orthopedically handicapped, blind, or deaf persons, their stay with family members is not prejudices as in case of leprosy patients. Preventive rehabilitation is need of early diagnosis and treatment to prevent disabilities. Therefore, one of the requirements in socioeconomic rehabilitation is to create suitable conditions in the community for social acceptance of leprosy-cured persons through advocacy methods. 7

6.2 NEED FOR THE STUDY

“To be good is noble, but to teach others

How to be good is nobler”

Leprosy is one of the most socially stigmatized diseases known today. Social stigma is associated mainly due to the prevalent myths like its hereditary and contagious nature, divine cure along with the physical deformities caused. The affected people not only face physical impairment but also suffer psychological repercussion due to the community’s attitudes. The long-term physical and psychological restrictions slowly push the leprosy-affected persons out of the society. With the lack of social support and self-confidence, some disability leprosy affected persons end up as beggars. There is a need to develop a holistic approach including both prevention of disabilities. Measures to prevent such disabilities in future rehabilitation of leprosy have been suggested.8

Rehabilitation of the leprosy patients is a multifaceted and long drawn process. Consisting efforts in various directions are necessary to bring success. Community based rehabilitation has been described as strategy for leprosy rehabilitation. Developments in community based rehabilitation services, including socioeconomic rehabilitation.9

The basic concept of community based leprosy rehabilitation focused on participation of the persons with a disability in their own community and position, promoting positive attitude towards their own life’s, prevention of causes of disabilities, provision of rehabilitative services, education and training, occupational training, socio economic training, supporting local initiatives.10

Rehabilitation require by the people with leprosy related disability includes physiotherapy, orthopedic services, occupational therapy and reconstructive surgery and socioeconomic rehabilitation. Rehabilitation activities include vocational training, integrated education of persons affected by leprosy, micro finance and business, creation schemes, provision or improvement of appropriate housing and advocacy.11

.

From the investigator own experience, many of the leprosy patients who got admitted in leprosy hospital were not aware of leprosy rehabilitative measures such as medical, surgical, occupational, socioeconomic rehabilitative measures.

So, the investigator felt that there is a need to educate the patients who are having some leprosy disabilities with the help of structured teaching programme, which covers the following aspects:

  1. Medical rehabilitation
  2. Surgical rehabilitation

By this structured teaching programme leprosy patients will able to improve the knowledge on leprosy rehabilitative measures and patient can get self confidence to carry out his activities.

6.3 STATEMENT OF PROBLEM

A study to assess the effectiveness of structured teaching programme on leprosy rehabilitative measures among leprosy patients in selected leprosy centers, Bangalore.

6.4 OBJECTIVES OF THE STUDY

  1. To assess the pre test knowledge regarding leprosy rehabilitative measures among leprosy patients.
  2. To assess the posttest knowledge regarding leprosy rehabilitative measures among leprosy patients.
  3. To assess the effectiveness of structured teaching programme regarding leprosy rehabilitative measures among leprosy patients.
  4. To associate the post test knowledge regarding leprosy rehabilitative measures among leprosy patients with their selected demographic variables

6.5 OPERATIONAL DEFINITIONS

1. Effectiveness

It refers to the increase in the level of knowledge of patients after receiving structured teaching programme on leprosy rehabilitative measures.

2. Structured teaching programme

It refers to systematically developed instructional aids designed for leprosy patients on aspects of rehabilitative measures such as medical and surgical rehabilitative measures

  1. Leprosy rehabilitative measures

It refers to the leprosy rehabilitative measures that prevents deformities by early detection and promote treatment of patients who are having deformities with either special accessories or corrective surgical procedures.

  1. Leprosy patients

It refers to the patients with leprosy and taking treatment in leprosy center.

6.6 ASSUMPTIONS

  1. Patients may have inadequate knowledge on leprosy rehabilitative measures.
  2. Structured teaching programme will enhance the knowledge of patients on leprosy rehabilitative measures.

6.7 RESEARCH HYPOTHESIS

HI - There is significant difference between the mean pretest and post test knowledge of patients on leprosy rehabilitative measures.

H2 - There is significant association between the post test score of patients and selected demographic variables.

6.8 REVIEW OF LITERATURE

Literature review is a key step in the research process, the task of reviewing involves the identification, selection of critical analysis and reporting of existing information on topics of interest.12

A study was conducted on socioeconomic rehabilitation; focus on the issues of abnormal psychological behavior among leprosy-affected persons. The result shows a high level of social stigma experienced by the leprosy affected persons. This is high lightened in various categories including marriage difficulties, homelessness, and negative affect on employment. The author states that the social prejudices and deformities due to leprosy have played key role in socioeconomic detoriation of affected persons. It is recommended that the leprosy rehabilitation is more needed to implement in effectively, efficiency with active involvement.13

A study was conducted on the process of rehabilitation among male and female leprosy affected persons. The study gathered data from 2495 inhabitants of Bihar and Maharashtra, including 934 who were receiving treatment and living relatively normal lives, 300 members of their families, 1071 who had to leave at home, 100 who were rehabilitated and 90 health workers. The studies results show both men and women were negatively affected in terms of their families and marital values, women suffered more isolation and rejection. The author concluded that there is a need to provide rehabilitation services. 14

A study was conducted on long-term consequences of leprosy through lack of social support and self-confidence. The study conducted through semi structured interview .the study shows that four of the resulting cases studies to illustrate the process of rehabilitation. The study concludes the rehabilitation services to worthless solution to the absents the problem.15

A longitudinal study was undertaken of 344 leprosy-affected persons attending a leprosy clinic in Gwalior India. The results of the study showed that social stigma was present in a variety forms, and was more prevalence among persons who are illiterate and form a low socioeconomic groups. The need for the socioeconomic rehabilitation is made clearly by this study.16

A study was conducted on impact of socioeconomic rehabilitation on stigma reduction. The study combined a quantitative questionnaire with semi-structured interview of individual participants, five focus group discuss and 10 key informant interviews. The p-scale results showed four men suffered significant participation restriction in finding work and in social integration. The results of the study suggests that improved self-esteem, positive family and community support for SER participants and increasing participation in community activities are indications of stigma reduction.17

A study was conducted on impact of social inequality and prevalence in the for of the caste system in India. A sample of 150 persons with deformities and their families, drawn from two districts in Tamil Nadu, was selected for the study. The study concludes that the gradual marginalization, rejection and rehabilitation of the affected is evident. Caste status is said to be a broad indicator of the nature and the extent of handicaps and acceptance in the family. Investigator recommended that this factor be appropriately taken care of in rehabilitation and disability management in leprosy control programme to work.18

A study was conducted on nature and extent of problems of leprosy affected families having persons with deformities and their strategies to cope up with those problems. This was carried out through data collection from 500 sample families in two districts in Tamil Nadu, in south India. The results of the study showed that about 20% of the families reported that they faced socioeconomic problems. Community education on leprosy is also required to dispel myths and fear surroundings the disease.19

A cross-sectional study was conducted on to determine the socioeconomic and nutritional status of cured persons with residual deformity. The study involved 155 index cases with deformity, 100 without deformity, and 616 household members. Nutritional status was evaluated using Anthropometry. A questionnaire was used to determine disease characteristics, socioeconomic, and house hold information. The study results that cured persons with physical deformity are more undernourished than those without deformity.20

A cross sectional study was conducted on to assess the extent to which leprosy cause physical disability on the persons. The population was two areas of leprosy-affected persons, one area from rural and other from urban, by using cluster-sampling method. The total study sample was 8.175 including 172 cases of physically handicapped. This study shows that the most common causes of leprosy disability of other than trauma and poliomyelitis. The study concludes that disability prevention measures should be incorporated into the national programme for the elimination of leprosy.21

A study was conducted on the general living condition, the psychological, economical and physical situation of 161 leprosy patients. The Results point to a negative correlation between general education and specific knowledge of leprosy and highlight a serious psychological situation of previously treated leprosy patient.22

A study was conducted on the living condition of people affected with leprosy. Sample of the study includes 13,034 cases, out of 13,034 cases, 91.19% were farmers and only 13.01% of the teenagers were at school. The conclusion of this study is the living condition of those leprosy affected people, particularly living in leprosy village called for special attention and the government should take comprehensive attention to publicize the knowledge on leprosy to reduce fear and discrimination against.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA

Patients of leprosy admitted in the leprosycenters, Bangalore.

7.2 METHODS OF COLLECTION OF DATA

i. Research design

Quasi experimental design - one group pre test post test design.

ii. Variable

Dependent variables

Level of knowledge of patients on leprosy rehabilitative measures.

Independent variables

Structured teaching programme on leprosy rehabilitative measures.

iii. Setting

The study will be conducted in selected leprosy centers, Bangalore.

iv. Population

All the leprosy patients admitted in the leprosy centers.

V. Sample

Leprosy patients who full fill the inclusion criteria considered as sample and sample size is 60.

vi. Criteria for sample technique

Inclusion criteria: The study includes

  1. Patients with leprosy admitted in the leprosy center.
  2. Patients who are willing to participate in the study.
  3. Patients who are able to understand Kannada or English.

Exclusion criteria: The study excludes

Patients who are not available at the time of data collection.

Vii. Sampling technique

Non –probability Convenience sampling technique.

Viii. Tool for data collection: The tool consists of 2sections

Section – A

Demographic Performa consisting of patient’s age, gender, religion, occupation, education, family income, duration of illness, source of information.

Section – B

Structured knowledge questionnaire on leprosy rehabilitative measures will be used to assess the knowledge level of the patient.

ix. Method of data collection

After obtaining formal administrative approval from concerned authorities and informed consent from the sample, the investigator will personally collect the data. The data will be collected in three phases.

Phase –I

Pre test will be conducted to assess the existing knowledge of the patients on leprosy rehabilitative measures with the structured questionnaire.

Phase -II

Structured teaching programme regarding leprosy rehabilitation will be given about 45 minutes on the same day.

Phase -III

Same questionnaire will be administered after 7 days its effectiveness will be measured. Duration of the study is 4-6weeks.

X. Plan for data analysis

The data will be analysed by using descriptive and inferential statistics.

Descriptive statistics

Frequency, percentage distribution, mean and standard deviation will be used to analyze the level of knowledge of patients on leprosy rehabilitative measures.20