INTRODUCTION:

‘Coming together is a beginning, keeping together is progress, working together is success’’-

Henry Ford

World health organization defines “health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’’¹.

A healthy person is an asset to the society, unhealthy life style and practices among people will lead to diseases. The most common hazardous and low prognosis disease, which still remains as a cause of concern to medical and common society is cancer. Despite of several measures of public awareness still people are unaware of its complication and its prevention leading to increase in death of individuals.

Cancer is an abnormal disorganized growth in the tissue of a person. Cancer cells keep on multiplying without paying heads to body’s command to stop. This abnormal growth of cells destroys the normal structure and function of the affected tissue and the body in general. Cancer of oral cavity which may occur in any part of the mouth or throat it’s curable if it is discovered at an early stage. Oral cancer may occur on the lips or anywhere within the mouth like tongue, floor of the mouth, buccal mucosa, hard and soft palate, pharyngeal walls and tonsils etc. Cancer is a major public health problem worldwide and a chronic life-threatening disease. It is increasing as a leading killer across the globe especially in the developing world. Presently more than 10 million people globally are diagnosed with oral cancer yearly.

Oral cancer develop due to many factors betel chewing, smoking and alcoholism remains the major risk factor that causes more than 75% of cases of oral cancer. Cigarette smoking is associated with 10 times more greater risk of developing oral cancer. Heavy smoking along with alcohol consumption results in 35 times more chances of developing oral cancer. Pipe smoking causes cancer in the part of the lips that touches the pipe stem. Chewing tobacco or snuff is associated with 50% increases in risk of developing cancer in the cheeks, gums and inner surface of lips. Second hand smoke may also increase a person’s risk of developing oral cancer.²There are about 7, 00,000 new cases of cancers every year in India out of which tobacco related cancer are about 3,00,000. This can be completely prevented by simple changes in life style and regular screening and even have health benefits that reach beyond cancer.

Compared to other cancers, oral cancer is the second most common cancer in men. A survey conducted in Sri Lanka by the national cancer control programme has revealed that 80% of drivers are more vulnerable to oral cancer due to their long journey, waiting for their next turn, to reduce their stress, under the influence of peers.³

Hence this shows that there is a need for health education among drivers to create and increase their level of awareness and knowledge regarding prevention of oral cancer, such awareness and knowledge could lead to better understanding and acceptance of the importance of early detection and treatment of oral cancer, thereby reducing the risk of oral cancer among drivers. As a health professional, the nurse has a major responsibility in providing adequate information about oral cancer and its early detection and prevention.

NEED AND SIGNIFICANCE OF THE STUDY:

India is one of the countries with the highest incidence of oral cancer in the world. Oral cancer ranks number one among men and number three among women in India. It is estimated that among the 400 million individuals aged 15 years and over 47% use tobacco in one form or the other. More than 20 persons around the world live with diagnosis of cancer, and more than half of all cancers occur in the developing countries. Cancer is responsible for about 20% of all death in high income countries and in low income countries due to high or increasing levels of prevailing cancer risk factors. In Indian scenario oral cancer is the most common cancer, 4 in 10 of all cancer are oral cancers. The reason for high prevalence of oral cancer in India is because tobacco is consumed in the form of gutka, quid, snuff or mishiri.⁶

In worldwide 25% of oral cancers are attributable of tobacco usage (smoking or chewing), 7-14% due to alcohol drinking, 10-15% due to micronutrient deficiency ⁽⁵⁾. Annually over 3,00,000 new cases of oral cancer are diagnosed all over the world where the majority are diagnosed in the advanced stage 3 and 4. Such data make the oral cancer an important public It is predicted that by 2020 there will about 15 million new cancer cases and 10 million cancer deaths may occur.^4.Health matter which is responsible for3% to 10% of cancer mortality worldwide.

Considering the above facts, the researcher felt that there is a need to assess the knowledge of drivers regarding early detection and prevention of oral cancer, as drivers were more prone to oral cancer due to stress, while waiting for their next turn, peer pressure etc.

BACK GROUND OF THE STUDY:

Background of the study helps in identifying and screening for information on a topic developing and understanding the state of knowledge on the topic. One of the reason concerns playing in the field of cancer study or oncology is increasing number of men who are being diagnosed with cancer.

A study was conducted by surveillance epidemiology and end result [SEER],in 2007 there will be an estimated 35720men and women (25240 men and 10480 women) diagnosed with oral cancer leading to 7600 deaths from 2002 to 2006 approximately 0.6% were diagnosed under age 20, 2.4% between 20 and 34, 6.8% between 35 and 44, 20.9% between 45 and 54 based on the rates from 2004 to 2006, 1.02% of men and women born today will be diagnosed with oral cancer.It is projected that by 2020there will every year 15 million new cancer cases and 10 million cancer death may occur.⁷

A case control study was conducted among taxi drivers in 2000 to assess smoking, alcohol consumption, dental hygiene and diet in the epidemiology of oral cancer in Tamil Nadu. A total of 300 cases were compared with those of 300 controls. The result confirmed that, cigarette smoking and alcohol consumption impart substantial risk for oral cancer and also poor oral hygiene increases risk for oral cancer.⁸

A co-relational study was conducted in 1996 among rickshaw drivers to estimate the prevalence and co-relation of oral lesions among tobacco smokers, tobacco chewers and alcohol users at Bangalore. A sample of 1028 patients were selected among them 60.2% were unskilled workers which included people with occupation like drivers and cleaners. Interview based questionnaire was used. The study provided information on habit trends in patients and is useful in educating them about deleterious effect of oral tobacco and betel exposure.⁹

STATEMENT OF THE PROBLEM:

A study to assess the knowledge regarding early detection of oral cancer among professional drivers attending Regional transport office Thiruvalla.

OBJECTIVES OF THE STUDY:

1) Assess the level of knowledge regarding early detection of oral cancer among drivers.

2) Find the association between levels of knowledge regarding early detection of oral cancer with selected demographic variable.

HYPOTHESIS:

— H1: There is significant association between pre-test knowledge and selected baseline variables

MATERIALS AND METHODS:

Reserach approach	Quantitative approach
Design	Pre experimental one group pre test
Setting	Regional transport office triuvalla
Population	Drivers attending regional transport office tiruvalla
Sample size	30 drivers
Sampling technique	Non probability convinent sampling

DATA COLLECTION INSTRUMENT:

Tool developed for the study was, a structured questionnaire to assess the knowledge of subjects related to early detection of oral cancer.

The tool contains two sections.

SECTION 1:

Demographic characteristics of subjects

{Age, Sex, Education, Socio -economic status, dietary habits, family history, residence, previous knowledge, attitude of drivers towards oral cancer}

SECTION 2:

Structured questionnaire to assess knowledge regarding early detection of oral cancer.

VALIDITY OF THE TOOL:

Validity of the tool refers to the degree to which the instrument measures what is supposed to measure.

Permission for the tool validation was obtained from the subject experts. The subject experts were requested to judge the items for the relevance, clarity, appropriateness of the title and content. The prepared tools was submitted to five experts [Two Oncologist, two experts from medical surgical nursing , one expert from community health nursing].

As per recommendations given by the subject expert’s modification were made in the structured knowledge questionnaire. The final tool was constructed with the consultation with the guide. The modified tool consists of items in the baseline performa, items in the structured knowledge questionnaire.

RELIABILITYOF THE TOOL:

The reliability of the research tool is defined as the degree of consistency and dependability with which an instrument measures the attribute it is designed to measure. For the present study the researcher calculated the reliability of the tool in the following manner.

DATA COLLECTION PROCESS:

Data collection is the process of gathering the data needed for the research study. The data collection plan specifies when, where and how the data will be collected. Data collection process for main study were done for two weeks in Regional Transport Office, Tiruvalla. The researchers introduced themselves to the sample and maintained good rapport with them. We obtained informed consent from the drivers. The knowledge regarding early detection of oral cancer were assessed using a structured questionnaire. A teaching program was given on the same day. The researchers were able to complete the data collection within the period of two weeks.

ANALYSIS AND INTERVENTION:

Analysis was performed using descriptive and inferential statistics. Frequency and percentage were used to describe baseline variables. Chi square test was used to find the association of pretest score variables .the data collected were analyzed using statistical package for social sciences software (SPSS).

PRESENTING OF DATA:

This chapter deals with the systemic presentation and interpretation of data. The collected data are organized and tabulated. The findings are presented with tables and figures. The details of each sections are presented below to correlate with the objectives.

Section 1: description of baseline data

Section 2: finding related to knowledge of professional drivers regarding early detection of oral cancer

Section 3: description of association between variable and demographic data

Section 1: Description of Basline Variables Of Professional Drivers

Table 1 Description of professional drivers according to their age and education n=30

Sl. No

Variables

Frequency

(f)

Percentage

(%)

Age (in years)

Less than 31

31-43

44-55

More then 55

16.7

46.7

20.0

16.7

Education

Primary Education

Secondary education

14.

46.7

53.3

Income

Below 5000

5000-15000

16000-25000

43.35

50.0

6.5

Dietary Pattern

Vegetarian

Non vegetarian

Both

6.7

3.3

90.0

Family

Yes

13.3

86.6

Residance

Urban

Rural

90.0

Previous knowledge regarding of oral cancer

Yes

36.

63.3

Do you think oral cancer is cureable

Yes

80.8

20.0

Classification of knowledge level of drivers N=30

Knowledge level category

frequency

Percentage

Poor

Average

Good

50.0%

46.7%

3.3%

TOTAL

100%

Section 2: Association of level of knowledge of professional drivers with selected baseline variables n=30

Baseline variables	Chi square value	p value
Age	7.690	0.26
Education	5.128	0.07
Income	4.009	0.40
Diet	1.114	0.89
Family history	1.37	0.84
Residence	0.42	0.80
Previous knowledge	2.60	0.27
Risk factor	1.377	0.50
Cancer is curable or not	1.31	0.52

ANALYSIS AND INTERPRETATION OF STUDY:

Analysis was interpreted under five sections. The analysis showed that education is moderately significant with knowledge; while others like age group, income, diet, family, residence, previous knowledge, risk factors etc. are not significant with knowledge.

RESULTS:

The results based on the objectives and hypothesis which are tested and described under the following sections.

SECTION 1: Description of subject according to demographic variable

SECTION 2: Association between knowledge of oral cancer among drivers.

Section 1: Description of subject according to demographic variable:

Baseline variables of participants with oral cancer where computed using descriptions statistics such as frequency and percentage.

· The majority of sample who participates were in the age group 31 - 43 (46.7%frequency 14), 44-55 (20.0% frequency 6), less than 31 (16.7 % frequency 5), more than 55(16.7% frequency 5)

· Majority of sample had secondary education (53.3% frequency 16). Primary education (46.7% frequency 14).

· Majority of sample have income between5000-15000(50%frequenc15). 43.3% have income below 5000(frequency 13). 6.7% has income between 16000-2500(frequency 2).

· 90%have a dietary pattern of both vegetarian and non-vegetarian(frequency 27).6.7% samples are vegetarian (frequency 2).3.3% are non-vegetarian (frequency 1)

· 83.3% has no family history of oral cancer (frequency 25).16.6 % has family history of oral cancer (frequency 5).

· Majority of sample lives in urban area (90% frequency 27).10% lives in rural area (frequency 3).

· 63.3% has no previous knowledge regarding oral cancer (frequency 19).36.7% has previous knowledge regarding oral cancer (frequency 11).

· 56.7% samples think that drivers are less vulnerable to oral cancer (frequency 17) while 43.3% thinks that drivers are vulnerable to oral cancer (frequency 13)

· 80% samples believe that oral cancer is curable (frequency 24) while 20% believes that oral cancer is not curable (frequency 6).

· 50% samples have poor knowledge regarding oral cancer (frequency 15). 46.7% has average knowledge regarding oral cancer (14). 3.3% has good knowledge regarding oral cancer(frequency 1)

Section 2 Association between knowledge of oral cancers among drivers:

Association between knowledge of oral cancer among drivers and selected base line variables were computed using chi -square test.

NURSING IMPLICATIONS:

The findings of the study have have certain important implications for the nursing profession in the field of Nursing practice, Nursing education, Nursing research and Oncological nursing.

NURSING PRACTICE:

The nurse plays an important role in making awareness people regarding the importance of early detection of oral cancer and its prevention. Health education regarding importance of early detection can make more effective outcome.

· Nurse can provide information to the people regarding the sign and symptoms that appear in the early stages of cancer.

· Nurse can promote practice of oral hygienic measures among people.

· Nurse should emphasize that early screening of oral mucosa for any unusual changes can make a positive outcome.

· Nurse should emphasize regarding the early detection and its preventive aspect about oral cancer.

· Nurse can educate people regarding preventive aspect of oral cancer and methods

· Nurse can reinforce regarding abstinence of alcohol, smoking, and betel chewing and its importance.

NURSING EDUCATION:

This study also emphasis on the improvement in the nursing student’s knowledge regarding importance of early detection of oral cancer.it is essential that students are informed about the importance of early detection of oral cancer so they can make use of this information effectively to the drivers.

· Nursing students can educate drivers and others about the benefits of early detection of oral cancer and importance of oral hygiene.

· Nursing students can educate them about oral hygiene is an essential aspect sof preventing oral cancer.

· Nursing students can encourage people to participate in cancer screening program.

· Nursing students can educate regarding the preventive aspect about oral cancer.

· Nursing students can emphasize regarding the importance of abstinence of smoking, alcoholism, and betel chewing.

NURSING RESEARCH:

The present research study may inspire other researchers for conducting the studies in the same area. Researchers can do studies related to various aspects of the oral care intervention in Indian setting, so that the early detection and prevention of oral cancer practice will be reflected. The nurse researcher can work towards developing a tool, for the early detection of oral cancer.

LIMITATION:

· The limited to 30 samples only.

· Samples were selected from a single Regional Transport Office Thiruvalla.

· The study was limited to 2 weeks.

· Study is limited only to professional drivers.

· The study was limited to knowledge and did not focus on attitude, practices regarding oral hygiene.

RECOMMENDATIONS:

· The study can be conducted in large samples to generalize findings.

· A prospective study can be conducted to assess the practice regarding oral hygiene.

· A comparative study can be conducted between knowledge and practice.

· An experimental study can be conducted with a control and experimental group.

· A similar study can be conducted in different setting.

CONCLUSION:

Oral cancer is now common among drivers. Education of drivers regarding this is a key element in prevention of oral cancer. As drivers play major role in maintaining the health of community, if they are educated, we would reduce incidence of oral cancer.

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Received on 12.01.2021 Modified on 19.02.2021

Int. J. Nur. Edu. and Research. 2021; 9(3):257-261.

DOI: 10.52711/2454-2660.2021.00061