Effectiveness of mother to mother approach on knowledge regarding safe administration of paediatric medication among mothers of under five children

 

Ms. Varsha. M. S 1, Dr. Nandini. M2

12nd Year MSc (N) Student, Aswini College of Nursing, Nadathara, Thrissur Dist, Kerala, India

2Vice Principal, Professor cum HOD of Child Health Nursing, Aswini College of Nursing,

Nadathara, Thrissur Dist, Kerala, India

*Corresponding Author Email: varshamohan006@gmail.com, nandinim31@gmail.com

 

ABSTRACT:

Child safety is one of the highest priority for health professionals and caregivers. Hence administering medication to the children is a great challenge for the parents, caregivers as well as to the health professionals. Many parents or caregivers are inexperienced in administering liquid medication, resulting in possible under dose and over dose medication error. Hence, the study was undertaken to assess the effectiveness of mother to mother approach on knowledge regarding safe administration of paediatric medication in selected village, Nadathara Gramapanchayath, Thrissur. The other objectives of the study was to assess pre-test knowledge among mothers of under five children and to find out the association between level of knowledge with selected demographic variables of mothers regarding safe administration of paediatric medication.  Quasi experimental one group pre-test post-test design was conducted among 30 mothers of under five children. Samples were selected by using simple random sampling method and 5 change agents were selected on basis of evaluation of the pre set criteria from 3 anganwadis. Pre-test was conducted using structured knowledge questionnaire. It was followed by rendering health education on safe administration of paediatric medication to the change agents with appropriate AV aids by the investigator. On the same day the change agents implemented mother to mother approach to the samples with same AV aids in the presence of the investigator. Followed by post-test knowledge was assessed after one week. The analysis shows that there is significant increase in knowledge score of mothers regarding safe administration of paediatric medication. Also the study findings revealed that there is no association between knowledge score of mothers with their selected demographic variables. Thus the study concludes that mother to mother approach was effective.

 

KEYWORDS: Effectiveness; mother to mother approach; mothers of under five children; change agent; safe administration of paediatric medication.

 

 


INTRODUCTION:

Infancy and childhood is the period of growth and development of a child. Any adverse events in this stage may result in severe limitations in their development. This age group is most affected various common and easily treatable illness. According to the National Family Heath survey (NFHS)-4 the incidence of diarrhoea accounts for 9%, acute respiratory infections 2.7% and anemia 58.4% was most common cause of morbidity in India.1 A prospective morbidity survey conducted in India showed that the average morbidity rate was 11.26 episodes/ child/ year.2 Accurate diagnosis and optimum course of therapy with properly planned medication regimen is playing an important role in effective medical treatment of paediatric patients. Improper administration of intended medicines by caregivers results in large proportion of outpatient medication errors. According to National Patient Safety Agency (NPSA)-2007 children aged four years and under were involved in 10.1% of medication incident reports.3 Many parents or caregivers are inexperienced in administering liquid medications, resulting in possible under-dose or over-dose medication error.4 Many parents feel that the process of giving medication to children is complicated and requires lots of skill and also knowledge of medicines like when to give, how much to give, how many times to give and how to give.5 Studies showed that paediatric patients are injured by parents who accidently gave the children an over dose of medications. Such wide spread and often incompetent use of medicines by mothers is a real health threat to growing children. Lack of adequate instructions on medication administration and overcoming the difficulties of the parents or caregivers may result in poor efficacy of the drug or an increased risk for adverse reaction while administering medication to children.

 

NEED AND SIGNIFICANCE OF THE STUDY:

Child safety is one of the highest priority for health professionals and caregivers. The most common threats to child safety is medication error. According to joint commission (2008), children are more vulnerable than adult to medication error because of their rapid growth and wide range of size. Oral formulations are typically prescribed to young children, and it is found that parents frequently misunderstand instructions regarding the correct administration of medication to their children, with over 40% of caregivers making errors in dosing liquid medication. 6 A study shows that 5.2 million medical errors happen in India annually. Out of 19.4% of adverse events 45% were due to medication error, 58% were potentially preventable and 27.6% could be considered as negligence.7 Paediatric medication misuse at an alarming rate these misuse are both avoidable and expensive to the health care system. The administration of oral medications to children is frequently an aspect of nursing care that causes concern for child, parents and family members. Therefore the mothers knowledge about child care influences the nature and quality of care, especially in medication at home. According to the studies done in the past, the medication error in children is due to the inadequate knowledge of parents regarding safe administration of paediatric medication. The only way to reduce medication error in children is by educating the parents.

 

The investigator from her clinical experience in the paediatric ward, outpatient department and community paediatrics has identified that many mothers having lack of knowledge regarding safe administration of paediatric medication.

 

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of mother to mother approach on knowledge regarding safe administration of paediatric medication among mothers of under five children in selected village, Nadathara Gramapanchayat, Thrissur.”

 

OBJECTIVES OF THE STUDY:

1.     To assess the knowledge regarding safe administration of paediatric medication among mothers of under five children.

2.     To evaluate the effectiveness of mother to mother approach on knowledge regarding safe administration of paediatric medication among mothers of under five children.

3.     To find out the association between knowledge of mothers regarding safe administration of paediatric medication with selected demographic variables.

 

OPERATIONAL DEFINITIONS:

1.     Mother to mother approach:

The process of conveying information gained by a mother from the investigator to her peer group regarding safe administration of paediatric medication. This mother is known as change agent for the present study.

2.     Effectiveness:

Change in knowledge level of mothers regarding safe administration of paediatric medication after mother to mother approach.

3.     Mothers of under five children:

Women who has children below 5 years of age.

4.     Safe administration of paediatric medication:

Oral liquid medicines prescribed for children to treat various diseases which is reconstituted and administered by the mothers safely.

 

Assumptions:

1.     The mothers of under five children may have lack of knowledge regarding safe administration of paediatric medication.

2.     The mother to mother approach may be effective in increasing the knowledge level of mothers regarding safe administration of paediatric medication.

3.     Knowledge regarding safe administration of paediatric medication among mothers may be influenced by demographic variables.

 

Hypotheses:

H1: The mean post-test score of mothers of under five children on knowledge regarding safe administration of paediatric medication is higher than the mean pre-test score.

H2: There is significant association between selected demographic variables and pre-test knowledge score of mothers of under five children on safe administration of paediatric medication.


CONCEPTUAL FRAMEWORK:

Conceptual framework based on Modified Imogene Kings theory of Goal Attainment (1981) (Fig.1) was used.

 

Figure 1: Conceptual framework based on modified Imogene king goal attainment mode (1981)

 


REVIEW OF LITERATURE:

The review of this study has been organized and presented under the following headings.

1.     Incidence of paediatric medication errors by mothers.                                                                    

2.     Knowledge regarding administration of paediatric medication among mothers.

3.     Effectiveness of mother to mother approach.

 

METHODS AND MATERIALS:

Research approach:

Quantitative research approach

Research design:

Quasi-experimental one group pre-test post-test design

Variables

·       Independent variable:

Mother to mother approach regarding safe administration of paediatric medication.

·       Dependent variable:

Knowledge of mothers regarding safe administration of paediatric medication.

 

Setting of the study:

3 anganwadis of Nadathara Gramapanchayath from ward XVII (Eravimangalam), ward XVI (Poochatty) and ward XII (Kumarapuram).


 

Figure 2: Sampling frame


Population:

Mothers of under five children

·       Target population: Mothers of under five children at Nadathara Gramapanchayath

·       Accessible population: Mothers of under five children of Kumarapuram, Poochatty and Eravimangalam anganwadi.

 

Sample size:

30 mothers and 5 change agents

 

Sampling technique:

The change agents were selected according to predetermined criteria (detailed in data collection). From the sampling frame (Fig 2), 30 samples were selected by simple random sampling technique (lottery method).

 

Inclusion criteria:

Mothers who were home makers and having a child under the age of five, available during data collection and able to read and write Malayalam

 

Exclusion criteria:

Mothers who were not able to read and write Malayalam and not willing to participate

 

Tool/ Instruments:

Section A:

Socio demographic profile of mother

 

Section B:

Structured knowledge questionnaire on safe administration of paediatric medication consist of four components; a) general aspects on oral medication administration, b) preparation of liquid medication, c) safe administration of paediatric medication and d) after care.

 

Section C:

Mother to mother approach on safe administration of paediatric medication

 

Ethical consideration:

Ethical clearance was obtained from ethical committee of Aswini College of Nursing and formal administrative permission from CDPO, Ollukkara Block Panchayath. Researcher obtained written consent from samples and change agents. Human rights were protected and dignity of individuals also preserved.

 

Pilot study:

Pilot study was conducted to 10 samples and 2 change agents. Reliability of the structured knowledge questionnaire was done by split half method by using Karl Pearson Correlation coefficient formula. The reliability of structured knowledge questionnaire was r₌0.79 which was found to be reliable.

 

 

 

Main study:

Data collection was conducted for a period of 4 weeks. It was done in 5 phases.  In phase I, the investigator obtained permission from the concerned authority and selected 3 anganwadis from Nadathara Gramapanchayath, such as Eravimangalam anganwadi from ward XVII, Poochatty anganawadi from ward XVI and Kumarapuram anganwadi from ward XII.

 

In the II phase, the investigator collected all details of mothers and contacted them personally with the help of anganwadi teacher. The total strength of the mothers in Kumarapuram anganwadi was 14, 16 in Poochatty and 20 in Eravimangalam.

 

The third phase of the study was to select change agents and samples. The investigator first approaches Eravimangalam anganwadi. For selecting the change agents the mothers were instructed to speak on importance of breast feeding for 5 minutes. The talk was evaluated based on the set criteria such as language proficiency (5 marks), audibility (2 marks), clarity of voice (4 marks), group control (2 marks), motivating skill (2 marks) and ability to command (5 marks). The mothers who scored 15 and above out of 20 points were selected. Thus out of 20 mothers 2 change agents were selected from Eravimangalam anganwadi. From the sampling frame 12 samples were selected by simple random sampling technique (lottery method). The selected 12 samples were equally distributed under 2 change agents. The investigator rendered health education on safe administration of paediatric medication to the change agents with appropriate AV aids. The same procedure was carried out at Poochatty and Kumarapuram anganwadi. Thus from Poochatty anganwadi 2 change agents and 12 samples were selected and from Kumarapuram 1 change agent and 6 samples were selected.

 

In phase IV, the investigator was obtained written consent from the samples. On the same day the investigator conducted pre-test to the samples using structured knowledge questionnaire followed by change agents implemented mother to mother approach to the samples by using same AV aids in the presence of the investigator. Throughout the data collection investigator ensures that the data collection was done on the same time in all anganwadis.

 

In the phase V, post-test was conducted after one week using same questionnaire. At the end of the data collection the investigator rendered the health education to all the mothers of each anganwadi. The data were analyzed by using descriptive and inferential statistics.

 

 

RESULTS AND DISCUSSION:

Section A: Description of the demographic profile of mother

Regarding the age it implies more than half of the samples 16 (53.3%) were in the age group 24-29 years, 10 (33.3%) were in the age group 30-35 years and 4 (13,3%) belongs to the age group 18-23 years. Regarding the type of family 17 (63.3%) were from nuclear family, 11 (36.7%) were from joint family. With respect to the religion majority of the samples 21(70%) were Hindus and the remaining 9(30%) belongs to Christian community. According to the area of residence majority of the samples 28 (93.3%) were residing in rural area and 2 (6.7%) were residing in urban area

 

In relation to the number of children, 10 (33.3%) samples have 1 child, 19 (63.3%) of samples have 2 children and only 1 (3.3%) sample ha 3 children. In terms of number of under five children, majority of samples 21 (70%) have one under five children, 9 (30%) samples have 2 under five children. In case of educational status majority of the samples 20 (66.7%) completed higher secondary education and below, 7 (23%) samples were graduates and only 3 (10%) samples were post graduates. Regarding the monthly family income nearly 17(56.7%) samples were having Rs. <10,000, 10 (33.3%) samples have monthly income between Rs.10,001- 20,000, 2 (6.7%) samples have monthly income between Rs. 20,001- 30,000 and 1 (3.3%) samples having a monthly income more than Rs.30,000.

 

In account of information received regarding the paediatric medication administration majority 16 (53.3%) samples did not receive any information where as 14 (56.7%) of samples had received information regarding paediatric medication administration. It is evident that out of 14 nearly half of the samples 7 (57.1%) were received information from health professionals, 3 (21.5%) from drug leaflets, 2 (14.3%) from mass media, 1 (7.1%) from relatives and 1 (7.1%) from friends. In view of self-medication administration, 20 (63.3%) samples were not practicing self medication while 10 (36.7%) samples practicing self-medication for their children. Among the 10 mothers, the majority of them 5 (50%) uses self-medication for fever, 2 (20%) for cough, 2 (20%) for cold and 1 (10%) for vomiting.

 

Section B: Description on assessment of pre-test and post-test knowledge score of mothers regarding safe administration of paediatric medication:

With the reference to pre-test knowledge of mothers regarding safe administration of paediatric medication (Fig 3) majority of the samples 16 (53.3%) had inadequate knowledge, 14 (46.7%) had moderate knowledge and none of the samples had adequate knowledge.

 

The result of the present study was supported by a descriptive cross sectional study to assess the knowledge and ability of mothers living in a semi-urban area at Sri Lanka to administer liquid medications to infants and preschool children. The sample size of the study was 99 mothers of infants and preschool children. The result showed that out of 99 participants only 39 (40.6%) had the basic knowledge required to administer liquid medicine. The study concluded that the majority of mothers lacked the basic knowledge and skills necessary to administer liquid medicine.8

 

The post-test (Fig 3) analysis reveals that most of the samples 27(90%) had adequate knowledge, whereas the remaining 3 (10%) had moderate knowledge and none of the samples hade inadequate knowledge regarding safe administration of paediatric medication

 

Figure 3: Comparison of pre-test and post-test knowledge of mothers regarding safe administration of paediatric medication

 

Section B: Description on component wise distribution of knowledge score of mothers regarding safe administration of paediatric medication:

Table 1 depicts that in accordance with analysis of pre-test knowledge score of mothers on general aspect on oral medication administration majority of the mothers 23 (76.7%) had inadequate knowledge, 6 (20%) had moderate knowledge and only 1 (3.3%) had adequate knowledge. Whereas the post-test scores of mothers after the mother to mother approach show 22 (73.3%) had adequate knowledge, 6 (26.7%) had moderate knowledge and none of them had inadequate knowledge.  

 

On account of pre-test score of mothers on preparation of liquid medication, 14 (46.7%) had adequate knowledge, 14 (46.7%) had moderate and only 2 (6.7%) had inadequate knowledge. The post-test score of mothers after mother to mother approach 26 (86.7%) had adequate knowledge, 4 (13.3%) had moderate knowledge and none of them had inadequate knowledge.

 

Pre-test score of mothers on safe administration of paediatric medication reveals, 13 (43.3%) had inadequate knowledge, 12 (40%) had moderate knowledge and only 5 (16.7%) had adequate knowledge. Whereas the post-test knowledge score reveals that 27(90%) had adequate knowledge, 3 (10%) had moderate knowledge and none of them had inadequate knowledge.

 

 

Pre-test knowledge of mothers on after care reveals that all of the samples 30 (100%) had inadequate knowledge, whereas the post-test score of mothers reveals, 27 (90%) had adequate knowledge, 3 (10%) had moderate knowledge and none of them had inadequate knowledge.


 

Table 1: Description on component wise distribution of knowledge score of mothers regarding safe administration of paediatric medication.                                                                                                                                                           N =30

Sl No

Components of safe administration of paediatric medication

Knowledge level

Pre-test

Post-test

F (n)

Percentage (%)

F (n)

Percentage(%)

1

General aspects on oral medication administration

Adequate

1

3.3

22

73.3

Moderate

6

20

8

26.7

Inadequate

23

76.7

0

0

2

Preparation of liquid medication

Adequate

14

46.7

26

86.7

Moderate

14

46.7

4

13.3

Inadequate

2

6.7

0

0

3

Safe administration of paediatric medication

Adequate

5

16.7

27

90

Moderate

12

40

3

10

Inadequate

13

43.3

0

0

4

After care

Adequate

0

0

27

90

Moderate

0

0

3

10

Inadequate

30

100

0

0

 

Table 2: Assessment of effectiveness of mother to mother approach by paired ‘t’ test                                                    N=30

 

Mean

SD

Mean  difference

‘t’ value

P value

Pre test

17.00

3.983

 

29

 

14.617*

< 0.001

Post test

30.30

3.87

*Significant at 0.01 level

 


Section D: Description on assessment of effectiveness of mother to mother approach on knowledge regarding safe administration of paediatric medication:

The mean pre-test score (table 2) on safe administration of paediatric medication was 17.00 and after mother to mother approach it has been raised to 30.30.  The calculated ‘t’ value for knowledge about safe administration of paediatric medication was found to be 14.617 and P value < 0.001 which is highly significant at 0.01 level. So the null hypothesis H01was rejected and research hypothesis H1was accepted. This implies that the mother to mother approach on knowledge regarding safe administration of paediatric medication was effective.

 

The present study findings was in tune with a quasi-experimental study aimed to evaluate the impact of an educational program for mothers about preventing oral medications misuse for children under five years. The result showed that the majority of the mothers (88%) had poor score of knowledge about practice before the program while 94% of them had a good knowledge score after the program.9

 

Section E: Description of association between pre-test knowledge score of mothers regarding safe administration of paediatric medication with selected demographic variables:

Table 3 explains that there was no significant association between the pre-test knowledge score of mothers regarding safe administration of paediatric medication and selected demographic variables such as age (c2 =0.067), type of family (c2 = 0.433), religion (c2 =3.374), education (c2 = 0.067) and information received regarding administration of paediatric medication (c2 =3.274) at 0.05 level of significance. Hence, the research hypothesis H2 is rejected and null hypothesis H02 is accepted.


 

Table 3: Association between pre-test knowledge score of mothers regarding safe administration of paediatric medication with selected demographic variables                                                                                                                                                     N=30

Sl No

 

Demographic Variable

Inadequate knowledge

Moderate knowledge

 

c2

 

P

N

%

N

%

1

Age in years

a.      < 30

b.     30-35

 

11

5

 

55.0

50

 

9

5

 

45

50

 

 

0.067**

 

 

0.766

2

Type of family

a.      Nuclear

b.      Joint

 

11

5

 

57.9

47.5

 

8

6

 

42.1

54.5

 

 

0.433**

 

 

0.510

3

Religion

a.      Hindu

b.      Christian

 

14

2

 

66.7

22.2

 

7

7

 

33.3

77.8

 

 

3.374**

 

 

0.066

4

Education of the mother

a.      Higher secondary and below

b.      Graduation and above

 

11

5

 

55

50

 

9

5

 

45

50

 

 

0.067**

 

 

0.796

5

Have you received any information regarding paediatric drug administration?

a.      No

b.      Yes

 

 

11

5

 

 

68.5

36.7

 

 

3

9

 

 

31.3

64.3

 

 

3.274**

 

 

 

0.070

** nonsignificant at 0.05 level


 

The result of the present study in tunes with a descriptive survey to assess the knowledge of mothers regarding the administration of medication in children and difficulties experienced during medication administration to children. The finding showed that there is no association between knowledge score with religion and type of family.10

 

CONCLUSION:

In conclusion, this study provides an insight in to the inadequate knowledge of mothers about the safe administration of paediatric medication. Hence, it can be suggested from this study that all the health care providers especially child health nurses should take the initiative to educate the mothers regarding safe administration of paediatric medication. From this study, it is proved that the mother to mother approach regarding safe administration of paediatric medication helped the mothers to improve their knowledge. Relevant and need based continuing health education to mothers by adapting mother to mother approach improves their knowledge. This would contribute to making medicines safer and more effective for ailing children.

 

LIMITATION:

The study period is limited to 4 weeks. The investigator had found difficulty in collecting review of literature as there were limited numbers of studies on effectiveness of mother to mother approach on knowledge regarding safe administration of paediatric medication. Tool used for knowledge score were structured, thus free response were restricted.

 

RECOMMENDATIONS:

Based on the findings of the present study, the recommendations offered for the future research are:

·       A similar study can be replicated on a larger sample for wider generalization

·       A follow up study can be conducted to assess the effectiveness of mother to mother approach.

·       A comparative study can be carried out to assess the knowledge and practice of rural and urban mothers regarding safe administration of paediatric medication.

·       A true experimental study can be undertaken to identify the effectiveness of mother to mother approach.

·       A study can be done to assess the incidence of paediatric medication errors by caregivers.

·       Nationwide study could be conducted to evaluate the knowledge, attitude and practice of parents on self medication in children.

·       A comparative evaluation study can be undertaken to assess the efficacy of mother to mother approach and other various health education strategies like Educational Package (EP), Video Assisted Teaching (VAT) and Computer Assisted Instructions (CAI).

·       A qualitative study can be carried out to explore the difficulties experienced by mothers during the medication administration to children.

 

REFERENCES:

1.      Nonita Dhirar, et al. Childhood Morbidity and mortality in India- analysis of National Family Health Survey 4(NFHS-4) findings. Indian Paediatrics. April 15. 2018; 335-337. Available from https://link.springer.com/article/10.1007/s13312-018-1276-6

2.      Beryl P Gladstone, et al. Burden of Illness in the First 3 Years of Life in an Indian Slum. Journal of tropical paediatrics. August 2010;56(4): 221-226. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693507

3.      National Patient Safety Agency. The fourth report from the Patient Safety Observatory: safety in doses: medication safety incidents in the NHS. London: National Patient Safety Agency. 2007

4.      Honey B L, Condren M, Phillips C, Vptruba A. Evaluation of oral medication delivery devices provided by community pharmacies. Clinical paediatrics. 2013; 52(5): 418-422

5.      Medication safety. Available from www.medpathways.info

6.      Miller M R, Robinson K A, Rinke M L, Pronovost P J. Medication errors in pediatric care: a systematic review of epidemiology and evaluation of evidence supporting reduction strategy recommendations. Quality safety health care. 2007; 16 (2): 116- 126

7.      Leape L L, Nrennan TA, Laird N. The nature of adverse events in hospitalizes patients: Results of the Harward M edical Practice Study II. N Engl J Med. 1991; 324: 377-384

8.      Chamari Weeraratne. Knowledge and ability of mothers living in a semi urban area Sri Lanka to administer liquid medications to infants and preschool children. International journal of pharmacy review & research. 2015; 5(2): 103-107

9.      Atyat Mohammed Hassan, et al. Impact of an educational program for mothers regarding prevention of oral medications misuse among under five children. 2018; 6(3): 125-136. Available from: http://pubs.sciepub.com/ajnr/6/3/7/index.htm

10.   Ragima PV, et al. Knowledge of mothers regarding administration of medication in children and difficulties experience during medication administration to children.  European journal of biomedical and pharmaceutical sciences. 2018; 5(9): 440-443. Available from: http://www.ejbps.com

 

 

 

 

Received on 04.11.2019         Modified on 30.11.2019

Accepted on 27.12.2019      ©A&V Publications All right reserved

Asian J. Nursing Education and Research. 2020; 10(1):53-59.

DOI: 10.5958/2349-2996.2020.00013.0