A Study to Assess the Lifestyle Associated Risk Factors for Selected Non Communicable Diseases and to Determine the Effectiveness of Structured Teaching Programme on Health Promotive behaviors among Adolescents in the selected PU Colleges of Mysore

Ms. Linta T Abraham¹, Mrs. Usha M Thomas², Prof. Sheela Williams³, Mrs. Anitha V N⁴,

Mrs. Janet Mathias⁵

¹Msc (N), JSS college of Nursing, Mysore

²Associate Professor, JSS college of Nursing, Mysore

³Professor, JSS college of Nursing, Mysore

⁴Assistant Professor, JSS college of Nursing, Mysore

⁵Associate Professor, JSS college of Nursing, Mysore

*Corresponding Author Email: lintatabraham@gmail.com

ABSTRACT:

Background: Non-communicable diseases and their associated risk factors have emerged rapidly and are becoming a major public health challenge worldwide. Prevalence of risk factors for non communicable diseases in childhood and adolescence bears significant tendency towards the development of disease in adulthood.

Aim: The aim of the study is to assess the lifestyle associated risk factors for selected non communicable diseases and to determine the effectiveness of structured teaching programme on health promotive behaviors among adolescents in the selected PU colleges of Mysore.

Methods: Research design adopted for the study was exploratory survey in phase I and quasi experimental, non equivalent control group, pre test post test design in the phase II. Purposive sampling technique was used to select the adolescents for the study. Structured life style assessment scale was used to collect the data regarding the life style associated risk factors of 200 adolescents. Knowledge of adolescents regarding HPB was assessed using SKQ.

Results: The results of the study revealed that majority of adolescents (61.5%) were having moderate life style associated risk for selected non communicable diseases. Findings also revealed that structured teaching programme regarding health promotive behaviors was an effective strategy to increase the knowledge of adolescents as indicated by the computed ‘t’ value which was statistically significant at 0.05 level of significance (t(78)=13.252; p<0.05). Study findings also revealed that adolescents from higher socioeconomic classes with good parental education had better knowledge regarding health promotive behaviours.

Conclusion: Structured teaching programme was effective in increasing the knowledge of adolescents regarding health promotive behaviours and the study finding stresses the increasing responsibility of health professionals in planning and implementing various educational strategies to improve the knowledge of adolescents.

KEY WORDS: Lifestyle, non communicable diseases, structured teaching programme, health promotive behaviors, adolescents.

INTRODUCTION:

World changes every second of everyday which brings about the changes in lifestyle. Modern lifestyle has drastically changed the way we live and the way it has affected our health and fitness. Chronic non-communicable diseases are a major contributor to the burden of disease in developed countries, and are increasing rapidly in developing countries.¹Adolescence is one of the most dynamic stages of human growth and development. Lifelong patterns of healthy behaviors are established at this time. Unhealthy adolescent behaviors can become long term risk factors for chronic health conditions in adulthood. ²Adolescent health is the optimal state of well being in all areas of life - physical, emotional, cognitive, social, and spiritual. Adolescents can achieve this level of health only when they engage in healthy behaviors that contribute to a healthy life style.³

The rising burden of preventable risk factors for non communicable diseases among adolescents is a major public health challenge worldwide.⁴ Preventing risky behavior and promoting healthy choices among adolescents can yield positive health outcomes not just during adolescence but also during adulthood. It is critical that adolescents should receive the guidance and support that fosters their healthy development as the adolescent health is shaped by the world in which they grow and people who surround them.⁵

OBJECTIVES:

1 To identify the life style associated risk factors of adolescents for selected non communicable diseases.

2 To assess the knowledge of adolescents regarding health promotive behaviors before and after administration of structured teaching programme

3 To determine the effectiveness of structured teaching programme on health promotive behaviors in terms of gain in knowledge score of adolescents

4 To determine the association between the knowledge of adolescents regarding health promotive behaviors and their selected personal variables.

HYPOTHESES:

H₁: The mean post test knowledge score of adolescents regarding health promotive behavior will be significantly higher than their mean pre test knowledge score.

H₂: The mean post test knowledge score of adolescents who have received structured teaching programme will be significantly higher than the mean post test knowledge score of adolescents who have not received structured teaching programme on health promotive behaviors.

H₃: There will be significant association between the knowledge of adolescents regarding health promotive behaviors and their selected personal variables.

CONCEPTUAL/ THEORETICAL FRAME WORK

The conceptual frame work of this study is drawn on the basis of the concepts in Pender’s Health Promotion model.

METHODOLOGY:

Research approach

Exploratory, evaluative approach was adopted for the study.

Research design

Phase 1- Exploratory survey

Phase 2- Quasi experimental non equivalent control group pre test ^_post test design

Variables of the study

1. Independent variable:

Structured teaching programme on health promotive behaviors.

2. Dependent variable:

Knowledge of adolescents regarding health promotive behaviors.

3. Other variables

· Life style associated risk factors of adolescents for selected non communicable diseases.

· Selected personal variables of adolescents viz. age, gender, blood pressure, height, weight, educational status of parents, type of family, economic status of family, and family history of selected non communicable diseases.

Setting of the study

Selected PU colleges in Mysore district.

Population

Population comprises of adolescents in the age group of 16 - 18yrs and studying in selected PU colleges of Mysore.

Sample and sampling

Two hundred (200) adolescents were selected for survey in phase I and eighty (80) adolescents were selected for phase II with forty (40) adolescents each in experimental and control group.

Sampling technique

Purposive sampling was used to select the adolescents for the present study.

Data collection technique and instruments

Section I: Proforma to assess selected personal variables of adolescents.

Section II: Structured life style assessment scale to assess life style associated risk of adolescents for selected non communicable diseases.

Section III:Structured knowledge questionnaire to assess the knowledge of adolescents on health promotive behaviors.

Data collection procedure

Study was conducted at the selected PU colleges of Mysore from 3^rd September 2012 to 19^th September 2012. After obtaining the formal administrative permission from the heads of selected PU colleges, subjects were selected using purposive sampling technique. During Phase I (3^rd September 2012 to 9^th September 2012), Structured life style assessment scale was administered to 200 adolescents. Phase II was conducted from 10^th September 2012 to 19^th September 2012. On day I of phase II, structured knowledge questionnaire as administered to adolescents in both experimental and control groups. Structured teaching programme on health promotive behaviors was done for experimental group on day II. Post test was given to both groups on day8.

RESULTS AND DISCUSSION:

Life style associated risk factors of adolescents for selected non communicable diseases

TABLE: 1 Frequency and percentage distribution of the life style associated risk factors of adolescents for selected non communicable diseases n= 200

Life style associated risk factors	Frequency(f)	Percentage (%)
Low risk	77	38.5
Moderate risk	123	61.5
High risk	00	00

As shown in Table 1, majority of adolescents (61.5%) had moderate risk for selected non communicable diseases.

Description of selected personal variables

Findings of the present study showed that majority (92.5%) of the adolescents were in the age group of 16-17 years and 73.75% of adolescents were females. Majority of the adolescents (78.75%) were belonging to nuclear family. 50% of adolescents consumed vegetarian foods. Majority of parents had educational status of PUC and more (76.25%). Majority of adolescents (58.75%) were having family monthly income of Rs.12001 and above. Only 3% of adolescents had over weight. 14% of adolescents had family history of diabetes mellitus, 31.25% of adolescents had family history of hypertension and 13.75% of adolescents had family history of coronary artery diseases.

Effectiveness of structured teaching programme

A. Knowledge of adolescents regarding health promotive behaviors.

Knowledge of adolescents regarding health promotive behaviours were assessed using structured life style knowledge questionnaire. The total knowledge score ranged from 0-35. The knowledge score were further arbiterily divided as poor knowledge (0-11), average knowledge (12- 23), and good knowledge (24-35). The findings are presented in Table 2.

TABLE 2 Frequency and percentage distribution of adolescents according to their level of knowledge regarding health promotive behaviors n=80

Level of Knowledge

Experimental Group n = 40

f (%)

Control Group

n =40

f (%)

Total

n₌80

f (%)

Pre-test

Poor

Average

Good

23(57.5)

17(42.5)

00 (0)

22(55)

18 (45)

00 (0)

45(56.25)

35(43.75)

00 (0)

Post-test

Poor

Average

Good

00 (0)

20(50)

22 (55)

18(45)

00(0)

22(27.5)

38(47.5)

20(25)

Majority of the adolescents (56.25%) had poor knowledge regarding health promotive behaviors (Exp-57.5%, Control-55%) in the pre-test. Data also revealed that in the post test, there was an increase in the knowledge level of adolescents in experimental group i.e., majority of adolescents (50%) in experimental group had good level of knowledge, which was not exhibited by the adolescents in the control group.

B. Gain in knowledge: Comparing pre test and post test knowledge scores of adolescents among experimental and control group

The pre test and post test knowledge scores of adolescents were tabulated to a master sheet and the total scores obtained by each adolescent in the pre test and post test were tabulated. Mean, standard deviation, median and range of pre test and post test were computed. The findings are presented in Table 3

TABLE: 3 Mean, Median, Standard deviation, and Range of pre-test and Post-test knowledge scores of adolescents in experimental and control group n=40

Group	Pre-test				Post-test
Group	Mean	Median	Range	SD	Mean	Median	Range	SD
Experimental n=40	11.06	11	7-18	±2.86	22.58	23	15-31	±4.47
Control n=40	11.25	11	6-19	±3.38	11.4	11	7-19	±2.9

TABLE 4 Mean, mean difference and paired ‘t’ value of pre-test and Post-test knowledge scores of adolescents in experimental and control groups n=40

Knowledge scores

Mean

Mean difference

SD difference

SEMD

Paired ‘t’ test value

Control group n=40

Pre-test

Post-test

11.25

11.4

-0.15

±0.48

0.5

0.798

Experimental group n=40

Pre-test

Post-test

11.08

22.58

-11.5

±1.61

0.8

31.80*

t ₍₃₉₎₌2.02; p<0.05, p>0.05 *- significant

In experimental group, the pre-test knowledge scores ranged from 7-18, with a mean score of 11.06 and standard deviation of ±2.86. In control group the pre test knowledge scores ranged from 6-19, with a mean score of 11.25 and standard deviation of ±3.38. Data also revealed that in experimental group, the post test knowledge scores ranged from 15-31, with a mean score of 22.58 and standard deviation of ±4.47. In control group the post test knowledge scores ranged from 7-19, with a mean score of 11.4 and standard deviation of ±2.9.

C. Significance of difference between pre test and post test knowledge scores of adolescents among experimental and control groups.

Paired ‘t’ value was computed to find out the significance of difference between means of pre-test and post- test knowledge scores of adolescents in the experimental and control group.

In control group, the mean difference between the pre-test and post-test mean score was -.15. To find the significance of the gain in knowledge, paired‘t’ test was computed and obtained value of t₍₃₉₎=.798 was found not significant at 0.05 level of significance. In experimental group, the mean difference between the pre-test and post-test mean score is -11.5.This indicates that there was an increase in knowledge scores of adolescents after the administration of STP. To find the significance of the gain in knowledge, paired ‘t’ test was computed and obtained value of t₍₃₉₎=31.8 was found significant at 0.05 level of significance.

D. Significance of difference between the mean post- test knowledge scores of adolescents among experimental and control groups

Independent ‘t’ value was computed to find out the significance of differences between the mean post-test knowledge scores of adolescents in experimental group and control group.

The mean difference between the post test knowledge score in experimental and control group was 11.18. The obtained value of independent‘t’ (78) = 13.25, was found statistically significant at 0.05 level of significance

Findings related to the association between the level of knowledge of adolescents regarding health promotive behaviors and their selected personal variables

The computed Chi-square values of association between the pre test levels of knowledge of adolescents regarding health promotive behaviors with their selected personal variables viz. educational status of parents and monthly income of family was statistically significant,inferring that adolescents from economically higher classes and with good parental education had better knowledge regarding health promotive behaviors.

CONCLUSION:

Majority of adolescents had moderate life style associated risk towards selected non communicable diseases and had poor knowledge regarding health promotive behaviors. Adolescents from higher socioeconomic classes with good parental education had better knowledge regarding health promotive behaviours. It was concluded that structured teaching programme was effective in increasing the knowledge of adolescents regarding health promotive behaviours which in turn help to reduce their risk for selected non communicable diseases like diabetic mellitus, hypertension, obesity and coronary artery diseases in their later life.

LIMITATIONS:

¨ The study was limited to adolescents in selected PU colleges in Mysore.

¨ Study adopted non probability purposive sampling, hence the generalization of the findings outside study samples are limited.

¨ The sample size was limited to 200 for survey and 80 for experimental study. Hence this limits the generalization of findings beyond the study samples.

RECOMMENDATIONS:

· Similar study can be carried out on a large sample for broader generalization.

· A comparative study can be undertaken to compare the life style practices and knowledge of adolescents regarding health promotive behaviors in urban and rural area.

· Similar studies can be conducted to assess the effectiveness of other educational strategies to improve the knowledge of adolescents regarding health promotive behaviors.