RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

SYNOPSIS OF THE M.SC.(N) DISSERTATION

A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF- INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING THE ILL EFFECTS OF CARRYING HEAVY SCHOOL BAGS IN CHILDREN AMONG PRIMARY SCHOOL TEACHERS AT SELECTED SCHOOLS IN MANGALORE

Submitted By: Mr. Dijo P. Jose 1st year M.Sc. Nursing student, Srinivas Institute of Nursing Sciences, Valachil Padavu, Arkula, Mangalore – 574 143. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. ANNEXURE – II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION 1. NAME OF THE CANDIDATE MR. DIJO P. JOSE AND ADDRESS 1st YEAR M. Sc. (NURSING) (IN BLOCK LETTERS) COMMUNITY HEALTH NURSING

SRINIVAS INSTITUTE OF NURSING SCIENCES, VALACHIL PADAVU, ARKULA, MANGALORE – 574 143.

2. NAME OF THE SRINIVAS INSTITUTE OF NURSING INSTITUTION SCIENCES, VALACHIL PADAVU, ARKULA, MANGALORE – 574 143.

3. COURSE OF STUDY 1st YEAR M.Sc. NURSING SUBJECT COMMUNITY HEALTH NURSING

4. DATE OF ADMISSION 08-08-2013

5. TITLE OF THE TOPIC.

A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF-INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING THE ILL EFFECTS OF CARRYING HEAVY SCHOOL BAGS IN CHILDREN AMONG PRIMARY SCHOOL TEACHERS AT SELECTED SCHOOLS IN MANGALORE

2 6. BRIEF RESUME OF INTENDED WORK

6.1 Introduction

Children are the major consumers of health care in India, About 42% of the children below the age of 16 occupy the major portion of population of the country and also belong to age group in which good healthful living style could be inculcated; Good health is essential for learning and cognitive aptitude of children. Ensuring that children are healthy and able to learn is an indispensable constituent of an effective education system. It is all the more important to impart them with right knowledge at right time.1

Next to home, schools play an important role in supporting the health and well-being of children and young people. The Healthy Schools toolkit is designed to help schools to ‘plan, do and review’ health and well-being improvements for their children and young people and to identify and select activities and interventions effectively. This approach will ensure schools put in place the most appropriate services and meet the needs of children and young people.2

The modern school child is required to carry a variety of heavy objects to school. The weight of bag of school children is mainly contributed by text books, note books (separate for school & private tuition), collection books, project album, and assignments as the academic materials. Other materials such as lunch box, snack box, water bottle, pencil box, umbrella, etc, are the other articles cause increase in weight of the bag .Large books, stationery, sports kits, and even laptop computers are often a mandatory part of the child’s inventory. Many children carry all the separate things in a school bag, usually a backpack.3

Today school bag carried by school children as a daily load becomes a health problem. Back pain in school children is becoming a new topic of growing health problem raising a red flag and an alarm about the dangers associated with improper childhood school bag weight and use. The weight of school bag and the negative consequences of such a heavy load may cause back pain and damage the spine in children. A large number of grade school children and adolescents are reported to have upper limb including back, neck, and shoulder pain. Heavy backpacks which carried improperly on the backs or shoulders of school

3 children can put pressure on their joints and ligaments and may be associated with several potential health problems and have a substantial economic impact either direct medical care costs or indirect costs of disability.4

The role of teacher is important and fundamental in children health care. Participation of the teacher in the child care is of great value and there is no substitute for this. Teachers help the children to gain knowledge and understanding of health, develop favorable attitudes and formulate desirable habits to improve their own health as well as that of the community. 3 So it is necessary to assess the teachers knowledge on ill effects of school backpack.

Need for Study 6.2 Across the nation, millions of elementary, high school and college students are racing out to the school bus or carrying to their classes with overstuffed backpacks hang over their shoulders. It is assumed that daily discontinuous postural adaptations could result in pain and disability in school going children. Children carrying backpacks for school that load is too much weight is also at risk for short term and possible long term health issues. Recent worldwide attention has focused on the role of backpacks in the development of children non-specific low back pain.5

The use of backpack increased substantially among the school children. Studies have shown that carrying a backpack cause to develop different symptoms of musculoskeletal disorders among the carrier of the backpack. A study conducted in India, was found that the mean bag weight carried by urban school children is 7.1Kg, which is 17% of their body weight and for rural school children it’s 3.2Kg. These back packs can seriously attribute to the regional pains in the children especially in the upper back, shoulder and neck. Researchers have explored the incidents of backpacks use by school children in the developed countries is at least 90%. In the UK the average backpack weight is 15-20% of their body weight, and some children carry backpacks as heavy as 30% to 40% of their body weight. The average loads vary greatly between studies the majority of reports indicate that the loads carried by students greater than the recommended limits.6 The school children across the world suffer from musculoskeletal pain or

4 discomfort in the shoulder and back. In today’s life, there is a growing concern among the teachers, medical professionals and parents over the increasing incidents of backpack related injury in school children. A cross sectional study conducted on school girls and boys of age between 5-15 years in Karachi. Students were interviewed with structured pre-tested questionnaire, the results of the study revealed that School bags averaged weight is 4.9 kg. Related to body weight of the students, About 89. 1% of students carried bags weighing more than 10% of their body mass, the proportion of students who experienced bodily pain due to back pack carriage was 67%. Regarding intensity of pain; 40.5% students had complain of mild pain, 17.4% students had complain of moderate pain, while 10.8% had severe intensity of pain. The study concluded that school students of Karachi 5-15 years old seem to carry substantial backpack loads which causes back pain.6

There is need of this study, which can provide us with information about the average weight a child has to carry to school. Therefore if preventive measures can be introduce now with the regard to safe load carriage in school students. A Descriptive study conducted on teachers between the relationship of backpack weight and its influence on musculoskeletal problems and shoulder posture. Majority of teachers (86.5%) were inadequately knowledge about the posture problems and skeletal effects. The researchers recommended that there is an emerging need to educate the teachers about the problems involved with

carrying heavy back packs. So the Investigator found that it is relevant to conduct a study to evaluate the effectiveness of the self instructional module on Knowledge regarding the effects of carrying heavy school back packs in children among primary school teachers at selected schools in Mangalore.7

Review of Literature 6.3 In the present study, the review of literature related to topic are organized and presented under the following headings namely, 1. Review of literature related to the ill effects of carrying heavy school bags. 2. Review of literature related to knowledge of teachers regarding the effects of carrying heavy school bags. 3. Review of literature related to self instructional module on effects of carrying heavy school bags.

5 1. Review of literature related to the ill effects of carrying heavy school bags:

A retrospective study carried to find out the prevalence of different musculoskeletal problems among the school children in India. Data were collected for twenty two students Results revealed that pain in the upper back (40%), neck (27%) and shoulder (20%) were most prevalent body regions followed by forearm and wrist pain (7%) and low back (6%). Results further revealed that all the students participated in this study have a pressure mark over shoulder. 54.55% of the children were diagnosed with mayo facial pain and rest with thoracic outlet syndrome.8

A cross sectional study of self reported back and neck pain associated physical and psychological risk factors was carried out among English school children of University of Surrey, UK. The study set out to identify the associations between ergonomics and other factors with back and neck pain among school children. Self reported questionnaires were used to record health outcomes and potential risk factors in state schools. 679 school children aged between 11–14 years took part. 27% of children reported having neck pain, 18% reported having upper back pain, and 22% reported having low back pain. It concluded carrying back packs increasing risk of back pain and the risk of pain pathology. 9

An observational study conducted on Schools in Milan, Italy to assess the perceived school bag load, duration of carriage, and method of transport to school are associated with spinal pain in adolescent. Use and perceived load of school bags as well as spinal pain were measured by questionnaire. The prevalence of back and neck pain were approximately 50% and 53% of females reported neck pain compared with 44% of males. Almost half of participants carried their school bag for more than 30 minutes per day with 85% carrying their bag over both shoulders. School bags were felt to be heavy by 54% and to cause fatigue by 51%. Carrying a school bag for more than 30 minutes daily and taking an inactive form of transport to school either by car or bus increased the odds of having both back and neck pain. Neck pain is as common as back pain amongst adolescents, the study revealed that perceived school bag load, duration of carriage and method of transport to school are

6 associated with back and neck pain.9 A cross-sectional study conducted on schools in northern Galicia, Spain to investigate whether backpack weight is associated with back pain and back pathology in school children. 1403 school children were analysed. Of these, 61.4% had backpacks exceeding 10% of their body weight. Those carrying the heaviest backpacks had a 50% higher risk of back pain and a 42% higher risk of back pathology, although this last result was not statistically significant. Girls presented a higher risk of back pain compared with boys. The results obtained have strong implications. Many children transport excessively loaded backpacks, an excess which would not be allowed for workers in employment. We strongly encourage the medical and educational community to start advising parents and school children about the risks posed by heavy school bags and the fact that this risk can be easily reduced.10

The cross-sectional study has been done in eight primary schools in Yazd city in which a total of 783 students’ boys grades 1 to 5, were studied. Measures included body mass and school bag weight of students and then the relative backpack weight (RBW) was calculated as percentage of body weight. The average backpack weight was 4.6 kg and represented 12.9% of the subjects’ body weights. In private schools, about 43.7% of the students carried backpacks weighing less than 10 percent, 38.4% between 10 – 14% and 17.9% of the students 15 percent or more of their body weights versus 66.2%, 23.5% and 10.3% in governmental schools, respectively. The majority of students carried their bags over one or two shoulders and only 4% used roller bags. The contents of backpacks were mainly text books, exercise books or test books. The result of this study indicated that the students of private schools carried heavier backpacks than those of governmental ones and therefore it appears to be reasonable to lighten the load of backpacks and educate students for carrying correctly school backpacks.11

2. Review of literature related to knowledge of teachers regarding the ill effects of carrying heavy school bags.

A Quasi experimental study conducted on primary school teachers regarding the knowledge of ideal load carriage of school aged children of about 7-11 years. The sample size was 125 selected from various schools under the University Of Aarhus, Denmark. The results shown that the two third

7 of population (76.5%) were unaware of ideal load carrying of children. However their knowledge score increased to 93.67% after implementing the educational interventional programmers at planned schedule.12

A Descriptive study done on the identification of symptoms of effects of carrying heavy school bags such as poor concentration, assuming clumsy posture in class rooms and its effects on class room performance. The study concluded that the majority (68.9%) of teachers pay less attention towards the physical symptoms those in turn show effect on class room performance.13

An Experimental study has done to investigate knowledge among teachers on the effect of different methods of carrying schoolbags on gait and postural changes of children aged 11 to 13 years old. It was examined by using structured questionnaires which was distributed to the primary school teachers. The study concluded that the teachers develop knowledge on the identification of effects of the school bags on postural changes in children.14

A descriptive study has conducted among teachers knowledge on the occurrence of low back pain on children by school bag carrying. 250 teachers were selected as samples. It was examined using self report questionnaire. The results have shown that more than half of the teachers have inadequate knowledge. 24.2% reported that occurrence of low back pain was associated with carrying the school bag on 1 shoulder. The study concluded that more work is required to explore the problems of school children.15

3. Review of literature related to self instructional module on effects of carrying heavy school bags

An experimental study conducted to evaluate the effectiveness of self instructional module on Backpack Intelligence program. The questionnaire included demographic information, self-reported knowledge of backpack safety, behavior changes as a result of the programming, and belief that improper backpack use can cause injury. The study shown that the majority teachers were to be knowledgeable (86.9%) after administering educational interventional than the pre educational programme score (33.5%). Hence the study concluded that the educational intervention is recommended for the teachers to be aware of

8 school children’s problems.16 An experimental study conducted on the effectiveness of self instructional module on the Changes in gait patterns with heavy loads carrying at their backs. The results shown tremendous increase in post test knowledge score (96.5%) than the pre test score (44.5%). The researchers concluded that the self instructional module has great impact on increasing the knowledge of teachers and educational trainers.17 6.4 Statement of the Problem

A study to evaluate the effectiveness of Self-Instructional Module on Knowledge regarding the ill effects of carrying heavy school bags in children among primary school teachers at selected schools in Mangalore. 6.5 Objectives of the Study The objectives for the present study are;  To assess the knowledge of Primary School Teachers regarding the ill Effects of carrying heavy school bags in children.  To develop and administer Self-Instructional Module on the ill effects of carrying heavy school bags in children.  To evaluate the effectiveness of the Self Instructional Module on effects of carrying heavy school bags in children.  To determine association between the pre test knowledge scores with their selected demographic variables. 6.6 Operational Definitions

EFFECTIVENESS Refers to the desirable changes brought about by the self instructional module as measured in terms of significant knowledge gain in the post test and graded as adequate knowledge, moderately adequate and inadequate knowledge.

SELF INSTRUCTIONAL MODULE It refers to the extent to which the SIM delivered has achieved the desired the improvement as assessed by gain in knowledge of primary school teachers on

9 ill effect of carrying heavy school bags. KNOWLEDGE It refers to the correct response of primary school teachers to the items on cognitive aspects regarding the effects of heavy school bags in children and it is expressed in terms of knowledge scores measured by structured questionnaire.

Ill-EFFECTS: It refers to the health problems arising due to the heavy school bags.

SCHOOL BAGS In this study it refers to rucksack which children hangs on their shoulders to carry their belongings usually books.

PRIMARY SCHOOL TEACHER It refers to the school teachers who teach in selected primary schools. 6.7 Assumptions  The teachers may have inadequate knowledge regarding the effects of carrying heavy school bags in children.  The self instructional module will help to enhance the knowledge of School teachers regarding the ill-effects of carrying heavy school bags in children. 6.8 Delimitations The study is limited to  The Primary school teachers  Selected urban primary schools at Mangalore.  Sample size 50 primary school teachers 6.9 Hypotheses

 H1 – The mean post-test knowledge scores of the primary school teachers on ill-effects of carrying heavy school bags in children will be significantly higher than the mean pre test knowledge scores.

 H2 - There will be significant association between the mean pretest knowledge scores of primary school teachers with their selected

10 7. demographic variables. 7.1 MATERIALS AND METHODS Source of Data

Data will be collected from primary school teachers working in selected urban primary schools in Mangalore. 7.2 Research Design

One group pre-test and post – test pre – experimental design. 01 X 02 (DAY 1) (DAY 1) (DAY 7)

01 – Pretest 02 - Post Test X - Administration of SIM. 7.2.1 Variables under study

 Dependent variables: Knowledge of the primary school teachers regarding the ill effects of carrying heavy school bags and its prevention in children.

 Independent variables: Self instruction module regarding the ill effects of carrying heavy school bags and its prevention in children among primary school teachers.

 Demographic variables: Age, sex, marital status, religion, educational qualification, experience, source of information.

11 SCHEMATIC OUTLINE OF RESEARCH DESIGN

DESIGN One group pretest and posttest pre-experimental design

STUDY SETTING POPULATION Urban primary schools Primary school teachers

SAMPLE SIZE SAMPLING TECHNIQUE 50 Purposive Sampling

DATA COLLECTION PROCEDURE

PRE-TEST INTERVENTION POST-TEST Structured knowledge Structured knowledge questionnaire SIM questionnaire

VARIABLES

DEPENDENT INDEPENDENT ATTRIBUTES Knowledge of Age, Sex, Occupation, the primary SIM Experience, Educational school teachers Qualification, Marital status, religion, Source of information

ANALYSIS

Descriptive Statistics Inferential Statistics – Frequency, Percentage, X2 , paired ‘t’ Test distribution, Mean, Medium, Standard deviation

FINDINGS, DISCUSSION AND CONCLUSION

12 7.3 Research Setting The study will be conducted at selected urban Primary schools in Mangalore. 7.4 Population School teachers working at selected Urban Primary schools in Mangalore. 7.5 Method of Data Collection 7.5.1 Sampling Technique Non probability- Purposive sampling technique will be used in this study. 7.5.2 Sample size 50 primary school teachers working at selected primary schools at Mangalore. 7.5.3 Sample Inclusion Criteria

The study includes primary school teachers who are  Able to communicate in English & Kannada.  Willing to participate in the study.  Available at the time of data collection. 7.5.4 Sample Exclusion Criteria Exclusion criteria The study excludes primary school teachers  Who have attended workshops or seminars on the effects of heavy school bags in children 7.5.5 Tools for data collection Section A: Items of demographic variables such as age, sex, marital status, religion, educational qualification, experience, source of information.

Section B: A structured questionnaire to assess the knowledge of primary school

13 7.5.6 teachers regarding the ill effects of carrying heavy school bags in children. Data Collection Method Data will be collected after getting permission from the administrative heads (director) and Principal of selected schools The investigator will introduce him to the participants. The objectives of the study will be explained to the participants and formal written consent will be taken from the subjects. Then the tool is administered after 20 minutes, the questionnaire will be collected back on the same day. A well designed self instructional module on ill effects of carrying heavy school back packs and its prevention in children will be distributed among the participants with proper explanations. After 7 days a post test will be conducted by using the same questionnaire. 7.6 Data Analysis Plan The data collection will be analyzed by means of descriptive and inferential statistics. 7.6.1 Descriptive Statistics  Frequency and percentage distribution will be used to analyze demographic variables. It will also be described descriptively.  The obtained data will be calculated by Mean, Median and standard deviation. 7.6.2 Inferential Statistics  A paired’ t’ test will be used to compare the mean pretest and post test knowledge scores of school teachers on effects of carrying heavy school back packs.  A Chi square test will be used to determine association between the mean pretest knowledge scores and selected demographic variables. 7.7 Does the study require any investigation or interventions to be conducted on patients or other humans or animals? Yes. It involves administration of SIM on ill effects of carrying heavy school bags which causes no pain to the primary school teachers 7.8 Has the ethical clearance been obtained from your institution?  Ethical clearance will be obtained from the research committee of Srinivas Institute of nursing sciences, Mangalore.  Permission will be obtained from the concerned authority of selected primary schools in Mangalore.

14 8.  The informed consent will be obtained from the samples for their willingness to participate in the study. 1. BIBLIOGRAPHY

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