The Present society is complex and ever changing. Growing up emotionally is complicated and difficult in many circumstances, however especially when a child’s behaviour and appearance like a grown up , while a child should feels a cry . All the stages in human life are exposed to challenges and difficulties. One such stage is the early childhood period, which is the magical time of childhood. It is a different exciting and interesting period of life.¹

Children are the blooming buds, who are important asset to the nation. As children grow, they must learn not only to face the current demands but also to prepare for the many unexpected events, they have to accept tomorrow’s changes by bringing new techniques and technology. Children are expected to grow and learn to their fullest potential.

Fundamental learning process develops in the child as the child begins to seek autonomy to explore the world. It learns how things mostly begin to express desires and develop relationships.²

Achieving control of the body function of defecation and urination is one of the major tasks of the toddler period. Relative importance of this achievement depends on the culture and the socioeconomic status of the child family. Toilet control over defecation and urination are two personal phases of toddler learning closely revealed to their sensory and motor control.

Toilet training is often taken for granted because it appears to occur so readily in such a large majority of children. It would be easy to hypothesize some internal mechanism which, if triggered at the right point in time, results in the initiation of a pre-programmed process that terminates with the child being trained. Variations across cultures regarding the age at which children are trained; the parents are encountered in multitude of training procedures used and the variety of problems different during toilet training.²

There are many different ways a child can communicate the need to go ahead, including body language, vocalizations, imploring looks, pointing and eventually sign language and verbalizations. Some babies may give obvious signals for one kind of elimination but not the other. In situations where an infant's signals are not clear, you may need to rely on timing, elimination patterns, body language, intuition or a combination of these.⁴

The correct knowledge and awareness among parents or caregivers is very essential to the development of the child. Sometimes they may have either inadequate or inappropriate knowledge regarding initiation readiness process and hazards of toilet training .It is essential to find proper development in each child and also for the parents to be aware of proper guidelines.

NEED FOR THE STUDY:

Children learn to care for themselves initially by attempting to imitate the actions of their parents and siblings. Achieving control of the bodily functions of defecation and urination is one of the major tasks of the toddler period. The control of bladder and bowel functions involves a complex integration of neuromuscular pathways at the peripheral and central levels.⁴The 50% of the girls and boys are toilet trained at 18 and 30 month respectively.⁵

Toilet training is an essential issue in child education, and its completion represents a developmental milestone. The Western medical community has recommended starting toilet training after 18 months of age. As currently practiced, assisted child toilet training emphasizes child-caregiver communication for the gradual acquisition of bowel and bladder control. Signals emitted by the child lead the caregiver during elimination assistance⁶

Babyhood is often referred to as a ‘critical period’ in the development of personality. This is the time when the foundations were laid upon which the adult personality structure will be built. There are many developmental tasks to be achieved during this period. Among them toilet training is the most important task to be attained by each child.⁷

Above literature in day to day life of observation and through professional interest to promote health child development the researcher felt the need to explore this area and thus it is necessary to assess the level of knowledge and practice of mothers regarding the toilet tainting. The investigator aim to assess the need for education of mothers regarding toilet tainting.

STATEMENT OF THE PROBLEM:

A Descriptive study to assess the knowledge and practice regarding toilet training among the mothers of early childhood (17 to 30 months) children in selected rural area at Tumkur district. Karnatakka.

OBJECTIVES:

1. To assess the level of knowledge regarding toilet training among mothers of early childhood children.

2. To assess the practice regarding toilet training among mothers of early childhood children.

3. To correlate the scores of level of knowledge and practice regarding toilet training among mothers of early childhood children.

4. To find an association between the level of knowledge with their selected socio-demographic variables.

5. To find an association between the practice with their selected socio-demographic variables.

RESEARCH APPROACH:

The selection of research approach is the basic procedure for the conduction of research enquiry. In this study descriptive approach was adopted to assess the knowledge and the practice regarding toilet training among the mothers of early childhood (17 to 30 months) children.

RESEARCH DESIGN:

The descriptive correlation design was considered as the appropriate design for this study.

Variables:

Variables are qualities, properties or characteristics of persons, things or situation that change or vary.

1. Dependent variable: Knowledge and Practice regarding toilet training among the mothers of early childhood (17 to 30 months) children are the dependent variables.

2. Independent variable Age, religion, type of family, educational status, occupation, number of children and monthly family income are the independent variables.

Setting of the Study:

The study was conducted in Hebbur village, Tumkur, which is situated 15 km away from the Shree Siddaganga mutt, Tumkur. This setting is feasible due to geographical proximity and availability of sufficient sample ie. 100 mothers.

Population:

In this present study, the population includes mothers of early childhood (17to30months) children.

Sample:

A sample consists of the sub set of a population set of a population selected to participate in a research study. The sample includes mothers of early childhood (17to30) children in Hebbur village, Tumkur. Karnataka. Rural area those where available at the time of data collection.

Sample Size:

A sample is a small portion of the population selected for observation and analysis. The sample size for the present study comprised of 100 mothers early childhood (17 to 30 months) children.

Sampling Technique:

Random sample technique was used to select the sample for this study. Random sampling is based on the belief that researchers knowledge about the population can be used to handpick the cases to be included in the sample.

Sampling Criteria:

Inclusion criteria

1. Mothers who are having children between age group of 17 to 30 months.

2. Mothers of early childhood children who are willing to participate in the study.

3. Mothers of early childhood children who are available at the time of data collection.

Exclusion criteria

1. Early childhood children who are suffering from infection of bowel & bladder.

2. Mothers who cannot understand Kannada language.

Selection and Development of Tool:

Tool was prepared on the basis of objectives of the study. A Questionnaire to assess the level of knowledge regarding toilet training and a self reported checklist to assess the practice regarding toilet training.

Description of the Tool:

In this study a structured questionnaire was prepared to assess the knowledge and self reported checklist to assess the practice regarding toilet training among the mothers of early childhood (17 to 30 months) children.

The tool consists of three sections

Section-I: Socio - demographic data- Consists 09 Items.

Section-II: Structured questionnaire to assess the knowledge regarding toilet training comprised 20 Items.

Section-III: A self reported checklist to assess practice comprised 21 items.

Section- I: Socio - Demographic data

The socio-demographic characteristics include the personal characteristics of mothers of early childhood children. The characteristics included: age, religion, educational status mother, occupation mother, number of children, and type of family, monthly family income, lavatory facilities and source of previous exposure of information on toilet training mothers of early childhood children.

Section- II: Structured questionnaire to assess the knowledge

The Related literature was reviewed for the construction of the structured questionnaire to the asses the knowledge on toilet training.

It consisted of 20 items under 3 sections

Sub section –A Consists, items related to general information toilet training

Sub section –B Consists, items related to procedure of toilet training

Sub section –C Consists, physical and emotional changes during toilet training

Scoring procedure:

All the items were multiple choice questionnaires which had four alternative responses. A score value of (1) was allotted to each correct response. The total knowledge score was 20 an arbitrary classification of knowledge score was done, which was classified as follows:

Level of knowledge	Percentage	Scores
Adequate	>75	16-20
Moderately adequate	50 to 75	11-15
Inadequate	< 50	0-10

Section –III: Checklist to assess the knowledge on practice regarding toilet training

Scoring procedure:

A self reported checklist to regarding practice of toilet training consisted of 21 yes or no statement. A score value of (1) was allotted to each correct response. The total practice score was 21 an arbitrary classification of practice score was done, which was classified as follows:

Level of practice	Percentage	Scores
Good practice	>75	16-21
Better practice	50 to 75	11-15
Poor practice	< 50	0-10

Development of Criteria Checklist:

The criteria rating scale was prepared to assess the relevancy, accuracy and appropriateness of the items included in the socio-demographic data, structured questionnaire to assess the knowledge and checklist to assess the practice.

Data Collection Procedure:

The written permission was obtained from the authorities concerned, the Medical superintendent of health centre Hebbur village, and prior to the data collection. It was conducted in Hebbur village among 100 mothers. The period of data collection was from 03/01/12 to 03/02/12. The purpose of the study was explained to them and informed consent was obtained from the respondents. The socio demographic variables, questionnaire to assess the knowledge and a self reported checklist to assess the practice regarding toilet training was administered to mothers having early childhood children. The data collection process was terminated by thanking the respondent for their patience and cooperation.

Plan for Data Analysis:

Data analysis is the systematic organization of research data and the testing of research hypothesis using that data. The data obtained would be analyzed by both descriptive and inferential statistics. The descriptive statistics would be used to describe the sample characteristic in terms of frequency and percentage. The plan of data analysis was as follows:

Ø Organization of data in master sheet and then in computer.

Ø Socio-demographic data would be analyzed in terms of frequency and percentage.

Ø The level of knowledge and practice of mothers of early childhood children regarding toilet training would be analyzed using frequency, percentage, mean, standard deviation and mean percentage.

Ø Chi square test would be used to find out the association between knowledge score and practice score of mother with selected socio- demographic variables.

Ø Correlation coefficient would be used to correlate the knowledge score and practice score regarding toilet training among the mothers of early childhood (17 to 30 months) children.

Ethical Consideration:

1. Permission for the study was obtained from the principal, Shree Siddaganga Institute of Nursing Sciences and Research Centre Tumkur and Medical officer of the PHC of Hebbur village for conducting the study.

2. An informed consent was also obtained from the respondents after proper explanation about the purpose, usefulness of the study and assurance given about the confidentiality of their responses.

RESULTS:

Major Findings Of The Study

· Majority 76% mothers of early childhood children belong to the age group of 15-25 years.

· Majority of the respondents 64% were belonged to Hindu religion.

· Majority of the mothers of early childhood (17 to 30 months) children, 50% had higher secondary education.

· Majority 49% mothers of early childhood (17 to 30 months) children were housewives.

· Majority of the mothers of early childhood (17 to 30 months) children, 54% had one children.

· Majority of the mothers of early childhood (17 to 30 months) children, 55% respondents belong to nuclear family.

· The majority of the mothers of early childhood (17 to 30 months) children, 53% Rs2501 to Rs 3500.

· Majority of the mothers of early childhood (17 to 30 months) children, 53% had received the information from prior practice.

· The majority of the mothers of early childhood (17 to 30 months) children, 58% were using own latrine.

The statistical analysis showed that out of 100 mothers of early childhood (17 to 30 months) children, 17% had adequate knowledge, 68% had moderately adequate knowledge and only 15% had inadequate knowledge regarding toilet training of early childhood.

The mean percentage level of knowledge of mothers of early childhood (17 to 30 months) children regarding toilet training was 59.5% and the mean was 11.9 with standard deviation of 2.3.

The statistical analysis showed that out of 100 mothers of early childhood (17 to 30 months) children26% had better practice, 63% had good practice and 11% of them had poor practice regarding toilets training among mothers of early childhood children.

· The mean percentage level of practices of mothers of early childhood (17 to 30 months) children regarding toilet training was 65.71%, the mean was 13.8 with standard deviation of 2.9.

· The correlation coefficient between level of knowledge and practice of mothers of early childhood (17 to 30 months) children regarding toilet training. The correlation coefficient obtained was r=0.62. This value indicates that there was a positive correlation between level of knowledge and practice of mothers of early childhood (17 to 30 months) regarding toilet training.

· The obtained chi-square value shows that there was a significant association between level of knowledge with education of mother (χ ² = 6.41, df=2, p<0.05), but it didn’t show any significant association between knowledge with their other socio-demographic variables of mothers of early childhood children.

· The obtained chi-square value shows that there was a significant association the practice with number of children (χ ² = 6.99, df=2, p<0.05), but it didn’t show any significant association between practice with their other demographic variables of mothers of early childhood children.

The overall experience of conducting this study was satisfying one. The direction from the guide and various experts and by the cooperation from the subjects helped in successful completion of the study.

It also simulated to contribute for my profession and society especially the dependent group like children in further development.

LIMITATION OF THE STUDY:

v This study is limited to 100 samples.

v This study is limited to only mothers of early childhood children.

v This study is limited to selected rural community at Tumkur.

ASSUMPTIONS:

1. Mothers of early childhood children will have limited knowledge regarding toilet training.

2. Mothers of early childhood children may not be practicing proper way of toilet training.

3. Knowledge and practice of mothers of early childhood children may vary according to the socio- demographic variables.

HYPOTHESIS:

All the hypotheses will be tested at the 0.05 level of significance.

H₁: There will be significant correlation between the level of knowledge and the practice of mothers of early childhood (17 to 30 months) regarding toilet training.

H₂: There will be significant association between the levels of knowledge with their selected socio-demographic variables of mothers of early childhood (17 to 30 months).

H₃: There will be significant association between the practices with thier selected socio-demographic variables of mothers of early childhood (17 to 30 months).

CONCLUSION:

· The statistical analysis showed that out of 100 mothers of early childhood (17 to 30 months) children, 17% had adequate knowledge, 68% had moderately adequate knowledge and only 15% had inadequate knowledge regarding toilet training of early childhood children.

· The mean percentage level of knowledge mothers of early childhood (17 to 30 months) children regarding toilet training was 59.5% and the mean was 11.9 with standard deviation of 2.3.

· The statistical analysis showed that out of 100 mothers of early childhood (17 to 30 months) children, 26% had better practices, 63% had good practice and 11% of them had good practice regarding toilets training among mothers of early childhood children.

· The main percentage level of practice of mothers of early childhood(17 to 30 months)children regarding toilet training was 65.71%, the mean was 11.9 with standard deviation of 2.9.

· The correlation coefficient between level of knowledge and practices of mothers of early childhood (17 to 30 months) children regarding toilet training. The correlation coefficient obtained was r=0.62. This value indicates that there was a positive correlation between level of knowledge and practice of mothers of early childhood (17 to 30 months)children regarding toilet training.

· The obtained chi-square value shows that there was a significant association between the education of mother (χ ² = 6.41, df=2, p<0.05), but it didn’t show any significant association with other demographic variables of mothers of early childhood children.

· The obtained chi-square value shows that there was statistical significant association between the practice with number of children ( χ ² = 6.99, df=2, p<0.05),but it did not show any significant with other socio-demographic variables of mothers of early childhood children.

RECOMMENDATIONS:

v A comparative study can be carried out to find out the knowledge and practice of mothers on toilet training in urban and rural areas

v Knowledge of health worker can be studied, as they are responsible at PHC.

v Level study can be conducted for the fathers separately as they are also responsible for the childcare as per the present trend.

v Mass media and health education programmers should be arranged to educate mothers regarding toilet training at appropriate and in a proper way for better child development.

BIBLIOGRAPHY:

1. Marilyn J. Hockenberry. Essentials of Pediatric Nursing. 17th edition. New Delhi: Elsevier Publication; 2005,965-969.

2. Potts and Mandleco. Pediatric Nursing Caring for Children and the Families.10th edition. U.S: Library of congress catalogue in publication data; 2002,784-786.

3. www. google. com. Danna Henderson. “Potty Training”. Parenting University.

4. Marlow R. Dorothy and Barbara. Textbook of Pediatric Nursing. 17th edition. New Delhi: Elsevier Publication; 2005,1045-1047.

5. Schumb, Kolb and Mc. Auliffe. “Sequential Acquisition of Toilet Training Skills”. A descriptive study. Journal of Pediatrics. 3rd March 2002; Vol. (109).No.3. Pp. 48

6. http://www.myparentime.com/articles/articleS65.shtml infant potty training, article by Laurie Boucke 12/05/2010 (cited on 02^nd Dec 2010)

7. Hurlock. E. B. Developmental Psychology. 3rd edition. New Delhi: Mc. Grow Hill Publishing Company; 1992

Received on 11.02.2014 Modified on 25.05.2014

Int. J. Nur. Edu. and Research 2(2): April- June 2014; Page 180-185