Effect of Planned teaching Programme on Knowledge and practices regarding selected cancers among the school Teachers in Rural Area

Sr. Sholly. CK

Nursing Tutor, Holy Family Institute of Nursing Education, Mumbai Premier Road, Kurla (West).

*Corresponding Author Email: deepaumi96@gmail.com

ABSTRACT:

A hundred years ago, cancer was not common but for the last couple of decades number of incidence has been rising alarmingly, probably due to our changing life style and habits. The situation is alarming since every fourth person is having a lifetime risk of cancer. India registers more than eleven lakh new cases. We are constantly exposed to a variety of cancer causing agents known as carcinogens in the food we eat, in the water we drink and in the air we breathe. One single meal may contain danger of carcinogen in the form of residues of particles or insecticides. Exposure to electromagnetic radiation emitted by cell phone, computer and other electrical appliances can cause cancer. Like wise there is a long list of chemical, physical, biological and geographical carcinogens¹. The total number of cancer deaths by the country is collected annually and are made available by the World Health Organization (WHO). About 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008 worldwide, with 56% of the cases and 64% of the deaths in the economically developing world. Breast cancer in females and lung cancer in males are the most frequently diagnosed cancers and the leading cause of cancer death for each sex in both economically developed and developing countries, except lung cancer is preceded by prostate cancer as the most frequent cancer among males in economically developed countries. Cancer affects everyone in different ways, and everyone has the power to take action to reduce the impact of the disease on individuals, families and communities. The global cancer epidemic is enormous and is set to rise. Currently 8.2 million people die from cancer worldwide every year, out of which 4 million are premature deaths. Over the next ten years cancer deaths are projected to increase to over 14 million per year². Despite significant advances in the understanding of cancer, including causes, prevention, early detection, diagnostic tools, prognostic indications, treatment, and symptoms management, many people still associate cancer with pain and death. World cancer research fund international estimates that for the 13 most common cancers, about 31% of cases in the United States are preventable through a healthy diet, being physically active and maintaining a healthy weight³. Tobacco is the most important risk factor for oral cavity and oropharyngeal cancer. Mouth cancer is largely a lifestyle disease, meaning that the majority of cases are related to tobacco use. Approximately 90% of people with mouth cancer are tobacco users. People, who stop using tobacco, even after many years of use, can greatly reduce their risk of all smoking related illnesses, including mouth cancer.

KEYWORDS: Chemical, physical, biological and geographical carcinogens.

INTRODUCTION:

Though the government has taken a number of steps towards improving the living standards and the health situation of citizens in India, the impact has not been as profound as anticipated. The government of India has been making efforts through a galaxy of programs and initiatives over the years to improve the health situation of the nation. Though efforts are being made in the right direction, more needs to be done to achieve the desired goal set by the government. The major health problems plaguing the nation in the present era are Communicable diseases, Malaria, Tuberculosis, Diarrheal Disease, Acute Respiratory Infection, Leprosy, Filariasis, AIDS, Non-Communicable Diseases-Diabetes Mellitus, Cancer, Cardiovascular Diseases, Blindness, Environmental sanitation problems, Medical Care Problems, Population Problem and Nutritional Problems¹.

Currently Cancer a non-communicable disease that accounts for the leading cause of death. Cancer afflicts different communities’ world wide.it affects not only the single individual but also the entire family and society thereby increases a substantial burden on the individual, family and society. Cancer is most important community health problem in India⁵.

The global cancer epidemic is enormous and is set to rise. Currently 8.2 million people die from cancer worldwide every year, out of which 4 million are premature deaths. Over the next ten years cancer deaths are projected to increase to over 14 million per year.

Cancer is the leading cause of death in economically developed countries and the second leading cause of death in developing countries. The burden of cancer is increasing in economically developing countries as a result of population, aging and growth as well as, increasingly, an adoption of cancer-associated lifestyle choices including smoking, physical inactivity, and “westernized” diets.

Urgent action must be taken to raise awareness about the disease and to develop practical strategies to address the cancer burden. Until cancer awareness is improved globally and actions are taken to prevent and treat the disease, millions of people around the world will die unnecessarily

Every yearOne important step to reduce the number of deaths due to cancer is to create awareness among population. Hence I felt the need to do this above study^.

NEED OF THE STUDY:

India reports about one million new cases every year. Of the eight million cancer-related deaths in 2012, nearly 700,000 were in India, accounting to about 8% of the world’s cancer patients. Again, in India, 71% deaths between 30-69 years are cancer related. As against global average of 0.5%, 15% cancers in India are in minors. The estimated incidence of cases of cancer in the country rose from 1,086,783 in 2013 to 1,117,269 in 2014. The estimated cancer mortality cases in the country have also risen from 478,185 in 2013 to 491,597 in 2014. Cancer is the second most common disease in India responsible for maximum mortality with about 0.3 million deaths per year. An estimated 600,000-700,000 deaths in India were caused by cancer in 2012. In age-standardized terms this figure is close to the mortality burden seen in high developed countries. Oral cancer ranks among the top three of all cancers in India: four in ten of all cancers in India are oral cancers. Annually, 130,000 individuals succumbs to oral cancer, approximately 14 deaths per hour⁴.

Cancer is one of the leading causes of death worldwide, and thus represents a priority for national public health programs. Prevention has been assumed as the best strategy to reduce cancer burden, however most cancer prevention programs are implemented by healthcare professionals, which constrain range and educational impacts⁶.

The teachers were able to independently develop and implement prevention campaigns focused on students and school-related communities. School teachers and schools as cancer prevention promoters and opens a new perspective for the development and validation of cancer prevention education strategies, based upon focused interventions in restricted targets (students) through non-health professionals (teachers).

All this calls for increased awareness as well as education and training to foster better informed decision-making, together with improved cancer surveillance, early detection and emphasis on prevention. Teachers are the population of interest because of the important role they play in education and possibly in prevention of cancer.One important step to reduce the number of deaths due to cancer is to create awareness among population. Urgent action needs to be taken to be taken to raise awareness about the disease and to develop practical strategies to address the cancer burden. Global disparities in access to prevention, treatment and palliative care are growing exponentially. Hence I felt the need to do this above study^.

STATEMENT OF THE PROBLEM:

“A study to assess the effect of planned teaching programme on knowledge and practice regarding selected cancers among the school teachers in rural area”

OBJECTIVES:

PRIMARY;

1) To assess the effect of planned teaching programme on knowledge and practice regarding selected cancers among school teachers in rural area.

SECONDARY:

1 To assess the knowledge and practice of selected cancer among school teachers before and after planned teaching.

2 To compare the effect of planed teaching on knowledge and practice of selected cancer among school teachers.

3 To find the association between knowledge and practices of school teachers regarding selected cancer with demographic variable.

HYPOTHESIS:

H01: There will be no significant change in knowledge score of school teachers regarding selected cancers after planned teaching.

H02: There will be no significant change in practice score of school teacher regarding selected cancers after planned teaching.

H03: There will be no significant association of knowledge and practice score of school teachers regarding selected cancers to demographic variables

OPERATIONAL DEFINITIONS:

1. Effect: `

According to oxford dictionary, effect means “the result or outcome of change produced by an action”

· In this study effect means change produced by planned teaching program on knowledge and practices of school teachers regarding selected cancers assessed by difference between pre-test and post-test score using a structured questionnaire.

2. Planned teaching programme:

According to oxford dictionary, planned teaching programme means “an organized method of instruction”. In this study, planned teaching programme refers to information given to school teachers using prepared teaching plan on selected aspects.

Planned teaching includes the following selected aspects:

a) Meaning of cancer

b) Types

c) Causes and risk factors

d) Early detection

e) Prevention

f) Home management

3. Knowledge:

According to oxford dictionary, knowledge means “state of being aware or of informed”

In this study, knowledge is considered as the information of the, school teachers regarding selected cancers that will be assessed using a structured questionnaire.it is measured by difference between pre-test and post-test knowledge scores.

4. Practices:

According to oxford dictionary, Practices means “the actual doing of something rather than the theories about it”^.

In this study, practice refers to activities carried out by the school teachers regarding selected cancers by a self-reported questionnaire, such as habits, dietary pattern, and physical activity.

5. Cancer:

According to medical dictionary Cancer means “a group diseases characterized by abnormal growth of cells”

Same in this study.

7. School teachers:

According to oxford dictionary school teachers means “A person who teaches in a school^”

In this study, the school teachers refers to the population of interest because of the important role they play in education and possibly in prevention of cancer

8. Selected:

According to oxford dictionary Selected means “carefully choose as being the best or most suitable”

In this study selected cancers are Lung cancer, cervical cancer, oral cancer and larynx

RESEARCH METHODOLOGY:

In this study, a descriptive approach has been used to describe the existing knowledge and practices of school teachers regarding selected cancers. The evaluative approach has helped the investigator to find out the effect of structured teaching program on knowledge and practices of school teachers regarding selected cancers. One group pre-test post-test design was adopted in this study. The study was conducted among the school teachers in the rural areas.50 teachers were selected using Non- probability convenient Sampling Technique.

VALIDITY:

The content validity of the tool was done by experts in their respected fields which included 2 from community medicine 1 statistician and 8 nursing experts from the field of Community Health Nursing. After receiving the suggestions and opinions from the experts, relevant changes were incorporated with necessary modifications.

RELIABILITY:

The reliability of the questionnaire was established using the test-retest method and split half method. The reliability was calculated by spearman’s rank correlation formula. A high correlation coefficient o r = 0.850 was obtained indicating the tool was reliable.

SETTING OF THE STUDY:

Setting is defined as the physical location and conditions in which data collection takes place

The study was conducted in selected schools at rural area. The schools were situated under Thane district. Three schools were selected in the village area of Mahral and Raitha.The selected cancers are very common among the people of rural areas due to lack of awareness. Familiarity with setting, administrative approval, co-operation and availability of subjects.

POPULATION:

The word population means the entire set of individuals (or objects) having some common characteristics.Population is the entire group to whom the researcher generalizes the study results. In this present study, population consists of school teachers working in the rural areas.

TARGET POPULATION:

The target population is the aggregate of cases about which the researcher would like to generalize.The entire population in which the researcher were interested and in which they would like to generalize the research finding.The target population of this study consisted of school teachers working in the rural areas and who meet inclusion and exclusion criteria.

ACCESSIBLE POPULATION:

The accessible population is the aggregate of the cases that cases that conform to designated criteria and that are accessible as the subjects for the study.

In this study the accessible population consisted of the school teachers working in the rural areas.

SAMPLE:

A sample is the subgroup of individuals in the population, usually proportionately few in number, selected so as to be, to some degree, representative of the population.

In this study, the sample consisted of the school teachers working in the rural areas.

SAMPLE SIZE:

Sample size consisted of 50 school teachers working in the rural area.

SAMPLING TECHNIQUE:

Sampling refers to the process of selecting a portion of the population to represent the entire population. Sample is a subset of population of interest, selected for participation in this study.

Sampling technique is an important step in the research process. It is the process of selecting representative units or subsets of a population of the study in a research. Non probability convenient sampling technique was used to select the sample. Non probability convenient sampling entails the selection of most readily available individuals as a subject in the study. It represents typical condition and researches knowledge about his population and its elements can be used to hand pick cases. The investigator selected the samples from selected rural area who were school teachers.

FINDING OF THE STUDY:

The data collected was presented in to six sections are as follows

Section 1

Deals with distribution of samples with regard to their demographic data.it is analyzed and presented in the form of frequency and percentage table and graph.

· Data related to age of respondents are Maximum sample 19 (38 %) were aged between 41- 50 years. Then 15 (30%) sample were aged above 51yrs. very few samples 9(18%) were aged between 31yrs-40yrs. Minimum sample 7(14%) were aged between 25yrs-30yrs.

· Gender of respondents. 32 (64%) samples were males and 18 (36%) samples were females.

· Educational status, Most of sample 27(54%) studied up to B.Ed. Next 15(30%) samples completed education up to D.Ed. Few 7(14%) samples had done other study. Minimum of 1 (2%) sample were M.Ed.

· All the 50(100%) samples were Hindus, None were Muslims and Christians.

· Family income of sample, it depicts maximum sample 19 (38 %), were earning Above Rs. 50000/ month, followed by 12 (24%) samples were earning between Rs. 40100-50000/ month. 7 (14 %) samples each were earning Rs.30100-40000/ month and below Rs.20000/month. Minimum sample 5 (10%) were earning between Rs.20100-30000and month. The samples were almost equally distributed in all the Income range groups.

· Marital status, Majority of the sample that is 47(94%) was Married. 2(4%) samples were Unmarried. and 1(2%) sample was Widow/widower.

· In the whether having habit of smoking. Majority of the sample that is 48(96%) were non smokers. Only 2 (4%) samples had the habit of smoking and were smoking sometimes.

· Having habit of Paan/Tobacco chewing. Majority of the sample that is 49(98%) had no habit of Paan / Tobacco chewing. Only 1 (2%) sample had the habit of Paan/Tobacco chewing and was doing it sometimes.

· Whether having habit of consuming alcohol. Majority of the sample that is 46(92%) had no habit of consuming alcohol. Only 4 (8%) samples had the habit of consuming alcohol. Out of which 3(6%) samples were drinking alcohol occasionally and 1(2%) sample was drinking alcohol 1-2 times / week.

· Having family history of cancer. Majority of the sample that is 49(98%) had no family history of cancer. Only 1 (2%) sample had family history of cancer, and person affected was mother.

· Whether having genital tract infection or diseases. All the samples that are 50(100%) had no genital tract infection or diseases.

SECTION-II:

This section deals with assessment of knowledge and practices regarding selected cancers among school teachers in rural area before and after administration of Planned Teaching.

Part –A: Deals with the analysis of knowledge scores of school teachers regarding the concept of cancer before and after the planned teaching

· Before administering the planned teaching 18(36%) teachers had good knowledge followed by 14(28%) teachers with poor knowledge. There were 11(22%) teachers with average knowledge and minimum 7(14%) teachers had excellent knowledge.

· After the planned teaching program, The post test score shows improvement as number of sample rose to 38(76%) samples in Excellent knowledge category, followed by6 (12%) samples in good knowledge category. There were 5(10%) samples in average knowledge category and only 1 (2%) sample was having poor knowledge.

Part B

Assessment of area wise knowledge levels regarding Lung cancers among school teachers in rural area before and after the planned teaching

· Before administering the planned teaching, maximum 18(36%) samples had average knowledge followed by 17(34%) samples with good knowledge. There were 10(20%) samples with poor knowledge and minimum 5(10%) samples had excellent knowledge.

· After the planned teaching program the score shows improvement as number of sample rose to 36(72%) samples in good knowledge category, followed by 9 (18%) samples in excellent knowledge category. There were 5(10%) samples in average knowledge category and none of the sample was having poor knowledge.

Part C:

Knowledge levels regarding Oral cancers among school teachers in rural area, before and after the planned teaching

· Before administering the planned teaching, 20(40%) samples had excellent knowledge followed by 19(38%) samples with good knowledge. There were 11(22%) samples with average knowledge and none of the samples had poor knowledge.

· After the planned teaching program, score shows drastic change as number of sample increased to 45(90%) samples in excellent knowledge category, followed by 5 (10%) samples in good knowledge category. There were nil samples in average knowledge and poor knowledge category.

Part D:

Assessment of area wise knowledge levels regarding Larynx cancers among school teachers in rural area.

· Before administering the planned teaching, 26(52%) samples had average knowledge followed by 17(34%) samples with poor knowledge. There were 7(14%) samples with good knowledge and none of the samples had excellent knowledge.

· After the planned teaching program, score shows good improvement as number of sample increased to 24(48%) samples in good knowledge category, followed by 16 (32%) samples in average knowledge category. 10(20%) samples had excellent knowledge there were nil samples in poor knowledge category.

Part E

Assessment of area wise knowledge levels regarding cervical cancers among school teachers in rural area.

· Before administering the planned teaching, 23(46%) samples had average knowledge followed by 20(40%) samples with poor knowledge. There were 7(14%) samples with good knowledge and none of the samples had excellent knowledge.

· After the planned teaching program score shows good improvement as number of sample increased to 35(70%) samples in good knowledge category, followed by 14 (28%) samples in Excellent knowledge category. Only 1(2%) sample had average knowledge. None of the samples were in poor knowledge category.

Part F

Assessment of Overall knowledge levels regarding selected Cancers among school teachers in rural area.

· Before administering the planned teaching depicts maximum 29 (58%) sample had Average knowledge followed by 18(36%) samples with good knowledge. There were 3 (6%) samples in poor knowledge category and there were no samples in excellent knowledge category.

· After the planned teaching program, score reveals that 41(82%) sample each had excellent knowledge and 9 (18%) samples had good knowledge. None of the sample had poor or Average knowledge

PART G:

Assessment of overall Practice levels among regarding selected cancers among school teachers in rural area.

· Before the planned teaching 23 (46%) sample had Average Practice followed by 19(38%) samples with good Practice. Minimum of 7 (14%) samples were practicing poorly. Only 1 (2%) sample was in excellent Practice category.

· After the planned teaching program, score shows significant change as 29(58%) sample had excellent Practice and 20(40%) sample had good Practice. Only 1 (2%) sample was in average Practice category none of the sample had poor Practice.

SECTION-III:

This section deals with comparison of overall mean regarding knowledge and practice regarding selected cancers among school teachers in rural area.

The t test for small correlated sample was used to test significance of difference between the pre and post test and to assess the effect of Planned Teaching on the knowledge and practices regarding selected cancers among school teachers in rural area.

Part A:

Deals with the comparison of area wise knowledge mean score before and after administration of Planned Teaching Program regarding selected cancers among school teachers in rural area.

· Before calculating the‘t’ value Null hypothesis (H₀) and alternate hypothesis (H₁) was stated. The table‘t’ value for 0.05 level of significance was 2.01 for degree of freedom of 49.

· The calculated ‘t’ value was found to be 6.14 for Concept of cancers, 12.1 for Lung cancer, 6.14 for Oral cancer, 8.68 for Larynx cancer and 15.9 for Cervical cancer.

Part B:

Comparison of the overall pretest and post test knowledge regarding selected cancers among school teachers in rural area.

· The calculated ‘t’ value is found to be 18.9 for overall knowledge. As the calculated ‘t’ value is greater than the table ‘t’ value of 2.01 at 0.05 level of significance with the degrees of freedom being 49 so null hypothesis (H₀) is rejected and alternate hypothesis (H₁) is accepted for overall Knowledge.

· This shows that there is a significant difference in the mean of pre and post test knowledge of the sample. Therefore it was concluded that there is a statistical significant difference at 0.05 levels with regard to the knowledge score after administration of Planned Teaching on the knowledge regarding selected cancers among school teachers in rural area.

SECTION-IV

In this section Analysis and interpretation of data is done in order to find out association of pretest score of knowledge and practice with selected demographic variable.

· ANOVA is used to find out any association exists between the scores of knowledge and practice with pre administration of Planned Teaching on the knowledge and practices regarding selected cancers among school teachers in rural area

· Before calculating the F value null hypothesis (H₀) and alternate hypothesis (H₁) was stated for knowledge and Practice as below.

· H₀: There will be no significant difference between the groups of demographic variables with respect to pre-test knowledge and practice scores among School teachers in rural area.

· H₁: There will be significant difference between the groups of demographic variables with respect to pre-test knowledge and practice scores among School teachers in rural area

Part A:

Association of pretest knowledge score regarding selected cancers with demographic variables such as Age, Gender, Education and Family Income among school teachers in rural area.

· Based on the ‘F’ test for unpaired sample the calculated ‘F’ value of knowledge score for Age is 0.94, Gender is 0.67, Education is 0.26 and Family Income is 2.12. The calculated ‘F’ values of all the demographic variables is less than the respective ‘F’ table value at 0.05 levels.

Part B:

Association of pretest Practice score regarding selected cancers with demographic variables such as Age, Gender, Education and Family Income among school teachers in rural area.

· Based on the ‘F’ test for unpaired sample the calculated ‘F’ value of Practice score for Age is 0.59, Gender is 0.12, Education is 0.34 and Family Income is 1.31. The calculated ‘F’ values of all the demographic variables is less than the respective ‘F’ table value at 0.05 levels.

· There is no statistical significant mean difference between the groups of the demographic variables Age, Gender, Education and Family Income with respect to their pretest Practice means scores. Hence null hypothesis (H₀) is accepted and alternate hypothesis (H₁) is rejected for all.

RECOMMENDATIONS:

A similar study may be replicated on a larger scale

A comparative study could be done to assess the effectiveness of other teaching modalities like self-instructional module, information booklets on the same topic.

The same study could be done among people of rural area to assess their knowledge on selected cancer.

The same study can be done with a control group.

The study can be conducted over a longer period of time to assess the effectiveness of planned teaching in reducing the risk of cancer.

PERSONAL EXPERIENCE:

The present study has been an enriching learning experience for the investigator. The researcher got the first hand experience of going through all the phases of the research work the researcher obtained needed co-operation from all the teachers under study and the headmasters of the schools the entire study was varied and rich learning experience which enabled the investigator to develop her skill in dealing with different personalities.

The timely help and guidance of the guide enabled the researcher to overcome all the initial obstacles and brought to the completion of the study.

CONCLUSION:

This study has helped to assess the knowledge and practices of school teachers in the rural area regarding the selected cancers. The study reveals that it is important to have regular health teaching program for the teachers to improve their knowledge and to impart this to their students and to the society where they live.

The findings of the study show that the planned teaching program on selected cancers were highly effective to increase the knowledge and practices of the teachers. All subjects expressed their keen interest to participate in the study. Over all the entire study was carried out smoothly and gave a feeling of satisfaction and accomplishment.

REFERENCES:

1. Gulani KK: Community health Nursing Principles and Practices, 2nd ed. Kumar Publishing House; 2016.

2. Asian Journal of Nursing Education and Research, Vol 7, Issue 1, Jan-Mar;2017

3. Brunner and Suddarths: Textbook of Medical-Surgical Nursing, Volume 1,13^thed. Wolters Kluwer, p 310-321

4. Nightingale Nursing Times, Vol XII No 11, February; 2017

5. Nightingale Nursing Times, Vol XII No 1, April ;2016

6. World cancer research fund/American institute for cancer research. Continuous Update Project Report. Available from: URL: http/ www.dietandcancerreport.org/cuo/in dex .php.