Knowledge and Attitude of Nursing
Personnel and Accredited Social Health Activists (ASHAs) Regarding Prevention of Female Foeticide
in Faridabad, Haryana
Sr. Merly1, Dr. Mrs. Angela
Gnanadurai2
1St. James College of Nursing, Chalakudy,
Thrissur, Kerala
2Principal,
Jubilee College of Nursing, Thrissur, Kerala
*Corresponding Author Email: fccmerly@gmail.com
ABSTRACT:
The
present study was aimed to assess the effectiveness of structured training
program regarding prevention of female feticide on knowledge and attitude of
nursing personnel and Accredited Social Health Activists (ASHAs). The
conceptual framework of the study was based on Imogene M. King’s theory of goal
attainment (1981). The research approach included both quantitative and qualitative.
One group pretest-posttest design was used to assess the effectiveness of
training program and phenomenological approach is used to analyze the experience
of nurses and ASHA workers regarding female foeticide.
The sample consisted of 39 subjects in interventional group and 40 in control
group. The instruments of data collection include a self developed self
administered knowledge questionnaire to assess the knowledge regarding female foeticide, a 5 point likert scale to assess the
attitude of sample towards female foeticide and a
short film on prevention of female foeticide to
sensitize the nurses and ASHA workers. An in-depth interview was used to assess the experience of nursing personnel and ASHA workers regarding
female foeticide. After pretesting of knowledge and attitude of interventional and control
group, training program
was administered to the intervention group, which include teaching program
regarding selected aspects of female foeticide and administration
of short film- ‘JEEVANNIDHI’, which was prepared by the investigator. An
in-depth interview was conducted for every 10th sample in
the interventional and control group in order to analyze the experience of nursing personnel and ASHA workers
regarding female foeticide.
Post interventional assessment was done at one week and one month both in the interventional and
control group. Among the total 79 sample, there were 56 ASHA workers, 20 ANMs
and 3 LHVs. During the second post assessment, all the nurses and ASHA workers in the
interventional group had excellent
knowledge where as none of them had excellent knowledge in the
control group. The mean post test attitude (156.65) of nurses and ASHA workers is
higher than their mean pre test attitude (136.53). The results show significant
difference in the knowledge and attitude score between the interventional and
control group at 0.01 level of significance. The
findings reveal that the training program is effective in sensitizing the nurses
and ASHA workers
regarding prevention of female foeticide.
The findings of qualitative analysis reveal that the nurses and ASHA workers are sensitized
about the issue and they want to take immediate steps to eliminate female foeticide from our country.
The results substantiate that the nurses and ASHA workers can become channels
in the prevention of female foeticide.
KEYWORDS:
Female foeticide, training program, ASHAs, knowledge, attitude.
Contemporary
Indian society professes a profound faith in every individual’s right to life and
dignity. The rights relating to the weaker and vulnerable sections of Indian
society especially women and more specially the girl child were violated.1
Today, the rejection of the unwanted girls begin even
before her birth. Female feticide is a reality of some societies that
discriminate the unborn females and subject them to silent deaths inside the
womb itself.2 Sex ratio is a
sensitive social indicator of development
and it shows the status of women in a country. Prenatal sex
determination tests followed by quick abortions eliminate thousands of female
fetuses. This is due to the mentality that looks down upon the female child as
a burden.3 In India, the child sex ratio has dropped into 914
females against 1000 males
(2011 census). Haryana has the lowest sex ratio in the country at
830 females per 1000 males. Selective abortion is very prominent in the state,
reflecting a widespread preference for male child.4
At
a recent symposium on female foeticide organized by
J.K Banthia, Registrar, General and Census
commissioner of India,
said “Two major goals of India’s current population policies are population
stabilization and sex ratio parity.” An official from the Department of Family
Welfare, added, “There are two important strategies to solve the problem of
female feticide. One is education and the second is employment.”5 It is
felt that unless immediate action is taken to change the mindset of the people,
the girl child is on her way to utter deprivation, destitution and even
extinction.6 There is urgent need to embark on a massive
nationwide sensitization and advocacy compaign with specific focus on the importance of girl
child to reinforce the view that she is an asset not a burden.7 Nursing
has a direct impact on the society and the health of the mother. Nurses and ASHA
workers can act as the disseminator of the information on prevention of female
feticide. For this, nurses themselves should become knowledgeable about the
different aspects of female feticide in order to sensitize the people.8
STATEMENT OF
THE PROBLEM:
‘A
study to evaluate the effectiveness of structured training program regarding
prevention of female feticide on knowledge and attitude of nursing personnel and Accredited Social
Health Activists (ASHAs) in Faridabad
district, Haryana.’
OBJECTIVES:
1 To assess the knowledge and attitude of nursing personnel and
ASHAs regarding prevention of female foeticide before
and after structured training program.
2 To compare the level of knowledge and attitude regarding
prevention of female foeticide among nursing
personnel and ASHAs before and after structured training program.
3 To find the association between knowledge and attitude of
nursing personnel and ASHAs regarding female foeticide structured training program.
4 To analyze the experiences of nursing personnel and ASHAs regarding prevention
of female feticide.
Hypothesis:
H1- There will be significant difference in the pre
and post-assessment score of knowledge
of nursing personnel and ASHAs regarding prevention of female feticide
at 0.05 level of significance.
H2- There will be significant difference in the pre
and post-assessment score of attitude of nursing personnel and
ASHAs regarding prevention of female feticide at 0.05 level of
significance.
H3- There will be significant correlation between
knowledge and attitude of nursing personnel and ASHAs regarding prevention of female
feticide at 0.05 level of significance.
CONCEPTUAL
FRAMEWORK:
The
conceptual framework used for this study is based on Imogene. M. King’s goal
attainment theory (1981). It is based on the assumption that humans are open
systems in constant interaction with their environment.
MATERIALS AND
METHODS:
Research approach:
Qualitative
and Quantitative research approach is used for the study.
Research design:
Pretest-posttest
design was used to assess the effectiveness of structured training program.
Phenomenological research design was used for conducting interview to the
experts in the field regarding female feticide and to develop tools and intervention. An in-depth interview is
conducted for the nursing personnel and ASHAs to analyze the experience
regarding female feticide.
Setting of the study:
The
study is conducted in RCH FRU 11, Ballabgarh – interventional group and Palla PHC- control group in
Faridabad district, Haryana.
Population:
The
population of this study consists of nursing personnel and ASHA workers in
Faridabad district of
Haryana.
Sample:
39
samples were included in the interventional group and 40 in control group
Sampling technique:
Purposive
sampling technique is used
for the study.
Tools for
data collection:
1.
Self Developed Self Administered Structured Questionnaire (SDSASQ):
Section
A:
Sociodemographic profile
of sample, which include age, sex, religion, education, place of residence, workplace,
experience, income, marital status, type of family and family size.
Section
B:
Self
developed self Administered structured
questionnaire to assess the knowledge of nursing personnel and ASHAs regarding prevention
of female feticide. There are total 33
items. The grading of knowledge score include excellent: 80-100%, Good: 60-79%,
Average: 40-59% and poor : ≤ 39%.
2.
Likert scale:
A
5- point Likert scale is used to assess the attitude of
nursing personnel and ASHAs towards female
feticide. The Likert scale contains 40 items in which there were 24 positive statements and
16 negative statements and the total
score is 200. It is categorized as positive : 70-100%,
neutral: 35-70% and negative: 0-35%
3.
Structured Training program: Section. A:
Teaching
regarding selected aspects of female foeticide using
power point presentation, which include
general concept of female foeticide, sex ratio,
consequences of female foeticide and strategies to prevent female foeticide.
Section. B:
Short
film- ‘JEEVANNIDHI’, which is prepared by the investigator with the help of
GOODNESS T V, in
order to sensitize the subjects regarding the issue of female foeticide. Its duration is 30 minutes.
4.In-depth
Interview:
An
in-depth interview
was prepared in order to analyze the experience of nursing personnel and
ASHAs regarding female foeticide for every 10th sample in the
interventional and control group.
Method of data collection:
Formal
permission is collected from State Appropriate Authority-cum-Director General, Health
services, Haryana and District Appropriate Authority (PNDT) –cum-Civil Surgeon,
Faridabad District. Informed consent is taken from the nursing personnel and
ASHAs before data collection. Pilot study was started on 26/08/14. After the pretesting of knowledge and
attitude of nursing personnel and ASHAs in the interventional and control group, training program
was implemented only to the
interventional group. The training
program had two sessions; the first session was teaching the nursing personnel
and ASHAs regarding selected aspects of female foeticide
with the aid of power point presentation
and the second session was
administration of short film- ‘JEEVANNIDHI’ on prevention of female foeticide. Post-interventional assessment of knowledge and
attitude of both interventional and control group is
done at one week on 02/09/14,
and at one month, on 25/09/14 . An In depth-interview has been conducted for every 10th sample
in the interventional and control group in order to assess their experiences
related to female foeticide.
RESULTS:
Part.1:
Description of sociodemographic variables of sample
·
71.8% of the sample in
the interventional group and 55% of them in the control
group were above the age group of 30
years. All the samples were females and 97.4% of them in the interventional group and 92.5% in the control group were belong
to the Hindu religion.
·
In the
interventional group, 25 of them were ASHA workers, 12 ANMs and 2 lady health visitors. Where as in
the control group, 31 of them were ASHA workers, 8 ANMs and one lady health visitors.
·
Most of the
subjects, 74.4% in the interventional group and 92.5% in the control group
are from rural area. Majority of the sample, 97.4% in the interventional group and 95% in the control group were married and 87.2% in the interventional group and 57.5%
in the control group had more than 4
years of experience.
·
Regarding the
likeness of sex of the baby, 97.4% of the subjects in the interventional group and 70% in the control group had neutral opinion, they don’t
mind in having girl or boy.
·
Almost all the nursing personnel
and ASHAs had received the
information regarding the prevention of female foeticide.
Among those who received the information, 76.9% of them in the interventional group
and 45% in the control group received it from the health personnel.
Part.2: Description of knowledge of
nursing personnel and ASHA workers regarding prevention of female foeticide in the interventional and control group before and after the
training program
It
is evident from the table -1 that in the interventional group, none of the
sample had excellent knowledge in the pretest. Where as in the 1st
post test, 21 (53.8%) of them had excellent knowledge and in the 2nd post test, all
of them had excellent knowledge. In the control group none of them had
excellent knowledge during pre and post assessments.
Table. No.1.
Frequency and percentage
distribution of pre and post test knowledge score
of sample in the interventional and
control group N==79
|
|
Pretest |
Post test-1 |
Posttest-2 |
|||||||||
|
Level of knowledge |
Interventional Group (39) |
Control Group (40) |
Interventional Group (39) |
Control Group (40) |
Interventional Group (39) |
control group
(40) |
||||||
|
F |
% |
F |
% |
F |
% |
F |
% |
F |
% |
F |
% |
|
|
Excellent (80-100% |
0 |
0.0 |
0 |
0.0 |
21 |
53.8 |
0 |
0.0 |
39 |
100 |
0 |
0.0 |
|
Good (60-79%) |
0 |
0.0 |
13 |
32.5 |
18 |
46.2 |
11 |
27.5 |
0 |
0.0 |
10 |
25 |
|
Average (40-59%) |
33 |
84.6 |
21 |
52.5 |
0 |
0.0 |
26 |
65.0 |
0 |
0.0 |
25 |
62.5 |
|
Poor (≤ 39%) |
6 |
15.4 |
6 |
15 |
0 |
0.0 |
3 |
7.5 |
0 |
0.0 |
5 |
12.5 |
Table No.2. Findings related to
comparison of level of
knowledge of sample in the
control and interventional groups
N=79
|
Variables |
Interventional
group(39) |
Control
group (40) |
t-value |
p-value |
||
|
Mean |
SE |
Mean |
SE |
|||
|
Pre-knowledge |
15.33 |
0.413 |
17.05 |
0.651 |
2.213* |
0.030 |
|
Post 1 |
26.10 |
0.423 |
17.05 |
0.500 |
13.787** |
<
0.001 |
|
Post 2 |
32.79 |
0.075 |
16.18 |
0.706 |
23.114** |
<
0.001 |
**
significant at 0.01 level; * significant at 0.05 level
Table. No.3.
Frequency and percentage
distribution of pre and post attitude score
of sample in the interventional and
control group N=79
|
|
Pretest |
Post test-1 |
Posttest-2 |
|||||||||
|
Level of
attitude |
Interventional Group (39) |
Control Group (40) |
Interventional Group |
Control group |
Interventional group |
control group |
||||||
|
F |
% |
F |
% |
F |
% |
F |
% |
F |
% |
F |
% |
|
|
Positive (70-100% |
31 |
79.5 |
34 |
84.0 |
38 |
97.4 |
26 |
65 |
38 |
97.4 |
37 |
95 |
|
Neutral (35-70%) |
8 |
20.5 |
6 |
15.0 |
1 |
2.6 |
13 |
32.5 |
1 |
2.6 |
2 |
5.0 |
|
Negative (0-35%) |
0 |
0.0 |
0 |
0.0 |
0 |
0.0 |
1 |
2.5 |
0 |
0.0 |
0 |
0.0 |
Table No.4. Findings related to comparison of attitude score of sample in the experimental and control
groups N=79
|
Variables |
Interventional group (39) |
Control group (40) |
t-value |
p-value |
||
|
Mean |
SE |
Mean |
SE |
|||
|
Pre-Attitude |
149.08 |
3.255 |
145.80 |
3.489 |
0.686ns |
0.495 |
|
Post 1 |
156.67 |
2.477 |
136.53 |
3.920 |
4.320** |
< 0.001 |
|
Post 2 |
160.08 |
1.578 |
151.58 |
1.945 |
3.385** |
0.001 |
** significant at 0.01
level; ns non significant at 0.05 level
The above table depicts
that there is significant difference in the level of knowledge score between
interventional and control group.
Hence research hypothesis, H1 is
accepted.
Part.3:
Description
of attitude of nursing personnel and ASHAs regarding prevention of female foeticide in the interventional and control group
It
is evident from the table- that in the interventional group, 31 of them had positive
attitude in the pretest. In
first and second post
assessments, 38 of them had positive attitude,
one sample had neutral attitude and none of them had negative attitude.
The above table
shows there is no significant
difference in the pre attitude score between
the experimental group and control group, whereas in the first and second post
assessments, there is significant
difference at 0.05 level between
the attitude score of experimental
group and control group.
Table .5. Correlation between
between knowledge and attitude score of nursing personnel and ASHAs regarding prevention of female foeticide N=79
|
Group |
Correlation |
p-value |
|
Experimental |
0.075 |
0.649 |
|
Control |
-0.070 |
0.668 |
|
Overall |
-0.036 |
0.754 |
The
above table shows that there is no relation between the knowledge and
attitude score of nursing personnel and
ASHAs between the interventional and control group.
Part.4.
Qualitative analysis of subjects regarding the experience of female foeticide:
An in-depth interview was conducted for every 10th
sample in the interventional and control group to assess the
experiences of nurses and ASHA workers regarding the different aspects
of female feticide. The important points
of the interview include:
1.
What is your opinion about female feticide?
·
Female foeticide is a social evil and it should stop at any
cost
·
We should give more orientation for
the prevention of female foeticide.
2. Why do people prefer sons?
·
Boy carries the name of the family
·
“People think that only boy carries the name of the family; But actually
girls carry the name
of the generation”.
·
“People think only boy can take care of the assests-
land, building, agriculture; but girls also can manage that”.
3. What are the reasons for female feticide?
·
Dowry is the main reason- All the respondents suggested dowry as the main reason.
·
“Husband and in-laws has more importance in family in decision making than woman in the. So woman
act according to their will”
4. What is your perception about dowry?
·
We should not
give and take dowry; we should stop
dowry system a.t any cost
·
Dowry is the
cause for many problems in the family including suicide of women.
5. What are the challenges faced by the
women in Faridabad with regard to female foeticide?
·
“Women are not
coming out of houses
; family members torture them for the
issue of female foeticide.; few of them even go to their own house after marriage because of
the problem with sex of the baby”.
6. What can we do to improve the status
of women in our society?
·
Only through
awareness to the girls, we can stop female foeticide
·
Women should come
together and support each other.
7.
What do you think about the social consequences of
female feticide?
·
“The number of females will come down and from
where the man get
wives?”
·
The existence of
the society will be affecting.
8. How can we
prevent gender discrimination and female feticide ?
·
We should stand
together , discuss and act together
against the female foeticide
·
Improve the awareness
about the issue to all categories of society.
9.
Have you come across woman
with history of female feticide?
If yes. What was the reason?
· Yes. “ I have come across
about 15-20 cases during my seven years of experience. After the registration
of pregnancy, when the woman is not coming for check up, I enquired about
it , then I came to know the
reality.” one
ASHA worker said. In most of the cases, the reason was that it was
second pregnancy with girl baby and they
wanted a boy baby.
10. What is the role of
Doctors in the prevention of female
feticide?
· “The main role is Doctors’ only; because they are the
people who detect the sex of the baby and do the abortion. If Doctor does not do this, we can stop
female foeticide”.
11. What is the role of
nurses and ASHA workers in the prevention of female feticide?
·
We should support
the pregnant mothers throughout their pregnancy for preventing
female foeticide
·
We can conduct
meetings for women in the village; can organize rallies against the issue.
·
If we come across the cases, can give FIR.
12. What actions can
be taken to tackle the problem of decreased sex ratio?
·
Conduct awareness
classes to all categories of society
·
Actions should
come from political leaders also; they should have real awareness regarding the
problem of female foeticide.
·
Training like
this also will have influence to improve sex ratio.
DISCUSSION:
Knowledge
of nursing personnel and
ASHA workers regarding prevention of female foeticide
The present study revealed that training program is
effective in improving knowledge of
nurses and ASHA workers regarding the prevention of female foeticide. The mean of post assessment knowledge score in
the interventional
group, 32.79 is
significantly higher than the knowledge
score of
control group, 16.18 and there was significant difference in the knowledge score between the
interventional and control group at 0.01 level of significance. The knowledge
score was high in the second post assessment compared to the first post
assessment. The present study
is in consistant with the study done by Nilima
Sonawane (2010) on effect of planned teaching on knowledge and attitude regarding female foeticide among
college students in Mumbai. There was significant difference in the mean
scores of the pre-test and the posttest of knowledge and attitude of the
college students regarding female foeticide as
measured by the semi structured questionnaire and attitude scale, respectively
at 0.01 level of significance.9
Attitude of nursing personnel and ASHA
workers towards female foeticide:
During the post assessment of attitude of nurses and
ASHA workers towards prevention of female foeticide in the interventional group, 38 (97.4%) of the sample had positive attitude whereas
in the control group, only 26 (65%) of them had positive attitude. There was significant
difference in the attitude score between the interventional and control group. The
findings of the present study contradicts another
study conducted in Punjab to assess the attitude of female respondents towards
the practice of female foeticide. There were 240
female respondents from 3 districts of Punjab-Ludhiana, Bathinda
and Ferozepur. 67.50% of respondents approved of
female foeticide. In Bathinda,
many respondents openly admitted to have undergone female foeticide.10
Qualitative analysis of experience of nurses and ASHA
workers regarding female foeticide:
The findings of qualitative analysis reveals that
the nurses and ASHA workers are aware about the dangers of female foeticide and they
want to take immediate steps to eliminate
female foeticide from their area. And they expressed the
importance of media like short film. With regard to the reasons for female foeticide, all the respondents suggested dowry as the main
reason. And for the actions to improve sex ratio, the respondents pointed about the importance of
awareness programs to all categories of
society and also they mentioned about
the role of political leaders in initiating
the actions for prevention of female foeticide. These
findings support another study conducted in Maulana
Azad Medical College, New Delhi to assess the knowledge and attitude of medical students and interns with regard to female foeticide.
The main dangers of female foeticide, listed by
medical students include: increasing
sexual and social crimes (64%), increase in prostitution, sexual expoitation and cases of sexually transmitted infection and
HIV/AIDS (66%) and
effect on women;s health because of repeated
pregnancies and forced abortion (53%). The important suggestions for the
prevention of female foeticide, which are listed by
the medical students include: raising women’s status in society (78%), support
the cause of girl child through mass media (65%), strict punishment for woman’s
family (56%) and strict punishment for
doctors conducting illegal medical termination of pregnancy (15%).11
CONCLUSION:
Based on the analyzed data, it is clear that the training program is effective in
improving the knowledge and to change the mindset of nurses and ASHA workers towards female foeticide. Hence they
can take up the responsibility to create awareness among the public regarding prevention of female foeticide and
can try to end gender based discrimination in our country. As they are directly come in contact with many people in their homes, they can disseminate this message of saving
the girl child. When knowledge is power with good mindset, nurses
and ASHA workers can become channels in
the prevention of female feticide.
REFERENCES:
1. Nilima V Sonawane.
Effect of planned teaching on knowledge and attitude regarding female feticide among
college students of Mumbai. Indian Nursing Journal of India.2010:3.
2. Government of India. Census
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3. The Times of India .Female
infanticide continues unchecked, unheard. Nov.6.2000.
4. Singh. Census 2011: Trends in
the female to male sex ratio.
5. Deepti Priya
Mehrotra. Delhi’s Endangered
species-Girls. Journal of social welfare.2010 Feb: 29-30.
6. S Puri,
V Batia, HM Swami. Gender preference and awareness
regarding sex determination among married women in slums of Chandigarh. Indian Journal
of Community Medicine.2007; Vol.1(1): 60-62.
7. Amruta Byatanal.
‘Silent observer’ to check female feticide. THE HINDU. Friday May 2011.
8. Female feticide in the U.S.
by immigrant women from India: Census 2011.The Hindu: May 28, 2011.
9. Census 2011: Trends in the
female to male sex ratio. Available from: mistersingh.wordpress.com/2011.
10. Anit Nath,
Nandhini Sharma. Knowledge and attitude of medical
students and interns with regard to female foeticide.
Indian Journal of Community medicine. 2009.April;34
(2).
11. Ajinder Valia.
Female feticide in Punjab: Exploring the socioeconomic and cultural dimensions.
IDEA-A Journal of Social Issues. August 2005.Vol.10.No.1
Received on 18.09.2015 Modified
on 29.09.2015
Accepted on 17.10.2015
© AandV Publications all right reserved
Asian J. Nur. Edu. and Research 6(1): Jan.-
Mar.2016; Page 127-132
DOI: 10.5958/2349-2996.2016.00025.2