INTRODUCTION:

Health is the level of functional or metabolic efficiency of a living being. Health is deeply related to lifestyle. Today increasing emphasis is placed on health, health promotion, wellness and self care. Millions of workers spend majority of the working day on their feet and many hours in static positions. Standing uses 20% more energy than sitting and because human bodies are not designed to stand continuously at work, prolonged standing, can lead to tiredness, loss of concentration and increased health risks.¹

At present scenario one of the most important condition that results due to prolonged standing is varicose veins. Severe varicose veins can have an impact on the lives of the people who work on their feet especially the teachers, nursing staffs, flight attendants, dental staff, traffic and bar workers, postal workers, construction workers and bank staff.²The teachers are the main pillars of a sound and progressive society.

The term “varicose” is derived from Latin “varix” (pleural varices) meaning bent. Varicose veins, or varicosities, are dilated, tortuous subcutaneous veins most frequently found in the saphenous system. They may be small and innocuous or large and bulging.³

A twelve year prospective study was conducted to assess the risk of hospitalization due to varicose veins in the lower extremities, prospectively in workers standing or walking at least 75% of their time at work. A representative random sample of 9653 working age adults was drawn from the Central Population Register of Denmark in 1991. Of these, 8664 accepted to be interviewed by telephone (response rate 90%). Respondents (2939 men and 2708 women) were 20–59 years old and employed in 1990. During 12 year follow up, 40 hospitalizations due to varicose veins were observed among men and 71 among women. For employees with jobs that require prolonged standing or walking compared to all other employees, the relative risk was 1.75 (95% Confidence Interval 0.92 to 3.34) for men and 1.82 (95% CI 1.12 to 2.95) for women. The pooled estimate of the relative risk was 1.78 (95% CI 1.19 to 2.68). The etiological fraction of prolonged standing or walking at work was estimated as 22.5% for men and 22.6% for women. This prospective study confirms that prolonged standing at work constitutes an excess risk of varicose veins and that it accounts for more than one fifth of all cases of working age.⁴

A cohort study was done to assess the prevalence and extent of treatment of varicose veins in a Finnish population by using mailed questionnaires. In 1989 a questionnaire was mailed to every resident born in 1929, 1939 and 1949 living in Tampere, a second largest town in Finland. The population comprised of 3284 men and 3590 women. The result found was the life time prevalence of varicose veins which was 18% for men and 32% for women. 25% of men and 41% of women who reported varicose vein had received treatment. Thus the researcher concluded that prevalence of varicose veins was high in the population studied and that preventive measures were required because treatment alone seems to be inadequate in control of varicose veins.⁵

MATERIAL AND METHODS:

Research approach

An evaluative approach was used by the investigator for the study to test the effectiveness of Self-instructional Module (SIM) prepared for the teachers.

Research Design

The research design selected was Pre- experimental (one group pre-test posttest) design was adopted for the study for measuring the effectiveness of a SIM on prevention and management of varicose veins.

Variables under study

Independent variable was the self instructional module (SIM) on prevention and management of varicose veins.

The dependent variable was the knowledge of the teachers regarding prevention and management of varicose veins.

Extraneous variables were age, gender, educational qualification, marital status, years of experience, number of classes per day, the positions teacher adopted while taking classes and source of information.

Setting of the study

The study was conducted in selected primary and high schools of Udupi district.

Population

The population in this study consisted of teachers of primary and high schools of Udupi district.

Sample

In this study the sample consisted of 60 primary and high school teachers.

Sampling technique

Purposive sampling technique was used to select 60 teachers as the sample for the present study from the selected schools of Udupi district.

Data collection instrument

Structured knowledge questionnaire was prepared on prevention and management of varicose veins.

It consisted of:

Part-1-Baseline characteristics

Part-II- Structured knowledge questionnaire on prevention and management of varicose veins.

RESULTS:

Effectiveness of self instructional module (SIM) regarding prevention and management of varicose veins.

Table 1: Distribution of teachers according to the grading of pre- test and post test knowledge score. n = 60

Score		Pre- test		Post-test
Score	Grade	Frequency (f)	Percentage (%)	Frequency (f)	Percentage (%)
0-10	Poor	7	11.66	-----	-----
11-15	Average	37	61.67	6	10
16-20	Good	16	26.67	52	86.7
21-25	Very good	------	-----	2	3.3

Maximum score=25

Data in the Table 1 reveals that highest (61.67) percentage of the teachers had average knowledge and 26.67% had good knowledge and 11.66% had poor knowledge in pre-test whereas in the post-test majority (86.7) percentage of teachers had good knowledge, 10% had average knowledge, 3.3% had very good knowledge and none of the teachers had poor knowledge.

Table 2: Mean, mean difference, standard deviation and‘t’ value of pre and post-test knowledge score of teachers n=60

Group	Mean knowledge score		Mean difference	Standard deviation		df	‘t’ value
	Pre-test	Post-test		Pre test	Post test
Teachers	13.92	17.82	3.9	2.7	1.74	59	12*

t59=1.67, p<0.05 ; *=Significant

Data in Table 2 shows that the mean post-test knowledge score (17.82) was higher than the mean pre-test knowledge score (13.92). The computed‘t’ value (t₅₉=12) was higher than the table value (t₅₉=1.67) at 0.05 level of significance. Hence, the null hypothesis was rejected and research hypothesis was accepted and it was inferred that the mean post-test knowledge score of teachers on prevention and management of varicose veins is significantly higher than the mean pre-test knowledge scores. This indicates that the SIM was effective in increasing the knowledge level of the teachers regarding prevention and management of varicose veins.

Table 3:Area-wise mean, SD, mean percentage with‘t’ value of pre-test and post test knowledge score of teachers regarding prevention and management of varicose veins. n=60

Area	Pre-test (X)			Post-test (Y)
Area	Mean	SD	Mean%	Mean	SD	Mean %	t value
Meaning and incidence of varicose veins	1.98	1.321	49.5	2.92	0.77	73	6.38*
Causes and risk factors	1.05	0.759	52.5	1.33	0.66	66.5	2.88*
Signs and symptoms, Diagnosis of varicose veins	3.03	1.057	60.6	3.52	0.95	70.4	3.68*
Treatment and prevention of varicose veins	5.53	1.672	55.3	7.17	1.44	71.7	7.21*
Complication and prognosis of varicose veins	2.38	1.091	59.5	2.82	0.91	70.5	3.2*
Total	13.97	5.91	55.48	17.76	4.73	70.42	12*

t₅₉=1.67, p<0.05 ;*= Significant

The data presented in Table 3 illustrates the significant difference between pre and post-test knowledge scores in all the areas. The computed ‘t’ value in all the areas in the post-test are higher than the table value (t₅₉ =1.67) at 0.05 level of significance. This showed that the SIM was effective in increasing the knowledge of teachers in all the areas of varicose veins.

Table 4: Association between pre test knowledge score and selected baseline characteristics (age, gender, educational qualification, marital status, years of experience, number of classes per day, positions teacher adopt while taking classes and source of information).

The following null hypothesis was formulated to find out the association between pre-test knowledge score and selected baseline characteristics:

H₀₂: There will be no significant association between the pre-test knowledge scores of teachers and selected baseline characteristics (age, gender, marital status, educational qualification, years of experience, number of classes per day, positions teacher adopt while taking classes and source of information).

Table 4a: Chi-square test showing the association between the mean pre-test knowledge score and selected baseline characteristics cont n=60

Variable	Knowledge scores		χ²
Variable	£median	> median	χ²
Age in years			2.3
20-30	6	14
31-40	0	9
41-50	7	12
>51	5	7
Gender			0.34
Male	3	8
Female	15	34
Educational qualification			0.74
BA/ BSC	1	7
MA/MSC	8	11
BEd	5	10
MEd	0	5
DEd	3	6
Other (LLB, BCom)	1	3
Marital status			0.22
Married	10	26
Unmarried	8	14
Divorced	0	0
Widow/ Widower	0	2

X₁²=3.84, p < 0.05

The data in table 4a shows the chi-square value computed for pre-test knowledge score and selected variables such as age (χ²1 = 2.3), gender (χ²1 =0.34), educational qualification (χ²1=0.74) and marital status (χ²1 = 0.22) were not significant at 0.05 level.

Table 4b: Chi-square test showing the association between the mean pre-test knowledge score and selected baseline characteristics

n=60

Variable	Knowledge scores		χ²
Variable	£median	> median	χ²
£5	6	12	1.43
6- 10	4	12
11- 15	0	6
16-20	3	9
≥21	5	3
Number of classes per day
£3	0	1
4-6	12	18	2.32
7- 8	6	23	2.32
The position teachers adopt the most while taking class
Sitting	0	1	0.388
Standing	11	21
Walking	7	20
Source of information
Family members, relatives, friends	4	4	1.85
Mass media	3	6
health personnel	0	2
No source of information	11	20

X₁²=3.84, p < 0.05

The data in table 4b shows the chi-square value computed for pre-test knowledge score and selected variables such as years of experience (χ²1 = 1.43), hours of class per day (χ²1 = 2.32), the position the most teachers adopt while taking classes (χ²1 = 0.388) and source of information (χ²1=0.021) were not significant at 0.05 level. Since the null hypothesis (H₀₂) was accepted and research hypothesis was rejected. Therefore it can be interpreted that there is no significant association between knowledge of teachers and selected variables.

DISCUSSION:

The distribution of teachers with regard to age revealed that 33.3% of the teachers were between the age group of 20 to 30years, 15% of teachers were in the age group of 31 to 40 years, 31.7% of teachers were in the age group of 41 to 50 years and 20% of teachers were above 51 years.

The findings of the study were consistent with other study conducted in Hong Kong to assess the health complaints of the teachers from primary and secondary schools. The findings revealed that 20.4% of teachers were in the age group of 20- 30 years of age, 31.9% were in the age group of 31- 40 years of age, 31.5% were in the age group of 41- 50 years of age and least (16.2) percentage were in the age group of ≥51 years.⁶

Knowledge scores of teachers revealed that majority (71.6) percentage of teachers had average knowledge on prevention and management of varicose veins, remaining (25) percentage of teachers had good knowledge on prevention and management of varicose veins and least (3.3) percentage of teachers had poor knowledge on prevention and management of varicose veins and none of teachers had very good knowledge on prevention and management of varicose veins in pre test. It suggested that the teachers should receive more information regarding prevention and management of varicose veins.

The findings of the study were consistent with other study conducted in Belgaum to assess the effectiveness of SIM on causes and prevention of Chronic Venous Disease (CVD) among staff nurses. The findings revealed that in the pre test, 8 (12.3%) of the staff nurses had poor knowledge level, 48 (73.8%) had average knowledge level 9 (13.9%) had good knowledge on causes and prevention of CVD.⁷

CONCLUSION:

The findings of the study showed that the knowledge scores of teachers regarding prevention and management of varicose veins were poor before the administration of SIM. This SIM facilitated to improve knowledge regarding prevention and management of varicose veins. Post-test knowledge scores were significantly high in teachers. Hence, the SIM was an effective teaching strategy to improve the knowledge the teachers on varicose veins.

LIST OF ABBREVIATIONS:

BA Bachelor of Arts

B.Ed Bachelor of Education

B.Com Bachelor of Commerce

BSc Bachelor of Science

CI Confidence Interval

CF Cumulative frequency

CVD Chronic Venous Disease

D.Ed Diploma in Education

F Frequency

LLB Legum Baccalaureus

MA Master of Arts

M.Ed Master in Education

MSc Master of Science

SD Standard deviation

SIM Self Instructional Module

VV Varicose Veins

WHO World Health Organization

REFERENCES:

1. Wright, K, Frey R. Varicose veins: The Gale Encyclopedia of Alternate Medicine. [online]. 2006 [cited 2012 Feb 2]; Available from: URL:http://www.ecyclopedia.com.

2. Neill R. Standing problem. Hazards Magazine [online]. 2005 Aug 10 [cited 2011 Oct 24]; Available from: URL:http://www.hazards.org/standing/index.htm.

3. Black JM, Hawks JH. Medical surgical nursing: Clinical management for positive outcomes. 7th ed. New Delhi: Saunders; 2005.

4. Tuchsen F, Hannerz H, Burr H, Krause N. Prolonged standing at work and hospitalization due to varicose veins: a 12 year prospective study of the Danish population. Occup Environ Med 2011 Oct 23; 62 (12):847-50.

5. Laurikka J, Sisto T, Auvinen O, Tarkka M, Hakama M. Varicose vein in Finnish population aged 40-60. J Epidemiol Community Health. 2011 Oct 26; 47(2):355-7.

6. Chong EY, Chan A H. Health complaints of teachers from primary and secondary schools in Hong Kong. International Journal of Occupational Safety and Ergonomics. 2010. Oct 10; 16(1): 23-39

7. Nazareth SO. A study to evaluate the effectiveness of SIM on prevention of varicosities among staff nurses working in KLES hospital. [MSc thesis]. Belgaum: RGUHS; 2008

Received on 18.08.2014 Modified on 09.10.2014

Int. J. Nur. Edu. and Research 2(4): Oct.- Dec. 2014; Page 338-343