A study to determine the effectiveness of structured teaching programme on knowledge and attitude regarding ear infection, management and its prevention among mothers of under five children in selected rural areas of Udupi District.

 

Ms. Soumya Mathew

Canara College of Nursing,Kundapur (RGUHS), Cherusseril (House) Kurichithanam (P.O) Kottayam (D.T) Kerala (State) Pin 686634

 

ABSTRACT:

Objectives of the study: To assess the knowledge of mothers of under five children regarding ear infection, management and its prevention. To assess the attitude of mothers of under five children regarding ear infection, management and its prevention. To evaluate the effectiveness of structured teaching programme on knowledge and attitude regarding ear infection management and its prevention among mothers of under five children in a selected rural areas of Udupi District.  To find out an association between knowledge on ear infection, management and its prevention with selected demographic variables. To find out an association between attitude on ear infection, management and its prevention with selected demographic variables. Settings and Design: A pre-experimental, “one group pre-test, post - test design” was used for the study. The study was carried out in the selected rural areas, named Kumbashi and Saligrama in Udupi District. Methods and Material: The sample size comprised of 50 mothers of under five children were selected using non-probability, purposive sampling technique. Formal written permission was obtained from the authorities and informed consent obtained from the mothers to conduct the study. The knowledge level and attitude scale were assessed by using structured knowledge and attitude questionnaire. The data was analysed by using descriptive and inferential statistics. Results: The study findings revealed that knowledge scores and attitude scores of mothers were inadequate before the administration of structured teaching programme. In the pre-test majority (84%) of mothers had moderate level of knowledge level and (14%) of mothers had inadequate knowledge level and in the case of attitude level (52%) of mothers had average attitude level and only (2%) of samples had good attitude level and the mean pre-test knowledge score and attitude score (12+_2.6) and (12.72+_5.49) respectively . In the post-test majority (64%) of mothers had adequate knowledge level and (34%) of mothers had moderate level of knowledge level and in the case of attitude level (56%) of mothers had good attitude level and none had poor attitude score. The mean post-test knowledge and attitude score (17.86 ⁺_{_} 2.72) and (25.82+_6.39) respectively. The mean obtained for overall mean pre-test knowledge and attitude score of sample’s is 8.90 with a standard deviation of 2.32 and 5.49 SD with 12.72 mean respectively. Overall post-test knowledge score of mothers is 16.78 with standard deviation of 1.82 and attitude score SD is 6.39 and mean is 25.82. The mean post-test knowledge and attitude scores 16.78 and 25.82 higher than mean pre-test knowledge scores 8.90 and 12.72. The computed ‘t’ value 11.84 (p<0.05)showed that there is highly significant difference between the pre-test and post- test mean knowledge scores 5.86. The computed ‘t’ value 12.19 (p<0.05)showed that there is highly significant difference between the pre-test and post- test mean attitude scores. The c² test showed that there was no significant association between the knowledge and attitude score with selected demographic variables. Interpretation and Conclusion: The data was analyzed by applying Descriptive and Inferential statistics. The results of the study showed that structured teaching programme helps the mother to improve their knowledge and attitude regarding management and prevention of ear infection in under five children.

 

INTRODUCTION:

“Safety is something that happens between yours ears, not something you hold in your hands.” - Jeff Cooper

 In children, health includes the physical, mental, emotional and social well-being of children from infancy through adolescence.¹ Ear infections are common in babies and young children, especially those aged six to eighteen months. Most children will have an ear infection before the age of five.² An ear infection medically termed otitis media generally refers to an infection of the middle part of the ear that lies behind the eardrum. The incidence rate of acute otitis media is 10.85%, that is 709 million cases each year with 51% of these occurring in under- fives. WHO estimated that 28 thousand deaths every year are attributable to complications of otitis media.³ Evidence suggest that severe cases of ear infection leads to impaired hearing which will affect learning, behavioural and social attitude and speaking capacity.⁴

 

NEED FOR THE STUDY:

The children of today are the future of tomorrow; this powerful statement assumes special significance in our context as children comprise one third of the total population in the country. Early childhood, that is the first six years constitutes the most crucial period in life, when the foundations are laid for cognitive, social and emotional language, physical or motor development and cumulative lifelong learning. The young child under 3 years is most vulnerable to the vicious cycles of malnutrition, disease or infection and resultant disability all of which influence the present condition of a child at micro level and the future human resource development of the nation at the macro level. Otitis media is one of the leading causes of health care visit and drug prescription. Three out of four children will have at least one ear infection by their third birthday. The scientific name for an ear infection is otitis media.⁵ Incidence of otitis media is most extreme in infancy and early childhood, because the eustachian tube is shorter, wider and in a more horizontal position, and the small muscles which control the opening of the tube are less efficient in function, leaving the Eustachian tubes and the middle ears open to the invasion of infection producing organisms. The World Health Organization reported that otitis media was responsible for the deaths of 51,000 children under the age five years each year in developing countries. ⁶

 

Ear infection is one of the leading causes of pain experiencing in children and to be brought to hospitals by parents. The infection from the ear spreads to other structures and the child develops problems in the nearby structures also. Research on ear infection indicates that children who have had more than 9 ear infection in the first 3 year are at greater risk for inattention in class, and may struggle with phonics, comprehension and other school task. So it will affect the overall development of social, physical, emotional, personality and learning factors. Therefore studying about ear infection, management and its prevention is very useful.⁷

 

STATEMENT OF THE PROBLEM:  

“A study to determine the effectiveness of structured teaching programme on knowledge and attitude regarding ear infection, management and its prevention among mothers of under five children in selected rural areas of Udupi District’’

 

OBJECTIVES OF THE STUDY:

1.    To assess the knowledge of mothers of under five children regarding ear infection, management and its prevention.

2.    To assess the attitude of mothers of under five children regarding ear infection, management and its prevention.

3.    To evaluate the effectiveness of structured teaching programme on knowledge and attitude regarding ear infection management and its prevention among mothers of under five children in a selected rural area of Udupi District.

4.    To find out an association between knowledge on ear infection, management and its prevention with selected demographic variables.

5.    To find out an association between attitude on ear infection, management and its prevention with selected demographic variables.

 

Assumptions

1.    Mothers of under five children may not have adequate knowledge and attitude regarding ear infection, management and its prevention.

2.    Structured teaching program may improve the knowledge and attitude of mothers of under five children regarding ear infection, management and its prevention.

 

Hypothesis         

The hypothesis will be tested a 0.05 level of significance:

H1 - There will be significant difference between mean pre-test and post-test knowledge scores of mothers of under five children regarding ear infection, management and its prevention.

H2 - There will be significant difference between mean pre-test and post-test attitude scores of mothers of under five children regarding ear infection, management and its prevention.

H3 - There will be significant association between the post-test knowledge scores of mothers of under five children regarding ear infection, management and its prevention with selected demographic variables.

H4 - There will be significant association between the post-test attitude scores of mothers of under five children regarding ear infection, management and its prevention with selected demographic variables.

 

Delimitations

1.    Mothers of under five children only.

2.    Mothers residing in selected rural areas of Udupi District.

3.    Mothers of under-five willing to participate in the study.

4.    Approximately 50 samples.

5.    The prescribed data collection period is limited 4 - 6 weeks.

 

RESEARCH METHODOLOGY:

Research Approach

Evaluative research is used to study the effectiveness of structured teaching programme on knowledge and attitude regarding ear infection, management and its prevention among mothers of under five children using an evaluative approach.

 

Research Design

“One group pre-test, post - test design” was selected which is a pre experimental design to measure the effectiveness of the structured teaching program on knowledge and attitude regarding ear infection, management and its prevention among mothers of under five children.

 

Research setting

The study was conducted in selected rural areas named Kumbashi and Saligrama in Udupi District.

 

Population

In this study population represents the mothers of under five children residing in selected rural areas named Kumbashi and Saligrama of Udupi District.

 

Sample

Fifty mothers of under five in the selected rural areas named Kumbashi and Saligrama of Udupi district.

 

Sampling technique

Non probability, purposive sampling technique was chosen for the study.

 

Methods of Data Collection

Sampling Criteria

Inclusion criteria

1.     Residing at selected rural areas of Udupi District.

2.     Willing to participate in the study.

3.     Able to read and write Kannada and English.

4.     Present at the time of data collection.

 

Exclusion criteria

1.     Not willing to participate in the study.

2.     Cannot read and write English and Kannada.

3.     Not present during the time of study.

 

Description of the tools

Part I: Base line proforma:

The base line proforma was prepared with 9 items to collect the personal information of the subjects.

 

Part II: Structured knowledge questionnaire

Structured knowledge questionnaire was prepared with 24 items to assess the knowledge level of mothers.

 

Part III: Structured attitude questionnaire

Structured attitude questionnaire was prepared with 9 items to assess the attitude level of mothers

 

RESULTS:

The analyses of the data from the study are presented under the following headings:

Section A: Description of the demographic variables of the mothers of under-five.

Section B: Assessment of the pre-test and post-test knowledge scores of mothers regarding ear infection, management and its prevention among under five children.

Section C: Assessment of the level of pre-test and post-test attitude scores of mothers regarding ear infection, management and its prevention among under five children.

Section D: Assessment of the effectiveness of structured teaching program of mothers on knowledge scores regarding ear infection, management and its prevention .

Section E: Assessment of the effectiveness of structured teaching program of mothers on attitude scores regarding ear infection, management and its prevention.

Section F: Association between post-test knowledge scores and selected demographic variables.

Section G: Association between post-test attitude scores and selected demographic variables

 

 

 

Section A: Demographic proforma of the mothers of under five. N = 50

Table 1: Demographic proforma of mothers of under five children

SI NO:	Sample Characteristics	Frequency	Percentage (%)
1	Age (in years)
1.1	< 20	-	-
1.2	21 -30	25	50
1.3	31 -40	20	40
1.4	> 41	5	10
2	Religion
2.1	Hindu	33	66
2.2	Muslim	15	30
2.3	Christian	02	04
3	Type of family
3.1	Nuclear	34	68
3.2	Extended	10	20
3.3	Joint	6	12
4	Education
4.1	Illiterate	03	06
4.2	Primary	32	64
4.3	Higher Primary	12	24
4.4	PUC and Above	03	06
5	Occupation
5.1	Home Maker	20	40
5.2	Coolie / Unskilled	20	40
5.3	Skilled	04	08
5.4	Semi Skilled	06	12
6	Number of children
6.1	1 Child	07	14
6.2	2 Child	33	66
6.3	3 Child	10	20
7	Family Income
7.1	< 3000	15	30
7.2	3001 - 5000	23	46
7.3	5001 - 7000	11	22
7.4	> 7001	01	02
8	Previous Experience
8.1	Yes	10	20
8.2	No	40	80
9	Previous source of information
9.1	No Information	08	16
9.2	Experience of family	15	30
9.3	Mass Media	19	38
9.4	Health Personnel	07	14
9.5	Books	01	02

 

Majority (50%) of mothers were in the age group of 21 - 30 years and (66%) of mothers were from Hindu family. And most of them (68%) were from nuclear family. Most of the subjects (64%) had primary school education. Majority (40%) of mothers were home makers, and (40%) were coolie workers respectively. (66%) of mothers had two children and 46% of mothers had family income of 3001-5000 Rs per month. Majority (80%) of mothers had no previous experience of ear infection in under five children. Most (38%) of mothers had previous information from mass media regarding ear infection in under five children.

Section B: Knowledge of mothers regarding ear infection, management and its prevention of under five children.

This section deals with the analysis and interpretation of knowledge level of mothers of under five children

 

Table 2: Frequency and percentage distribution of sample according to the level of knowledge   N = 50

Range of score	Pre-test		Post-test
	Frequency	(%)	Frequency	(%)
Inadequate	7	14	-	-
Moderate	42	84	18	36
Adequate	1	2	32	64
Total	50	100	50	100

                                        Figure 1: Bar diagram representing percentage distribution of samples according to the level of knowledge

 

 

The data presented in table 2 and figure 1shows that in the pre-test (14%) of mothers had inadequate knowledge whereas in the post test none had inadequate knowledge. In the pre-test, majority (84%) had moderate knowledge. In the post test only least (36%) had moderate knowledge but in the pre-test (2%) had only adequate _{knowledge whereas in the post test majority (64%) of them had adequate knowledge.}

 

_{Table 3: Range of scores,mean, median and standard deviation of pre-test and post-test knowledge scores                                                           N = 50}

	Range of score	Mean	Median	SD
Pre-test	6 – 17	12	12	2.6
Post-test	14 - 21	17.86	18	2.72

 

_{The data presented in the table 3 shows that, post test knowledge score was in the range of 14 - 21 which was higher than pre-test range 6 - 17. The data also reveals that post test knowledge score mean(17.86 ± 2.72) is significantly higher than mean pre-test knowledge score (12 ± 2.6).}

 

 

 

_{Table 4 : Frequency, percentage and cumulative frequency distribution of pre-test and post-test knowledge score of mothers                           N=50}

Range of score	Pre-test				Post test
	f	%	Cf	Cf %	f	%	Cf	Cf %
0 - 3	-	-	-	-	-	-	-	-
4 - 6	1	2	1	2	-	-	-	-
7 - 9	7	14	8	16	-	-	-	-
10 - 12	19	38	27	54	-	-	-	-
13 - 15	19	38	46	92	12	24	12	24
16 - 18	4	16	50	100	13	26	25	50
19 - 21	-	-	-	-	25	50	50	100
22 - 24	-	-	-	-	-	-	-	-
Total	50	100	50	100	50	100	50	100

                             

 

_{The data presented in table 4 shows the pre-test highest (38%) of sample had knowledge score range of 10 - 12 and 13 - 15 and least(2%) was in the score range of 4 - 6, whereas in the post test highest (50%) was in the score range of 19 - 21 and least (24%) was in the range of score of 13 - 15.}

 

 

_{Figure 2: Ogive representing pre and post test knowledge scores of mothers on ear infection of under five children}

 

 

_{The data presented in the figure 2 shows that, post- test scores ogive lies right to the pre- test scores ogive. Over the entire range shows that post -test scores are more than pre -test scores therefore structured teaching practice is effective. In the 50th percentile pre- test score is 10.4 and post- test score is 16.2.}

 

_{Table 5:Area-wise mean, standard deviation of pre-test and post-test knowledge scores                                                                                           N = 50}

                             

_{The data presented in the table 5 shows that in the area of meaning and types of ear infection mean score 3.3 and standard deviation is 1.1, which is lower than the post test score 4.2 and 0.6 respectively. In the pre test in the area of causes and risk factors, the mean and standard deviation are 4.6 and 1.2 as in case of post test results are 6.9 and 1.3.In the area of management and prevention the scores of mean and standard deviation in the pre test are 3.7 and 1.79 in the post test scores are 5.9 and 1.45. Therefore we can assume that structured teaching practice is effective regarding ear infection, management and its prevention.}

 

_{Table 6:Area - wise mean percentage and mean gain of pre-test and post-test}

_{knowledge score                                                                                                                                                                                                                    N = 50}

Areas of knowledge	Mean% knowledge score		Mean Actual Gain A	Mean Actual Gain B	% of modified gain score
	Pre test	Post test
Meaning and types of ear infection	54.66	66.33	45.34	11.67	25.74
Causes, risk factors of ear infection.	48.4	76	51.6	27.6	53.5
Management and prevention of ear infection	47.5	77.5	52.5	30	57.14

 

 

_{Figure 3: Bar diagram showing the pre-test and post-test knowledge score}

 

 

_{The data presented in the table 6 and figure 3 shows that, the percentage of modified gain score was maximum (57.14%) in the area of management and prevention of ear infection, and (53.5%) in the areas of causes and risk factors of ear infection and least (25.74%)in the area of meaning and types of ear infection.}

 

_{Section C: Attitude of mothers regarding ear infection, management and its prevention in under five children}

_{Attitude of 50 mothers assessed using a structured attitude questionnaire and analyzed using descriptive statistics.}

 

_{Table 7:Frequency and percentage distribution of sample  N = 50}

Range of score	Pre-test		Post-test
	Frequency	(%)	Frequency	(%)
Poor attitude	23	46	-	-
Average attitude	26	52	22	44
Good attitude	1	2	28	56
Total	50	100	50	100

                    Figure 4: Bar diagram representing percentage distribution of samples according to the level of attitude

 

 

 

The data presented in the table 7 and figure 4 shows that in the pre-test (46%) of mothers had poor attitude level whereas in the post test none had poor level of attitude In the pre-test, majority (52%) of mothers had average level of attitude where as in the post test only least (44%) of mothers had average level of attitude but in the pre-test (2%) had only good attitude level, _{whereas in the post test majority ( 56%) of them had good attitude level.}

 

 

 

 

 

 

Table 8: Range of scores, mean, median and standard deviation of pre-test and post test attitude scores         N = 50

	Range of score	Mean	Median	SD
Pre-test	3 - 26	12.72	13	5.49
Post-test	16 - 36	25.82	27	6.39

 

The data presented in the table 8 shows that post test attitude score was in the range of 16 - 36 which was higher than pre-test range 3 – 26.The data also reveals that post test attitude score mean (25.82 ± 6.39) is significantly higher than mean pre-test attitude score (12.72 ± 5.49)

 

Table 9: Frequency, percentage and cumulative frequency distribution of pre-test _{and post-test attitude score of mothers.  N = 50}

Range	Pre-test				Post test
	f	%	Cf	Cf %	f	%	Cf	Cf %
0 - 6	4	8	4	8	-	-	-	-
7 - 12	19	38	23	46	-	-	-	-
13 - 18	22	44	45	90	10	20	10	20
19 - 24	4	8	49	98	12	24	22	44
25 - 30	1	2	50	100	13	26	35	70
31 - 36	-	-	-	-	15	30	50	100
Total	50	100	50	100	50	100	50	100

 

The data presented in table 9 shows that, in the pre-test highest (44%) of the sample had knowledge score range of 13 - 18 and least (2%) was in the score range of 25 - 30, whereas in the post test highest (30%) was in the score range of 31 - 36 and least (20%) was in the range of score of 13 - 18.

 

 

Figure 5: Give representing pre and post test attitude scores of mothers on ear infection of under five children

 

The data presented in the above figure 5 shows that, post- test scores ogive lies right to the pre- test scores ogive. Over the entire range shows that post -test scores are more than pre - test scores. Therefore structured teaching practice is effective. In the 50th percentile pre- test score is 10 and post- test score is 23.

 

Section D: Effectiveness of structured teaching programme on knowledge regarding management and it’s prevention of ear infection among the mothers of under five children

 

Comparison of over-all pre-test and post-test knowledge scores of mothers of under five children.

To find out the significant differences between the mean pre-test and post test knowledge, paired “t” test was used. In order to test the statistical significance between the pre-test and post-test knowledge score, the following null hypothesis was formulated.

H₀1: The mean post-test knowledge scores of mothers regarding ear infection, management and its prevention among under five children will not be significantly higher than mean pre-test knowledge score at 0.05 level of significance.

 

 

Table 10: Mean, Mean difference, SD and t value of pre-test and post-test knowledge scores          N = 50

Parameters	Mean	SD	Mean Difference	t value
Pre-test	12	2.6	5.86	11.84
Post-test	17.86	2.72

^t₄₉ ^{= 2.00, P<0.05 * Significant}

 

The data presented in the table 10shows that the mean post-test knowledge score (17.86 ± 2.72) was higher than the mean pre-test knowledge score (12 ± 2.6). The calculated t value (t49= 11.84 p < 0.05) was greater than the table value (t49 =2.00 p< 0.05 level of significance). Hence the null hypothesis is rejected and research hypothesis was accepted. Hence it can be inferred that the structured teaching program was effective in increasing the knowledge of mothers.

 

Comparison of area-wise mean pre-test and post-test knowledge score:

H₀₂ : There is no significant difference between mean pre-test and post-test knowledge scores of mothers in various areas regarding ear infection, management and its prevention among under five children at 0.05 level of significance

Table 11: Comparison of area-wise mean pre-test and post-test knowledge score                                                                                           N _{= 50}

Areas of knowledge	Pre test		Post test		Mean difference	‘t’ value
	Mean	SD	Mean	SD
Meaning and types of ear infection	3.28	1.03	3.98	1.09	0.7	82.48*
Causes, risk factors of ear infection.	4.84	1.2	7.6	1.3	2.76	195.13*
Management and prevention of ear infection	3.8	1.32	6.2	1.6	2.4	60.6*

^t₄₉ ^{= 2.00, P<0.05    * Significant}

 

 

The data presented in table 11 shows that there was significant difference between the mean pre-test and post-test knowledge scores of mothers regarding ear infection, management and its prevention among under five children in all areas namely concept, meaning, prevention and management of ear infection, causes, risk factors and types of ear infection and prevention and management of ear infection.

 

As the calculated ‘t’ value p<0.05 was greater than the table value (t₄₉=2.00 p< 0.05 level of significance). So the null hypothesis rejected and research hypothesis accepted. Hence it can be inferred that the structured teaching programme was effective in increasing the knowledge of mothers

 

Section E: Effectiveness of structured teaching programme on attitude regarding management and it’s prevention of ear infection among the mothers of under five children

 

 

Comparison of overall pre-test and post-test attitude scores of mothers of under five children.

To find out the significant differences between the mean pre-test and post test attitude, paired “t” test was used. In order to test the statistical significance between the pre-test and post-test attitude score, the following null hypothesis was formulated.

 

H₀3: The mean post-test attitude scores of mothers regarding ear infection, management and its prevention among under five children will not be significantly higher than mean pre-test attitude score at 0.05 level of significance.

 

Table 12: Mean, Mean difference, SD and t value of pre-test and post-test attitude score                                                                 N = 50

Parameters	Mean	SD	Mean Difference	t value
Pre-test	12.72	5.49	13.1	12.19
Post-test	25.82	6.39

^t₄₉ ^{= 2.00, P<0.05   * Significant}

 

 

 

The data presented in the table 12 shows that the mean post-test attitude score (25.82 ± 6.39) was higher than the mean pre-test attitude score (12.72 ± 5.49). The calculated ‘t’ value (t49 = 12.19 p < 0.05) was greater than the table value (t49 = 2.00 p< 0.05 level of significance). Hence the null hypothesis is rejected and research hypothesis accepted. Hence it can be inferred the STP was effective in increasing the attitude of mothers.

 

ection F:Association between post-test knowledge scores and selected demographic variables

This section deals the findings to determine the association between post-test knowledge score and selected demographic variables with the Chi square test. The following null hypothesis was formulated.

H₀₃ : There is no significant association between the post-test level of knowledge regarding ear infection, management and its prevention among mothers of under five children and selected demographic variables at 0.05 level of significance. The data were classified as above median and below median.

 

Table 13: Chi-square test of association between post-test knowledge scores and demographic variables regarding ear infection management and its prevention among mothers of under five children.                                                                                                    N = 50

Sl. No	Variables	Below Median	Above Median	c2 value	Df	Table Value	P Value	Inference
1	Age (Yrs)			0.09	2	5.99	P>0.05	NS
1.1	<20	-	-
1.2	21-30	10	15
1.3	31-40	5	15
1.4	>41	3	2
2	Religion			0.72	2	5.99	P>0.05	NS
2.1	Hindu	10	23
2.2	Christian	2	-
2.3	Muslim	6	9
3	Type of Family			1.2	2	5.99	P>0.05	NS
3.1	Nuclear	10	24
3.2	Extended	2	8
3.3	Joint	6	-
4	Education			.50	3	7.82	P>0.05	NS
4.1	Illiterate	1	2
4.2	Primary	10	22
4.3	Higher Primary	4	8
4.4	PUC and Above	3	-
5	Occupation			.65	3	7.82	P>0.05	NS
5.1	Home Maker	8	12
5.2	Coolie/Unskilled	8	12
5.3	Skilled	2	2
5.4	Semi Skilled	-	6
6	NO. of Children			1.95	2	5.99	P>0.05	NS
6.1	One	6	1
6.2	Two	6	27
6.3	Three	6	4
7	Income			0.66	3	7.82	P>0.05	NS
7.1	<3000	6	9
7.2	3001-5000	6	17
7.3	5001-7000	6	5
7.4	>7001	-	1
8	Previous Experience			2.39	1	3.81	P>0.05	NS
8.1	Yes	5	5
8.2	No	13	27
9	Previous Source of Information			0.01	4	9.48	P>0.05	NS
9.1	No Information	4	4
9.2	Family	4	11
9.3	Mass Media	5	14
9.4	Health Personnel	4	3
9.5	Books	1	-

NS= Not Significant  

The above table 13 shows that c² value have no significant association with pre-test knowledge scores at 0.05 level of significance. So the null hypothesis is accepting and research hypothesis is rejecting.

Section G: Association between post-test attitude scores and selected demographic variables

H₀₄ : There is no significant association between the post-test level of attitude regarding ear infection, management and its prevention among mothers of under five children and selected demographic variables at 0.05 level of significance.

 

 

Table 14: Chi-square test of association between post-test attitude scores and demographic variables regarding ear infection management and its prevention among mothers of under five children.                                                                                                              N = 50

Sl. No	Variables	Below Median	Above Median	c2 value	Df	Table Value	P Value	Inference
1	Age (Yrs)			0.08	2	5.99	P>0.05	NS
1.1	<20	-	-
1.2	21-30	10	15
1.3	31-40	10	10
1.4	>41	2	3
2	Religion			3.29	2	5.99	P>0.05	NS
2.1	Hindu	11	22
2.2	Christian	1	1
2.3	Muslim	10	5
3	Type of Family			0.07	2	5.99	P>0.05	NS
3.1	Nuclear	14	20
3.2	Extended	5	5
3.3	Joint	3	3
4	Education			5.8	3	7.82	P>0.05	NS
4.1	Illiterate	1	2
4.2	Primary	10	22
4.3	Higher Primary	9	3
4.4	PUC and Above	2	1
5	Occupation			0.54	3	7.82	P>0.05	NS
5.1	Home Maker	5	15
5.2	Coolie/Unskilled	6	14
5.3	Skilled	2	2
5.4	Semi Skilled	5	1
6	NO. of Children			8.25	2	5.99	P>0.05	NS
6.1	One	5	2
6.2	Two	5	28
6.3	Three	8	2
7	Income			0.66	3	7.82	P>0.05	NS
7.1	<3000	6	9
7.2	3001-5000	6	17
7.3	5001-7000	5	6
7.4	>7001	1	-
8	Previous Experience			0.54	1	3.81	P>0.05	NS
8.1	Yes	5	5
8.2	No	13	27
9	Previous Source of Information			0.21	4	9.48	P>0.05	NS
9.1	No Information	4	4
9.2	Family	5	10
9.3	Mass Media	5	14
9.4	Health Personnel	3	4
9.5	Books	1	-

NS= Not Significant

 

The above table 14 shows that c² value of demographic variables have no significant association with post-test attitude scores at 0.05 level of significance. So the null hypothesis is accepting and research hypothesis is rejecting.

 

DISCUSSION:

Section I: Demographic proforma of mothers of under five children

Majority (50%) of mothers were in the age group of 21 - 30 years and (66%) of mothers were from Hindu family. And most of them (68%) were from nuclear family. Most of the subjects (64%) had primary school education. Majority (40%) of mothers were home makers, and (40%) were coolie workers respectively. (66%) of mothers had two children and 46% of mothers had family income of 3001-5000 Rs per month. Majority (80%) of mothers had no previous experience of ear infection in under five children. Most (38%) of mothers had previous information from mass media regarding ear infection in under five children.

 

Section - II: Knowledge of mothers regarding ear infection, management and its prevention of under five children.

In the pre-test majority (84%) of mothers had moderate knowledge level, (14%) samples had inadequate knowledge and (2%) had adequate knowledge level, whereas in the post-test majority (64%) had adequate knowledge level and (36%) had moderate knowledge level and none had inadequate knowledge level on ear infection, management and its prevention among mothers of under five children. The mean pretest knowledge score of sample’s is 12 with a standard deviation of 2.6 and overall post-test knowledge score of the mothers is 17.86 with a standard deviation of 2.72 and the range of score in post-test is 14 – 21 which is higher than the pre test range of score that is 6 - 17. This shows that knowledge of the mothers on ear infection, management and its prevention in under five children has increased after the administration of structured teaching programme.

 

The findings of the study are consistent with a prospective study was conducted on “comparison among care givers regarding otitis media risk factors knowledge in suburban and urban primary care environments” at USA. The method for collecting the data was the questionnaire. A total of 401 caregivers completed survey with 213 from an urban pediatric practice and 188 from a suburban practice. The study results shown that the suburban population had a significantly greater family history of ear infections where as the urban population had a significantly greater number of smokers in the household and decreased knowledge about day care as a risk for otitis media.⁸

 

Section III: Attitude of mothers regarding ear infection, management and its prevention of under five children

In the pre-test majority (52%) of samples had average attitude level, and (46%) had poor attitude level, and (2%) of samples had good attitude whereas in the post-test majority (56%) of mothers had good attitude level and (44%) of mothers had average attitude level and none had poor attitude level towards ear infection, management and its prevention among under five children. The mean pre-test attitude score of sample’s is 12.72 with a standard deviation of 5.49 and overall post-test attitude score of the mothers is 25.82 with a standard deviation of 6.39. This shows that attitude of the mothers on ear infection, management and its prevention in under five children has increased after the administration of structured teaching programme.

 

A study was conducted to assess the attitudes about otitis media risk factors and implications for prevention” among women in USA. Questionnaires mailed to a systematic sample of 50 women >/=18 years old. According to report, 29 per cent of infants (age 8 to 13 month) had recurrent otitis media (>/=3) and 2 per cent had tympanostomy tubes. 46 per cent attended day care 29 per cent had >/=1 months. Women were more knowledgeable about otitis media sign and symptoms than about risk factors. Mean otitis media knowledge score (the sum of correct true-false responses) was 7.0 (standard deviation = 1.6).⁹     

 

Section IV: Effectiveness of structured teaching programme on knowledge regarding ear infection, management and its prevention among mothers of under five children

The paired ‘t’ test was computed to compare the significant difference between the mean pre-test and post-test knowledge score. The calculated ‘t’ value (t49 = 11.84 p<0.05) indicate that structured teaching programme has helped mothers to improve their knowledge regarding ear infection, management and its prevention of under five children. The whole study showed that structured teaching programme was an effective teaching strategy.

 

The study result showed that the mean percentage of meaning and types of ear infection, causes and risk factors of ear infection, management and its prevention of ear infection in under five children in the pre-test were 54.66%, 48.4% and 47.55% respectively where as in the post-test in all these areas increased to 66.33%, 76% and 77.5% with ‘t’ values 82.48, 195.13 and 60.6 respectively; suggesting that structured teaching programme was effective in increasing the knowledge of mothers on ear infection, management and its prevention.           

 

A Quasi-experimental design was used to evaluate the effectiveness of structured teaching programme on domicillary management and prevention of ear infection among the mothers of under five children at Urban slums at Bengaluru. The sample consist of 60 mothers, 30 in experimental group and 30 in control group and selected by purposive sampling technique. Structured interview schedule is used for data collection and a pretest is administered to both groups. On the same day of the pretest a structured teaching programme was administered to experimental group only. The posttest conducted after the 7^th day with same interview schedule. The study findings revealed that overall mean pretest and post test knowledge score on management and prevention in experimental group was 48.8% and 79.7% with SD of 8.8% and 7.5%. Over all post test mean knowledge score of control and experimental was 49.1% and 79.7%. The obtained ‘t’ value is 16.78 is statistically significant at p<0.05 level. So the study concluded that structured teaching programme is effective in improving the knowledge of the mother.¹⁰

 

Section V: Effectiveness of structured teaching programme on attitude regarding ear infection, management and its prevention among mothers of under five children.

The paired ‘t’ test was computed to compare the significant difference between the mean pre-test and post-test attitude score. The calculated ‘t’ value (t49 = 12.19 p<0.05) indicate that structured teaching programme has helped the mothers to improve their attitude level regarding ear infection, management and its prevention of under five children. The whole study showed that structured teaching programme was an effective teaching strategy.

 

An experimental design was used to evaluate the effectiveness of structured teaching programme on attitude towards ear infection among the mothers of under five children at Urban slums at Mumbai. The sample consist of 80 mothers, 40 in experimental group and 40 in control group and selected by non-probability sampling technique. Structured interview schedule is used for data collection and a pretest is administered to both groups. On the same day of the pretest a structured teaching programme was administered to experimental group only. The post-test conducted after the 7^th day with same interview schedule. The study findings revealed that over all mean pretest and post test attitude score on ear infection in experimental group was 50% and 89.7% with SD of 9.8% and 8.5%. Over all post test mean attitude score of control and experimental was 52% and 90.7%. The obtained ‘t’ value is 17.78 is statistically significant at p<0.05 level. So the study concluded that structured teaching programme is effective in improving the attitude of the mother.¹¹

 

Section VI: Association between post-test knowledge scores of mothers regarding ear infection, management and its prevention of under five children and their selected demographic variables

An association of selected demographic variables in relation to their knowledge was studied using Chi- square test. The Chi- square value was of demographic variables were age (0.09), religion (0.74), type of family (1.2), education (0.50), occupation (0.65), number of children (1.95), income (0.66), previous experience (2.39), previous source (0.01) respectively. These values are higher than 0.05, therefore they have no significant association with pre test knowledge scores at 0.05 level of significance.

A study to discover the association between parental education, socio- economic status, and family type with knowledge regarding ear infection. Care givers of 150 children attended for the interview schedule. Correlations between sociodemographic parameters and knowledge, were studied using Chi-square test of proportions. Over 50% of the population showed knowledge deficits with regard to the various risk factors for otitis media. Care givers from nuclear families were slightly less knowledgeable regarding lack of immunization and household smoke as risk factors for the disease. Educated mothers were more likely than illiterate mothers to clean their children's ears of wax on a regular basis with the belief that it would prevent ear disease (p=0.05). Parents of higher SES were more likely to use home remedies than those of lower SES (p=0.008).¹²

 

Section G :Association between post-test attitude scores of mothers regarding ear infection, management and its prevention of under five children and their selected demographic variables

An association of selected demographic variables in relation to their knowledge was studied using Chi- square test. The Chi- square value was of demographic variables were age (0.08), religion (3.29), type of family (0.07), education (5.8), occupation (0.54), number of children (8.25), income (0.66), previous experience (0.54), previous source (0.21) respectively. These values are higher than 0.05, therefore they have no significant association with pre test knowledge scores at 0.05 level of significance. A study was conducted in Rural areas in Delhi community, to assess the attitude and practices of mothers and also to discover the association between parental education, socio economic status, family type and risk factors of otitis media. Study involved the care givers of two hundered and fifty children selected by cluster sampling. Data collected by questionnaire. Statistical analysis done through chi-square test proportions. Study reveals that 60% of the population showed poor attitude with regards to the various risk factors. There was no co-relation between any of the socio-demographic factors and attitudes.¹³

 

NURSING IMPLICATIONS:

The present study was conducted to evaluate the effectiveness of structured teaching programme on knowledge and attitude of mothers regarding ear infection, management and its prevention of under five children. The findings of the study have implications in the following areas: Nursing Education, Nursing Practice, Nursing Administration, Nursing Research

 

 

Nursing Education

Helps the nurse educators:

§  To enhance the knowledge of the students.

§  Planning the awareness in clinical teaching as well as in the hospitals.

§  Structured teaching programme can be used as a teaching tool.

Helps the students:

§  To be motivated

§  To increase the knowledge

 

Nursing Administration

Nurse administrators:

§  Organizing and conducting education programmes.

§  Prepare appropriate instructional materials and train the personnel in preparing the materials.

§  Teach the subordinates and ask them to teach the community by using structured teaching programme.

 

Nursing Research

§  Research enables the nurses to build on existing knowledge.

§  Extensive research studies can be undertaken in different fields.

§  Helps for the future research.

§  Helps the nurse to plan, implement and evaluate the structured teaching programme.

 

Nursing practice

§  Educating the mothers.

§  Conduct training programmes and health education.

§  Demonstrate the application of instilling medicines          

LIMITATIONS OF THE PRESENT STUDY:

1.    The study was confined to small number of subjects about 50 mothers and was selected by non- probability sampling technique, in a selected rural area, which limits the generalization of findings.

2.    A structured knowledge and attitude questionnaire was prepared for data collection, which restricts the amount of information that can be obtained from the respondents.

3.    No attempt was made to follow up of mothers.

4.    The study lacked control group that did not receive any specific teaching to allow the researcher to test the increase on mothers knowledge and attitude without structured teaching programme.

 

RECOMMENDATIONS:

1.    A similar study can be replicated on a larger sample with different demographic characters.

2.    An experimental study can be under taken with control group.

3.    A Similar study can be conducted using other strategies like SIM, booklets and pamphlets.

4.    Teaching and demonstration regarding preventive measures and management of ear infection can be given to the mothers.

5.    A comparative study can be carried out to assess the knowledge of mothers residing in rural and urban areas regarding ear infection, management and its prevention.

6.    A follow up study need to be conducted to find out the effectiveness terms of retention of knowledge among mothers and to re-in force health promotion.

 

CONCLUSION:

The structured teaching programme has been effective to increase knowledge and change attitude levels of mothers regarding management and prevention of ear infection in under five children.

 

REFERENCES:

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2.     Otitis Media – NHS Choices.[serial online] 2006 [cited 2013 Dec 10]; Available from: URL: http://www.nhs.uk/conditions/otitis-media/pages/ introduction. asp

3.     Lorenzo M, Luca R, Federic M, Marcella M, Liza VB, Alessandro B, et al.Burden of disease caused by otitis media systemic review and global estimation. [serial online] 2000 [cited 2013 Aug 12]; Available from:  URL:http://www.ncbi.n/m.nih.gov/pmc/article/pmc3340347

4.     Kangsanarak J, Fooanant S, Ruckphaopunt K. Extracranial and Intracranial Complications of Suppurative Otitis Media. J Laryngol Otol. 1993 Nov; 107(11):999-1004.

5.     Children in India 2012 A statistical Appraisals. [serial online] 2002 Sep [cited 2013 Oct 10];Availablefrom:URL:http://www.mospi.nic.in/mospi-new/upload/children-in-India-2012.pdf

6.     Higgins, PA and Moore, SM: Levels Of Theoretical Thinking In Nursing, Nursing Outlook. [serial online] 2010 August [cited 2013 Sep 24] Available from: URL:https://www.google.co.in/#q=theoretical+frame+work+nursing+research.

7.     Silverman LK. Invisible gifts invisible handicaps. [serial online] 2007 March 15 [cited 2014 sep 24] Available from: URL:http://www.gifteddevelopment.com /Articles/ visual spatial/v55.pdf.

8.     Kerschner JE, Lindstrom DR. Comparision of care giver otitis media risk factor knowledge in sub urban and urban primary care environments. 2005 January; 69 (1): 49-56.

9.     Daly KA, Selvius RE. Knowledge and attitude about otitis media: implications for prevention.1997 Dec; 100(6): 931-6.

10.  Sachin M. Effectiveness of Structured Teaching Programe On Knowledge of Mothers of Under Five Children on Domicillary Management and Prevention of Ear Infection. New Delhi [serial online]. 2006 Feb [cited 2014 nov.16]; Availablefrom:URL:https://www.google.co.in/#q=knowledge+of+mothers+ regarding+ear+ infection+managementandprevention.

11.  Yuan JF, Anja MH, Gregory LA. Effectiveness of Structured Teaching Programe On Attitudeof Mothers of Under Five Children on Ear Infection [serial online] 2003 Nov 8 [cited 2010 Sep 24]; 8(327): [7423]. Available from: URL:http://www.10.1136bmj.327.7423.1075

12.  Srikanth S, Isaac R, Rebekah G, Rupa V. Knowledge, attitudes and Practices with respect to risk factors for otitis media in a Rural South Indian Community. 2009 Oct; 73(10):1394-8.

13.  Mark S, Glynis R, Mark A. Attitudes and Practices in Relation with Ear Infection [serial online]. 2010 March [cited 2013 November16]; 3(3): [29–34]. Available from: URL:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921743/

 

 

 

 

 

 

Received on 19.03.2016           Modified on 08.04.2016

Accepted on 28.04.2016           © A&V Publication all right reserved

Int. J. Adv. Nur. Management. 2016; 4(3): 282-294.