Effectiveness of structured teaching program on knowledge regarding modifiable risk factors of cancer among adults at selected rural area of Bhavnagar district

Kavita Patel¹, Swamy P.G.N.²

¹2^nd Year M.Sc Nursing Student, Sumandeep Nursing College, Sumandeep Vidyapeeth, Piparia,

Vadodara-391760, Gujarat India.

²HOD of Community Health Nursing, Sumandeep Nursing College, Sumandeep Vidyapeeth, Piparia,

Vadodara-391760, Gujarat India.

Corresponding Author Email: kavitapandya1988@gmail.com

ABSTRACT:

Introduction: Cancer known medically as a malignant neoplasm is a broad group of diseases involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invading nearby parts of the body. The cancer may also spread to more distant parts of the body through the lymphatic system or bloodstream. Not all tumors are cancerous; benign tumors do not invade neighboring tissues and do not spread throughout the body. There are over 200 different known cancers that affect humans. The causes of cancer are diverse, complex, and only partially understood. Many things are known to increase the risk of cancer, including tobacco use, dietary factors, certain infections, exposure to radiation, and lack of physical activity, obesity, and environmental pollutants.

Objectives: To assess the pre-test level of knowledge regarding modifiable risk factors of cancer among adults in rural area. To evaluate the effectiveness of structured teaching program regarding modifiable risk factors of cancer among adults in rural area. To find out the association between pretest level of knowledge of rural adults with their selected socio-demographic variable.

Materials and methods: In this research study an evaluative research approach with pre- experimental design is used. Non probability purposive sampling technique was used to select the 100 samples of rural adults and data collection was done. Data was analyzed by using descriptive and interferential statistics such as standard deviation, chi- test, and paired ‘t’ test Table.

Results: in the group of the adults pre-test knowledge mean score was 12.35 (41.16%) and post-test mean score was 25.08(83.06%) and T calculated value is 54.22 which are more than the tabulated value of 1.658 at 0.05 level of significance and df value was 99. So hypothesis H₁ was accepted and the entire four variable that is significantly associated with pre-test knowledge score hence the hypothesis (H₂) was accept with marital status, educational qualification, occupation and source of information.

Conclusion: Hence structured teaching program was affected for the adults regarding modifiable risk factors of cancer.

KEY WORDS: Cancer, modifiable risk factor of cancer, Structured Teaching Program, Rural adults.

INTRODUCTION:

Cancer known medically as a malignant neoplasm is a broad group of diseases involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invading nearby parts of the body. The cancer may also spread to more distant parts of the body through the lymphatic system or bloodstream. Not all tumors are cancerous; benign tumors do not invade neighboring tissues and do not spread throughout the body. There are over 200 different known cancers that affect humans.¹

The causes of cancer are diverse, complex, and only partially understood. Many things are known to increase the risk of cancer, including tobacco use, dietary factors, certain infections, exposure to radiation, lack of physical activity, obesity, and environmental pollutants.² Many cancers could be prevented by not smoking, eating more vegetables, fruits and whole grains, eating less meat and refined carbohydrates, maintaining a healthy weight, exercising, minimizing sunlight exposure, and being vaccinated against some infectious diseases.^2-5

Cancers are primarily an environmental disease with 90–95% of cases attributed to environmental factors and 5–10% due to genetics. Environmental, as used by cancer researchers, means any cause that is not inherited genetically, not merely pollution. Common environmental factors that contribute to cancer death include tobacco (25–30%), diet and obesity (30–35%), infections (15–20%), radiation (both ionizing and non-ionizing, up to 10%), stress, lack of physical activity, and environmental pollutants.²

Many management options for cancer exist with the primary ones including surgery, chemotherapy, radiation therapy, and palliative care. Which treatments are used depends upon the type, location and grade of the cancer as well as the person's health and wishes.

NEED FOR THE STUDY:

The investigator has observed the number of cases of cancer seen in community areas and many of them are occur through modifiable risk factors like tobacco chewing, smoking, diet, environmental factors, infection, radiation etc. so knowledge regarding modifiable risk factors of cancer in rural adults is necessary to prevent the cancer.

According to the latest World Cancer Report from the World Health Organization (WHO), more women in India are being newly diagnosed with cancer annually. As against 4.77 lakh men, 5.37 lakh women were diagnosed with cancer in India in 2012.⁶ In terms of cancer deaths, the mortality rate among men and women in India is almost the same. While 3.56 lakh men died of cancer in 2012 in India, the corresponding number for women was 3.26 lakh.⁶

NUMBER OF RECORDS IN THE SEER

RESEARCH DATA

(Surveillance, Epidemiology, and End Results Program Turning Cancer Data In to Discovery)

In 2013, it is estimated that there will be 1,660,290 new cases of all cancer sites and an estimated 580,350 people will die of this disease.⁷

Sr. No	Common Types of Cancer	Estimated New Cases 2013	Estimated Deaths 2013
1	Prostate Cancer	238,590	29,720
2	Breast Cancer	232,340	39,620
3	Lung and Bronchus Cancer	228,190	159,480
4	Colon and Rectum Cancer	142,820	50,830
5	Melanoma of the Skin	76,690	9,480
6	Bladder Cancer	72,570	15,210
7	Non-Hodgkin Lymphoma	69,740	19,020
8	Kidney and Renal Pelvis Cancer	65,150	13,680
9	Thyroid Cancer	60,220	1,850
10	Endometrial Cancer	49,560	8,190
	All Cancer Sites	1,660,290	580,350

STATEMENT OF PROBLEM:

“Effectiveness of structured teaching program on knowledge regarding modifiable risk factors of cancer among adults at selected rural area of Bhavnagar district.”

OBJECTIVES OF THE STUDY:

1. To assess the pre-test level of knowledge regarding modifiable risk factors of cancer among adults in rural area.

2. To evaluate the effectiveness of structured teaching program regarding modifiable risk factors of cancer among adults in rural area.

3. To find out the association between pretest level of knowledge of rural adults with their selected socio-demographic variable.

HYPOTHESIS:

H₁–The mean post-test knowledge score of rural adults regarding modifiable risk factors of cancer will be significant higher than their mean pre-test knowledge score.

H₂– There will be significant association between pre-test levels of knowledge of adults with their selected demographic variables.

ASSUMPTION:

1. Rural adults may have limited knowledge regarding modifiable risk factors of cancer.

2. Structured teaching program will enhance the knowledge regarding modifiable risk factors of cancer among adults.

INCLUSION CRITERIA:

Rural Adults who are:

1. Able to understand Guajarati.

2. Available during the period of data collection

MATERIAL AND METHOD:

RESEARCH APPROACH:

The research method adopted for the present study was pre-experimental approach as the study aimed at development of an intervention (structured teaching program on modifiable risk factors of cancer) among rural adults at selected rural areas of Bhavnagar District and determining its effectiveness statistically. This approach would help the investigator to evaluate the effect of the specific intervention that is ‘Structured teaching program’ on the variable that is ‘knowledge’ of Rural Adults of Bhavnagar District.

RESEARCH DESIGN:

In the present study the investigator selected pre-experimental approach, one group pretest and post-test design, keeping in the view the objectives of the study, the investigator, observed the groups prior to the intervention (the pre-test). After pretest, intervention (Structured teaching program) was administered to the same group and was then again assessed (the post-test).

SETTING:

The study will be conducted in selected rural areas of Bhavnagar District.

VARIABLE:

Independent Variables

In this present study were independent variable is structured teaching program on modifiable risk factors of cancer.

Dependent Variable

In this present study were dependent variable is Knowledge level of rural adults.

Demographic Variable

Age, gender, religion, marital status, educational-qualification, occupation, source of information.

POPULATION:

In this study the target population consists of the rural adults in selected rural area of the Bhavnagar district.

SAMPLE:

The samples for the present study wererural adults in selected rural area of Bhavnagar district.

SAMPLE SIZE:

In the study the sample size constitutes of 100 rural adults in selected rural area of Bhavnagar district.

SAMPLING TECHNIQUE:

The samples of the study will be selected by using purposive sampling technique according to inclusive criteria as availability of samples.

DATA COLLECTION INSTRUMENT

In this study data collection instrument was structured knowledge questionnaire.

DEVELOPMENT OF THE TOOL

After an experience review of literature and discussion with the experts, a structured knowledge questionnaire was prepared to assess the knowledge regarding modifiable risk factors of cancer among rural adults.

The following steps were carried out in preparing the tool:

· Literature review

· Validity of tool

· Reliability

DESCRIPTION OF TOOL

On modifying the tool as per the expert’s suggestion the final tool consists of two parts.

Part I

Information on demographic variables of respondents containing seven items such as age, Gender, Religion, Marital Status, Educational Qualification, occupation, and Source of information.

Part II

Structured knowledge questionnaire consisting 30 items on knowledge regarding modifiable risk factors of cancer.

The items are based on varies areas which includes –

General Concept of cancer-3,

Modifiable Risk factors of cancer-17,

Early Sign and symptoms and diagnosis of cancer-3,

Treatment of cancer-2, and

Prevention of cancer-5.

All items are given score of one for each correct answer and zero for wrong answer.

Scoring interpretation

· Excellent above 80%

· Good 65-80%

· Average 50-64%

· Poor below 50%

CONTENT VALIDITY

Content validity was established by experts comprising of 04 nursing experts from community health nursing department, 01 community medicine, and 01 biostatistician. 100 % agreement on all items of the tool except the correction made in the tool and content. The final content was prepared as per the suggestions and advice given by the experts.

RELIABILITY

Reliability is the degree of consistency or dependability with which an instrument measures the attribute it is designed to measure. The tool after validation was subjected to test for its reliability. The questionnaire was administered to ten rural adults. The reliability was established by using split half technique and spearman’s brown prophecy formula. Co – efficient of correlation of knowledge test was found to be r = 0.75. So tool was found to be highly reliable for data collection.

PLAN FOR DATA ANALYSIS

For the present study, the data obtained were analyzed in respect to the objectives of the study by using descriptive and inferential statistics. The plan of data analysis was worked out with the experts in the field of statistics and nursing.

The plan of data analysis is as follows:

· Organize data in master sheet / computer.

· Frequency and percentage for the analysis of demographic data.

· Mean standard deviation of pre-test and post-test scores.

· Paired‘t’ test for testing effectiveness of structured teaching program and research hypothesis.

- Chi square test would be applied to determine the significance of the difference between mean score of pretest and posttest subjects.

RESULTS:

THE DATA IS ANALYZED AND PRESENTED UNDER THE FOLLOWING SECTIONS:

SECTION: A Description of Sample Characteristic

Baseline data containing sample characteristics would be analyzed using frequency and percentage.

SECTION: B Assessment of Pre Test Knowledge Score of rural adults

Analysis of existing knowledge ofrural adults among modifiable risk factors of cancer.

SECTION: C Analysis of Effectiveness of Structured Teaching Program among rural adults regarding modifiable risk factors of cancer.

Comparison of pre-test and post-test knowledge scores of rural adults regarding modifiable risk factors of cancer

SECTION: D Association of selected demographic variable with the level of pre-test knowledge score of rural adults.

SECTION A: DESCRIPTION OF THE DEMOGRAPHIC VARIABLES OF THE RURAL ADULTS .

TABLE:1 Frequencies and Percentage Distribution of Rural Adults According To Their Personal Characteristics (Demographic Variables) (N=100)

Sr. No	Characteristics	Categories	Frequency	Percentage%
1	AGE	20-30 30-40 40-50 50-60	15 40 35 10	15% 40% 35% 10%
1	AGE	TOTAL	100	100%
2	GENDER	Male Female	55 45	55% 45%
2	GENDER	TOTAL	100	100%
3	RELIGION	Hindu Muslim Christian Other	80 20 00 00	80% 20% 00% 00%
3	RELIGION	TOTAL	100	100%
4	MARITAL STATUS	Married Unmarried Widow Other	80 10 10 00	80% 10% 10% 00%
4	MARITAL STATUS	TOTAL	100	100%
5	EDUCATIONAL QUALIFICATION	Illiterate Below S.S.C S.S.C H.S.C Graduate	15 35 20 12 18	15% 35% 20% 12% 18%
5	EDUCATIONAL QUALIFICATION	TOTAL	100	100%
6	OCCUPATION	Farmer Business Professional worker Other	47 10 13 30	47% 10% 13% 30%
6	OCCUPATION	TOTAL	100	100%
7	SOURCE OF INFORMATION	Mass media Any cancer related attended program No any	72 18 10	72% 18% 10%
7	SOURCE OF INFORMATION	TOTAL	100	100%

SECTION B: ASSESSMENT OF PRE TEST KNOWLEDGE SCORE OF RURAL ADULTS (N=100)

Table No: 2 Pre-Test Knowledge Score Regarding Modifiable Risk Factors Of Cancer.

Percentage and Mean of the Pre-test
	N	Minimum	Maximum	Mean	%	S.D	S.D %
Total	100	8	21	12.35	41.16%	3.46	11.53%
Valid N (list wise)	100

Table No.4 Association of Selected Demographic Variable with the Level of Pre-Test Knowledge Score of Rural Adults.

Demographic Variable		c²	D.F	Level of Significance at 0.05 level
1. Age in year	20-30years	12.21	6	12.21<12.59 NS
	30-40years
	40-50years
	50-60years
2. Gender	Male	1.66	2	1.66<5.99 NS
	Female
3. Religion	Hindu	4.47	6	4.47<12.59 NS
	Muslim
	Christian
	Other
4. Marital Status	Married	35.67	6	35.67>12.59 S
	Unmarried
	Widow
	Other
5. Educational Qualification	Illiterate	48	8	48>15.51 S
	Below S.S.C
	S.S.C
	H.S.C
	Graduate
6. Occupation	Farmer	82.33	6	82.33>12.59 S
	Business
	Professional worker
	Other
7. Source of information	Mass media	31.21	4	31.21>9.49 S
	Any cancer related program
	No any

Variables of age (χ2=12.21), Gender (χ2=1.66 ),Religion (χ2=4.47) marital status (χ2=35.67), educational qualification (χ2=48), occupation (χ2=82.33), source of information (χ2=31.21), was found significant at 0.05 level of significance , Thus it can be interpreted that there is a significant association between knowledge of rural adults with their marital status, educational qualification, occupation, source of information and there is no significant association between knowledge of rural adults with selected socio demographic variables such as age, gender and religion.

Hence the hypothesis (H₂) was accept with marital status, educational qualification, occupation and source of information.

DISCUSSION:

The present study was undertaken to evaluate the effectiveness of STP on modifiable risk factors of cancer among rural adults. Pre experimental research design with single group pretest posttest design approach was adopted in order to achieve the objectives of the study. The samples were selected using purposive sampling technique. The sample size was 100 and the data was collected from them by using a structured knowledge questionnaire before and after administration of STP.

2010 Jul 28 a study was conducted by Khan N¹, Afaq F, Mukhtar H at USA Lifestyle as risk factor for cancer: Evidence from human studies.. It is increasingly appreciated that the chances of developing cancer are significantly affected by the choice of our lifestyle. There are several uncontrollable risk factors which account for the majority of cancers, but we can modify our lifestyle to reduce enhanced threat of cancer. Healthy lifestyle behaviors for cancer risk reduction include a healthy diet, weight management, regular exercise, reduction in alcohol consumption and smoking cessation. In this article, we present evidences on the association between certain lifestyle characteristics and their contribution for developing breast, prostate, lung and colon cancers, using information derived from human studies.⁸

CONCLUSION:

In the pretest conducted among 100 subjects, none had excellent knowledge score. In the post test, 72% had excellent knowledge score on modifiable risk factors of cancer after administration of structured teaching program.

There was significant increase in posttest knowledge scores through structured teaching program. The gain in knowledge score was significant at 0.05 level of significant and calculated paired t test value is 54.22 which is greater than table paired t value 1.658. Findings revealed that structured teaching program on modifiable risk factors of cancer was an effective teaching strategy in gain in knowledge of the students.

So we conclude that from the entire four variables that are significantly associated with pre-test knowledge score hence the hypothesis (H2) was associate with marital status, educational qualification, occupation and source of information.

REFERENCES:

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Paired Sample Statistics: Effectiveness of Planned teaching program
	Mean	Mean Difference	%	SD	Coefficient of correlation	T	P	Significance Level
Pre-test Score	12.35	12.73	41.16%	3.46	0.493	54.22	.00	Significant
Post-test score	25.08	12.73	83.6%	2.21	0.493	54.22	.00	Significant