INTRODUCTION:

“All children are born to grow, to develop, to live, to love, and to articulate their needs and feelings for their self-protection.”¹ A newborn or neonate refers to a baby in the first 28 days after birth. The term infant is typically applied to young children between the ages of 1 month and 12 months.²Child's first year of life is an amazing period of growth and development.

Growth and development is a fundamental feature of children, child’s growth and development purely depends upon the fulfillment of his basic needs and must be satisfied for higher growth.²

The terms “growth and development” are often used together. These are not interchangeable because they represent two different facets of the dynamics of change, i.e. those of quantity and quality.³ Growth and development of a child is assessed periodically since it is a vital aspect of a child’s life. Growth and development is a continuous and orderly process that starts from conception (fertilization) and continues until the child grows into a fully mature adult.

Growth is a physical maturation or quantitative changes in the child’s body. It can be defined as an increase in physical size of the body and its parts (organs) in the form of height and weight due to cell multiplication. Length/height can be measured in centimetres or inches and weight in Kilograms or pounds. Criteria for assessment of Growth includes weight, height, head and chest circumferences, mid-upper arm circumference, body ratios, body mass index and teething.²

Development is a functional maturation or physiological maturation or a qualitative change in the child’s functioning. It is defined as a progressive increase in skills and capacity to function due to maturation and myelination of the nervous system. It includes gross motor, fine motor, language, intellectual, psychological, social, sexual, emotional, and spiritual development.²

Accurate measurement at the regular intervals is vital to assess the growth and development. Measuring a child’s growth and development is one way of measuring his/or her health. A steadily progressive trend in the pattern of growth and development of a child is a reliable index at the state of his/or her health. It is assumed that parents’ education and economic status have a major role to play in enabling the growth and development of their children.⁴

Infants are completely dependent on their parents especially upon their mothers for the fulfillment of their basic needs and mothers are the persons, who always accompany their children. They witness the growth and development, so they need to acquire knowledge of normal growth and development and also its variations, attainment of milestones at the appropriate age and any delay in attainment.⁵

The child’s growth status depends upon the health of the family and the parent’s socio-economic, educational, cultural and emotional background. It is found that the present changes in social and family structure that is, industrialization, urbanization nuclear family system, working mothers etc. affects the growth status of children. Healthy marriage is an important element of support because it supports both the mother and the mother child relationship. A healthy stable environment also helps with the infant’s brain development.⁶

NEED FOR THE STUDY:

Parental knowledge of child development has often been mentioned as a factor related to child development outcomes. It can be defined as “understanding of developmental norms and milestones, processes of child development, and familiarity with care giving skills.” Studies have indicated that when mothers have higher knowledge of infant and child development, they show higher levels of parenting skills,their children have higher cognitive skills, and there are fewer child behaviour problems.⁷

The Rapid Survey on Children was conducted by the ministry of women and child development with technical support from UNICEF. It found that underweight (low in weight for their age) children aged less than 3 years are 29.4 per cent, Wasted (low weight for their height) children are 15 per cent. Stunted (low in height for age) children are 38.7 per cent. But in absolute terms, the current levels of underweight and stunted children are abnormally high and former Prime Minister of India Dr. Man Mohan Singh’s assertion that malnutrition is a “National Shame” is still valid.⁸

According to the just released SRS (Sample Registration System) bulletin, IMR of India has 34 per 1000 live births in 2016. In India infant mortality rate is high than the other countries such as IMR of Japan has 2, England has 4.3, USA has 5.8, China has 12.2, Sri Lanka has 8.6, Nepal has 28.9 even though Bangladesh has 32.9 Per 1000 live births.⁹ Data shows that 30% -40% of children below 3 years of age are underweight. The previous research studies and available data indicate that IMR, malnutrition, underweight and growth retardate infants are more in India compare to other most of the developed countries. Researcher believes that poor knowledge and practice regarding child care, nutrition, and growth and development are the key factors behind the increased IMR, malnutrition, failure to thrive and arrested growth during the infancy. Health education to the caregivers may reduce the IMR and improve the growth and development. Hence the investigator had planned to conduct a study on the effectiveness of self-instructional module on knowledge and practice regarding growth and development of infants among caregivers residing in selected rural areas, Sikar, Rajasthan.

AIM OF THE STUDY:

The aim of the study was to identify and improve the knowledge and practice regarding growth and development of infants among Caregivers residing in selected rural areas, Sikar; Rajasthan”.

OBJECTIVES OF THE STUDY:

1. To identify the knowledge and practice regarding growth and development of infants among caregivers of the Experimental and Control group during the pre-test.

2. To assess the effectiveness of self-instructional module on knowledge and practice regarding growth and development of infants among caregivers of infants of the Experimental group.

3. To evaluate the knowledge and practice regarding growth and development of infants among caregivers of the Experimental and Control group after the post-test.

4. To correlate the pre-test and post-test scores of knowledge and practice regarding growth and development of infants among caregivers of the Experimental and Control group.

5. To find out the association between the pre and post-test scores of knowledge and practice regarding growth and development of infants among caregivers of the Experimental and Control group with selected socio-demographic variables.

RESEARCH HYPOTHESIS:

H₀: There is no significant relationship between the pre and post-test scores of knowledge and practice regarding growth and development of infants among caregivers residing in selected rural areas, Sikar, Rajasthan.

H₁: There is significant difference in the pre and post-test scores of knowledge and practice of the Experimental group than pre and post-test scores of knowledge and practice of control group regarding growth and development of infants among caregivers residing in selected rural areas, Sikar, Rajasthan.

H₂: The post-test mean score of knowledge and practice regarding growth and development of infants among caregivers of Experimental group will be significantly higher than the post-test mean score of the control group.

H₃: There will be significant association between post-test scores of knowledge and practice regarding growth and development of infants among caregivers of the Experimental group with the selected socio-demographic variables.

In the study review of literature was divided into 6 parts:

1. Literature related to knowledge and practices regarding growth chart and growth pattern of infants among caregivers.

2. Literature related to knowledge and practices regarding development of infants among caregivers.

3. Literature related to knowledge and practices regarding growth and development of infants among caregivers.

4. Literature related to knowledge and practices regarding infant feeding among caregivers.

5. Literature related to knowledge and practices regarding weaning/ supplementary nutrition and weaning foods of infants among caregivers.

6. Literature related to knowledge regarding diet/nutrition, nutritional deficiency disorders, and infection of infants among caregivers.

Conceptual frame work of the study:

The conceptual frame work for the study is based on Betty Neuman’s “General System Theory”.

METHODOLOGY:

Research Design:

In this research, non-randomized control group design was used which is the Sub-type of quasi-experimental research design.

Sampling technique and sample Size:

The sample size 400 caregivers of infants residing in rural areas, Sikar Rajasthan were selected by convenient non-probability sampling technique. In the study 200 caregivers of infants were in the experimental group and 200 caregivers of infants were in the control group

Variables:

1. Independent variable: - “Self-instructional module on knowledge and practices regarding growth and development of infants”.

2. Dependent variable: - “knowledge and practices regarding growth and development of infants among caregivers”.

Description of the instrument:

The instrument was organized into two parts: -

Part I: Information regarding socio-demographic variables.

Part II: Information on knowledge and practice regarding growth and development of infants among caregivers. It consisted of a structured questionnaire containing 30 objective types of multiple choice questions and observation check-list containing 15 items.

Validation of the instrument:

Researcher developed a structured questionnaire and observation check-list and then the content validity of the instrument was taken from the experts who are Ph. D. in the field of Nursing, and medical experts. The instrument was further modified as per the recommendations of the experts and guidance was sought for the preparation of the self-instructional module on knowledge and practice regarding growth and development of infants.

Reliability of the instrument:

The reliability of the tool was assessed by using Test-retest method. Knowledge score reliability correlation coefficient value was 0.81 and practice score reliability correlation coefficient value was 0.85. These correlation coefficients were very high and it is good tool for assessing effectiveness of self-instructional module on knowledge and practice regarding growth and development of infants among caregivers residing in selected rural areas, Sikar, Rajasthan.

Development of the self-instructional module:

The draft of the self-instructional module on knowledge and practice regarding growth and development of infants among caregivers was developed with the guidance of the research supervisor based on the objectives, review of literature and to the level of understanding of the caregivers of infants and then contents of the self-instructional module were modified as per the opinions and instructions given by the experts in the medical and nursing field.

Ethical Considerations:

The Researcher followed all the institutional ethical committee guidelines to conduct the research study. First of all, before pilot study and main study certificate of ethical approval was obtained from the Institutional Ethical Committee of Tantia University. Then written permission was obtained from the Research Director, and Ph.D. Guide Dr. W. Indira. Then written permission was obtained from the five Sarpanches of different Gram Panchayats of laxmangarh tehsil in the Sikar district of Rajasthan. Oral and written permission was taken from the 400 caregivers of infants included in the main study (200 caregivers of infants in the experimental group and 200 caregivers of infants in the control group) in the form of informed consent.

Method of data collection:

After completion of the pilot study, result was prepared and some necessary modifications were done in the tool and self-instructional module. The feasibility of conducting the research study was ensured. Data collection was done from 20^th July 2017 to 10^th February 2018.

Plan for statistical analysis:

Data was collected and observed from 400 caregivers of infants from selected rural areas Sikar, Rajasthan. The collected data was summarized and tabulated by utilizing descriptive statistics which included of Mean, Percentage, Standard Deviation and inferential statistics includes Student’s Independent ‘t’ test, Chi-Square, Extended Mc Nemar’s test, etc.

DATA ANALYSIS AND INTERPRETATION:

Section I: Distribution of subjects according to socio-demographic variables:

In the socio-demographic variables, there is no statistically significant difference between the experimental and the control group. It was tested by using Chi-square test.

In the experimental group, in pre-test caregivers of infants were having 6.55(43.67%) practice score and in Post-test caregivers of infants were having 12.06(80.4%) practice score, so the difference was 5.51(36.73%), this difference was large and it was statistically significant. t=31.28 p=0.001*** (highly significant)

In the Control group, in pre-test caregivers of infants were having 6.35(42.33%) practice score and in Post-test caregivers of infants were having 6.52(43.47%) practice score, so the difference was 0.17(1.4%), this difference was small and it was not statistically significant. Statistical significant difference between pre-test and post-test was calculated by using student paired t-test. t=1.89 and p=0.06 (Not Significant).

Section IV: To evaluate the knowledge and practice regarding growth and development of infants among caregivers of the experimental and control group after the post-test:

In the Experimental group, in post-test, caregivers of infants were having 23.63(78.77%) mean knowledge score, SD=2.39 and in the control group caregivers of infants were having 11.28(37.6%) mean knowledge score, SD=1.84 so the difference was 12.35(41.17%) this difference was large and it was statistically significant difference. It was calculated by using student’s independent ‘t’ test. t=57.96 and P=0.001*** and DF = 398, ((***P<0.001 highly significant DF=Degrees of Freedom)

Section V: To correlate the mean gain scores of knowledge and practice regarding growth and development of infants among caregivers of the experimental and control group:

There is a significant positive moderate correlation between knowledge gain score and practice gain score in the experimental group. It means knowledge increases their practice score also increases moderately.

Section VI: To association between the pre and post- test scores of knowledge and practice regarding growth and development of infants among caregivers of the experimental and control group with selected socio-demographic variables:

Association between post-test level of knowledge gain score and demographic variables in the experimental group in which Elder caregivers, more educated caregivers, multi-para caregivers, nuclear family caregivers, government job caregivers have gained more knowledge score than others. It was calculated by using Chi-square test.

Association between post-test level of practice score and demographic variables in the experimental group in which Elder caregivers (c2=8.01 and P=0.05* Significant), more educated caregivers (c2=18.56 and P=0.01** (Significant), multi-para caregivers (c2=4.82 and P=0.02 *S), nuclear family caregivers (c2=7.03 and P=0.05*S), government job caregivers c2=8.20 and P=0.04* S) and more income caregivers (c2=15.51 and P=0.001*** S) have gained more practice score than others. It was calculated by using chi-square test.

Testing the Hypothesis:

H₀:

There will be no significant difference between the pre and post-test scores of knowledge and practice regarding growth and development of infants among caregivers of the Experimental group residing in selected rural areas, Sikar, Rajasthan.

Caregivers of infants of the Experimental group, in pre-test they were having 11.46 (38.2%) knowledge mean score and in post-test they were having 23.63 (78.77%) knowledge mean score, so the difference was 12.17 (40.57%), this difference is large and it is statistically significant.

Caregivers of infants of the Experimental group, in pre-test they were having 6.55 (43.67%) practice mean score and in post-test they were having 12.06 (80.4%) practice score, so the difference is 5.51 (36.73%), this difference is large and it is statistically significant.

The findings of the study show that post-test mean knowledge score and mean practice score were more than the pre-test mean scores in the experimental group. It means significant difference between the pre and post-test scores of knowledge and practice regarding growth and development of infants among caregivers of the Experimental group residing in selected rural areas, Sikar, Rajasthan. So null hypothesis (H₀)is false and it is rejected.

H₁:

There will be significant difference in the pre and post-test scores of knowledge and practice regarding growth and development of infants among caregivers of the Experimental group residing in selected rural areas, Sikar, Rajasthan.

The findings of the study show that post-test mean knowledge score and mean practice score were more than the pre-test mean score in the experimental group. It means there is significant difference between the pre and post-test scores of knowledge and practice regarding growth and development of infants among caregivers of the Experimental group residing in selected rural areas, Sikar, Rajasthan. So research hypothesis (H₁)is true and it is accepted.

H₂:

The post-test mean score of knowledge and practice regarding growth and development of infants among caregivers of Experimental group will be significantly higher than the post-test mean score of the control group.

In the experimental group, post-test mean knowledge score regarding growth and development of infants among caregivers was 23.63 (78.77%) and in the control group, post-test mean knowledge score was 11.28 (37.6%), so the mean knowledge score difference was 12.35 (41.17%). The difference was large and it has statistical significant difference.

Caregivers of the experimental group, in post-test, were having 12.06 (80.4%) mean practice score and in control group, post-test mean practice score was 6.52 (43.47%), so the mean practice score difference was 5.54 (36.93%), this difference was large and it has statistically significant difference.

The findings of the study show that post-test mean knowledge score and mean practice score in the experimental group were more than the post-test mean knowledge and practice score in the control group. It means there was the significant difference between the post-test scores of knowledge and practice regarding growth and development of infants among caregivers of the Experimental and control groups residing in selected rural areas, Sikar, Rajasthan. So H₂ hypothesis is true and it is accepted.

The association between post-test level of knowledge score and demographic variables in the experimental group caregivers that elder care givers, more educated care givers, multi-gravid care givers, nuclear family caregivers, government job caregivers have gained more knowledge score than the others. It was calculated by using chi-square test.

The findings of the study show that there was significant association between post-test scores of knowledge and practice regarding growth and development of infants among caregivers of the Experimental group with the selected socio-demographic variables. So H₃ hypothesisis true and it is accepted.

CONCLUSION:

From the findings of the present study, it is concluded that the score gained on knowledge and practice regarding growth and development of infants was inadequate among caregivers of the experimental and control group during the pre-test. However, the findings of the post-test in the experimental group, the level of knowledge and practice regarding growth and development of infants among caregivers has improved and the score has indicated that the score gained during post-test was more than pre-test. This improvement was due to the implementation of the self-instructional module on knowledge and practice regarding growth and development of infants. Therefore knowledge and practice regarding growth and development of infants among caregivers can be further improved by providing ongoing teaching and health education programmes.

The findings of this study support the need for paediatric nurses to conduct health education programme, to increase the knowledge and improve the practice regarding growth and development of infants among caregivers. This study has proved that the caregivers had a remarkable increase in the knowledge and improve the practice regarding growth and development of infants after the implementation of the self instruction module during the post-test when compared to the previous knowledge (Pre-test), prior to the implementation of the self instruction module. Thus for the future, there is a need to improve their knowledge and practice regarding growth and development by conducting the health awareness programme through the self-instructional module on growth and development of infants.

REFERENCES:

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Received on 09.09.2018 Modified on 14.10.2018

Asian J. Nursing Education and Research. 2019; 9(1):87-93.

DOI: 10.5958/2349-2996.2019.00017.X