RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGLORE, KARNATAKA

PROFORM FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME AND ADDRESS OF THE CANDIDATE / Ms. BIDHYA SHAH
BHARATPUR-13, CHITWAN. NEPAL
2. / NAME OF THE INSTITUTION / ACHARYA COLLEGE OF NURSING, CHOLANAGAR, R.T.NAGAR POST, BANGLORE
3. / COURSE OF THE STUDY AND SUBJECT / M.Sc. NURSING 1st YEAR
PAEDIATRIC NURSING
4. / DATE OF ADMISSION TO COURSE / JUNE 30, 2011
5. / STATEMENT OF THE PROBLEM
A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING THE PHYSICAL HEALTH PROMOTION AMONG ADOLESENCENTS IN SELECTED SCHOOLS, BANGALORE.

A BRIEF RESUME OF THE INTENDED WORK

“Snow and adolescence are the only problems that disappear if you ignore them long enough.” - Earl Wilson

6. INTRODUCTION

Adolescents – young people between the ages of 10 and 19 years – are often thought of as a healthy group. Adolescents is a period of transition between childhood and adulthood, a time of profound biologic, intellectual, psychosocial and economic change. During this period individuals reach physical and sexual maturity, develop more sophisticated reasoning abilities and make educational and occupational decisions that will shape their adult careers. The changes of adolescents have important implications for understanding the kinds of health risks to which young people are exposed, the health-enhancing and risk- taking behaviors in which they engage and the major opportunities for health promotion among the population.1

The adolescents begin with the onset of puberty, defined by UNICEF as “the sequence of events by which the individual is transformed into a young adult by a series of biological changes It is during this period that secondary sex characteristics develop in both male and female. Adolescence is divided into three phases: early, middle and late adolescence. Early adolescence refers to age 10- 13years, middle adolescence refers 14- 16 years and late adolescence refers to 17 -20 years.2

As adolescent’s mature, they are able to accept increasing responsibility for their own health care. Although few illnesses are characteristic of this period, the need is great for health supervision and counseling. During the adolescents they approach adulthood, they are completely responsible for their health care and for achieving their goal in communication techniques, physical examination, self-care, nutrition, dental health, accident prevention, prevention of addictive behavior, sex educations etc.3

Adolescence, the period between childhood and adulthood, begins after secondary sexual characteristics like appearance of pubic/ axillaries hair and continues until sexual maturity is complete. It is a period during which bones are still growing and there is a high risk of skeletal injuries. Rapid physical changes are accompanied by important psychological changes relating particularly to the way the adolescents perceive himself or herself. It is unwise for adolescents to take part in exercises which put undue strain on the growth regions of their bones.4

The government of India has launched a Programme called the Adolescents Reproductive and Sexual Health Programme under National Rural Health Mission as a part of RCH. This focus on ARSH and special interventions for adolescents was in anticipation of the following expected outcomes: Delay age of marriage, reduce incidence of teenage pregnancies, meet unmet contraceptive needs and reduce the number of maternal deaths, reduce the incidence of sexually transmitted diseases and reduce the proportion of HIV positive cases in the 10-19 years age group.5

Adolescence is considered as a bridging period from childhood to adulthood. Biological, cognitive, moral, as well as social development occurs during this period. It can be identified as one the vulnerable period of life when the various health problems may be seen. Substance abuse, disregard of traffic regulations are the examples of behavioral patterns that frequently endanger adolescents health. Stress leads to emotional problems in adolescents giving warning signs, suicidal behavior and depression. Teenage pregnancy, abortion, child birth, unsafe sex and sex abuse endanger adolescents health. Therefore, a practical approach to the adolescents health problems should be developed in a country like India where general health care system has not come to a level where it can serve the needs of individual age groups separately.6

6.1. NEED FOR THE STUDY

Adolescents are the period of rapid change and maturation when the child grows into the adult. This is one of the most enjoyable stages of one’s life and it has to be experienced with joy and friendship paving the way for building a healthy society with good social relationships.7

Promoting adolescents health and development means realizing the full potential of adolescents by addressing their health and development needs and safeguarding their rights. During this critical period, adolescents go through rapid development. The process allows them to gain self-worth, and to experience safety, structure, belonging, intimate relationships, feelings of accomplishment, responsibility and autonomy, spirituality.5

Many adolescents do die prematurely due to accidents, suicide, violence, pregnancy related complications and other illnesses that are either preventable or treatable. Many more suffer chronic ill-health and disability. In addition, many serious diseases in adulthood have their roots in adolescence. For example, tobacco use, sexually transmitted infections including HIV, poor eating and exercise habits, lead to illness or premature death later in life.6

Adolescence carries the highest risks of morbidity and mortality from certain causes, including accidents and injuries, early pregnancy and sexually transmitted diseases. Furthermore, many lifestyle diseases (caused by smoking, risky sexual behavior, alcohol and drug dependency, etc.,) have their roots in adolescence. These statistics show us the magnitude of the problem: Of the 300 million adolescents smoking today, 150 million will die of tobacco-related diseases later in life. About 25 % of adolescents aged 15-19 in some Western Pacific countries smoke. In some Pacific Island countries children begin chewing tobacco at age 5. About 100 000 adolescents die from suicides every year. Girls under 18 are 2 to 5 times more likely to die in childbirth a woman in their twenties. About 50% of HIV infection is among people of 15-24 age groups. One in twenty adolescents and young people contracts STI each 2 year. Promoting the healthy development of adolescents now, is one of the most important investments that any societies can make.8

A descriptive study was conducted among 4203 adolescents in a school at New Delhi with a view to prevalence and type of substance used by children in India among boys and girls. The prevalence of use of alcohol: 1.4%, betel leaf: 10.9%, Tobacco: 2.1% and among girls prevalence of use of alcohol: 1.6% betel leaf, 7.9% Tobacco: 1.1%. Over all chewing betel leaf is very high (10.2%) among the respondents.9

While there is generally an improvement in the nutritional status of children and adolescents in the Western Pacific Region, there are new problems and issues that need to be addressed. The types of nutritional problems affecting adolescents have changed over the past two decades.8

Under nutrition, wasting and growth stunting are still reported, but these conditions are on the decline. The prevalence of obesity is increasing due to changes in the socio-cultural and economic life of the community, widespread nutrition transitions to lipid-rich diets and a decrease in physical activity.8

In the more developed countries in the Region, “malnutrition of affluence” is caused by social pressures to achieve a distorted body image. Adolescents are increasingly confronted with the pressure to have a "perfect" body shape and eating disorders society can make.8

Both adolescents boys and girls are at risk of contracting STIs. for adolescents girls, STIs, if untreated, can lead to cervical cancer, pelvic inflammatory disease, ectopic pregnancy, infertility and increased risk of HIV infection and mother to child transmission. Young people ages 15 to 24 have the highest infection rates of STIs. About half of the 35 million new cases of STIs each year occur among young people (10-24 years). Around 7000 young people (10-24 years) are infected with HIV daily. Within the context of a supportive environment, adults should be able to explain safe sex to adolescents. Health services should introduce sexually active adolescents to the use of condoms.8

A study was done among adolescents about health risk behaviors ofsubstance use: cigarettes-24% and marijuana-17%;high risk sexual behaviour: initiation of sexual activity ≤ 10 years old-19% and those having more than six partners-19%;teenage pregnancy: teens account for 15–20% of all pregnancies and one-fifth of these teens were in their second pregnancy;Sexually-Transmitted Infections (STIs): population prevalence of gonorrhoea and/or chlamydia in 18–21 year-olds was 26%;mental health: severe depression in the adolescents age group was 9%, and attempted suicide-12%;violence and juvenile delinquency: carrying a weapon to school in the last 30 days-10% and almost always wanting to kill or injure someone-5%;eating disorders and obesity: overweight-11%, and obesity-7%.10

A community-based cross-sectionalstudy was doneamong 554 in Kolkata city street children to assess nontobacco substance use and sexual abuses along with human immunodeficiency virus (HIV)/ sexually transmitted infections (STIs) during 2007. The nontobacco substance use was 30%; 9% reported having been sexually abused. Some factors (age, lack of contact with family, orphan children, night stay at public place, etc.) were documented to be associated with substance use and sexual abuses. Seroprevalence of HIV was found to be 1% and that of STIs was 4%. This 1% HIV seroprevalence in street children is a matter of concern. Community-based intervention is necessary for them. Thestudy's limitations are noted.11

If we ignore the needs of adolescents then we put both the present and future of our society at risk. In the long term, our society cannot bear the costs of an unhealthy population and an unproductive workforce. Healthy adolescents have a better chance of becoming healthy, responsible and productive adults, leading to greater skills development, fewer days lost to illness, longer working lives and increased productivity and progress. Hence investigator found interest in promoting physical health promotion among adolescents.

6.2. REVIEW OF THE LITERATURE:

A review of literature enables one to get an insight into the various aspects of the problem under study. It covers promising methodological tools, throws light on ways to improve the efficiency of data collection and suggests how to increase effectiveness of data analysis and interpretation. Review of literature is therefore an essential step in the development of the research project.

The result studies conducted in various aspects on physical health promotion is presented below.

6.2.1. Review of literature related to physical health promotion among adolescents.

6.2.2. Review of literature related to knowledge regarding physical health promotion among adolescents.

6.2.3. Review of literature regarding effectiveness of self- instructional module on physical health promotion among the adolescents.

6.2.1. Review of literature related to physical health promotion.

A cross sectional study was done to determine the prevalence of under-nutrition, overweight and obesity as measured by Body Mass Index (BMI) in a representative among adolescents aged 10-19 years. Adolescents (n = 401) from 32 schools in urban and rural districts of the state responded to a socio-demographic questionnaire. BMI for age was calculated and the prevalence of underweight, overweight and obesity was determined based on WHO/NCHS value of <5th, 85th and 95th percentiles respectively. The results consisted of 182 boys and 219 girls. The prevalence of underweight was 20.1% in the study area, which was higher among the rural adolescents (22.4%) than urban (18.7%) and 25.8% and 15.1% among boys and girls respectively, overweight was 3.2% with 4.1% from urban and 1.5% from rural, while 1.1% was boys and 5.0% were girls. Only 0.5% urban girls were obese, underweight was significantly higher in boys at mid adolescence (24.2%, p<0.02), boys who were involved in jobs after school hours (13.7%, p<0.06) and who do not travel regularly (22.5%, p<0.12). While among girls who reside with extended family member (11.9%, p<0.05). In conclusion, adolescents living in Osun state, Nigeria are at high risk of underweight.12

A cross-sectional, descriptive study was done regarding irregular breakfast eating (IRBF) and health status among 1069 (7th-12thgrade) adolescents. The main variables comprised breakfast eating pattern, body weight, and health promoting behaviors (HPB). 64.1% in junior high school and 35.9% in high school, boys (47.1%) and girls (52.9%) ranging in age from 12–20 years among the total participant population, 28.8% were overweight and nearly one quarter (23.6%) reported eating breakfast irregularly during schooldays. The findings indicated that adolescents with regular breakfast eating (RBE) had a lower risk of overweight (OR for IRBE vs. RBE = 1.51, 95%) and that the odds of becoming overweight were 51% greater for IRBE than for RBE even after controlling for demographical and HPB variables. IRBE also was a strong indicator for HPB.13

A cross-sectional survey was done to investigate the relationship between adolescents' alcohol use and physical health, aged 13-19 years, attending secondary or high school. Nearly 8,983 youths (91%) answered the Young-Hunt questionnaire in the 1995-1997 HUNT-survey. About 80% of the respondents had tried alcohol, and 29% reported more than 10 intoxications. Girls who frequently used health services had frequent alcohol intoxications. The result shows that there is a close association of physical health complaints and alcohol intoxication among the adolescents.14

The community-based cross-sectional study was done to assess the health problems in adolescence and factors influencing those health problems among 740 adolescents of 10 – 20 years age group, 700 adolescents were studied. Out of 700 adolescents 336 (48%) were males and 364 (52%) were females. As many as 379 (54.14%) were having acne, 259 (37.0%) were having dental caries, 240 (34.28%) were having nicotine stains on teeth, 25 (3.57%) obesity). Out of 700 adolescents, 401 (57.28%) were anaemic, with 117 (16.71%) having moderate and 284 (40.57%) having mild anaemia. Higher prevalence of anaemia was seen in 219 (60.16%) female adolescents as compared to 182 (54.16%) male adolescents. It was observed that percentage of adolescents having habit of chewing tobacco and gutka was higher in nuclear families (60.47% males and 53.03% females) as compared to joint families (45% males, 47.17% females). The percentage of morbid conditions was higher in joint families (82.42%) as compared to nuclear families (61.08%), due to overcrowding and poor sanitation.17

This study was conducted amongst 930 adolescents of 10 – 19 years age group. The main observations of the study are, 33.12% of the adolescents were addicted with one or other type of tobacco chewing, majority of addicted adolescents were 36.26%. Tobacco chewing is the most frequent form of using tobacco by adolescents than smoking. Majority of the adolescents were addicted for more than 12 months 57.47%. Main inducing factor for addiction was found to be friends (61.69%).15