Rajiv Gandhi University of Health Sciences s51

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DESERRTATION

Submitted by: Mrs. ARUL SELVI.M 1st year M. Sc Nursing, 2009-2011 Batch Harsha College of Nursing BANGALORE. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DESERRTATION

1.. NAME OF THE CANDIDATE AND MRS. ARUL SELVI.M ADDRESS 1ST YEAR M.SC NURSING, HARSHA COLLEGE OF NURSING NO.193/4,SONDEKOPPA CIRCLE NH-4,NELAMANGALA, BANGALORE-562123. 2. NAME OF THE INSTITUTE HARSHA COLLEGE OF NURSING

3. COURSE OF STUDY AND SUBJECT M.SC NURSING CHILD HEALTH NURSING

4. DATE OF ADMISSION 06 – 07 - 2009

5. TITLE : A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING PROMOTION OF HEALTHY LIFE STYLE AMONG ADOLESECENTS IN SELECTED SCHOOL AT BANGALORE. 6) BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

‘’If you do not control your diet and lifestyle eventually your diet and

life style will control you’’

- AFRICAN PROVERB

The health maintenance behaviour refers to any activity or behaviour undertaken

primarily for the purpose of protecting or assuring current level of health, as observed by

the individual .Every individual overlook their body’s basic needs example proper

nutrition, sleep, rest and exercise .Further, health maintenance requires preventive

measures at all three levels such as primary,secondary,tertiary prevention. It has been also

observed that so many people use such health activities, which are perceived by

themselves and found healthy. People are following some types of techniques such as

nutrition, exercise, sleep etc. (1)

Adolescents are on the whole, healthy individuals the disease level low during

this age period, but there is heightened concern about the body. Most of the health

problem and the more common illnesses are in some way related to the body changes of

puberty.(2) Health life style has been operationally defined as “a way of life that promotes

and protects health and well being” .This would include practices that promote health

such as health and nutrition, regular and adequate physical activity and leisure,

avoidance of substances that can be abused as tobacco, alcohol and other addicting

substances adequate stress management and relaxation; and practices that offer

protection from health risk such as safe and responsible parenthood.(3)

Health promotion in persons in this age group is primarily one of health teaching

and guidance. Adolescents as a group are eager to learn about themselves, and Nurses

who are truly interested in them, who respect them as persons, and who are willing to

listen to them will be able to gain their confidence and trust. Individual counseling

provides adolescents with a knowledgeable adult in whom they confide with out the

threat of an intimate relationship. So; every adolescents must have through knowledge

regarding promotion of healthy lifestyle.

6.1) NEED FOR THE STUDY

The American academy of pediatrics has included quality of care in its

strategic priorities providing quality care for children and adolescents require that

pediatricians maintain relationship with families and with community institution such

as schools or childcare providers while maintaining the relationship with their patient.

In providing quality care for adolescents, pediatricians must also help patients and

their families as teenagers develop autonomy, responsibility and an adult identity.(4) Thus, adolescent services should also be developmentally appropriate.

Confidentiality, both in determining whether youth receive what they need and

whether their opportunities for private one –on- one time during health care visits, is a

major factor that affects quality of care for many youth.

Most adolescent are healthy. However the preventable health problems of adolescents make specific screening and counseling services important. Most adult chronic diseases have origins during childhood and adolescence. Reduction of risky behavior has great potential for reducing preventable adolescent and adult mortality and mortality and primary care clinician can play a critical role in preventing adverse outcomes and promoting healthy lifestyles.(4)

Nonetheless, many youth are at high risk of early unintended pregnancy,

sexually transmitted infections and tobacco, alcohol, and substance use. Alcohol

substance abuse, drunk driving, sexual activity, depression, suicide, smoking, violence

and guns are the primary cause of morbidity and mortality among adolescents.

Anticipatory guidance, screening and counseling to reduce health risks are the

centerpiece of pediatric and adolescent preventive care; nonetheless, the content of

care delivered to many youth does not meet guidelines for care or the perceived need

of adolescent patients. With passage of the state children’s health insurance programs,

commitment has been building to ensure that children and adolescent are part of

national, state, local efforts to improve health care quality. Homicide and suicide are

the leading causes of death among adolescents. Violence affects adolescents as both perpetrators and victims. Adolescents are susceptible to intimate partner violence as well, with between 9% and 60% of adolescents having experienced some form of dating violence, and as many as 21%of child abuse cases are perpetrated against adolescents. Risky and healthy behaviors that affect adult morbidity also have their origins during the adolescent years. According to centers for disease control and prevention more than half of all teenagers report having had sex, many do not use appropriate barrier protection, and 25% of all annual Sexually Transmitted Desease cases in the United States had smoked at least 1 cigarette in the previous 30 days, and

23%have reported current cigarette use. Most American adolescents have consumed alcohol at least once in their lifetimes, almost half(43.3%)had consumed alcohol al least once in the previous 30days,and more than 1(25.5%)in 4 reported having consumed 5 or more alcoholic drinks on at least 1 occasion in the preceding months.

Only 25.1% of adolescents eat recommended amount of diet .In addition most adolescent engaged physical activities at lower than recommended.(5)

This study highlighted the need for a planned educational intervention in schools regarding improving the knowledge on promotion of healthy life style by educating the adolescents

6.2) REVIEW OF LITERATURE

Good research does not exit in vacuum. Research finding should be an extension of previous knowledge and theory as well as guide for future research activity. In order to build an existing work, it is essential to understand what is already know about a topic. A through review of literature provides a foundation upon which

to base new knowledge.(6)

This study will be planned to review the literature under the following sections.

SECTION :- I) Studies related to the physical activities among adolescents

SECTION II:- studies related to the mental activities among adolescents

SECTION III :- studies related to social activities among adolescent girls. SECTION IV :- studies related to dietary pattern among adolescent girls. SECTION V :- studies related to knowledge regarding sexual education & guidance among adolescent girls.

SECTION I:- Studies related to the physical activities among adolescent .

A cross sectional study was conducted on atherosclerosis is a pathological condition that begins in early childhood, but clinically the disease manifests in older age. The aim was to determine frequency of atherosclerosis risk factors in healthy school children. Cross- sectional study included 214 children in mean age within Age 7 to 15 years. Patients body mass index, blood pressure, lipid status, dietary habits, physical activity and sedentary habits have been evaluated. Cardiovascular risk factors are significantly present in children (P<0,05) i.e. one cardiovascular risk factor is present in 21,96%children, two risk factors had 11,68% children, while 7,94% children had three or more cardiovascular risk factors. Obesity was present in 9,34% children, while overweight was present in 10,74%in children. Research shows that a large number within study group has one or more cardiovascular risk factors that can lead to premature atherosclerosis. Using massive screening of cardiovascular risk factors, along with adequate physical activity, healthy dietary habits, reduced sedentary habits, doctors and teacher's education, parents and children can reduce premature clinical sequels in atherosclerotic process. (7)

A longitudinal study was conducted that to examine the association between leisure time physical activity over a three year period and health related behaviour, social relationships, and health status in late adolescence as part of a nationwide longitudinal study.

Five birth cohorts of adolescent twins aged 16 at baseline (n = 5028; 2311 boys and 2717 girls) participated in the study.. The combined response rate to the three questionnaires was

75.8% for boys and 81.7% for girls. The results showed that the overall, 20.4% of boys and

13.0% of girls were persistent exercisers and 6.5% of boys and 5.3% of girls were persistently inactive. In both sexes, smoking, irregular breakfast eating, attending vocational school, an poor self perceived.(8)

SECTION II:- Studies related to the mental activities among Adolescents.

A cross sectional study was conducted on Amount of sleep is an important indicator of health and well-being in children and adolescents. Adequate sleep (AS: adequate sleep is defined as 6-8 hours per night regularly) is a critical factor in adolescent health and health- related behaviors. The aim was to examine the relationship between AS during schooldays and excessive body weight, frequency of visiting doctors and health-related behaviors among

Taiwanese adolescents. A cross-sectional study design, categorical and multivariate data analyses were used. The findings were a total of 656 boys (53.2%) and girls (46.8%), ranging in age from 13-18 years were studied between January and June 2004. Three hundred and fifty seven subjects (54%) reported that they slept less than the suggested 6-8 hours on schooldays. A study concluded that inadequate sleep may be a screening indicator for an unhealthy lifestyle and poor health status. The results might be useful for future research into the development of intervention strategies to assist adolescents who are not receiving enough hours of sleep.(9)

A cross-sectional descriptive design was used and investigated the hypothesis that family structure and level of parent education are strongly associated with health-related behavior in adolescents. Study subjects consisted of sixth to eighth graders drawn from six schools .Five hundred and forty-six youths, with a mean age of 13 years, participated in this study. Results indicated that, when potentially confounding factors were controlled, adolescents living with both parents have healthier behavior than those living with a single parent. In addition, when potentially confounding factors were controlled, adolescents residing with both parents with relatively high educational levels only achieved higher healthy behavior scores in the dimensions of health responsibility, nutrition, and exercise. Further, adolescent females had substantially higher health-related behavior scores than their male peers in all dimensions, with the exception of "exercise behavior". Findings supported that the hypothesis that family structure and female gender are significant variables affecting adolescent health-related behavior. Research results are useful in developing intervention strategies to assist adolescents in single parent families.(10)

SECTION III :- studies related to social activities among adolescents. A study to investigate the association between the spatial concentration of deprived households and teenage non-marital childbearing. Associations with area deprivation are tested before and after allowing for levels of personal deprivation.

The individual data are derived from the 2% sample of anonymous records from the census of

1991 in Great Britain, and are combined with area data from the 278 districts of residence identifiable in the sample of anonymous records. The Sample was restricted to unmarried women living at home (with at least one parent) and aged 16 to 19.The results suggested that generally higher risk of teenage childbearing for women who are economically inactive, women from households with no access to a car or households resident in local authority accommodation. Without adjusting for personal circumstances, the risk of teenage pregnancy shows a clear, significant and approximately linear association with social deprivation of area of residence in 1991. .(11)

A cross sectional study was conducted to assess overweight and related risk factors among urban low socio-economic status African-American adolescents in an attempt to study the underlying causes of ethnicity and gender disparities in overweight. Cross-sectional method was used for data collection.498 students in grades 5-7 in four Chicago public schools were analyzed to study the risk factors for overweight using stepwise regression analysis. The results are Only 37.2% of the students lived with two parents. Nearly 90% had a television in their bedroom, and had cable TV and a video game system at home. Overall. 21.8% (17.7% boys versus 25.1% girls) were overweight (body mass index (BMI) >/= 95th percentile); and

39.8% had a BMI >/= 85th percentile. The study concluded that several factors in the students' behaviors, school and family environments may increase overweight risk among this population. There is a great need for health promotion programmes with a focus on healthy weight and lifestyle, and targeting urban low-socio economic status minority communities(121).

A study was conducted on Health Self-Empowerment Theory as a framework for examining the predictors of engagement in both a health-promoting lifestyle and individual health-promoting behaviors among low-income African American mothers and non-Hispanic white mothers (N = 96), each of whom is the primary caregiver for a chronically ill adolescent. The individual health-promoting behaviors investigated are eating a healthy diet, exercising consistently, stress management practices, and health responsibility behaviors.

Findings from this study suggest that further research should be conducted to assess the usefulness of Health Self-Empowerment Theory in predicting level of engagement in health- promoting behaviors and to examine the effectiveness of Health Self-Empowerment Theory- based interventions for increasing health-promoting behaviors among women similar to those in this study. The findings suggested that health care providers should promote active coping, health self-praise, health self-efficacy, and health motivation to increase health-promoting behaviors among patients who are similar to those in this study.(13)

SECTION IV:- studies related to the dietary pattern among adolescents.

A study was conducted on iron deficiency anemia. The prevalence is 35% in no pregnant women of fertile age and 24.7% in adolescent girls in slums of periurban Lima. The major cause of anemia is low intake of dietary iron. A community-based, randomized behavioral and dietary intervention trial was conducted to improve dietary iron intake and iron bioavailability of adolescent girls living in periurban areas of Lima, Peru. Results show that there was a change in knowledge about anemia and improved dietary iron intake in the 71 girls who completed the study compared with the 66 girls in the control group. Although the

9-month. intervention was not sufficient to improve hemoglobin levels significantly, there appeared to be a protective effect in maintaining the iron status of girls in comparison with the control group.(14)

A study conducted on increases in calcium intake and physical activity effectively increase the bone mineral status of adolescents aged 16-18 osteoporosis may be prevented or delayed by maximizing peak bone mass through diet modification and physical activity during adolescence. The subjects were randomly allocated to an exercise (three 45-min exercise-to-music classes/wk during term time) or no exercise group. Dual-energy X-ray absorptiometry of the whole body, spine, forearm, and hip was performed before and after intervention. The results showed that the mean (± SD) percentage of subjects compliant with supplement taking was 70 ± 27% and with exercise class attendance was 36 ± 25%. Baseline calcium intake was 938 ± 411 mg/d. Calcium supplementation significantly increased size- adjusted bone mineral content. The study concluded that Calcium supplementation and exercise enhanced bone mineral status in adolescent girls. (15)

A cross sectional study was conducted on regular breakfast eating (RBE) is an important contributor to a healthy lifestyle and health status. The aims of the present study were to evaluate the relationships among irregular breakfast eating (IRBE), health status, and health promoting behavior (HPB) for Taiwanese adolescents. A cross-sectional, descriptive design was used to investigate a cluster sample of 1609 (7th-12th grade) adolescents located in the metropolitan Tao-Yuan area during the 2005 academic year. The main variables comprised breakfast eating pattern, body weight, and health promoting behaviors. Data were collected by a self-administered questionnaire .The results showed that a 28.8% were overweight and nearly one quarter (23.6%) reported eating breakfast irregularly during schooldays. The findings indicated that adolescents with RBE had a lower risk of overweight and that the odds of becoming overweight were 51% greater for irregular breakfast eating than for Regular Breakfast Eating even after controlling for demographical and Health

Promotion Behavior Variables. Irregular Break fast Eating also was a strong indicator for

Health Promotion Behavior. However, the profile of the high-risk Irregular Break fast Eating

Group was predominantly junior high schoolchildren and/or children living without both parents. This study provides valuable information about irregular breakfast eating among adolescents, which is associated with being overweight and with a low frequency of health promoting behavior. School and family health promotion strategies should be used to encourage all adolescents to eat breakfast regularly.(16)

SECTION V:- Studies related to knowledge regarding sexual education &

guidance among adolescents.

A cross sectional study on education programme in primary schools aimed at AIDS prevention in Soroti district of Uganda emphasized improved access to information, improved peer interaction and improved quality of performance of the existing school health education system. A cross-sectional sample of students, average age 14 years, in their final year of primary school was surveyed before and after two years of interventions. The percentage of students who stated they had been sexually active fell from 42.9% to 11.1% in the intervention group, while no significant change was recorded in a control group. The changes remained significant when segregated by gender or rural and urban location. Students in the intervention group tended to speak to peers and teachers more often about sexual matters.

Increases in reasons given by students for abstaining from sex over the study period occurred in those reasons associated with a rational decision-making model rather than a punishment model. A primary school health education programme which emphasizes social interaction methods can be effective in increasing sexual abstinence among school-going adolescents in

Uganda. The programme does not have to be expensive and can be implemented with staff present in most districts in the region(17)

A study was conducted on review the epidemiology and etiology of risky sexual behavior in adolescent girls, and to discuss implications for primary prevention of sexual problems. The study concluded that adolescent girls who participate in risky sexual behavior are at risk for sexually transmitted infections, including HIV. Black, Hispanic, and out-of- home adolescent girls, however, are at greatest risk. Factors contributing to risky sexual behavior include early initiation of sexual intercourse, inconsistent use of condoms and other barrier contraception, and unprotected sexual intercourse. Identified protective factors for early initiation of sexual activity include the development of healthy sexuality, family and school connectedness, and the presence of caring adults. (18)

6.3) STATEMENT OF THE PROBLEM: “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME REGARDING PROMOTION OF HEALTHY LIFE STYLE AMONG

ADOLESECENTS IN SELECTED SCHOOL AT BANGALORE”.

6.4) OBJECTIVES OF THE STUDY

1. To assess the level of knowledge regarding promotion of healthy lifestyle among

adolescents.

2. To determine the posttest knowledge level among adolescent regarding

promotion of healthy life style following structured teaching programme.

3. To compare the pre and post teaching knowledge score regarding promotion of

healthy lifestyle among adolescents.

4. To associate the post teaching knowledge score regarding promotion of healthy

lifestyle among adolescents with the selected demographic characteristics.

6.5.) HYPOTHESIS

There is a significant increase in the knowledge regarding promotion of healthy

lifestyle among adolescents after the structured teaching programme.

6.6.) OPERATIONAL DEFINITIONS ASSESS

It refers to gather the subjective and objective data. it includes gathering

,classifying and analyzing the information about the adolescent .in this study the back ground factors such as age ,sex socio economic status ,religion and education etc among adolescent

(13-19 years) and pretest knowledge of promotion of healthy life style will be asses through the multiple choice questionnaire.

EFFECTIVENESS

It refers to gain in knowledge on promotion of healthy life style as determined by significant differences in pre test and post test knowledge scores among the adolescent (13-19 years)

STRUCTURED TEACHING PROGRAMME:-

It refers to the systematized edited and organized content, which will be designed by the investigator for the adolescent on promotion of healthy life style.

PROMOTION

It refers upgrading of knowledge regarding promotion of healthy life style among adolescents.

LIFE STYLE It refers to the way in which a person or a group of people lives and works

ADOLESCENT

The age group between 13 to 19 years

KNOWLEDGE

It refers to the correct responses of promotion of healthy life style among the adolescent 13-19 years from selected school to the items listed in self-administered questionnaire schedule.

6.7) ASSUMPTION

1) Most of the adolescent may have inadequate knowledge regarding promotion of healthy life style.

2) By teaching about the healthy life style of adolescent will be gain knowledge in advance and able to improve the life style modification in future.

3) The increase knowledge will facilitated to adopt optimum health to prevent health hazards.

6.8) DELIMITATIONS

 This study is delimited with in adolescents with the age of 13 to 19 years

 The samples will be from at selected school at Bangalore.

 The sample will be selected by purposive sampling method.

 Knowledge level of promotion of healthy life style will be measured by the self-

administered multiple-choice questionnaire.

6.9) VARIABLES A variable is a measurable component of an object or event that may fluctuate in quantity or quality from one individual, objects or event to another individual of the same general class.

Independent variables

The independent variable is that phenomena in the hypothesis that ,in the quasi experimental study ,to test the hypothesis is manipulated by the investigator in order to study the effect up on the dependent variable. In this study the independent variable will be

Structured Teaching Programme on promotion of healthy life styles among adolescents aged

13 to 19 years.

Dependent variables

The dependent variable is also called the effect, the response the criterion measure, behaviour or outcome that is researcher wishes to predict study and explain. In this study, the dependent variable will be adequate Knowledge level of promotion of healthy life style, which will be tested before and after conducting structure-teaching programme among adolescents (13-19)

Demographic variables:-

It refers to those variable which are highly influence the dependent variable such as

Age ,sex, socio economic status ,religion and education .

7) MATERIALS AND METHODS: 7.1.1) RESEARCH DESIGN AND APPROACH

The research design selected for the present study is quasi experimental design

(1group pretest, post test design- 01x02)

The quantitative study with evaluative research approach is considered as an

Appropriate research approach for the present study.

7.1.2) SETTING OF THE STUDY:

Research setting is the specific place where data collection is to be made. The selection of setting will be done on the basis of feasibility of conducting the study ,availability of subject .the study will be conducted in selected school in Bangalore.

7.1.3)POPULATION:-

The population of the present study comprised of adolescents in selected school at

Bangalore.

7.2) METHOD OF DATA COLLECTION:-

Structured questionnaire for assessing the knowledge.

7.2.1) SAMPLING PROCEDURE:

The purpose of using a sampling technique is to increase representative ness and to decrease bias and sampling error .in this study purposive sampling technique will be used to select subject as they fulfilled the inclusion criteria.

7.2.2) SAMPLE SIZE: The Sample size for the present study will be decided to be 60 adolescent for the experiment. The sample size will be determined based on the type of study, variables being studied, and the statistical significant required availability of sample and feasibility of conducting the study

7.2.3) INCLUSION CRITERIA:

 with the age of 13 to 19 years only

 Who are able to read or speak Kannada and English.

 Who are willing to participate in this study.

7.2.4) EXCLUSION CRITERIA

 Who are not willing to participate in this study

 Who cannot read or speak kannada and english

 Who have already exposure to this kind of teaching programme

7.2.5) TOOLS FOR DATA COLLECTION:

An instrument in research refers to the tools asked for collecting data. The researcher will develop a self-administered multiple-choice questionnaire to asses the level of knowledge regarding promotion of healthy life style.

7.2.6) PLAN FOR ANALYSIS The collected data will be planed and analyzed in the form of inferential statistics. The analyzed will be presented in the form of tables, graph and diagrams.

7.3) DOES THE STUDY REQUIRE ANY OR INTERVENTION TO BE

CONDUCTED ON THE PATIENT OR OTHER HUMAN BEINGS

(or) ANIMALS?

7.4) ETHICAL CLEARENCE:-

Has ethical clearance been obtained from your institution ?

Yes. Permission will be obtained from Ethical committee of Harsha college of nursing.

LIST OF REFERENCES

1. Keshavswwarnakar, “COMMUNITY HEALTH NURSING” 1st edition, NR

brothers publishers, 2004 page no. 319

2. Marilyn.J.Hockenberry Wilson .winkelstein,WONG’S “TEXT BOOK OF

PAEDIATRIC NURSING” 7th edition, Elsevier publication page no 506

3. Http//www.pubmed.com

4. www.peadiatric.org/10.1542

5. www.peatric American Academy of pediatrics’ volume 121

6. Polit and Hungler ‘NURSING RESEARCH PRINCIPLES AND METHODS’

Philadelphia JP Lippincott community publishers 7. porisevic.L kreelj.v. Bajrakfarevic.A, Jahic’E EVALUATION OF

CARDIOVASCULAR RISK IN SCHOOL CHILDREN Aug 2009: 9(3);182-6

8. Aarnio M,Winter, Kujala U,Kaprio J.ASSOCIATION OF HEALTH RELATED

BEHAVIOUR Oct 2002 36(5)

9. Chen MY,Wang EK,Jeng YJ ADEQUATE SLEEP AMONG ADOLOCENTS

March 2006 8:6:59

10. Chen MY,Shiao YC,Gau YM COMPARISON OF ADOLOCENT HEALTH

RELATED BEHAVIOUR IN DIFFERENT FAMILY STRUCTURE March

2007:1-10

11. Meculloch A TEENAGE CHILDBEARING 2001 55-16-23

12. Wang.Y,Liang H, OBESITY AND RELATED RISK FACTORS AMONG

LOE SOCIO ECNOMIC STATUS SEP 2007 1927-38

13. Tucker CM,Butler AM PREDICTORS OF A HEALTH –PROMOTING

LIFESTYLE AND BEHAVIOUR PMID 19378625

14. Dixey R.EATING DISORDERS PMID 8817583

15. CREED-KANASHIRO HM,Uribe TG, IMPROVING DIETARY INTAKE TO

PREVENT ANEMIA,2000 -130

16. STEAR SJ,Prentice A,CALSIUM SUPPLEMENTATION ,2003

17. Yang RJ ,Wang EK,IRRUGULAR BREAK FAST EATING AND HEALTH

STATUS 2006 7-6.295

18. Shuey DA,Babishangire BB PREVENTION PROGRAMME ON AIDS 1999

9. SIGNATURE OF THE CANDIDATE 10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF 1. GUIDE

GUIDE NAME SIGNATURE OF THE GUIDE

12. CO-GUIDE NAME

13. SIGNATURE OF THE CO-GUIDE

HEAD OF THE DEPARTMENT NAME

SIGNATURE OF HOD

14. REMARKS OF CHAIRMAN AND PRINCIPAL

SIGNATURE OF PRINCIPAL