INTRODUCTION:

Loss of vision and visual impairment are common among elderly age group. 82% of people living with blindness are aged 50 years and above, while the elderly age group comprises about 20 % of the world's population. ¹ With an increasing elderly population in many countries, more people will be at risk of age-related visual impairment. There are 45 million blind persons in the World, of which 12 millions blind people live in India.² As per WHO estimates the blind population will double by 2020 due to rise in population and longevity. Vision impairment affects about 10% of people aged between 65 – 75years, and about 20% of those aged 75years or older.³ The major causes of age-related visual impairment among older people includes presbyopia, cataract, macular degeneration, open angle glaucoma, and diabetic retinopathy.⁴

In a focus group interview conducted to assess the knowledge of the samples regarding knowledge, attitudes, and beliefs about dilated eye examinations among African-Americans, it was found that many people did not know the risk factors for glaucoma.⁵ In a community-based study conducted on 40-80 years old people, it was found that 80% of those with common eye conditions were unaware of their condition.⁶ The major barriers for seeking eye care were economic reason, fear of operation, far distance from a hospital, etc. It is only through patient’s education and low price services, visual impairment can be prevented.⁷ In a study conducted in Bharatpur district of Rajasthan, India, it was observed that blindness, particularly blindness because of cataract, continues to be a significant problem among the elderly living in remote areas of rural northwest India.⁸ Individual awareness and knowledge of eye diseases are important factors in screening, diagnosis, treatment compliance, and prevention of various eye problems. Spreading knowledge will motivate people to visit ophthalmologists which is important in preventing age related blindness.⁹ Thus, in the current study, STP (structured teaching Programme) was used as a strategy to improve the knowledge and attitude of older people towards early detection and prevention of visual impairment.

MATERIALS AND METHODS:

The study was aimed at determining the effectiveness of the STP in terms of knowledge and attitude of older people regarding early detection and prevention of visual impairment. A non-randomised control group design was adopted to conduct the study. A total of 100 older people in age group 50-70 years, (50 each in experimental & control group) were selected as subjects by using purposive sampling technique. Older people already diagnosed or treated with any visual impairment condition were excluded from the criteria of selection of the subjects. The distribution of subjects in experimental and control group was done non-randomly.

Structured interview schedule was used as a tool for data collection. It consisted of two sections: A) Knowledge questions comprising of 45 items and B) 5-point Likert scale comprising of 21 items; to detect knowledge and attitude levels of older people respectively. STP constructed to improve the knowledge and attitude of older people consisted of risk factors, causes of visual impairment: cataract, glaucoma, age related macular degeneration, diabetic retinopathy, sign and symptoms, early detection and prevention etc.

Experimental and Control groups were selected from two different villages of Meerut district. Data collection for pretest was done for both the groups in the initial phase. After 5 days of the pre test, STP was administered to the experimental group(50). Post test was conducted for both the groups after 7-10 days of the STP administeration. Before the data collection an informed consent was taken from the subjects. The anonymity and the confidentiality of the subjects were maintained throughout the study. The data was analysed using descriptive and inferential statistics. The level of significance was set at constructed levels of 0.05.

RESULTS:

The study was conducted on 100 older people, i.e, 50 in each experimental and control group, belonging to rural community of Meerut District. Majority of the subjects in experimental group (44%) were in the age group 50-54yrs, while control group had 28% subjects in 50-54 yrs. In terms of gender, both the groups had almost similar percentages of females i.e. 54% (Exp.)and 52% (Control). 38% and 40% in experimental and control groups respectively, were alcoholics and smokers subjects. 94% of the subjects in experimental group, and 86% of the subjects in control group were living with their children. It included all the subjects living with their sons or grandsons, irrespective of the separate kitchen. 42% and 34% subjects had family history of hypertension in experimental and control group respectively. 16% of the subjects in both experimental and control group had a family history of diabetes mellitus.

The study data in Table No.1 revealed that the mean post test knowledge scores of experimental group (29.98±2.81) was significantly higher than the mean post test knowledge scores of control group (17.88±3.12) at (p< 0.000). The post test attitude scores of experimental group, (89.98±5.96) was significantly higher than the post test attitude scores of control group (74.74±9.28) at (p< 0.000). Correlation between the knowledge and attitude was also computed by using Pearson’s coefficient (r), which revealed that knowledge and attitude had no significant correlation (r = 0.09) at (p< 0.5). Thus, the structured knowledge program was found to be effective in terms of knowledge and attitude of older people regarding early detection and prevention of visual impairment.

Table No. 1- Knowledge and Attitude Scores of Experimental and Control group regarding visual impairment n=100

Knowledge Scores	Pretest (Mean score)	Post test (Mean score)	t-value	p-Value
Experimental Group	17.48±4.11	29.98±2.81	20.34	<0.000
Control Group	16.78±3.45	17.88±3.12	20.34	<0.000
Attitude Scores
	Pretest (Mean score)	Post test (Mean score)	t-value	p-Value
Experimental Group	75.74±7.95	89.22±5.96	9.27	<0.000
Control Group	73.82±8.16	74.74±9.28	9.27	<0.000

Table No. 2. reveals the association of selected demographic variables with knowledgeand attitude scores of older people in experimental group. It was found that family income has significant association (p<0.01) with knowledge scores of older people. No other variable was found to have significant relationship with the knowledge scores. The data also revealed that variables like occupation (p<0.01) and family income (p<0.05) of the older people has association with the attitude scores of the older people.

Table No. 2- Association of knowledge and attitude scores and demographic variables of older people (experimental group) regarding visual impairment

Variable	Knowledge scores		p-Value
	Above mean score	Below mean score
Family Income (Monthly)
Rs 2,000-5,000/-	15	3	p<0.01
Rs 5001-8,000/-	10	12
More than Rs 8,001/-	2	8

Variable	Attitude scores		p-Value
	Above mean score	Below mean score
Occupation			p<0.01
Employed	6	17
Unemployed	15	9
Pensioner/Retired	2	1
Family Income(Monthly)
Rs 2,000-5,000/-	3	15	p<0.05
Rs 5001-8,000/-	12	10
More than Rs 8,001/-	8	2

DISCUSSION:

This study assessed the effectiveness of structured teaching program on visual impairment in terms of knowledge and attitude of older people. The study was conducted in rural area of Meerut District. The study data revealed that pre test knowledge of the experimental group was found to be inadequate(84%) and the pre test attitude score in experimental group was (68%) appropriate and inappropriate (32%). The study has also revealed that subjects had lesser knowledge in almost all the components included under the structured interview schedule like: cataract, glaucoma, age related macular degeneration, diabetic retinopathy and visual impairment in general. The older people had comparatively lesser knowledge in components like: Age related macular degeneration and diabetic retinopathy. The results were consistent with the findings of another study conducted by Kukuh Noertjojo, (2006), 69.2% reported familiarity with cataract, while 41.2% has shown familiarity with glaucoma and 20.2% with macular degeneration. 97.5% recognized the possibility of treatment for cataract, while 91.5% for glaucoma, and 77.0% for macular degeneration.¹⁰ Huang OS and Zheng Y(2013), have highlighted that 80% people were unaware of the eyes conditions.⁶ The findings are also consistent with Nancy J. Ellish et al (2007), study showed the subjects did not know regarding the risk factors for glaucoma, but they were aware regarding reducing the effects of diabetes on their eye.⁵

There was no correlation found between the knowledge and attitude of experimental group in the present study. The findings were contrary with the findings of the study conducted by S Suh et al (2012), where the researcher has found a less strong correlation between knowledge and attitude levels of older adults. The scores were found statistically significant.¹¹ The possible reasons for insignificant results may be other factors influencing attitude like economic reasons, far distance from the health setting etc.⁷

The present study revealed the effectiveness of STP on visual impairment in terms of adequate knowledge and appropriate attitude of the older people in the post test. The study has consistent findings with the study conducted by Laxman GB (2014), where it was observed that pre test mean score was lower than the mean post test score of older people regarding cataract.¹² The study found the effectiveness of the educational strategy used by the researcher to create awareness regarding eye conditions among older people.^(13,14) The positive knowledge among subjects of experimental group is associated with their monthly family income. While the attitude scores have been found to get influenced by occupation and monthly family income of the subjects. A study by Anna Rius Ulldemolins et al (2012) has shown similar findings where knowledge and attitude levels had significant association with socioeconomic status measured as higher income, higher educational status, or non-manual occupational social class was inversely associated with prevalence of blindness or visual impairment.¹⁵ In a study by J T F Lau et al, it was found that younger in age, better educated and higher income groups were having more knowledge than older, less educated, or lower income respondents.¹⁶

CONCLUSION AND RECOMMENDATIONS:

The structured teaching programme was found to be effective in increasing knowledge and attitude of older people regarding early detection and prevention of visual impairment. Monthly family income can influence knowledge; while occupation and monthly family income can influence attitude of the older people regarding early detection and prevention of visual impairment. The study recommends the development of educational package/ STP and involvement of community functionaries for mobilization of older people towards eye related health services to prevent the burden of ocular morbidity and irreversible blindness among older people.

ACKNOWLEDGEMENT:

We would express our sincere thanks to all the participants for giving their consent and opportunity for being part of this study.

SOURCE OF SUPPORT:

Nil.

CONFLICT OF INTEREST:

None .

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Received on 12.09.2017 Modified on 25.09.2017

Asian J. Nursing Education and Research. 2018; 8(1): 73-76.

DOI: 10.5958/2349-2996.2018.00017.4