INTRODUCTION:

“If I have belief that I can do it, I shall surely acquire the capacity to do it even if, I may not have it at the beginning.”

-Mahatma Gandhi.

The foundation for the whole human kind is the art of mothering. Motherhood is the greatest gift of nature to mankind. Life is mother’s gift to everyone and during the process of giving birth she has to undergo labour pain. Labour, purely in the physical sense, may be described as the process in which the fetus, placenta and the membrane are expelled through the birth canal. Normal labour occurs between 37-42 weeks of gestation. Accompanying the physical changes the women may have feelings of great intensity varying from exited anticipation to fearful expectancy¹.

A good childbirth experience makes the woman to have adequate information prior to the labour to ensure comprehension of the changes the labour will bring and to have some control over the birth of her baby. Woman in labour should be encouraged to trust her own instincts, listen to her own body, verbalize feelings in order to get the help and support they need. Increase in confidence has associated with lower level of pain experience during labour. Improved knowledge about how they can cope and work during labour will help the woman to have a positive child birth experience².

Analgesics may be given during labor as needed, but as little as possible should be given because they cross the placenta and may depress the neonate's breathing. Neonatal toxicity can occur because after the umbilical cord is cut, the neonate, whose metabolic and excretory processes are immature, clears the transferred drug much more slowly, by liver metabolism or by urinary excretion. Preparation and education about childbirth lessen anxiety, pain perception, and thus markedly decreasing the need for analgesics³.

The Lamaze philosophy teaches that birth is a normal, natural, and healthy process and that woman should be empowered to approach it with confidence. Lamaze classes educate women about the ways they can decrease their perception of pain, such as through relaxation techniques, breathing exercises, distraction, or massage by a supportive coach. Lamaze approach takes a neutral position toward pain medication, encouraging women to make an informed decision about whether it's right for them. Lamaze method is a child birth preparation technique most often taught in United States and also in India in centers like Bangalore, Hyderabad, and Pune and so on. It is based on Pavlov’s stimulus- response conditioning. This method is also termed as psycho prophylaxis method that means preventing pain in labour (prophylaxis) by the use of mind (psyche). The pregnant woman will learn activities that can be applied to control pain sensation during the uterine contractions by using conditioned responses. The goal of the child birth preparation is to cut short the labour stages wisely, with an understanding what is happening and physiological changes and to reduce the intensity or the perception of pain⁵.

NEED FOR THE STUDY:

Pregnancy and childbirth are natural changes and women are afraid of them. The fear stimulates the body and makes it to be stressed. The stressed body interferes with the blood circulation and smooth muscles of the uterus. The increasing tension in smooth muscles of lower uterus and cervix delays the cervical dilatation and leads to pain when uterine contraction occurs. As labour progresses the pregnant woman increasingly becomes anxious and fearful. Gradually the anxiety and tension mounts up past the ability of a control, which increases the intensity of pain. Gain in knowledge through child birth preparation has eliminated the fear of unknown and has increased self confidence¹.

Lamaze method is also termed as psycho prophylactic method that means preventing labour pain (prophylaxis) by the use of mind (psyche). The gravid woman will learn activities and breathing pattern that can be applied to control pain sensation during uterine contractions. Lamaze method helps the pregnant woman to keep her calm during labour and save her energy for the delivery time. Methods like conditioned reflexes, imagery, conscious relaxations, visualization, hydrotherapy, massage, hot and cold applications, breathing exercises, effleurage, body movements and position changes are taught to the mother³. The goal of the child birth preparation is to cut short the labour stages wisely, by making the mother to understand what is happening, the physiological changes and thereby reducing the intensity and the perception of pain².

A quasi- experimental study was conducted in Thailand to determine the effect of child birth preparation on fear, labour pain, coping behavior and child birth satisfaction among 60 primi Para women .In the control group 30 subjects received only routine care from staff nurses and 30 subjects in the experimental group received routine care plus child birth preparation classes. Results revealed that the primiparas in the experimental group had better labour pain coping behavior (16.37) than those in the control group (15.18). The study also showed that child birth satisfaction was(82.77) in experimental group and was higher than those in the control group (76.03).¹

An evaluative experimental study was conducted to determine the effectiveness of child birth preparation classes in terms of behavioral response during the first stage of labour and outcome of labour among 30 primi- gravid women in selected hospitals of Udupi district. Results showed that the experimental group had a positive behavioral response (31.882) when compared with control group (8.82)⁴.

A quasi-experimental time series non equivalent control group design was conducted in Udupi to assess the effectiveness of video-clip intervention related to birthing process on behavioral response among 30 primi-gravid women during first stage of labour. The experimental group received video-clip intervention related to birthing process along with the routine treatment. The findings of the study revealed a high positive behavioral response in the experimental group (84.84) and negative behavioral response in the control group (47.56) which showed that knowledge of birthing process improved the behavioral response of primi mothers during first stage of labour⁵.

These studies reveal a strong correlation between child birth preparation, pain and behavioral response of the women in labour. Research studies on Lamaze method and child birth preparations are less in our country. The investigator during her clinical experience witnessed that women routinely ask “How much longer does this go on, what shall I do now?” as if natural comfortable birthing requires some more special skills and knowledge that they lack. Besides, the investigator noticed that considerable number of women in labour not receiving any measures than the routine measures for comfort and pain relief. Interest on the topic and also a feeling of empathy to reduce the pain of women in labour influenced the researcher to select this study.

STATEMENT OF THE PROBLEM:

Effect of Lamaze method on child birth experiences among primi gravid women in first stage of labour in a selected hospital of Udupi.

OBJECTIVES OF THE STUDY:

The objectives of the study were to:

To find the effect of Lamaze method on child birth experiences among gravid women in terms of labour pain measured using visual analogue scale in experimental group and control group

To find the effect of Lamaze method on child birth experiences among gravid women in terms of behavioral responses as measured using observational check list in experimental and control group.

To find the difference in child birth experiences of gravid women in terms of labour pain in experimental and control group.

To find the difference child birth experiences of gravid women in terms of behavioral responses of experimental and control group.

ASSUMPTION:

Labour pain can be relieved by alternative measures other than the medication.

HYPOTHESIS:

All hypotheses will be tested at 0.05 level of significance.

H₁: There will be significant difference between the mean scores of child birth experiences in terms of labour pain among Group1 and Group2.

H_2: There will be significant difference between the mean scores of child birth experiences in terms of behavioral response among Group1 and Group2

DELIMITATIONS:

The study is delimited to primi gravid women who have completed 37 weeks of gestation with the cervical dilation less than 3 centimeters admitted to the selected hospital of Mangalore.

RESEARCH METHODOLOGY

Research Approach

A quasi experimental research approach was used and the subjects were selected by purposive sampling method.

Research Design

A quasi-experimental time series control group design was selected for the study. The experimental group consisted of primigravid women in the first stage of labour who received the Lamaze method of treatment, and the control group was not given the Lamaze method of treatment. However, both group received the routine line of treatment according to the hospital protocol. The investigator observed the behavioral responses of both the groups during the first stage of labour five times with 75 minutes of interval and the degree of labour pain using numerical pain rating scale (NRS) five times with an interval of one hour and encouraged the experimental group to practice Lamaze methods throughout labour.

Setting of The Study

The study was conducted in a selected maternity hospital at Udupi with 75 beds. The maternity centre had an adequately equipped labour ward and recorded more than 100 deliveries per month. . It registered more than40 maternity outpatient cases per day and had 20 antenatal beds 12 postnatal beds and eight beds for gynecological cases. It was located about 30 km away from the institution.

Population

The population in this study comprised of primigravid women in the first stage of labour.

Sample

Sample of the study consisted of 30 primi gravid women who were in first stage of labour admitted in the selected maternity hospital. Experimental group-15: Primi gravid women in the first stage of labour who would receive the Lamaze method of treatment and routine line of treatment. Control group---15: Primi gravid women in the first stage of labour who would receive only the routine line of treatment.

Sampling Technique

Purposive sampling technique was used for the present study because of the shortage of time and limited availability of samples. Purposive sampling technique is a procedure in which the researcher selects some special group, because there is good evidence that is representative of the total population he/she wishes to study.

DATA COLLECTION METHOD:

Sampling Criteria

Inclusion Criteria For Sampling

Primi gravid women with cervical dilation three to ten centimeter admitted in a selected hospital of Mangalore.

Primi gravid women who were willing to participate in the study

Exclusion criteria for sampling

· multi gravid women

· gravid women with high risk pregnancy.

Description of The Tool

The instruments designed for the study consisted of numerical pain rating scale and observation check list.

TOOL1:

Part A: Base line characteristics

Part B: Numerical pain rating scale to assess the labour pain experienced by the primi gravid women during the 1^st stage of labour.

TOOL 2: Observation check list to assess the behavioral responses of the primi gravid women during first stage labour.

Description of The Tool:

The tool consisted of two parts.

TOOL 1: Part-A: Baseline Characteristics

It contained eight items for collecting data regarding age, religion, education, income, type of family, source of information and type of labour.

Part. B: Numerical pain rating scale: The scale consisted of ranked choices that are no pain, mild pain, moderate pain, severe pain, worst possible pain. The pain scale is divided into 10 parts. Each choice is assigned a corresponding number. The investigator uses the scale five times with an hour interval.

Figure.1 Showing Numerical Pain Rating Scale

SCORE KEYS:

1 to 3 = Mild pain

4 to 6 = Moderate pain

7 to 9 = Severe pain

10 = Worst pain possible.

Sl. No/.

Latent phase [3-4 cm] – one observation.

Active phase [4-7 cm] - two observations.

Transient phase [7-10 cm]-two observations

TOOL 2: Structured observation checklist

The structured observation checklist was used to assess the behavior responses of the primigravid women during first stage of labour which consisted of 48 items. The items were placed under two distinct areas.

A -Behavior responses during uterine contractions

B -Behavior responses in between contractions.

The investigator observes the behavioral responses five times with 75 minutes of interval and places a tick (√) mark in the column of appropriate observation as indicated by ‘Y’ if yes and ‘N’ if No. For positive behavioral responses, if response is ‘Yes’ then score of ‘one’ and if ‘No ‘then ‘zero score will be given. On the other hand, for negative behavioral responses, if ‘Yes’ it will be scored ‘zero’ and if ‘No’ the score of ‘one’ will be given. The maximum possible score was 240 and minimum possible score was zero”.

ETHICAL CONSIDERATION:

The researcher had obtained permission from the parent institution to conduct the research study. Permission from the District Medical Officer was obtained to conduct the study in the district maternity hospital of Udupi. Prior permission was obtained from the nursing superintendent and ward-in-charge. Consent was taken from the primigravid women before data collection.

Pre-Testing and Reliability of The Tool:

Pre-testing and reliability of the tool were carried out among six primigravid women in the labour room of District maternity hospital Udupi. Inter rater reliability was used to find the reliability of the constructed observation checklist. Reliability of the observation checklist to assess the behavior response of primigravid women during first stage of labour was computed as 0.868, using Karl-Pearson’s coefficient correlation formula. The tool was thus found reliable and hence no modifications were made.

Pilot Study

Pilot study for the present study was conducted among six primigravid mothers selected by purposive sampling technique with the same inclusion criteria, at Concetta Hospital Mangalore from 22.07.2011 to 28.07.2011 after obtaining written permission from the concerned authorities. The purpose of the study was explained to the mothers and confidentiality was assured. The Lamaze method was taught to the experimental group with cervical dilation of three and below. The numerical pain rating scale was used to assess the intensity of labor pain at every hour of interval and behavioral responses were assessed using observation checklist in 75 minutes interval. The data were analyzed using descriptive and inferential statistics.

Organization of The Study Findings

Data were organized and presented under the following headings.

Section I: Description of baseline characteristics.

Section II: Evaluation of effect of Lamaze method on child birth experiences in terms of labour pain among primigravid women

Section III: Difference in child birth experiences of gravid women in terms of labour pain in experimental and control group

Section IV: Evaluation of effect of Lamaze method on child birth experiences in improving the behavioral response of primi gravid women in the first stage of labour.

Section V: Difference in child birth experiences in terms of behavioral response of primi gravid women in experimental and control group.

Section I: Description of baseline characteristics

Figure 2: Percentage Distribution of Primigravid Women According to Their Age

Majority (53.3%) of the primigravid women in the experimental group were belongs to the age group between 26-30 years of age, 33.3% of them were between the age group 21-25 years and 6.7% of them were less than 21 years of age. In the control group majority (73.3%) of the women were in between the age group of 21-25 years, 20% of them were belonged to the age group between 26-30 years and 6.7% were less than 21 years of age.

Figure 3: Percentage distribution of primigravid women according to education.

Majority (60%) of the primigravid women in the experimental group had primary education and there were equal number of women (20% in each) who had primary, secondary education. In the control group 73.3% of the women had primary education, 13.3% had no formal, secondary education.

Figure 4: Percentage distribution of primigravid women in experimental and control group according to Religion

The data presented above shows that the experimental group 40% of the women were Hindus, 33.3% of them were Christians and 26.7% were Muslims. In the control group majority (60%) of the women were Hindus, 13.3% were Christians and 26.7% were Muslims.

Figure 5: Percentage distribution of primigravid women according to their income in the experimental and control group

The data presented above indicates that majority (93.3%) of the women in the experimental group had the income ≤3000 rupees and 6.7% of them had income between 3001-5000 rupees. In the control group majority (73.3%) of them had income ≤3000 rupees and 26.7% of them had income between 3001-5000 rupees.

Figure 6: Percentage distribution of primigravid women according to the type of family in experimental and control group.

The above depicted data shows majority (73.3%) of the primigravid women in the experimental group belonged to the nuclear family and 26.7% of them belonged to the joint family. In the control group 60% of the primigravid women belonged to the nuclear family and 40% of them belonged to the joint family.

Figure 7: Percentage distribution of primigravid women according to the source of information in the experimental and control group.

The data shown above indicates that 53.3% of the women in the experimental and 66.7% of the women in the control group had received information related to labour process.

Figure 8: Percentage distribution of primigravid women according to the type of labour in the experimental and control group.

The mean percentage of behavioural responses of primigravid women during the first stage of labour was196.53 and 153.13 in the experimental and control group respectively. Calculated ‘t’ value was greater than the table value t28=1.700 at 0.05% level of significance. So there is a significant difference between the control group and the experimental group. Hence the null hypothesis H₀₂was rejected and the research hypothesis H₂was accepted. The above table describes that the Lamaze method has produced significant difference in the behavioral response of women in two groups.

DISCUSSION:

Section 1: The results reveal that the mean scores of labour pain of primigravid women in the first stage of labour in experimental group (2.4,3.86, 7.733) are lesser than those in control group (4.4, 6.33, 8.633) in all phases (latent, active, transient) respectively. The ‘t’value computed in all phases (‘t’ (28) =1.700 at 5% level) shows that there is a significant difference in the labour pains of primigravid women in the first stage of labour in all phases.

The findings of the present study are consistent with many other studies. A study on “Effect of acupressure on labour in full term gravid women in a selected hospital in Mangalore” showed that mean percentage labour pain score of 69.6% in women who received acupressure was higher than 59.7% in women received acupressure plus regular treatment and the women who received only regular treatment (34%). The computed test of ANOVA depicts a significant difference F _{(2, 57)}=77.79, at P<0.01 in the pain score among the three groups⁴⁴.

Another study was conducted on “Effectiveness of warm compress on selected areas to women in labour pain during the first stage of labour in a selected hospital in Mangalore”. The results showed that the pre-test mean percentage labour pain score of 50.5% was higher than the post-test labour pain score (35.25%) in women who received only the regular treatment, whereas the post test labour pain scores in women received the warm compress was 57.75% and women received warm compress plus regular treatment 56.5% which was higher than that of pre test scores of 45.75% and 44.5% respectively. The computed test of ANOVA depicted a significant difference F_{(2, 57)}=57.78, at P<0.01 in the pain score among the three groups⁴⁵.

Section 2: In the present study most of the women (93.3%) in the experimental group had a high positive behavioral response and only 6.7% of the women had a positive behavioral response. All women belonged to the control group had a positive behavioral response. The results reveals that the mean scores of behavioural responses of primigravid women in the first stage of labour in experimental group was (102.47, 94.07) higher than those in control group (78.53, 74.6) in both the areas (during contractions and in between contractions). The ‘t’value computed in two areas (‘t’ (28) =1.700 at 5% level) shows that there is a significant difference in the behavioural responses of primigravid women in the first stage of labour in both the areas.

The findings of the present study is supported by a study conducted to determine the effectiveness of lower back massage on pain and behavioral response of gravid women in the first stage of labour admitted to the labor unit of a selected hospital in Mangalore. The results showed that the mean scores of behavioral responses of women in the first stage of labour in the experimental group (235) were higher than those in control group (141) with a mean difference of 94 between the two groups. The computed ‘t’value (‘t’ at (38) =27.49 at 5% level) showed that there was a significant difference between the behavioral responses of women in the first stage of labour in experimental and control group⁴⁶.

The present study was also supported by a study on “effect of acupressure on labour in full term gravid women in a selected hospital in Mangalore”. The results reveal that mean percentage score of behavioral responses in women received acupressure was (80.62%) higher than (70.37%) in women received acupressure plus regular treatment and in women who received only the regular treatment (53.92%). The computed test of ANOVA depicts a significant difference F _{(2, 57)}=27.81 which was higher than the table value 4.98 at P<0.01 in the pain score among the three groups⁴⁴.

The findings of the present study were analyzed and discussed with the findings of other similar studies confirmed that Lamaze is effective in reducing the labour pain and improves the behavioral response of primi gravid women in first stage of labour.

CONCLUSIONS:

Lamaze method is an effective non-invasive, cost-effective, non pharmacologic, supportive and educative alternative for reducing the labour pain and to improve the behavioral responses of women in first stage of labour.

Lamaze method was effective in labour pain reduction. The mean difference in pain perception in experimental group was less than those in the control group. (mean difference = 2, 2.46, 0.9 in latent, active and transient phase respectively). The t value showed a significant difference between the pain scores. Labour pain increased as the labour progressed (latent<active<transient) and in each phase experimental group women experienced less pain than that of those in the control group

Labour pain increased as the labour progressed (latent<active<transient) and in each phase experimental group women experienced less pain than that of those in the control group

Lamaze method was effective in terms of behavioral response of primi gravid women in the experimental group. The mean difference in behavioral response of women in the first stage of labour in experimental and control group was 43.4. The t value (t28=1.700 at 0.05% level of significance) showed a significant difference between the behavioral response of women in both the groups.

IMPLICATIONS:

The finding of this study has brought out certain facts that have far-reaching implications for nursing, particularly in the areas of practice, education, administration and research.

Nursing Practice

Labour pain is a phenomenon embedded in the very nature of human existence. The unique aspect is the association of physiological process with pain and discomfort. The nurse attending labour can make this experience a pleasant and memorable one for the rest of the woman’s life by providing Lamaze method. Lamaze method not only provides physical comfort but also conveys the massage of caring, sympathy, love and reassurance to the mother throughout labour process. The findings of the study can be utilized by practicing nurse in alleviating the sufferings of the women in labour.

Nursing Education

Nurses with higher education and up to date knowledge can provide cost effective and quality patient care. Nurse educators need to include various child birth preparation methods like Lamaze method in the curriculum of basic nursing education as a part of intra natal care along with the physiology of labour and labour supportive techniques and should encourage their students to practice the same in the clinical setting.

Nursing Administration

Today there is an increasing demand for quality care. Nurse administrators are in a key position to prepare policies and its execution of quality nursing care based on research findings. In- service education should be organized periodically to upgrade the knowledge and skills of health care professionals in child birth education courses like Lamaze method.

Nursing Research

Nursing researchers should be aware of the new trends and existing health care system. Emphasis should be laid on research in the areas of effectiveness of various child birth education classes. The findings of the research need to be disseminated through publications so that the utilization of such research findings could be encouraged.

LIMITATIONS:

The limitations of the study were:

· Since the sample size is small and is limited to one hospital generalization of the findings are limited

· The study is limited to primi gravid women in labour.

· Pain and behavioral responses were not compared with the various demographic variables.

SUGGESTIONS:

· Adequate nurse –patient ratio should be maintained in the labour room for the provision of care

· Child birth preparation classes can be included in the prenatal care settings.

· Topics on different child birth preparation classes and its effectiveness can be included in the nursing curriculum so as to provide effective intranatal care.

· Nursing students can conduct projects on various child birth preparation classes.

RECOMMENDATIONS:

On the basis of the findings of the present study, the following recommendations are drawn for the future research.

· A similar study can be conducted on a large sample to generalize the study findings.

· Comparative study can be done between primi gravid and multi gravid women

· Pain and behavioral responses of the gravid women can be compared with various demographic variables in a future study.

· The study can be undertaken in different settings private hospitals and primary health centers

· A comparative study can be conducted with other child birth preparation classes like Bradley method, Dick-Read method⁴.

REFERENCES:

1. http://www.kariclub.co.nz/pregnancy/labour_and_birth/article/the_stages_of_labour.

2. Dickson, Silverman, Kaplan. Maternal-infant nursing care. 3^rd ed. Mosby publications, Misouri. 1998. Pg: 261-73

3. http://www.merckmanuals.com/professional/print/gynecology_and_obstetrics/normal_pregnancy_labor_and_delivery/management_of_normal_labor.html

4. Pillitteri A. Maternal and child health nursing: Care of childbearing and child rearing family. 5^th ed. Philadelphia. Lippincott williams and wilkins. 2007. Pg:332-336.

5. Gayle L, Reidmann. Education for childbirth: Nurse- midwife, female health association. West Suburban Hospital Medical Center, Oak Park, Illinois. 2008. Vol 2, Chap 18.

6. Joseph CSR. A true experimental study to determine the effect of breathing exercise on outcome of labour among primigravid mothers at selected maternity hospital. Unpublished master’s degree dissertation. Dr.M.G.R. Medical Unniversity. Chennai. March. 2008.

7. Thampawiboon K. Effects of childbirth preparation on fear, labour pain, coping behaviors and childbirth satisfaction on primiparas. Unpublished thesis. Master’s degree dissertation. Mahidol University. Thailand. Sept 2005

8. Karkarda E C. Preparing Primigravid Women for Childbirth: Behavioral Responses to Labour Pain and Outcome of Labour. Unpublished thesis. Master’s degree. Manipal University. Manipal. 2008.

9. Rosario B A. Effectiveness of video- clip intervention related to birthing process on behavioral response among primi gravid during first stage of labour. Unpublished thesis. Master’s degree dissertation. RGUHS.Bangalore.2010.

10. Joseph B. Effect of acupressure on labour in full term gravid women in a selected hospital at Mangalore, Unpublished master’s dissertation, RGUHS. May 2005.

11.  Joseph S. Effectiveness of warm compress on selected areas to women in labour pain during the first stage of labour in a selected hospital at Mangalore. Unpublished Master’s Dissertation, RGUHS. May 2005.

12.  Crasta P W. Effectiveness of lower back massage on pain and behavioral response of gravid women in the first stage of labour admitted to the labor unit of a selected hospital in Mangalore Unpublished Master’s Dissertation, RGUHS. May 2004.

Received on 28.10.2015 Modified on 06.11.2015

Asian J. Nur. Edu. and Research.2016; 6(4): 443-453.

DOI: 10.5958/2349-2996.2016.00084.7

Latent Phase	Max. Possible Score	Max. Score	Mean	S.D	Mean %
Experimental	10	3	2.4	0.50709	24
Control Group	10	6	4.4	0.73679	44

Active phase	Max. Possible Score	Max. Score	Mean	S.D	Mean %
Experimental	10	5	3.8667	0.6114	38.6
Control Group	10	7.5	6.3333	0.55635	63.3

Phases	Group	Mean	S.D	Mean Difference	S. Error Difference	T
Latent	Experimental	2.4	0.50709	2	0.23094	8.66*
Latent	Control	4.4	0.73679
Active	Experimental	3.8667	0.6114	2.46667	0.21344	11.56*
Active	Control	6.3333	0.55635
Transient	Experimental	7.7333	0.65101	0.9	0.17817	5.05*
Transient	control	8.6333	0.2288

Group	Max. Score	Mean	S.D	Median	Mean %
Experimental	130	102.47	7.68	104	78.82
Control	130	78.53	7.972	79	60.41

Group	Max Score	Mean	S.D	Median	Mean%
Experimental	110	94.07	4.605	94	85.82
Control	110	74.6	7.5	74	67.82

Group	Areas of Assessment	mean	S.D	Mean. Diff	S.E Diff	t' value
Experimental	During Contraction	102.47	7.68	23.93	2.88*	8.37
Control		78.53	7.972
Experimental	In Between Contraction	94.07	4.605	19.47	2.27*	8.57
Control		74.6	7.5

		Experimental Group		Control Group
Range	Category	Frequency	Percentage	Frequency	Percentage
0-25%	High negative	0	0	0	0
26-50%	Negative	0	0	0	0
51-75%	Positive	1	6.7	15	100
76-100%	high positive	14	93.3	0	0

Group	Mean	S.D	Mean. Difference	S.E of Difference	T' Value
Experimental	196.53	11.47	43.4	4.23*	10.25
Control	153.13	11.72