A Quasi Experimental study to evaluate the effectiveness of self instructional module on knowledge regarding hypertension among teachers of selected schools in district Mohali.

 

Shalini¹, Rashmi Choudhary²

¹Mata Sahib Kaur College of Nursing, Mohali

²Associate Professor, Mata Sahib Kaur College of Nursing, Mohali

 

ABSTRACT:

Hypertension is a real and important public health problem, especially for developed countries compared with the underdeveloped ones. Hypertension is not only the leading causes of death but is also contributing to disability among adults. Most of the problems are preventable or controllable if it is anticipated or recognized and treated correctly. This study aimed to evaluate the effectiveness of self instructional module on the knowledge regarding hypertension among teachers of selected schools in district Mohali. For the purpose of this study, quantitative approach and quasi experimental research design was adopted.150 school teachers were selected as sample by using convenient sampling technique. Self administered structured knowledge questionnaire was used to collect the data from school teachers. It was found that in experimental group, maximum of school teachers i.e.80% possessed poor knowledge and in control group also majority of school teachers i.e.93.3% possessed poor knowledge during pre-test. Whereas during post test, 94.7% school teachers possessed good knowledge in experimental group and 96% possessed poor knowledge in control group. Hence, study findings revealed that there was significant difference in mean pre-test and post-test knowledge scores of experimental group regarding hypertension at p<0.05 level. Moreover, there was no significant difference in pre-test and post-test knowledge scores among control group. It was found that there was significant association of pre-test knowledge level with educational qualification, family income and personal history of hypertension.

 

 

 

INTRODUCTION:

Flow of blood is based on the beat of which the heart pumps blood. The pressure of the heart does not stay at the same level at all times. It varies based on activities at a particular time.¹

 

Primary hypertension is also known as essential hypertension and it affects 95%  of persons suffering from the disease. High blood pressure occurring as a result to a consequence of another disorder or a side effect of medication is referred to as secondary high blood pressure. Such disorders may include renal failure or renovascular disease. This type of blood pressure is evident in about five to 10% of cases.² The increasing prevalence of hypertension in developing countries is of great concern. According to a report from the World Health Organization (WHO 2010), there was an estimated 972 million people with hypertension in the year 2000. 65% lived in developing world with the number predicted to grow to 1.5 billion by 2025. The increasing prevalence is well reflected in the increase in cardiovascular disease mortalities.  Hypertension has acquired above incidence for several reasons as it is a disease itself as well as a risk factor, it has a high prevalence and an uneven distribution and it does not receive satisfactory control.³

 

Causes of hypertension are not yet known, however, factors such as age, high salt intake, sedentary lifestyle, stress as well as genes have been found as contributing to hypertension. Women after age 65 and men after age 55, are more likely to have uncontrolled hypertension.Individuals with family history of hypertension, stroke and other cardiovascular diseases are always at risk of developing hypertension.³

 

Heavy consumption of alcohol drinking can damage heart. Having more than two drinks (40 ml) in a day for men and more than one drink (20 ml) in a day for women may affect blood pressure.⁴Hypertension is potentially a preventive disease. Lifestyle modification has a major impact on prevention of hypertension.⁵

 

The nurse with her knowledge and skills can meet the needs of hypertensive people and able to fulfill the needs of other to accept healthy life style.⁶ Hypertension is becoming a public health emergency. The job of teachers of schools is both sedentary in nature and accompanies high level of mental stress, thereby at a higher risk of developing hypertension.⁷

 

OBJECTIVES:

·        To assess the existing knowledge of teachers regarding hypertension.

·        To develop and administer self instructional module on hypertension.

·        To find out the effectiveness of self instructional module on hypertension among teachers of selected schools.

·        To find out the association between the research findings and selected socio - demographic variables.

 

MATERIAL AND METHODS:

Quantitative approach with non randomized control group research design was used. study was conducted in Shaheed Ranjodh Singh Government Senior Secondary School, Teor (Mohali) and Government Elementary School, Naglia (Mohali). Sample for the present study comprise of 150 teachers who fulfill the inclusion criteria. Convenience sampling technique was used to draw sample from the target population. Dependent variable:  Knowledge on hypertension. Independent variable: Self instructional module.

 

Inclusion Criteria

Study included the school teachers who were:

·        working in the primary or secondary schools   

·        available and willing to participate in the study

·        able to communicate in English

·        with educational qualification of B.Sc. or M.Sc.

 

Exclusion Criteria:

Study excluded the school teachers who were:

·        not available during the study because of medical leave, maternity leave or due to some other reason.

·        Drop-out during the post test.

 

Validity of the Tool:

Self administered structured knowledge questionnaire on hypertension was given to 7 experts of nursing field and 2 cardiologists for content validity.

 

Reliability of the Tool:

Reliability of the self administered structured knowledge questionnaire on hypertension was analyzed by test- retest method and was found to be significant (r = 0.75).

 

 

RESULTS:

TABLE- 1:  FREQUENCY DISTRIBUTION OF SOCIO-DEMOGRAPHIC VARIABLES AMONG TEACHERS OF SELECTED SCHOOLS IN EXPERIMENTAL AND CONTROL GROUP AND HOMOGENITY OF GROUPS N=150

Socio-demographic variables	Experimental Group (ne=75)		Control Group (nc=75)		Chi square	df	p-value
	fe	%	fc	%
Age(in years)					2.345NS	2	0.310
≤ 35	28	37.3	36	48.0
36-45	25	33.4	24	32.0
>45	22	29.3	15	20.0
Gender					0.027NS	1	1.000
Male	39	52.0	40	53.3
Female	36	48.0	35	46.7
Marital status					13.703**	2	0.001
Single	12	16.0	32	42.7
Married	57	76.0	41	54.7
Divorced	6	8.0	2	2.6
Educational qualification					0.107NS	1	0.870
B.Sc.	39	52.0	37	49.3
M.Sc.	36	48.0	38	50.7
Income (in Rs.)					0.000NS	2	1.000
≤ 20000	28	37.3	28	37.3
20001-25000	23	30.7	23	30.7
>25000	24	32.0	24	32.0
Family history of hypertension					0.000NS	1	1.000
Yes	13	17.3	13	17.3
No	62	82.7	62	82.7
Personal history of hypertension					0.000NS	1	1.000
Yes	6	8.0	6	8.0
No	69	92.0	69	92.0
Duration of hypertension since diagnosis  (in months)					0.000NS	1	1.000
≤ 6	4	66.7	4	66.7
>6	2	33.3	2	33.3
Currently on medication of hypertension					0.000NS	1	1.000
Yes	2	2.7	2	2.7
No	73	97.3	73	97.3
Mention medicine					0.000NS	1	1.000
Ramipril	2	100	2	100

* = Significant (p<0.05) NS= Non significant

 

Table I: depicts frequency along with percentage distribution among teachers of selected schools in experimental and control group. Moreover, it depicts that experimental and control groups are homogenous in regard to age, gender, educational qualification, income (in Rs), family history of hypertension, personal history of hypertension, duration of hypertension since diagnosis (in months) and currently on medication of hypertension

 

 

 

 

.

FIGURE 1:  Pre-test knowledge level of experimental and control group regarding hypertension among teachers of selected schools

TABLE 2.1: COMPARISON OF PRE-TEST AND POST-TEST KNOWLEDGE LEVEL OF EXPERIMENTAL AND CONTROL GROUP REGARDING HYPERTENSION AMONG TEACHERS OF SELECTED SCHOOLS N= 150

Knowledge level	Score	Experimental  Group  (ne=75)		χ2, df,  p-value	Control Group  (nc=75)		χ2, df,    p-value
		Pre-test (%)	Post-test (%)		Pre-test (%)	Post-test (%)
Very poor	0-6	9(12.0)	0(0.0)	142.0***, 4, 0.000	1(1.3)	0(0.0)	1.171NS, 2, 0.05
Poor	7-12	60(80.0)	0(0.0)		70(93.3)	72(96.0)
Average	13-18	6(8.0)	3(4.0)		4(5.3)	3(4.0)
Good	19-24	0(0.0)	71(94.7)		0(0.0)	0(0.0)
Excellent	25-30	0(0.0)	1(1.3)		0(0.0)	0(0.0)

*** = Highly Significant (p<0.05) NS = Non significant

TABLE 2.2: COMPARISON OF PRE-TEST AND POST-TEST MEAN KNOWLEDGE SCORE OF EXPERIMENTAL AND CONTROL GROUP REGARDING HYPERTENSION AMONG TEACHERS OF SELECTED SCHOOLS N=150

Pre/post test	Experimental ne=75		Control nc=75		Unpaired t-test	df	p-value
	Mean	±SD	Mean	±SD
Pre-test	9.4	2.3	9.9	1.9	-1.557 NS	148	0.122
Post-test	21.2	1.4	10.0	1.8	42.687***	148	0.000

*** = Highly Significant (p<0.05) NS= Non significant

 

Table 2.1: depicts the effectiveness of self instructional module on hypertension among teachers of selected schools. There was significant difference in pre-test and post-test knowledge scores of experimental group as calculated by χ² and among control group there was no significant difference.

 

 

 

Table 2.2: There was significant difference among the post test knowledge scores of the experimental and control group.

 

Thus, it was inferred that school teachers of experimental group had gained knowledge after self instructional module but the knowledge level of the school teachers in control group remained approximately same.

 

TABLE 3.1: ASSOCIATION OF PRE-TEST KNOWLEDGE LEVEL REGARDING HYPERTENSION AMONG TEACHERS OF SELECTED SCHOOLS WITH THEIR SOCIO-DEMOGRAPHIC VARIABLES N = 150

Socio-demographic variables	Very Poor (n1=10)		Poor (n2=130)		Average (n3=10)		F ( f1 + f2+ f3)	χ2, df, p-value
	f1	%	f2	%	f3	%
Age(in years)
≤ 35	1	1.6	59	92.1	4	6.3	64	7.535NS , 4, 0.05
36-45	4	8.0	43	88.0	2	4.0	49
>45	5	13.6	28	75.6	4	10.8	37
Gender
Male	7	8.9	66	83.5	6	7.6	79	1.59NS , 2, 0.05
Female	3	4.2	64	90.2	4	5.6	71
Marital status
Single	1	2.3	39	88.7	4	9.0	44	3.2801NS , 4, 0.05
Married	8	8.2	85	86.8	5	5.0	98
Divorced	1	12.5	6	75.0	1	10.0	8
Educational qualification
B.Sc.	9	11.8	66	86.8	1	1.4	76	12.7902* , 2, 0.05
M.Sc.	1	1.4	64	86.4	9	12.2	74
Income (in Rs.)
≤ 20000	0	0	52	92.8	4	7.2	56	11.802* , 4, 0.05
20001-25000	4	8.7	40	86.0	2	4.3	46
>25000	6	12.5	38	79.1	4	8.4	48
Family history of hypertension
Yes	1	3.8	23	88.4	2	7.8	26	0.419NS , 2, 0.05
No	9	7.3	107	86.3	8	6.5	124
Personal history of hypertension
Yes	1	8.3	8	66.7	3	25.0	12	7.284* , 2, 0.05
No	9	6.5	122	88.4	7	5.1	138
Duration of hypertension since diagnosis  (in months)
≤ 6	0	0	5	62.5	3	37.5	8	15.33NS , 2, 0.05
>6	1	25.0	3	75.0	0	0	4
Currently on medication of hypertension
Yes	1	25.0	3	75.0	0	0	4	2.5NS , 2, 0.05
No	9	6.2	127	87.8	10	6.0	146

 

 

CONCLUSION:

The present study concluded that majority of school teachers in experimental group had poor knowledge level regarding hypertension but after administration of self instructional module maximum school teachers had good knowledge level regarding hypertension. In control group both pre-test and post-test knowledge level remained same. The results revealed that there was significant impact on knowledge level of school teachers after administration of self instructional module.

 

 

 

 

DISCUSSION:

A similar study evaluated the knowledge, awareness and attitude of school teachers regarding hypertension. Overall only 20% of teachers were able to correctly answer questions regarding hypertension. The results revealed maximum school teachers had less knowledge regarding hypertension.⁸ A similar study was conducted to assess the effectiveness of structured teaching program on hypertension among hypertensive adults. The study results revealed that adults had inadequate knowledge in pre-test. In post- test it was found that adults gained adequate knowledge. Overall findings of the study showed that structured teaching program is very effective in improving knowledge.⁹ An experimental study was conducted to evaluate effectiveness of two teaching strategies for teachers diagnosed with hypertension. The findings revealed that a structured approach to health education is more effective as compared to giving verbal information to patients.¹⁰

 

ACKNOWLEDGEMENT:

Special thanks to Mrs. Neelam Kalia for valuable help in statistical analysis.

 

CONFLICT OF INTEREST:

There was no conflict of interest in the study.

 

SOURCE OF FUNDING:

Self

 

ETHICAL CLEARANCE:

Permission for the research study was taken from Ethical and Research committee of Mata Sahib Kaur College of Nursing, Balongi.

·        A formal written permission was obtained from the selected schools.

·        Written informed consent was taken from the school teachers. They were assured about the confidentiality and anonymity.

 

REFERENCES:

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2.       James J. Hypertension signs and symptoms: warning you can’t afford ignore, 2010 April 10; Available from : URL: http://www.ncbii.gov/healthcare.com.

3.       WHO.Global health risks. mortality and burden of disease attributable to selected major risks, 2010 Sep 7; Available from : URL: http://www.WHO.int/healthinfo/global burden disease

4.       Sundell L. Alcohol consumption and binge drinking as risk factors for cardiovascular diseases, 2010 April 12; Available from : URL: http://www.thl.fi/thl-client/pdfs.

5.       Johnson F. Symptoms of hypertension, Introduction, 2007 Oct 16; Available from : URL:  http://www.ncbi.gov/health care.

6.       Fahey T. Schroeder K.  Ebrahim S. Interventions used to improve control of blood pressure in patients with hypertension,2006 Mar 10; Available from : Cochrane Database System

7.       Swahn M. American Heart Association: Heart disease and stroke statistics, 2004 Apr 8; Available from: URL:  http://www.american heart.org.

8.       Olivaria SA, et.al. Hypertension knowledge, awareness and attitudes related to hypertension among school teachers, 2005 Nov 15; Available from: URL:  http://www.medscap.com/medline/abstract.

9.       Duong A. Diep et.al, Study to identify the extent of hypertension and risk factors in Vietnamese school teachers, 2002 Oct 18; Available from: URL: http:// Hypertension and risk factors. Pubmed.com.

10.     Jokar, Educational model to determine the status of hypertension awareness, treatment, and control, 2004 Aug 2; Available from : URL: www.pubmed.com.

 

 

Received on 11.09.2017       Modified on 18.11.2017

Accepted on 15.12.2017      ©A&V Publications All right reserved