Impact of Health Education Programme on knowledge regarding prevention of complications of diabetic mellitus among diabetes veterans at selected old age home of Baroda

 

Neha Patel1*, Ravindra  H.N.2

1MSc Nursing Student, Sumandeep Nursing College, Sumandeep Vidyapeeth, Piparia, Vadodara-391760 Gujarat India

2HOD of MSN, Sumandeep Nursing College, Sumandeep Vidyapeeth, Piparia, Vadodara-391760 Gujarat, India

*Corresponding Author Email: patelneha.5790@yahoo.com

 

ABSTRACT:

Introduction: According to WHO (1994) Diabetes Mellitus is characterised by hyperglycaemia and disturbance of the carbohydrate, fat and protein metabolism that is associated with the absolute or relative deficiencies of insulin action or secretion. India has now been declared by WHO as the diabetes capital of the world. The choice of treatment and complaints is important for the metabolic control to be achieved by the diabetic patients. While diet, exercise and oral drugs are useful in controlling diabetes in many patients, it is now recognized that a large number of Type 2 diabetic patients require insulin therapy. The number of adults with diabetes in the world will rise from 135 million in 1995 to 300 million in the year 2025. The major part of this numerical increase will occur in developing countries.

Objectives: The objectives of the study were to determine the level of knowledge on prevention of complications of diabetic mellitus, evaluate the effectiveness of health education program in terms of gain in knowledge score among diabetes veterans, and find an association between level of pre test knowledge of diabetes veterans with their selected demographic variables.

Materials and methods: An evaluative research approach with pre-experimental one group pre-test and post-test design was used. 40 samples were collected by using convenient method from jalaram seva trust and community old age home care. Tool consisted of 6 demographical variables and 30 structured questioners was administered before and after HEP. The reliability of the tool was established by using test retest method. Data was analzed using inferential and descriptive statistics.

Result: Paired sample t-test revealed that the mean posttest knowledge score regarding prevention of complications of DM was significantly higher (24.23 ± 3.69) than that of mean pretest knowledge score (15.63 ± 3.91) (P< 0.05).  Computed T value 12.908 is higher than table value t99  at P< 0.05. Hence hypothesis is accepted and thus shows that HEP was highly effective in increasing knowledge of prevention of complications of DM among Diabetes veterans.

Conclusion: The study finding revealed that health education programme was highly effective in improving knowledge of prevention of complications of DM in Diabetes veterans.

 

KEYWORDS: Impact, knowledge, health education programme, diabetes mellitus, diabetes veterans.  

 

 

 

 

INTRODUCTION:

Diabetes Mellitus is a disease known during the period of 1500 BC and it was described by Ebers Papyrus of ancient Egyptians. In 1000 BC Sushrutha, the father of medicine in India, diagnosed Diabetes Mellitus. The diseasewas explained by Charaka in 400 BC and the same concept was described in 200 AD by Aratenus Cappadocia.1

The term “Diabetes Mellitus” is derived from the Greek word, “diabetes” meaning “to go through” or a siphon and the word “mellitus” is derived from the Latin word “mel” meaning honey describing the sweet odour of urine.2

 

According to WHO (1994) Diabetes Mellitus is characterised by hyperglycaemia and disturbance of the carbohydrate, fat and protein metabolism that is associated with the absolute or relative deficiencies of insulin action or secretion.

 

The different types of Diabetes Mellitus as adopted by the WHO (1995) include Type 1 - insulin dependent Diabetes Mellitus (IDDM), Type 2 - non- insulin dependent Diabetes Mellitus (NIDDM) and gestational Diabetes Mellitus.3

 

India has now been declared by WHO as the diabetes capital of the world. The choice of treatment and complaints is important for the metabolic control to be achieved by the diabetic patients. While diet, exercise and oral drugs are useful in controlling diabetes in many patients, it is now recognized that a large number of Type 2 diabetic patients require insulin therapy.4

 

According to the IDF’s 2003 statistics, committee of RSSDI 2009 report, the World Health Organization and the International Diabetes Federation predict that India has the highest numbers of diabetics in the world.5 Hence Knowledge about the disease plays a vital role in future development of disease and its early prevention and detection. Research studies have shown that wherever massive education regarding diabetes mellitus is provided to general population, it resulted in significant increase in knowledge about the disease6.

 

NEED FOR THE STUDY:

“Uncontrolled diabetes can damage vitalorgans”.

 

"India accounts for the largest number of people - 61.3 million - suffering from diabetes in the world, followed by China and the United States. Gujarat is having the second highest number of diabetics in the country after Tamil Nadu. Gujaratis are genetically prone to this disease. Furthermore, our less physical work environment and bad eating habits are responsible for the current high prevalence of type 2 diabetes in the state," a release from CHARUSAT mentioned, adding that although there is no cure for diabetes, it can be managed fairly well with appropriate interventions and treatments.

 

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).7

 

As many as 37% of patients with diabetes suffer at least one microvascular complication, and at least 13% have more than one. In a study of 3010 diabetics by Ramachandran, the prevalence of microvascular complications was – Retinopathy – 23.7%, Nephropathy-5.5%, Neuropathy-27.5% and Prevalence of CHD-11.4% and PVD was 4%. In our own study from North Delhi Diabetes Centre comprising 720 type-2 diabetics, Retinopathy was seen in 21.2%, Micoralbuminuria in 41%, Peripheral Neuropathy in 15.3%, CAD in 7% and PVD was seen in 7.4% of patients.

 

PROBLEM STATEMENT:

"Impact of health education programme on knowledge regarding prevention of complications of diabetic mellitus among diabetes veterans at selected old age home of Baroda"

 

Objectives:

The objectives of the study were to:

1.    Determine the level of knowledge on prevention of complications of diabetic mellitus.

2.    Evaluate the effectiveness of health education program in terms of gain in knowledge score among diabetes veterans.

3.    Find an association between level of pre test knowledge of diabetes veterans with their selected demographic variables.

 

Operational definition:

    Health education program: In this study, health education program refers to systematically program providing knowledge regarding prevention of complication of diabetes mellitus.

    Knowledge: In this study knowledge refers to it is ability and understand of the diabetes veterans to answer the question regarding prevention of complications of DM.

    Diabetes mellitus: for the purpose of the study it will mean diabetes mellitus with a blood sugar level of 10mm1/L and above and the diabetes mellitus may be experience complication of DM.

    Prevention: Prevention is the action or measure intended to avoid complication or the disease.

    Complication: it is refer to secondary disease or condition aggregating and already existing one.

 

    Diabetes veterans: person who have diabetes history more than 5 years.

    Old age home: A retirement home – sometimes called an old people's home, although this term can also refer to a nursing home – is a multi-residence housing facility intended for senior citizens. 

 

Hypothesis:

The study is based on the hypotheses:

H1: The mean post test knowledge score of diabetes veterans on complication of diabetes mellitus will be significantly higher than their mean pre-test knowledge scores.

H2: There will be significant association between pre-test knowledge score of diabetes veterans with their selected demographic variables.

 

Assumption:

The study assumes that:

1.    Diabetes veterans will show the pre-test knowledge and score of diabetic mellitus.

2.    Knowledge of diabetes veterans can be assessed by using structured knowledge questionnaire.

3.    Health education program can bring about desired changes in the individuals lifestyle.

 
Delimitations:
The study is limited to:

1.    Diabetes veterans having diabetic mellitus more than 5 years.

2.    Who are willing to participate.

3.    Diabetes veterans who are present at the time of data collection.

 

Conceptual Framework: General Model by Bertanlanffy (1968) was used as conceptual framework.

 

MATERIALS AND METHODS:

Research Approach: Evaluating approach was used.

Research Design: A pre- experimental research one group pre-test post-test design was adopted

 

Setting of the Study:  The study was conducted in two selected old age homes of Vadodara district.

 

Target Population:  In the present study, the target populations were diabetes veterans residing  in oldage homes.

 

Sample: A total of 40 diabetes veterans from selected oldage homes of Vadodara formed the sample for the study.

 

Sampling technique: Non-probability convenience sampling technique was used to select the sample for this study.

Development of tool for data collection: it consists of 2 parts:

Part 1: The demographical variables are age, gender, marital status, monthly income, previous area of working and previous area of living.

 

Part –2:  Structured questionnaire consisting of 30 items on knowledge about prevention of complications of Diabetic Mellitus. The questionnaires consist of total 3 sections this are:

    Introduction of Diabetic Mellitus

    Complication and its management of Diabetic Mellitus

    Prevention of complication of Diabetic Mellitus

 

Validity of instrument: The content validity of the tools was obtained from various experts of concerned field like medicine, nursing, research and statistics.

 

Reliability: Reliability of the tool was tested by split half technique (Spearman’s Brown prophecy) where r = 0.9% was found and inter rater reliability (Karl Pearson Co-efficient correlation formula) where r = 0.86% was obtained.

 

A pilot study was conducted with five diabetes veterans to refine the methodology and to find the feasibility of the study.

 

Development of health education programme:

The following steps were adopted to develop to the health education programme.

    Development of content blueprint.

    Development of Health Education Programme

    Establishment of content validity of Health Education Programme

    Pre-testing of Health Education Programme

    Planning for Health Education Programme

 

Data collection procedure:

Data collection for the study was conducted at the selected oldage homes of Vadodara where the feasibility of conducting study was ensured after a written permission was obtained from the oldage homes manager  for undertaking the study.

 

Informed consent was also taken from the participants.  The socio demographic data and knowledge on prevention of complications of DM, of the participants were collected by using close ended questionnaire. Data was collected from 40 diabetes veterans. Immediately after pre-test, Health Education Programme on were administered to the participants with the help of power point presentation, chart, flash cards. Evaluation of the Health Education Programme was be done by conducting post-test, 7 days after the implementation of Health Education Programme.

 

RESULT:

The finding discussed under the following heading based on the objectives of the study.

Part I : Description of Demographic characteristic of the samples

Part II : Analysis of knowledge of diabetes veterans

Section A : Description of the level of knowledge

Section B : Area wise description of knowledge score

Part III: Evaluation of the effectiveness of health education programme regarding prevention of complications of DM

Part IV: Testing the hypothesis.

 

Part I:

Description of Demographic characteristic of the samples

Age wise distribution of the study sample revealed that the highest percentage (50%) of the sample were in the age group of 70-79 years, (30%) of the respondent were between 80-89 years  and (20%) of the respondent were between 60-69years.

 

With regard to the gender of the diabetes veterans shows that majority (55%) of them were males and (45%) of the subjects were females.

Marital status wise distribution of the study sample revealed that the highest percentages (75%) of the sample were widow/ widower, 15% of the respondents were married and 5% of the respondents were unmarried and divorced.

 

Percentage distribution of diabetes veterans on the basis of socio-economic status reveals that majority 60% of the respondent had income between 5001-10,000Rs , 25% of the respondent had income below 5000Rs and 7.5% of the respondent had income between 10,001- 15,000Rs and 7.5% of the respondent had income above 15,001 Rs.

 

Percentage distribution of diabetes veterans on the basis of previous working area reveals that majority 42.5% of the respondents were working in private sector, 40% of the respondents were working in other sector and 12.5% of the respondents were working in government sector and 5% of the respondents were working in semi government sector.

 

Percentage distribution of diabetes veterans on the basis of previous place of residence reveals that majority 82.5% of the respondents were living in urban area and 17.5% of the respondents were lining in rural area.

 

 

 

 

PART II:

Analysis of knowledge of diabetes veterans regarding prevention of complications of dm

Section A : Description of level of knowledge

Table: 1  Grading of Pretest Knowledge Scores of Diabetes veterans.

Range of Score

Percentage of Score

Level of Knowledge

Number of diabetes veterans

Percentage of diabetes veterans

0 – 10

0 - 33.33

Poor

1

2.5

10 – 20

33.33 - 66.66

Average

35

87.5

20 – 30

66.66 – 100

Good

4

10

Total

40

100

 

The level of knowledge of diabetes veterans shows that majority 35 (87.5%) of the sample had average knowledge, 4 (10%) of the subjects had good knowledge regarding and 1 (2.5%) had poor knowledge regarding prevention of complications of Diabetes Mellitus.

 

Table: 2 Grading of  Post test Knowledge Scores of Diabetes veterans.

Range of Score

Percentage of Score

Level of Knowledge

Number of diabetes veterans

Percentage of

diabetes veterans

0 – 10

0 - 33.33

Poor

0

0

10 – 20

33.33 - 66.66

Average

04

10

20 – 30

66.66 - 100

Good

36

90

Total

50

100

 

The level of knowledge of diabetes veterans shows that majority 36 (90%) of the sample had good  knowledge, 4 (10%) of the subjects had average knowledge regarding and none of them had poor knowledge regarding prevention of complications of DM (table 2).

 

Section B: Area wise description of knowledge score

 

Table 3 : Distribution of area wise mean, SD and mean percentage of knowledge scores.

Sl. No

Knowledge score

Maximum possible scores

Pre test

Post test

Mean %

Mean 

SD

Mean

SD

Pre

post

1

1. Introduction of DM

09

5.13

1.07

7.58

1.13

57

84.22

2

2. Complication and Management of DM

11

6.225

1.48

8.85

1.45

56.59

80.45

3

3. Prevention of complications of DM

10

4.27

1.36

7.8

1.11

42.7

78

 

Total

30

15.63

3.91

24.23

3.69

52.1

80.77

 

Area wise distribution of the knowledge scores of the diabetes veterans  reveals that out of 30 maximum obtainable scores the total mean score was 15.63 which is 52.1% of the maximum score. The highest mean percentage (57%) was obtained in the area of “Introduction of DM” with mean and SD of 5.13± 1.07. The mean percentage of 56.59 was obtained in the area of “Complication and management of DM  with mean and SD of 6.225 ± 1.48and the mean percentage of 42.7  was obtained in the area of “prevention of complications of DM” with mean and SD of 4.27 ± 1.36.

 

PART III:

Evaluation of the effectiveness of health education programme regarding prevention of complication of DM..

Section A: Quartile distribution of pre-test and post-test knowledge scores of diabetes veterans.

 

 

 

Fig. 1 :       Quartile distribution of knowledge scores of the diabetes veterans in pre-test and post-test.

 

The data presented in the form of ogive shows that there is a significant difference between pre-test and post-test scores. By graphical method the pre-test median score was 16.19 whereas post-test median score was 25. The ogive plotted shows that the post-test score is higher than the pre-test score in the first second as well as the third quartile. The ogive indicates that there is a significant increase in knowledge of the diabetes veterans regarding prevention of complications of DM.

 

 

Section B :Areawise effectiveness of HEP

 

Table 4 : Areawise effectiveness of HEP distribution of Mean, SD and Mean percentage of knowledge score of diabetes veterans

 

Areas

No. of Statement

Score

Knowledge Scores

Paired ‘t’ test value

Pre-test (x)

Post-test (y)

Effectiveness (y-x)

Mean

SD

Mean %

Mean

SD

Mean %

Mean

Mean %

1. Introduction of DM

09

09

5.13

1.07

57

7.58

1.13

84.22

2.45

27.22

2.864

2. Complication and Management of DM

11

11

6.225

1.48

56.59

8.85

1.45

80.45

2.63

23.91

4.465

3. Prevention of complications of DM

10

10

4.27

1.36

42.7

7.8

1.11

78

3.53

35.3

5.579

Total

30

30

15.63

3.91

52.1

24.23

3.69

80.77

8.61

28.7

12.908

 

Area wise distribution of knowledge score of the diabetes veterans reveal that, the mean post-test knowledge score was 84.22% than the mean pre-test knowledge score 57%. The effectiveness score was 27.22%. The ‘t’ value was computed to find the level of significance between the Means and it was observed very highly significant (‘t’ = 2.864) significance at 0.05 level for the ‘Introduction of DM.’

 

The knowledge score of Mean post-test was 80.45% than the Mean pre-test score of 56.59% with the effectiveness of 23.91%. The statistical test indicates the effectiveness of score was 23.91% found very highly significant (‘t’ = 4.465) significance at 0.05 level for the ‘Complication and Management of DM.’

 

The mean post-test knowledge score of ‘prevention of complications of DM’ was observed to be 78% than the mean knowledge pre-test score of 42.7% with the effectiveness knowledge score of 35.3% established significant result ‘t’ = 5.579 and significance at 0.05 level which is highly significant.

 

The enhancement of knowledge score was more in the prevention of complications of DM (35.3%) followed by Introduction of DM(27.22%) and prevention of complications of DM (29.20%).

 

 

 

 

 

Fig. 2 : Areawise knowledge score on prevention of complications of DM

 

PART IV:

Testing the research hypothesis

1) H1= the mean post-test knowledge scores of diabetes veterans will be significantly higher than the mean pre-test knowledge score regarding prevention of complications of DM.

 

Scores of respondents in pre-test and post-test

To find the significant difference between computed mean of pre-test and post-test knowledge score, the paired ‘t’ test was calculated.

 

Table 5: Significance of the difference between pre and post-test knowledge Score                                                                                                                   

Areas

Mean effectiveness

‘t’ value

Table value

Level of significance at 0.05

Introduction of DM

2.45

2.864x

2.306

HS

Complication and Management of DM

2.63

4.465x

2.210

VHS

Prevention of complications of DM

3.53

5.579x

2.262

VHS

Total

8.61

12.908

2.045

VHS

 

Pre-test and post-test mean knowledge scores and ‘t’ value showed that the mean gain in knowledge was 8.61. The ‘t’ value was significant (t=12.908) at 0.05 level indicating the health education programme regarding prevention of complications of DM was effective. Hence, stated research hypothesis is accepted.

 

2) H2. There will be significant association between level of pre test knowledge regarding prevention of complications of DM with selected demographic variables

 

Table 6: Association between Level of Pretest Knowledge Scores and Selected Variable

Characteristics

Frequency

Level of knowledge

df.

Chi- sq. value

Table value

Significant

at 0.5%

Poor

(0-10)

 Average

(11-20)

Good

(21-30)

1.     Age

 

60 - 69

8

0

6

2

 

6

 

 

5.811x

 

 

5.35

 

S

70 – 79

20

0

18

2

80 – 89

12

1

11

0

90– Above

0

0

0

0

2.     Gender

 

Male

22

0

19

3

2

1.87x

1.39

S

Female

18

1

16

1

3.     Marital status

 

Married

06

0

4

2

6

71.58x

5.35

S

Unmarried

02

0

0

2

Widow

30

0

30

0

Divorce

           02

1

1

0

 

4.     Monthly income

 

Below – 5000

10

1

9

0

6

28.12x

5.35

 

S

5001 – 10000

24

0

24

0

10001 –15000

03

0

1

2

15001 - above

03

0

1

2

 

 

 

 

5.     Previous area of working

 

Private sector

17

0

15

2

 

 

6

 

 

8.4009x

 

 

5.35

 

 

S

Government sector

05

0

3

2

Semi government sector

02

0

2

0

Other

16

1

15

0

6. Previous area of living

 

 

 

 

 

 

 

 

Urban

33

0

29

4

2

1.542x

1.39

S

Rural

07

1

6

0

 

 

 

 

 

 

 

 

Finding reveals that there is association between pretest knowledge score and the HEP is effective to increase the knowledge of respondents and another finding reveals that there is significant association of age group, gender, and economic condition, previous area of working and previous area of living with pretest knowledge of respondents with their pre knowledge score. Hence, stated research hypothesis is accepted.

 

DISCUSSION:

The present study was conducted to determine the effectiveness of HEP on Prevention of complications of DM among diabetes veterans in selected oldage homes at Vadodara city. Hence observed that post-test knowledge score mean difference was 28.7% and the  ‘t’ value was 12.908. The significance was set at 0.05 levels. It is observed that health education program is very effective tool in improving the knowledge of diabetes veterans.

 

ACKNOWLEDGEMENT:

I express my gratitude and thanks towards all who have directly or indirectly helped me to complete this study and their support in each major step of the study.

 

ETHICAL STANDARDS

This study was conducted after getting approval from the Institutional Ethics Committee and after obtaining written consents from all subjects.

 

REFERENCES:

1.    http:// www.clinical evidence.org/a web

2.       Black JM, Luckmann, Sorenson. Medical Surgical Nursing, A Psychosocial Approach. 4th edition. Toranto, W.B. Saunder, s Company; 1993

3.       Park K. Text book of Preventive and Social Medicine. 17th edition. Jabalpur: M/S. Banarasidas Bhanot Publishers; 2002

4.       http://www.diabetes herbs.com

5.       MA Martinez-Gonzalez. Prevalence and risk of developing Diabetes. British Medical Journal Published online. 2006

6.       Barnard ND, Katcher HI. Knowledge of Diabetes Management. Nutr Rev. 2000; May 67(5): 255-63.

7.       Misra P, Upadhyay RP, Misra A, Anand K. A review of the epidemiology of diabetes in rural India. Diabetes Res ClinPract. 2011 Jun;92(3):303-11

 

ABBREVETION USED FOR STUDY

SHORT FORM

FULL FORM

DM

Diabetic mellitus.

IGT

Impaired glucose tolerance

IFG

Impaired fasting glucose

HEP

Health education programme.

and

And

S

Significant

NS

Not significant

FIG.

Figure

SD

Standard deviation

PPT

Power point presentation

A.V. AIDS

Audio visual aids

DF

Degree of freedom

 

 

 

 

Received on 26.03.2015           Modified on 11.05.2015

Accepted on 28.05.2015          © A&V Publication all right reserved

Asian J. Nur. Edu. and Research 5(3): July- Sept.2015; Page 405-412

DOI: 10.5958/2349-2996.2015.00081.6