Rajiv Gandhi University of Health Sciences Bangalore, Karnataka s41

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE MS. CHINNU THOMAS CANDIDATE AND Ist YEAR MSc. NURSING STUDENT, ADDRESS N.D.R.K. COLLEGE OF NURSING

B.M. ROAD HASSAN, KARNATAKA.

2 NAME OF THE N.D.R.K. COLLEGE OF NURSING, B.M. ROAD, HASSAN, INSTITUTION KARNATAKA.

3 COURSE OF STUDY AND MASTER OF SCIENCE IN NURSING SUBJECT (MEDICAL AND SURGICAL NURSING)

4 DATE OF ADMISSION TO 11.07.2011 THE COURSE

5 TITLE OF THE TOPIC “EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PRIMARY PREVENTION OF OSTEOPOROSIS AMONG HIGH SCHOOL TEACHERS IN SELECTED SCHOOLS, HASSAN, AND KARNATAKA”.

5.1 STATEMENT OF THE “A STUDY TO EVALUATE THE EFFECTIVENESS OF PROBLEM STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PRIMARY PREVENTION OF OSTEOPOROSIS AMONG HIGH SCHOOL TEACHERS IN SELECTED SCHOOLS, HASSAN, KARNATAKA”. 6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“An ounce of prevention is worth a pound of cure”.

 William Clark

National osteoporosis awareness and prevention month is celebrated each May, and becomes a chance for our Nation to become more familiar with the effects of this disease, and about the preventable steps that we can to deal with it.

Osteoporosis is a common musculoskeletal disorder, referred as silent diseases that often remains asymptomatic until bone fracture occur. Because of the high morbidity associated with fracture, prevention is a clinical priority. Osteoporosis is one of the metabolic bone disorder and remains and increasingly significant problem, affecting 200 million individuals worldwide. It affects men as well as women. One out of every two women and out of every four men over 50 is prone to develop osteoporosis – related fracture of the hip, vertebrae or wrist in their life time.1

Osteoporosis means porous bone. It is derived from Greek word osteon meaning “bone”, and poros meaning “pore”. It is a disease of bones that leads to an increased risk of fractures. In osteoporosis, the bone mineral density (BMD) is reduced, bone micro -architecture is deteriorating, and the amount and the variety of proteins in bone is altered. Osteoporosis is defined by World Health Organization (WHO) as a bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults); the term “established osteoporosis” includes the presence of a fragility fracture. The disease may be classified as primary type 1, primary type 2 or secondary. The form of osteoporosis is common in women after menopause.2

Despite the high prevalence and serious medical consequences of osteoporosis, many at risk patient are inadequately screened and diagnosed before symptoms occur. Despite the prevalence and deleterious consequence of bone loss and fracture, patient with osteoporosis continue to be under diagnosed and under treatment. It is important for physicians to identify individuals at high risk of osteoporosis and to implement

2 preventive strategies. Osteopathic physicians are in a unique position to improve diagnosis and management of this clinical condition when they implement a holistic and multi factorial approach.3

“To prevent “literally means “to keep something from happened”. The term “prevention” is reserved for those interventions that occur before the initial onset of disorder. Nursing care oriented to health promotion, wellness, and illness. Prevention can be understood is terms of health activities on primary, secondary, tertiary levels. Primary prevention programme address area such as adequate and proper nutrition, weight control, exercise and stress reduction among the healthy individuals. Secondary promote early detection or screening and treatment of a diseases and limitation of disability. Tertiary prevention directed towards recover or rehabilitation of a diseases or condition after the diseases have been developed osteoporosis can be treated and prevented and early screening.4

A study was conducted by scientific Advisory Board of osteoporosis society of Canada regarding prevention and management of osteoporosis. It was a controlled, randomized trials and prospective studies conducted among Canadians. The purpose of the study was to recommend appropriate levels of calcium intake in their dietary pattern. It was found that current recommended intakes of calcium are too low among Canadians. The study suggested Canadians should attempt to meet their calcium requirements principally through food sources. Revised intake guidelines designed to reduce bone loss and protected against osteoporotic fracture. Further research is necessary before recommending the general use of calcium supplements by adolescents. The study revealed that calcium supplementation cannot substitute for hormone therapy in the prevention of postmenopausal bone loss and fracture. Adequate amounts of vitamin-D are necessary for optimal calcium absorption and bone health.5

Although calcium and vitamin-D have been the primary focus of nutritional prevention of osteoporosis, recent research has clarified the importance of several additional nutrients and food constituents. Osteoporosis is a disease in which bones become weak and are more likely to break for fracture. Without prevention or treatment, osteoporosis can progress without pain or a symptom until a fracture occurs. Osteoporosis is not just an “old woman’s disease”. Although it is more common in white or Asian women older than 50 years,

3 osteoporosis can occur in almost any person at any age. In fact, more than 2 million American men have osteoporosis, and in women, bone loss can begin as early as age of 25 years.6

Building strong bones and reaching peak bone density (maximum strength and solidness) can be the best defense against developing osteoporosis. After reaching the peak, which usually occurs by the age of 30, a healthy lifestyle can help keep bones strong. Osteoporosis is more or less preventable for most people. Prevention is very important because, while treatments are available for osteoporosis, no cure currently exists.

6.2 NEED FOR THE STUDY

“Primary prevention includes all health promotion efforts as well as wellness education activities that focus on maintaining or improving the general health of individuals, families and communities”

 Edelmen and Mandle.

In the united states approximately 30 million women and 10 million men aged 50 year or older have osteoporosis, low bone mineral density, or both, placing them at risk for disabling fracture. Life style related diseases such as diabetes mellitus, hypertension, and dyslipidemias, are often accompanied by osteoporosis. It is a group of disorders in which there is a reduction of total bone mass without changes in the mineral composition. There is an imbalance in the normal homeostatic bone turnover; the rate of bone resorption is greater than the rate of bone formation, resulting in a reduced total bone mass. The bones become progressively more porous, brittle and fragile. They fracture easily under stress that would not break normal bone. Treatment of osteoporosis is essentially the same as that for primary osteoporosis, but it is important to be aware of the interference between osteoporosis treatment and the drug used for the life style related diseases.7

According to the India’s National newspaper 20th October 2004, over 30 million case of osteoporosis in India. The condition remains largely under diagnosis. This is because most doctors attribute to old age fracture in those over 50, according to osteoporosis society in India. National largest study of osteoporosis, National osteoporosis Risk Assessment [NORA] found that almost half of the more than 200000 postmenopausal women assess in the study had low bone mass, putting them at risk of a breaking bone seven present of women in study were found to osteoporosis and twice as high for women with low bone mass compared to women with normal bone density. Osteoporosis is a major public health problem, and it prevalence may be increasing, unfortunately, once spinal fracture occur, the treatment of osteoporosis is less than satisfactory. Prevention is the preferred

4 approach. Since the aetiologyof osteoporosis is multifactorial and the diagnosis usually delayed, treatment becomes difficult. There are no set treatment methods as yet. Treatment can be divided in to medical and orthopedic. Medical treatment consists of high protein diet, calcium supplementation, androgens, estrogen, vitamin D and fluoride. Orthopedic treatment includes weight bearing exercise and prophylactic bracing of the spine by using an ASH brace or Taylor brace.8

According to public health, there are three steps to prevention: primary, secondary, and tertiary. The prevention of osteoporosis is made up of general life style preferences and other more specific treatments. Keeping strong bone is the key to primary prevention and calcium build strong and health bones. Others include vitamin D, weight bearing exercise and hormonal therapy. During the growing year of adolescence and teen years, attention must be paid to dietary calcium if peak bone mass is to be achieved. Specific attention to dietary calcium intake may also be warranted beyond age 60 which may come in the form of increased food calcium or form specific calcium and vitamin D supplements. The main dietary sources of calcium include milk and other daily products such as cottage cheese, yogurt or hard cheese and green vegetable. Milk is the primary source of vitamin D. Exercise can help to prevent and treat thinning bones and should be done for at least 30 minutes three times per week. Any weight bearing exercise is recommended since it is most beneficial to increase the bone density, which is the primary factor in the prevention of osteoporosis. Smoking cigarettes can cause bones to become thinner and weaker. Stopping smoking can reduce the risk. Some medications like glucocorticoid medications, heparin, vitamin A and certain synthetic retinoid and antiepileptic drugs can lead bone thinning. Patient should ask their health care provider about the possibility that these medications should be replaced or the dose lowered. Hormone therapy is recommended for young women whose ovaries do not make estrogen normally.9

A study was conducted by NIH consensus development panel on osteoporosis prevention, diagnosis; therapy and objective were to clarify the factors associated with prevention and treatment of osteoporosis. The participants were a nonfederal, nonadvocate, 13 members a panel was convened, representing the fields of internal medicine, family and community medicine. Thirty two experts from these fields presented to the panel and audience of 699. The panel answering predefines question, developed conclusions based on evidence presented in one form and literature. They concluded the study that, through prevent in white post menopausal women, osteoporosis occurs in all population and at all ages. Adequate calcium and vitamin D intake is crucial

5 to develop optimal peak bone mass and to preserve bone mass throughout life. Regular exercises, especially resistance and high impact activities, contributes to development of high peak bone mass and may reduce risk of falls is older person. Fracture prevention is the primary treatment goal for patient with osteoporosis.10

A study was conducted by Sri Sathya Sai General Hospital and Institute of Higher Medical Science, Bangalore, India on deformities consequent to disorders of nutrition; bone and mineral metabolism constitute a serious national health problem. They surveyed 337.68 million populations residing in 0.39 million villages is 22states of India during the period o f 1963 – 2005. Here 4, 11,744 patient identified with the disorder of bone and mineral metabolism 2, 13,760 had nutritional bone diseases and 20, 784 had metabolic bone diseases. Vitamin D deficiency, osteomalacia and rickets caused by inadequate exposure to sun light, dietary calcium deficiency and fluoride interaction syndromes. The result showed the syndrome of bone diseases and deformities are largely responsible for the morbidity and mortality in the young and promising individuals, with economic consequences. Hence, the study recommended the health education on preventive aspect of osteoporosis among perimenopausal group to achieve health aging.11

Primary prevention is a true prevention; it precedes diseases or dysfunction and is applied to clients considered physically and emotionally healthy. Primary prevention aimed at health promotion includes health education programmes, physical and nutritional fitness activities. It can be provided to an individual or to a general population.12

Osteoporosis is often known as “The silent thief” because bone loss occurs without symptoms and progressive loss and tinning of bone tissue happens over many years. This disease affects millions of people throughout the world. Women are four time more likely than men to develop this disease. According to the National osteoporosis foundation (NOF), primary defense is important before the age of 30. It is evident in most of the cases that between the age of 30 and 40, one should start taking care to avoid osteoporosis. In current situation, working women especially school teachers won’t give much attention to their health due to lack of time and other overload activities in their daily life. Most often, they rely on junk or processed food instead of regular balanced diet which has calcium, vitamin D and other minerals. Hence forth, the researcher felt the need to shed light regarding the prevention of osteoporosis by providing adequate knowledge regarding the importance of good nutrition, following healthy life style and regular exercise which can increase the bone density is a primary factor in prevention of osteoporosis. With the aging of population, the incidence of fracture

6 associated with osteoporosis is rising. Therefore, the early detection and timely treatment of osteoporosis can substantially decrease the risk of future, it is difficult to completely rebuild bone that has been weakened by osteoporosis. Hence, the prevention of osteoporosis is as important as treatment.

It is expected to affect 36 million Indians by 2013 but osteoporosis – a disease associated with brittle bones, fracture and painful recovery remains one of the most undermined diseases in the country.

6.3 STATEMENT OF PROBLEM

“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PRIMARY PREVENTION OF OSTEOPOROSIS AMONG HIGH SCHOOL TEACHERS IN SELECTED SCHOOLS, HASSAN, KARNATAKA”.

6.4 OBJECTIEVES OF THE STUDY

1. To assess the knowledge of high school teachers in selected schools at Hassan, regarding “the primary prevention of osteoporosis” before the administration of the structured teaching programme.

2. To develop and administer structured teaching programme regarding “the primary prevention of osteoporosis” among high school teachers in selected schools at Hassan.

3. To assess the knowledge of high school teachers in selected schools at Hassan, regarding “the primary prevention of osteoporosis” after the administration of structured teaching programme.

4. To evaluate the effectiveness of structured teaching programme by comparing pre and post test

knowledge regarding primary prevention of osteoporosis among high school teachers in selected schools

at Hassan.

5. To associate post test knowledge with the selected sociodemographic variables regarding primary prevention of osteoporosis among high school teachers in selected schools at Hassan.

6.5 HYPOTHESIS

RESEARCH HYPOTHESIS

7 H1.There will be significant difference between pre-test and post-test knowledge, scores of high school teachers who received the structured teaching programme regarding primary prevention of osteoporosis.

H2.There will be significant association between the selected demographic variables and post-test knowledge of high school teachers regarding primary prevention of osteoporosis.

6.6 ASSUMPTIONS

 The study will improves the knowledge of high school teachers regarding primary prevention of osteoporosis in selected schools at Hassan, Karnataka.

 The study will improve the knowledge of high school teachers regarding the primary aspects of preventing osteoporosis such as early detection, nutritional management, physical exercise, life style modifications and hormonal replacement therapy.

6.7 OPERATIONAL DEFINITIONS

EVALUATE;

It refers to the assessment of effective structured teaching programme on “primary prevention of osteoporosis”.

EFFECTIVENESS;

It refers to the extent to which structured teaching programme has achieved the desired effect as measured by the subjects gain in knowledge scores.

STRUCTURED TEACHING PROGRAMME;

Refers to the systematically arranged facts regarding osteoporosis which includes definitions, meaning, signs and symptoms, prevention and management.

KNOWLEDGE; 8 It refers to the level of understanding of high school teachers regarding primary prevention of osteoporosis.

PRIMARY PREVENTION;

Primary prevention is true prevention; it precedes diseases or dysfunction and is applied to clients considered physically and emotionally healthy.

OSTEOPOROSIS;

A disorder characterized by abnormal loss of bone density and deterioration of bone tissue with an increased fracture risk.

HIGH SCHOOL TEACHERS;

A teacher who certifies in teaching 8th, 9th, and 10th grade students working in a reputed school.

SELECTED SCHOOLS;

C.K.S. English Medium School, United Academy, C.M.I. C.B.S.E School.

6.8 CRITERIA FOR SELECTION OF SAMPLE

INCLUSION CRITERIA;

High school teachers those who are,

 Female with the age group of 25 – 45 years.

 Present during the time of the study.

EXCLUSION CRITERIA

High school teachers those who are,

9  Male.

 Females with age group below 25 and above 45 years.

 Females absent during the time of the study.

6.9 SIGNIFICANCE OF THE STUDY

(a) Increases the knowledge of high school teachers regarding the primary prevention of osteoporosis.

(b) Helps the high school teachers to gain knowledge regarding the primary aspects of preventing osteoporosis such as early detection, nutritional management, physical exercise, life style modifications and hormonal replacement therapy.

6.10 CONCEPTUAL FRAME WORK

Based on- “Betty Neumann model of prevention”

6.11 REVIEW OF LITERATURE

A literature review is a body of text that aims to review the critical points of current knowledge including substantive findings as well as theoretical and methodological contributions to a particular topic. It is an important step in research. It can help with the orientation to what is known about an area of enquiry to ascertain what research can best make a contribution to the existing base evidence. Review of literature is therefore, an essential process in the development of the research projects.

The results of studies conducted in various aspects of structured teaching programme on osteoporosis are presented below.

Review of literature is divided into two parts; they are literature related to,

1) Osteoporosis and its prevalence.

10 2) Primary prevention of osteoporosis.

1. Review of Literature Related To Osteoporosis and Its Prevalence.

A study was conducted to assess the prevalence of osteoporosis in Saudi women. 110 radio graphs of calcaneum were reviewed for post-menopausal osteoporosis. The patients had come with unrelated complaints. The age of this patient group was in the range of 45-80 years. Of these 76 percent patient had osteoporosis, of these 42 had mild osteoporosis, 31 had frank osteoporosis and 11 were diagnosed to have severe osteoporosis. This study showed high prevalence of post-menopausal osteoporosis.13

A study was conducted in china to assess the prevalence of osteoporosis and to find low bone mass of healthy adult and its risk factors among 881 participants. Among these, 498 were women and 383 were men aged 50 and above were analyzed in this study. A self administered questionnaire was used to assess their demographic characteristics, diet, life styles and medical history. The prevalence of osteoporosis was high in women (47 percent) compared to men (15.5 percent).14

Osteoporosis is the thinning and weakening of the bones that leads to the break, even with minimum force. It is also in general higher among women and older people. According to a recent estimation, there are about 300 million people with osteoporosis in India. The study also indicates that there may be a 50 per cent increase in the number of people with osteoporosis in India in the next 10 years. This reveals that Indian women are at high risk of osteoporosis.15

2 Review of Literature Related To Primary Prevention of Osteoporosis.

A study was conducted by the scientific advisory board of osteoporosis society of Canada in physical activity as therapy for osteoporosis. Relevant epidemiological studies, clinical trials and reviews were examined, including the large scale FICSIT trial in the United States, a prospective 4 year study of women enrolled in an exercise programme in Toronto and the large scale study of osteoporotic fractures. The study revealed that immobilization should be avoided in any one with osteoporosis. Regular, moderate physical activity is

11 recommended for those with osteoporosis. Younger people with osteoporosis need exercise that will preserve or improve bone mass, muscular strength, endurance and cardiovascular fitness. Weight loss as a result of physical activity should be avoided and adequate intake of protein, vitamins and minerals assured. Because the benefits of physical activity are independent of the effect of other therapies, physical activity is an essential adjunct to appropriate nutrition and other therapies.16

A study was conducted by Scottish Centre for evidence based care of older people, Scotland, UK regarding the effectiveness of exercises interventions in preventing bone loss and fracture in postmenopausal women. Selection was based on randomized controlled trials (RCTs). 43 RCTs with 4320 participants met the inclusion criteria. the most effective type of exercise intervention on bone mineral density (BMD) for the neck of femur appears to be non-weight bearing high force exercise for the lower limbs (MD 1.03; 95% confidence interval 0.24 to 1.82). The most effective intervention for BMD at the spine was combination exercise programmers (MD 3.22; 95% CI 1.80 to 4.64) compared with control groups. The result suggested a relatively small statistically significant, but possibly important, effect of exercise on bone density compared with control groups. Exercise has the potential to be a safe and effective way to avert bone loss.17

A study was performed by a meeting held in Funchal, Madeira, based on hormone replacement therapy in the post- women’s health initiative era. It is important to note that randomized controlled trials such as the WHI are really scientific tools for a group of research participants, not a form of individualized medical management the WHI targeted a group of women who were much older than those normally treated and who had numerous other risk factors. It is clear that hormone therapy is effective for post menopausal symptoms and osteoporosis prevention. Timing is critical for the initiation of therapy and length of treatment. Additionally, presenters explored the possibility of class effect against the potential risk factors associated with particular estrogen and progestogen types. Evidence from preclinical and clinical studies support the conclusion that, HRT should be given to women with menopausal complaints to meet their individual needs, taking in to account their individual risk profile and the overall therapeutic objectives.18

A study was conducted to review, the effect of dietary intakes and the effect of vitamin D on bone mineral density, and fracture or fall risk. To minimize bias, study design was limited to randomized controlled trials. Data were abstracted in duplicate and study quality assessed. If clinically relevant and statistically feasible, meta-analyses of RCTs on vitamin D supplementation and bone health outcomes were conducted, with exploration of heterogeneity. Result shown that, largest body of evidence on vitamin D status and bone health was in older adults with a lack of studies in premenopausal women and infants, children and adolescents. The quality of RCTs was highest in the vitamin D efficacy trials for prevention of falls and or fractures in older adults. In older adults, there was fair evidence that serum 25(OH) D is inversely associated with falls. There was good evidence that intakes from vitamin D foods consistently increased serum 25(OH) D in both young and

12 older adults. The results highlight the need for additional high quality studies in infants, children and premenopausal women. Vitamin D with calcium supplementation has a small beneficial effect on BMD, and reduces the risk of fractures and falls. Vitamin D intake above current dietary reference in take was not reported to be associated with an increased risk of adverse events. However, most trials of higher doses of vitamin D were not adequately designed to assess long term harms.19

A study was conducted by Journal of the American Board of family medicine (JABFM) to determine the frequencies of female patients aged 65 years and older having bone density measurement performed and prescription therapy use among osteoporotic women. They completed a retrospective chart audit to assess our adherence to Physician Quality Reporting Initiative guidelines. Women aged 65 to 75 with an office visit between June 1 to November 30, 2007, were divided into 3 subgroups: those who had a recent preventive general medical examination (GME), those who received one in the last 10 years, and those who had not. They determined osteoporosis screening rates for all 3 groups. The first group then underwent electronic medical record review to obtain patient demographics, determine bone mineral density results, and review if those with osteoporosis were receiving prescription treatment. Result had shown that. Ninety-six percent of 305 female patients seen for a GME during the study period had completed bone mineral density testing. This was a screening rate significantly greater than that for patients with an earlier GME and those who never had one in the offices (70% and 50%, respectively). The study concluded that female patients who completed a recent GME had extraordinarily high rates of screening for osteoporosis. We believe this demonstrates the importance of a dedicated preventive health examination as well as the increased significance that physicians and patients currently place on this behavior. The study also highlights one thousand two hundred forty-eight female patients between the ages of 65 and 75 were seen by DFM physicians at MCA between June and November 2007. Three hundred five (24.4%) completed a GME during this time, as determined by billing data for a preventive service code. Six hundred forty-five (51.7%) of patients had completed a GME during the previous 10 years but not during our period of study. Two hundred ninety-eight patients (23.9%) had not been billed for a preventive service code within the proceeding 10 years.20

A study was conducted to examine osteoporosis knowledge and awareness among Vietnamese women who have accessed health care. A sample of 217 women, 13 to 76 years of age, who were attending 1 to 2 health care facilities in Vietnam, questionnaire assessing their awareness of osteoporosis and measuring their knowledge. Majority of women had heard of osteoporosis on average, women answered 49% 0f the knowledge questions correctly. Mean knowledge scores were higher among those reporting a family members with osteoporosis, nurses and women with high school education or greater. More than 90% of the women expressed interest in a prevention and treatment programme. The study was concluded that Vietnamese women may have 13 heard of osteoporosis, yet they would benefit from education, targeting prevention and treatment of the diseases.21

A study was conducted to assess the higher levels of knowledge regarding osteoporosis prevention. A classic experimental design was used. Convenience samples of thirty young college women were randomly assigned to an experimental group or to a controlled group to receive an osteoporosis prevention programme. Both groups completed the knowledge test, the osteoporosis health belief scale and self efficacy scale. The osteoporosis programme was effective in increasing awareness of osteoporosis prevention, in the experimental group of young women.22

A study was conducted in Hongkong using randomized controlled design to evaluate whether a nurse initiated education programme on four specific osteoporosis-prevention related behaviours leads to their adoption or positive attitude changes compared with women, who did not participate in this programme. Pre- post and follow-up education data compared attitude and conception frequency before and after the education programme. The study found that a targeted education programme conducted on Hongkong women resulted in significantly increasing consumption of calcium including Soya based foods, milk and vitamin D.23

A study was conducted to assess the effectiveness of workshop on Osteoporosis among Canadian women. A semi experimental design was used to measure any changes in the participant’s knowledge about osteoporosis and their preventions and treatment practices regarding this disease. It is found that the work shop was effective in increasing the participant’s level of knowledge on osteoporosis.24

7. MATERIALS AND METHODS OF STUDY

7.1 SOURCE OF DATA COLLECTION

Data will be collected from high school teachers working in selected schools, Hassan, Karnataka.

7.2 METHODS OF COLLECTING DATA 14

1. Research Design

Quasi experimental design (one group-pre-test post test design).

SCHEMATIC PLAN OF THE STUDY

Group Pre-test Intervention Post-test

A group of 60 high school O1 X O2 teachers. (single group)

O1; Pre test knowledge of high school teachers regarding “primary prevention of osteoporosis“.

X; structured teaching program on “primary prevention of osteoporosis“.

O2; Post test knowledge of high school teachers regarding “primary prevention of osteoporosis“.

2. Research Setting

Selected high schools in Hassan, Karnataka

3. Population

High school teachers working in selected high schools in Hassan, Karnataka

4. Sample

High school teachers who are fulfilling inclusion criteria

5. Sample Size

60 High school teachers in selected schools in Hassan, Karnataka.

6. Sampling Technique. 15 Probability sampling – Simple random technique.

7. Collection of Data

Data will be collected from samples using a structured questionnaire.

8. Selection of Tools.

Structured questionnaire consists of two sections

Section A – Sociodemographic Variable.

Section B – Structured Questionnaire regarding primary prevention of osteoporosis.

9. Data Collection Method.

Data collection is the gathering of information needed to address a research problem. The permission will be obtained from the authorities in respective institutions before the data collection. Pre test will be conducted with the demographic proforma and structured knowledge questionnaire followed by administration of structured teaching programme on primary prevention of osteoporosis. Post test will be conducted with the same structured knowledge questionnaire after 7 days.

8. VARIABLES

 INDEPENDENT VARIABLES;

Structured teaching programme regarding primary prevention of osteoporosis among high school teachers in selected schools in Hassan, Karnataka.

 DEPENDENT VARIABLES;

Knowledge of High school teachers regarding primary prevention of osteoporosis.

 EXTRANEOUS VARIABLES;

Age, sex, education, experience in teaching filed, exposure to mass media etc.

16 9. PLAN FOR DATA ANALYSIS

 Descriptive statistics:

It includes percentage, frequency, mean and standard deviation for High school teachers regarding primary prevention of osteoporosis.

 Inferential statistics:

It include paired ‘t’ test and chi square test and ANOVA ‘f’ test for the assessment of knowledge and to associate the sociodemographic variables planned.

10. PILOT STUDY

10% Population is planned for pilot study.

11. ETHICAL CONSIDERATION

1. Has the consent been taken from the respondents?

Yes, informed consent will be taken from the respondents.

2. Has ethical clearance being obtained from the institution?

Yes, it will be obtained at the time of study.

17 12. LIST OF REFERRENCSES (Vancouver style)

1. Lin J T, Lane J M, Hospital for special surgery, 535 East 70th street Newyork, Ny10021, USA, Aug 2004 126 -134.

2. www.emedicine.com/Prevention of Osteoporosis/article em.htm#prevention%20of%20 Osteoporosis introduction.

3. M.Jill.Gronholz, medical director, Bone density of North Idaho, 920 Iron wood, “prevention, diagnosis and management of osteoporosis” – related fracture; A multifactorial osteopathic approach.

4 Potter and Perry, Fundamentals of Nursing, 7th edition, Mosby publications, Page no- 19-20.

5. Murray TM, Division of Endocrinology and Medicine, University of Toronto, “Prevention and management of Osteoporosis, 1996 Oct 155(7), 935-940.

6. Katherine tucker, USDA Human Nutrition Research Center on Aging, Tufts university, 711 Washington Street. Boston.

7. Suzanne C. Smelter and Brinda G Bare, Brunner & Siddhartha’s Text book of Medical Surgical nursing, 10th editions, Lippincott, Williams& Wilkins, 2004. Page no 2058- 2060.

8. J Maheshwar, Essential. Orthopedics, Interprint publication, volume 1, page No- 232 – 234.

9. Center for promotion of clinical investigation, Tokyo Metropolitan Geriatric Hospital on Pharmacotherapy of osteoporosis accompanied by life style related disease.

10. NIH Consensus Development Panel on osteoporosis prevention, diagnosis & therapy, 2001 February 14; 285(6): 785 – 795.

11. www.medindia.net/patient/osteroposis.

12. Taylor Lillis, Lemone Lynne, Fundamentals of Nursing, 6th edition, Lippincott Williams & Wilkins, Page No 20-22.

13. Postmenopausal Osteoporosis in Saudi Women- A Pilot screening. Available from http://eprints.ktupm.edu.sa/8385/- 14k.

18 14. Prevalence and Associated factors of Low bone Mass in health check. Available from http://www.cjmed.net/journal/article/id/227?PHPSESSID=601f903d643ebfc92ded7594ee0a2bb.16k

15. International osteoporosis Foundation (IOF). Available from http://www.iofbonehealth.org/patients-public/about- osteoporosis.html.

16. Barr SI, Chow R, etal on “physical activity as therapy for osteoporosis” 1996, October 155(7), 940-945

17. Dawson L J, Downie F etal, Glasgow Caledonian University, Scottish Center for Evidence Based Care of Older People, Glasgow, Scotland, UK. 2011July 6(7), 180-185.

18. Report meeting held in Funchal, Madeira on “Hormone Replacement Therapy in the post- women’s Health Initiative era, 2003 February 24-25.

19. Cranney A, Horsley T etal, “Effectiveness and Safety of Vitamin D in relation to bone health, 2007 August (158) 1- 235.

20. Michael Grover, DO, Matthew Anderson, MD,etal, Department of Family Medicine, Mayoclinic Arizona, “Increased Osteoporosis Screening rates Associated with the Provision of a Preventive Health Examination, 2006 July (128) 268-275.

21. Nguyen NV, Dinh TA etal, University of Texas, Galveston, TX, USA “Awareness & Knowledge of Osteoporosis in Vietnamese Women, 2009 November (158) 290 -298.

22. Sedlak CA, Doheny MO, Jones SL. “Osteoporosis Prevention in young women”. Orthopedics nurses. 17(3):53-60, May 1998.

23. Chan MF, Kocy day MC. “the effectiveness of an osteoporosis prevention education programme for women in Hongkong a randomized controlled trail .journal of clinical nurse: 14(9):1112-23.

24. Rebeiro V, Blakely JA. “Evaluation of an Osteoporosis workshop for women. Public health nurse. 18(30:186-93.