Johnsy Rani, T (2017) Effectiveness of Structured Teaching Programme with Amla Supplement Vs Structured Teaching Programme alone upon Anaemia in Pregnant Women at selected communities of Kanyakumari. Doctoral thesis, The Tamilnadu Dr. M.G.R. Medical University, Chennai.
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Abstract
A comparative study to assess the effectiveness of structured teaching programme with amla supplement vs structured teaching programme alone upon anaemia in pregnant women was conducted at selected communities of Kanyakumari was conducted in partial fulfillment of the requirements for the award Doctor of Philosophy in Nursing by The Tamil Nadu Dr. M.G.R. Medical University, Chennai. OBJECTIVES: 1. To assess the haemoglobin levels among group I (structured teaching programme with amla supplement) and group II (structured teaching programme alone) pregnant women. 2. To assess the knowledge level on anaemia among group I and group II pregnant women. 3. To assess the signs and symptoms of anaemia among group I and group II pregnant women. 4. To compare the effectiveness of structured teaching programme with amla supplement (group I) vs structured teaching programme alone (group II) on haemoglobin level among pregnant women. 5. To compare the effectiveness of structured teaching programme on knowledge regarding anaemia among group I and group II pregnant women. 6. To compare the pretest and posttest signs and symptoms of anaemia among group I and group II pregnant women. 7. To correlate the pretest and posttest haemoglobin level among group I and group II pregnant women. 8. To correlate the pretest and posttest knowledge level among group I and group II pregnant women. 9. To correlate the pretest and posttest signs and symptoms among group I and group II pregnant women. 10. To correlate the pretest and posttest haemoglobin level, knowledge level and signs and symptoms among group I and group II pregnant women. 11. To assess posttest levels of satisfaction of intervention among group I and group II pregnant women. 12. To find out the relationship between the pretest levels of haemoglobin and their selected background variables among group I and group II pregnant women. 13. To find out the relationship between the posttest levels of haemoglobin and their selected background variables among group I and group II pregnant women. The conceptual framework of the study was developed based on Wiedenbach’s theory of helping art of clinical nursing. The major study variable in the study was anaemia in pregnant women in terms of their haemoglobin level, knowledge level and signs and symptoms before and after implementation of amla supplement and structured teaching programme. Amla supplement was provided for 90 days. Amla contains highest content of vitamin C, which is the major enhancer of iron absorption. Structured teaching programme is provided for about 20 minutes using PowerPoint in laptop. Hypotheses were formulated and P values less than or equal to 0.05 (P≤0.05) were treated as statistically significant. The data were collected from 240 pregnant women. 8 areas were selected and 4 areas each were allotted for group I and group II through random sampling technique. Then the pregnant women from the respective areas were selected by non probability purposive sampling technique depending upon the availability until the planned sample size was achieved. Background variables, haemoglobin levels, knowledge levels, signs and symptoms of anaemia and level of satisfaction were assessed. Then the pregnant women in group I and II were provided with structured teaching programme. Amla supplement was provided in a jar (containing 30 amlas with 450 ml of honey) for the pregnant women in group I alone. Two post tests were conducted, i.e., on 61st and 91st day. On both these days, haemoglobin level, knowledge level and signs and symptoms were assessed. The level of satisfaction of intervention, amla supplement and structured teaching programme were checked once on 91st day. The tools used for data collection were demographic variable proforma, obstetric variable proforma, physiologic variable proforma, Sahli’s haemoglobinometer scale, Structured questionnaire, Checklist and Rating scale. Validity was established with the guide and 10 experts. Sahli’s haemoglobinometer was checked for reliability and stability by inter rater method. The reliability of structured questionnaire to assess the knowledge, check list to assess the signs and symptoms and rating scale to assess the satisfaction of intervention were tested for stability and internal consistency. Pilot study was conducted on 24 pregnant women. The data collected were analyzed according to the objectives and hypotheses of the study. The statistical procedures have been performed with the help of statistical package namely IBM SPSS (Statistical Package for Social Sciences) Statistics-20. DEMOGRAPHIC VARIABLES OF THE PREGNANT WOMEN: Majority of the pregnant women in group I and group II were in the age group of 24 - 29 years (57.5% & 60%), Christians (71.7% & 80%), homemakers (59.2% & 44.2%), living in rural area (100% each) and non vegetarians (88.3% & 86.7%). Majority of pregnant women in group I have studied up to high school (31.7%), monthly income of 3000-5000 rupees (51.7%) and was living in joint families (53.3%) whereas majority of pregnant women in group II have no formal education (34.2%), monthly income of 5001-10000 rupees (46.7%) and been living in nuclear families (56.7%). OBSTETRIC VARIABLES OF THE PREGNANT WOMEN: Majority of the pregnant women in both groups were married at the age of 24 - 29 years (57.5% & 60%) and had their first pregnancy also at the same age group. Majority of them were primigravidas and thus nulliparas and do not have any children and hence birth spacing is not applicable for them. Only a significant number of pregnant women in both groups had abortions (96.7% each). Among them, none of them had more than one abortion and they all had abortions due to obstetric cause. All of them in both groups have regular antenatal checkups, regular immunization status and received information regarding anaemia through health professionals. None of them in both groups had history of anaemia in their family or during their previous pregnancy and complications during their previous pregnancy or delivery. PHYSIOLOGIC VARIABLES OF THE PREGNANT WOMEN: In height, majority of the group I and group II pregnant women were of height 162-172 cms (77.5% & 86.67%). Majority of them in group I and II were of weight 61-70 kgs (40% & 56.7%) and have weight gain of 5-7 kgs during pregnancy (57.5% & 56.6%). Majority of them have haemoglobin levels of 7-8 gm/dl (57.5% & 58.3%) in both groups. HAEMOGLOBIN LEVELS OF THE PREGNANT WOMEN: In group I, the haemoglobin levels of majority (57.5%) of the pregnant women were 7-8 gm/dl and none of them were more than 10 gm/dl in pretest. In post test 1, the haemoglobin levels of majority (82.5%) of them progressed to 8.1-9 gm/dl, a significant number (5.8%) of them improved to more than 10 gm/dl and none of them were found to be in 7-8 gm/dl. Whereas in post test 2, this number increased further. In group II, the haemoglobin levels of majority (58.3%) of the pregnant women were 7-8 gm/dl and none of them was more than 10 gm/dl in pretest. In post test 1, the haemoglobin levels of majority (78.3%) of them progressed to 8.1-9 gm/dl, a significant number (9.2%) of them improved to more than 10 gm/dl and only one (0.8%) was found to be in 7-8 gm/dl. Whereas in post test 2, this number improved further and there was none of them seen in 7-8 gm/dl haemoglobin level. In group I, the mean haemoglobin level improvement from pretest to post test 1 was 0.4 mg/dl (8-8.4), from post test 1 to post test 2 was 0.6 gm/dl (8.4 - 9) and totally from pretest to post test was 1 gm/dl (8-9). The “t” values are also high and these improvements were statistically very highly significant (P<0.001). Thus the formulated null hypothesis, Ho1: There is no significant difference between the pretest and post test haemoglobin levels among group I pregnant women was rejected. Thus there is an improvement of haemoglobin among group I pregnant women after intervention. Similarly, in group II, the mean haemoglobin level improvement from pretest to post test 1 was 0.4 mg/dl (8-1-8.5), from post test 1 to post test 2 was 0.3 gm/dl (8.5-8.8) and totally from pretest to post test was 0.7 gm/dl (8.1-8.8). The “t’ values are also high and these improvements were statistically very highly significant (P<0.001). So the formulated null hypothesis, Ho2: There is no significant difference between the pretest and post test haemoglobin level among group II pregnant women was rejected. Thus there is an improvement of haemoglobin among group II pregnant women after intervention. Between the two groups, the improvement from pretest to post test 1 was not statistically significant (P>0.05). The trends of improvement from post test 1 to post test 2 of the two groups were 0.6 and 0.3 gm/dl respectively. The difference between the two groups (0.3 gm/dl) was statistically very highly significant (P<0.001). Similarly, the trends of improvements from pretest to post test 2 of the two groups were 1.0 and 0.7 gm/dl respectively. The difference between these means is also statistically very highly significant (P<0.001). This shows that structured teaching programme with amla supplement was more effective than structured teaching programme alone. Thus the null hypothesis Ho3: There is no significant difference between the pretest and post test haemoglobin level among group I and group II pregnant women was rejected. The effectiveness of amla supplement in improving haemoglobin level was confirmed by the statistical model namely Repeated Measures of ANOVA. At pretest, there was a difference between the groups and the same was not statistically significant (P>0.05). At post test 1 to post test 2, group I over crossed the improvement of group II. The over crossing was attributed to the effectiveness of amla supplement. At post test 2, the difference was statistically very highly significant (P<0.001). Thus structured teaching programme with amla supplement was more effective than structured teaching programme alone. Hence it became evident that group I is more effective than group II. KNOWLEDGE LEVELS OF THE PREGNANT WOMEN: Majority of the pregnant women in both groups (55.8% & 57.5%) have inadequate knowledge and none of them had adequate knowledge. In post test 1, majority of the pregnant women in both groups (79.2% & 70%) developed moderate knowledge which further improved in post test 2 and cent percent of them gained adequate knowledge level in both groups. In group I, the mean knowledge level improvement from pretest to post test 1 was 5.6 (10.4-16), from post test 1 to post test 2 was 4.7 (16-20.7) and totally from pretest to post test was 10.3 (10.4-20.7). The “t” values shows that these improvements were statistically very highly significant (P<0.001). Thus it is revealed that structured teaching programme has an improvement in knowledge level in group I. So the null hypothesis, Ho4: There is no significant difference between the pretest and post test knowledge level among group I pregnant women was rejected. In group II, the mean knowledge level improvement from pretest to post test 1 was 5.1 (10.5-15.7), from post test 1 to post test 2 was 2.6 (15.7-18.2) and totally from pretest to post test was 7.7 (10.5-18.2). The “t” values also shows that these improvements were statistically very highly significant (P<0.001). It is revealed that structured teaching programme has an improvement in knowledge level in group II also. The difference of mean improvement from pretest to post test 1 was not statistically significant (P>0.05). But the difference of mean improvement from post test 1 to post test 2 and pretest to post test 2 were statistically significant (P<0.01). Consequently the hypothesis, Ho5: There is no significant difference between the pretest and post test knowledge level among group II pregnant women was rejected. Between the groups, the improvement from pretest to post test 1 was not statisticallysignificant (P>0.05). But the other two, post test 1 to post test 2 and pretest to post test 2 mean improvements were statistically significant (P<0.001). Thus it is found that improvement in knowledge level is high in group I than group II. As a result, the hypothesis, Ho6: There is no significant difference between the pretest and post test knowledge level among group I and group II pregnant women was rejected. The trends of improvement of knowledge level between group I and II were confirmed by Repeated Measures of ANOVA which shows that the knowledge at pretest of both groups was more or less equal. The trend of knowledge increase was taken from the post test 1 to post test 2 for both groups. At the post test 2, the improvements of knowledge between the groups were statistically very highly significant (P>0.001). SIGNS AND SYMPTOMS OF THE PREGNANT WOMEN: In both groups, majority (90.8% & 87.5%) of pregnant women had moderate signs and symptoms in pretest while in post test 1, majority (85.8% & 79.2%) of their signs and symptoms reduced and had mild signs and symptoms only. Whereas in post test 2, cent percent of group I pregnant women had mild signs and symptoms and majority of group II pregnant women (90%) had mild signs and symptoms. In group I, the mean signs and symptoms of the pregnant women in pretest and post tests were 12.3 and 7.4 respectively. Similarly, the signs and symptoms from post test 1 to post test 2 and pretest to post test 2 were also reduced. The above decrements within the groups were statistically very highly significant (P<0.001). Thus the null hypothesis, Ho7: There is no significant difference between the pretest and post test signs and symptoms among group I pregnant women was rejected. In group II, the mean signs and symptoms in pretest, post test 1 and post test 2 were 12.2, 7.7 and 5.2 respectively. The difference between them was statistically very highly significant (P<0.001). So the group II pregnant women also have the similar effect as that of group I pregnant women. Thus the null hypothesis, Ho8: There is no significant difference between the pretest and post test signs and symptoms among group II pregnant women was rejected. The reduction of signs and symptoms compared between the two groups were also statistically significant (P<0.01). Accordingly, the null hypothesis Ho9: There is no significant difference between the pretest and post test signs and symptoms among group I and group II pregnant women was rejected. The trends of reduction were confirmed by Repeated Measures of ANOVA and at pretests, it did not differ significantly. In the initial stage, the means were not statistically different. But at the later stages, the means of the reduction were statistically significantly different (P<0.01). The reduction of signs and symptoms was attributed to the effectiveness of amla supplement. SATISFACTION LEVELS OF INTERVENTION OF THE PREGNANT WOMEN: The level of satisfaction was assessed among group I and II pregnant women in post test 2. All of them had adequate satisfaction which had a score from 37-48. CORRELATION BETWEEN HAEMOGLOBIN LEVEL, KNOWLEDGE LEVEL AND SIGNS AND SYMPTOMS OF PREGNANT WOMEN: There is a strong positive correlation between pretest and post test 1, post test 1 and post test 2 and pretest and post test 2 of haemoglobin levels in group I and group II pregnant women. Thus the null hypothesis, Ho10: There is no significant correlation between the pretest and post test haemoglobin level of group I and group II pregnant women was rejected. There is a strong positive correlation between pretest and post test 1, post test 1 and post test 2 and pretest and post test 2 knowledge levels in group I and group II pregnant women. Thus the null hypothesis, Ho11: There is no significant correlation between the pretest and post test knowledge level among group I and group II pregnant women was rejected. There is a strong positive correlation between pretest and post test 1, post test 1 and post test 2 and pretest and post test 2 signs and symptoms in group I and group II pregnant women. Thus the null hypothesis Ho12: There is no significant correlation between the pretest and post test signs and symptoms among group I and group II pregnant women was rejected. In pretest, there is a weak positive correlation between haemoglobin level and knowledge level in group I and group II pregnant women, strong negative correlation between haemoglobin level and signs and symptoms in group I and group II pregnant women and weak positive correlation between knowledge level and signs and symptoms in group I pregnant women while weak negative correlation between knowledge level and signs and symptoms in group II pregnant women. Thus the null hypothesis, Ho13: There is no significant correlation between the pretest haemoglobin level, knowledge level and signs and symptoms among group I and group II pregnant women was rejected for correlation between haemoglobin level and knowledge level and retained for haemoglobin level and signs and symptoms and knowledge level and signs and symptoms. In posttest, between haemoglobin level and knowledge level, there exists a weak negative correlation and weak positive correlation among group I and group II pregnant women respectively, strong negative correlation between haemoglobin level and signs and symptoms among group I and group II pregnant women and weak positive correlation between knowledge level and signs and symptoms among group I and group II pregnant women. Thus the null hypothesis, Ho14: There is no significant correlation between the posttest haemoglobin level, knowledge level and signs and symptoms among group I and group II pregnant women was rejected for correlation between haemoglobin level and knowledge level and retained for haemoglobin level and signs and symptoms and knowledge level and signs and symptoms. RELATIONSHIP BETWEEN THE PRE TEST LEVELS OF HAEMOGLOBIN AMONG PREGNANT WOMEN AND THEIR SELECTED VARIABLES: In group I, variables such as age, age at marriage, age at first pregnancy, birth space, height, weight, weight gain during pregnancy, gravidity, parity, number of living children and abortions were positively correlated and determined the haemoglobin level as 7.1, 3.3, 3.3, 10.4, 5.2, 16.1, 9.4, 6.2, 1.7, 1.7 and 8 percentages respectively. Similarly, in group II, the same variables were positively correlated and determined the haemoglobin level as 15.5, 9.7, 9.7, 13.2, 12.5, 32.3, 8.9, 12.7, 6.8, 6.8 and 6.8 percentages respectively. The percentages of determinations between the two groups in respect of birth space, weight gain during pregnancy, gravidity and abortions were not statistically significant (P>0.05). All other variables’ determinations were statistically significant (P<0.05). In group I and group II, religion, education, dietary pattern and anaemia during previous pregnancy associate with the pretest haemoglobin level (P<0.001). In respect of religion, among the Christians 80.2% and 19.8% were of ≤ Median and >Median level of haemoglobin respectively. But others, all 100% were of >Median level of haemoglobin. In respect of education, in below middle class, 30.8% of pregnant women had ≤ Median and 69.2% had >Median level of anaemia respectively and vice versa in middle school and above educated pregnant women. Consequently the formulated null hypothesis, Ho15: There is no significant relationship between the pretest haemoglobin levels and their selected background variables was retained for birth space, weight gain during pregnancy, gravidity, abortions, occupation, family monthly income and type of family while rejected for all other variables. RELATIONSHIP BETWEEN THE POST TEST LEVELS OF HAEMOGLOBIN AMONG PREGNANT WOMEN AND THEIR SELECTED VARIABLES: In group I pregnant women, variables such as age, age at marriage, age at first pregnancy, birth space, height, weight, weight gain during pregnancy, gravidity, parity, number of living children and abortions were negatively correlated and determined the haemoglobin level as 0.1, 1.5, 1.5, 4.0, 0.4, 10.7, 9.4, 14.3, 7.4, 7.4 and 7.7 percentages respectively. Similarly, in group II, the same variables were positively correlated and determined the haemoglobin level as 15.4, 10.4, 10.4, 12.3, 13.0, 0.4, 13.5, 13.9, 7.9, 7.9 and 7.9 percentages respectively. The difference of percentages of determinations between the two groups in respect of gravidity and abortions were not statistically significant (P>0.05). In group I and group II pregnant women, religion, education, dietary pattern and anaemia during previous pregnancy associate with the posttest haemoglobin level (P<0.001). Hence the formulated null hypothesis, Ho16: There is no significant relationship between the posttest haemoglobin levels and their selected background variables was retained for weight, gravidity, parity, number of living children, abortions, occupation, family monthly income and type of family, while rejected for all other variables. Thus the results of the study projected well the level of haemoglobin, knowledge and signs and symptoms in pregnant women and the effectiveness of amla supplement in terms of increasing the haemoglobin and knowledge levels and reducing their signs and symptoms with clearly emerged implications for practice. RECOMMENDATIONS: It is believed that improving women’s overall nutrition status and their access to resources will have the greatest impact on reducing anaemia in India. Therefore, some special programmes are essential to combat anaemic condition. Public health education/information on reproductive health, monitoring the compliance of women with ante-natal care services, and strengthening of their health care seeking behaviour are important health care measures to be undertaken at the community level. Also, it is time for realization that health system should focus on various factors that contribute to the occurrence of anaemia and include them as an important indicator in the national health care policy. CONCLUSION: Anaemia is a major public health problem particularly in the developing countries. Nutritional iron deficiency is still common in developing countries, where monotonous plant-based diets provide low amounts of bioavailable iron. The National Nutritional Anaemia Control Programme in India was launched with the aims of significantly decreasing the prevalence and incidence of anaemia in women in the reproductive age group. However, it still continues to remain a chief community health dilemma.
| Item Type: | Thesis (Doctoral) |
|---|---|
| Uncontrolled Keywords: | Effectiveness, Structured Teaching Programme, Amla Supplement Vs Structured Teaching Programme alone upon Anaemia, Pregnant Women, selected communities, Kanyakumari. |
| Subjects: | NURSING > Community Health Nursing |
| Depositing User: | Subramani R |
| Date Deposited: | 23 Jan 2022 04:48 |
| Last Modified: | 23 Jan 2022 05:12 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19059 |
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