RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

MR. SANU VARGHESE

1 YEAR M.Sc. NURSING

COMMUNITY HEALTH NURSING

(2012-2014-BATCH)

SRI SHANTHINI COLLEGE OF NURSING

#188/B, PARVATHI NAGAR, OPP: SUB REGISTRAR OFFICE,

LAGGERE MAIN ROAD, LAGGERE

BANGALORE- 560058

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

01 / NAME OF THE CANDIDATE AND ADDRESS / MR. SANU VARGHESE
1ST YEAR M.Sc. NURSING
SRI SHANTHINI COLLEGE OF NURSING,
#188/B, PARVATHI NAGAR,
OPP SUB REGISTRAR OFFICE,
LAGGERE MAIN ROAD, LAGGERE,
BANGALORE-560058
02 / NAME OF THE INSTITUTION / SRI SHANTHINI COLLEGE OF NURSING,
#188/B, PARVATHI NAGAR,
OPP SUB REGISTRAR OFFICE,
LAGGERE MAIN ROAD, LAGGERE,
BANGALORE-560058
03 / COURCE OF THE STUDY AND SUBJECT / MASTER DEGREE IN NURSING
COMMUNITY HEALTH NURSING
04 / DATE OF ADMISSION TO COURSE / 28/06/2012
05 / TITLE OF THE TOPIC / THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND ATTITUDE REGARDING PREVENTION OF COMPLICATIONS OF DIABETES MELLITUS AMONG CHILDREN OF DIABETIC PATIENTS

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Diabetes mellitus is a major universal health problem afflicting human societies at all stages of development. Globally there are at least 30 million diabetes; the majority of them lack even the rudiments of care. The Hindustan times news paper stated that the total number of people suffering in the country (India) as a whole is estimated at 15.2 million.1

Diabetes mellitus, particularly type II, is a major public health concern worldwide. According to WHO, there will be an alarming increase in the population with type II diabetes mellitus, both in the developed and developing countries over the next two decades. In the developed world, the estimated increase is approximately 46%, from 55 million in 2000 to 83 million in 2030; whereas, among developing nations, the estimated increase is approximately 150%, from 30 million in 2000, to 80 million in 2030.2

Diabetes mellitus contributes significantly to premature death and prolonged ill-health and is major cause of disability through it complications of retinopathy, nephropathy, neuropathy and large blood vessel disease. It is a chronic life long illness. It can be only controlled by regulating diet, exercise, medication, monitoring blood glucose levels, urine testing for presence of sugar, maintenance of hygiene and by making adjustments in life style. These patients required health teaching and regular follow-up to maintain healthy active life. Successful readjustments to healthy life require careful planning on the part of the health care team and the patient. 5

Most of the individuals, healthy and ill, are now demanding greater control of their health care. Individuals want to identify their self care needs establish their learning goals and evaluate their self care behavior. The basic component of self care applies to all diabetic patients, but the care must be designed to fit each person individual’s needs and habits. So far systematic effort has not been made to maximize the self – care potentialities of each diabetic patients or his family.

6.1 NEED FOR THE STUDY

According to the World Health Organization (WHO) report, India today heads the world with over 32 million diabetic patients and this number is projected to increase to 79.4 million by the year 2030. Recent surveys indicate that diabetes now affects a staggering 10-16% of urban population and (5-8%) of rural population in India. There is very little data on the level of awareness and prevalence about diabetes in developing countries like India. Such data is important to plan the public health programme. Analysis of secular trends reveals an increase in diabetes prevalence among rural population at a rate of 2.02 per 1000 population per year. The rate of increase was high in males (3.33 per 1000 per year) as compared to females (0.88 per 1000 per year). 3

Diabetes was estimated to be responsible for 109 thousand deaths, 1157 thousand years of life lost and for 2263 thousand disability adjusted life year in India during 2004. However, health systems have not matured to manage diabetes effectively. Awareness about and understanding of the disease is less than satisfactory among patients, leading to delayed recognition of complications. The cost of treatment, need for lifelong medication, coupled with limited availability of anti-diabetic medications in the public sector and cost in the private sector are important issues for treatment compliance. 4

In order to meet learning need of the patients, structured teaching programmes have to be developed for the promotion of health, prevention of diseases or complications, early diagnosis and treatment and rehabilitation. It aims at the modification of inadequate behavior and life style for preventing a health crisis. A variety of teaching strategies can be utilized to teach patients. The need to test alternative strategy is an area that requires attention. 6

During the researcher’s personal and clinical experience researcher found the diabetes mellitus patients have complications and many problems. Lack of knowledge, attitude are the contribution of the quality of life in Diabetes mellitus patient. Hence the researcher identified an education to the care givers is necessary and Selected this topic.

6.2 REVIEW OF LITERATURE

An interventional study was carried out on122 randomly selected type 2 diabetics attending diabetes outpatient clinic in Egypt to assess the effectiveness of health education on knowledge, attitude, blood sugar and HbAlc levels in type 2 diabetics. . A questionnaire (pretest) was used to collect data on socio-demographic characteristics, knowledge and attitude, then a blood sample was taken for testing random blood sugar and HbAlc. Patients were subjected to the first health education session where information about diabetes was provided. Results of the study revealed that the majority of patients had low levels of knowledge regarding different aspects of diabetes (Correct answers ranged from 16.39% to 49.18%). Knowledge level was significantly poor, among females, not educated, low social class, and rural residence and of older age group. After implementation of the educational message, a significant improvement was revealed in patients' knowledge and attitude with lowering of their mean levels of blood sugar and HbAlc. 7

A study was conducted in India to highlight the current constraints in the health system to effectively manage diabetes and the need for developing workable strategies for ensuring timely and appropriate management with extensive linkage and support for enhancing the availability of trained manpower, investigational facilities and drugs. The results focused that Diabetes was estimated to be responsible for 109 thousand deaths, 1157 thousand years of life lost and for 2263 thousand disability adjusted life years (DALYs) in India during 2004. However, health systems have not matured to manage diabetes effectively. Awareness about and understanding of the disease is less than satisfactory among patients, leading to delayed recognition of complications. The cost of treatment, need for lifelong medication, coupled with limited availability of anti-diabetic medications in the public sector and cost in the private sector are important issues for treatment compliance. 4

A systematic review was done in USA to assess the published evidence for an association between glycaemic variability and the development of chronic micro- and macrovascular complications in patients with diabetes mellitus (DM). Interventional and observational studies in patients with type 1 or type 2 DM reporting a measure of glycaemic variability and its impact on the development or progression of micro- and macrovascular diabetic complications were assessed.A total of 18 studies -8 on type 1 DM and 10 on type 2 DM patients-meeting the inclusion criteria were identified. Studies in patients with type 1 DM revealed that glucose variability has little impact on the development of diabetic complications. Among type 2 DM studies, a significant positive association between glucose variability and the development or progression of diabetic retinopathy, cardiovascular events and mortality was reported in 9 of 10 studies. Only one type 2 DM study reported no association between glucose variability and progression of retinopathy. Future prospective trials evaluating and comparing the effect of the control of glycaemic variability on the development of diabetic micro- and macro vascular complications are needed to further strengthen the evidence base.8

A cross sectional study was conducted was to determine the prevalence of microvascular and macrovascular complications in type 2 diabetes and to identify the major risk factors for these complications in India .Sample size was 4067 patients out of 4400 type 2 diabetic patients attending the diabetic clinic during Jan 99 to Dec 2000. All patients underwent the specific tests for retinopathy, nephropathy, neuropathy, peripheral vascular diseases (PVD) and cardio-vascular diseases using relevant investigations.The result revealed evidence of retinopathy in 1176 patients (28.9%), nephropathy in 1323 (32.5%), neuropathy in 1225 (30.1%), CAD in 780 (19.2%) and PVD in 735 patients (18.1%). Logistic regression analysis revealed that age, duration of diabetes and hypertension was significantly associated with all these complications. Poor glycemic control (increased HbA1C) had definite contribution for increased prevalence of nephropathy and retinopathy. This study highlights the high prevalence of various microvascular and macrovascular complications especially nephropathy and neuropathy in Indian population.9

A study was conducted to assess the general characteristics, knowledge, attitude and practices of type 2 diabetic patients attending the Out-Patient Department (OPD) of Baqai Institute of Diabetology and Endocrinology (Karachi, Pakistan). The result revealed that 57% of the patients were overweight or obese. Only 10.7% had good glycemic control. Sixty seven percent did not do exercise of any kind. The overall awareness about the risk of complications was satisfactory but the misconceptions regarding diet, insulin and diabetes were quite common. This study highlights the need for better health information to the patient through large scale awareness programmes so as to change the attitude of our public regarding diabetes.11

A study was conducted on the knowledge, attitude and practice (KAP) among 100 Diabetes mellitus patients attending the diabetic clinic. A face-to-face interview using a structured questionnaire was carried out for data collection. The results revealed that 87% of the respondents were able to answer 50% or more questions on knowledge correctly, while 98% of them had 50% or more score for the attitude questions. Ninety-nine percent of them reported 50% or more score for the questions on practice. However, only 56% of them practice all 4 of the practices that were asked - regular exercise, healthy diet, monitoring blood glucose level, and monitoring body weight. There was a significant positive correlation between knowledge and attitude (r=0.536, p<0.01), but there was no significant correlation found between attitude and practice.13

A study was conducted in Nepal to assess the knowledge attitude practice (KAP) scores of the diabetic patients. Altogether 182 patients were enrolled in the study. There were 103 (56.59%) males and 79 (43.41%) females. The greatest number of patients was in the age group of 51-60 years. A total of 685 drugs were prescribed to these patients. Anti-diabetes were the commonest class of drugs prescribed accounting for 314 (45.84%) of the total drugs. The overall mean (± SD) scores of the patients was 7.78 ± 3.8. Knowledge score was 4.90 ± 3.34; attitude 2.03 ± 0.95 and practice 0.84±0.76, with maximum possible scores for knowledge, attitude and practice patient being 18, 4 and 3 respectively. This suggests the need for educational interventions to improve the knowledge, attitude and practices of the diabetes patients.14

A descriptive study was conducted I Pakistan to determine the knowledge, attitudes and practices among one hundred patients with type 2 diabetes. Patients were interviewed using a structured questionnaire. The mean age of the patients was 50±5 years with the male to female ratio being 1:3. The data was collected using convenience sampling technique and analyzed using statistical package Epi Info 6.0. The result of the study revealed that patients’ awareness about diabetes was low. The mean of correct answers for glycaemic control, risk factors and complications was 33.5%, 69% and 39% respectively. Sixty-one percent of the patients regularly checked blood sugar but only few knew target blood glucose values. 92% recognized blood pressure as a risk factor while the correct answers for hyperlipedimia, cigarette smoking, sedentary life style and body weight were 42%, 70%, 76% and 66% respectively. Awareness about eye and renal complications was also quite low. The knowledge, attitude and practice scores were low in most areas of diabetes care emphasizing the need for additional educational efforts.15

A cross-sectional study sought to establish the level of knowledge of diabetes among community members in rural and urban areas of Kenya and determine how this impacts on attitudes and practices towards diabetes. A face-to-face interview was performed for selected respondents using a structured questionnaire for data collection. Of 1982 respondents, 1151 (58%) were female and 831 (42%) male and age ranged from 13 to 65 years. There were 539 (27%) with a good knowledge of diabetes; of these 52% had tertiary education; 25% had secondary education, and 14% and 9% had primary and no education, respectively. Only 971(49%) of the respondents had a positive attitude towards diabetes, while 813 (41%) demonstrated good practices towards diabetes. This study indicated that the level of knowledge of diabetes was poor. It also indicated poor attitudes and practices of the community towards diabetes. A comprehensive nationwide diabetes education programme is necessary to improve this situation.16

STATEMENT OF THE PROBLEM

“A study to assess the Effectiveness of Structured Teaching Programme on Knowledge and Attitude regarding Prevention of Complications of Diabetes Mellitus among Children of Diabetic Patients in selected Community area at Bangalore.”

6.3 OBJECTIVES OF THE STUDY

The objectives of the study are

1.  To assess the number of diabetic patients in a selected community area.

2.  To determine the existing knowledge and attitude among children of diabetic patients on prevention of complications of diabetes mellitus.

3.  To determine the effectiveness of structured teaching programme on knowledge and attitude among children of diabetic patients on prevention of complications of diabetes mellitus.

4.  To determine the correlation between knowledge and attitude.

5.  To find the association of the pre test knowledge and attitude with selected demographic variables.