INTRODUCTION:
“Acting is the physical representation of a mental
picture and the projection of an emotional concept.”
Laurete Taylor
“Good attitudes
are magnets for good news, seen it proven a hundred times”. A mental disorder
or mental illness is a psychological or behavioural pattern generally
associated with subjective distress or disability that occurs in an individual,
and which is not a part of normal development or culture.1
“Health is a
state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity”. A sound mind in a sound body has been
recognized as a social ideal for many centuries. The Indian sages and seers had
paid particular attention to the unconscious, wherein lay the suppressed
unfulfilled desires and compulsions of several kinds which led the individual
astray; by mastering their minds, they attained the highest level of emotional
equilibrium.2
“Mental illness
is a mental and behavioral disorders are understood as clinically significant
conditions characterized by alterations in thinking, mood (emotions) or
behavior associated with personal distress and or impaired functioning”. Mental
illness is maladjustment in living. It produces a disharmony in the person’s
ability to meet human needs comfortably or effectively and function within a
culture.3
A universal concept of mental illness is difficult,
because of the cultural factors that influence such a definition. However,
certain elements are associated with individual’s perceptions of mental
illness, regardless of cultural origin.4
The public view towards mental illness has been
considered as negative, stigmatized, uninformed and fearful entity right from
the ancient time till date which varies according to age, race, ethnicity,
religion, culture, tradition, and education of the different community.5
Mental illness stigma means “devaluing, disgracing,
and disfavoring by the general public of individuals with mental illness”. The
concept of ‘stigma’ is a combination of three related problems: a lack of
knowledge (ignorance and misinformation); negative attitude (prejudice); and
excluding or avoiding behaviors (discrimination). This discrimination results
in increased social distance: the distance people desire to have between
themselves and people with mental disorders in various social situations.
Self-stigma, which involves internalization of these negative attitudes,
further compounds these effects. Stigmatization of people with mental disorders
is common wherever it has been studied, and it is clear that these processes
present formidable barriers both to social inclusion for affected people and
their families, and to proper access to mental health care. In order to
understand the stigma on mental health service utilization in India, it is
essential to understand the issues related to stigma in the relevant cultural context.6
In rural areas of India, many villagers still believe
mental illness is caused by evil spirits that the sick person had killed a cow
during a past life. In today’s fast-paced life, stress persecutes each one of
us. A worry over not having delivered his best in the exam. A teenager, not as
well-off as his other friends, tries hard to combat peer pressure. No-one like
to talk about mental illness, not one of them would approach a mental health
practitioner for their issues because each one of them believes doing so will
make people believe that they are creating mountains out of mole-holes. So, we
can say with certainty that stigma surrounding mental health is still present
and wish to reduce it with more concern about mental illness with education, we
can blame westernization for the rise of mental health issues, but it does not
change the fact that our society is in a state of constant flux, and we are not
going back to the old ways.7
The first step has already been taken by a courageous
few who have brought the issue of mental health in the limelight, but it is up
to us now to walk the rest of the path. We need to bring about a shift in our
attitude and develop a more open mind-set on mental health, In the past, many
of us lost the battle against mental illness by letting our fears get the
better of us. Since then, we have become experts in pushing our issues away and
some of us have even failed to acknowledge their existence. To reduce the
stigma around mental health, we need to start with ourselves to educate the
people especially young generation to identify concern and stop judging the
inner voice inside our head that begs us to speak to someone.7
NEED FOR THE STUDY:
Mental health problems and prejudiced attitudes toward
mental illness have common risk factors. The school is a central place for
adolescent, social interactions and an important setting for promoting pupils’
health and well-being. The importance is associated with the opportunity to
promote mental health through the school. Adolescent mental health disorders are present in
around 10% of the population. Research indicates that many young people possess
negative attitudes towards mental health difficulties among peers.9
School communities give teachers and administrators
important opportunities to share information and work with parents and
families. With their concentrations of children and trained caregivers, schools
are an ideal place to leverage evidence-based mental health knowledge and make
a transformative impact on the mental health landscape of this country. 9
A co-relation descriptive study is conducted on to
assess the knowledge and attitude of school students towards mental illness of
selected school of Amritsar, Panjab. The aim of study was to reduce stigma and
examined the prevalence of stigmatizing attitude and the factors associated
with stigmatizing of school going students with mental disorders. 100 sample
were selected from school. Probability purposive sampling technique was used
for data collection. Data was collected by self-structured Likert scale for
knowledge and attitude towards mental illness. The study result revealed that
majority (37%) of students have knowledge followed by 35%who were having poor
knowledge, 28% were having good knowledge and majority (56%) of students have
negative attitude, followed by 44% who were having positive attitude
Coefficient correlation was 0.52 concluded that knowledge and attitude towards
mental illness among school students have positive correlation. The study
concluded that there was no significant association between gender whereas
stream of education and area of residence is associated with knowledge and
attitude towards mental illnesses of school students. 10
An epidemiological study on psychiatric
morbidity in India showed that the prevalence rate of all mental disorder was
65.4% per 1000 population. The urban morbidity rates were 2 per 1000 higher
than the rural morbidity rate. A study on screening for psychiatric disorder in
adult population reported 39% of the adult population had mental illness.
Proportion of psychiatric morbidity among males and females was 36.2% and 42.2%
respectively.8
Researcher thought through mental health
education, educational training programs, provision of promotion of mental
health and encourage more concern regarding uses of mental health services we
can improve the mental health of people, reduce the mental illness and related
stigma, students as well as people false beliefs and change people’s attitude.
As the young children are the future of next generation, they must be smart and
with perfect knowledge. If they are educated regarding mental health and mental
illness they can handle their life more gracefully, will solve their problems
more tactfully and also educate family members and society. With the provision
of mental health education, we can change their attitudes and discrimination.
Also, they can know various types of mental disorders, so that they can inform
at exact time and will take help from respected sources. So, researcher felt to
take this research for the study.
PROBLEM STATEMENT:
Assessment of effectiveness of planned
teaching about knowledge and attitude of students towards person suffering from
mental illness; in selected school.
OBJECTIVES OF THE STUDY:
1. To assess the level of knowledge among
students towards mentally ill person.
2. To assess the level of attitude among
students towards mentally ill person.
3. To assess the effectiveness of planned
teaching on level of knowledge and attitude among students towards mentally ill
person.
4. To find out association between knowledge
among students towards mentally ill person with their selected demographic
variables.
5. To find out association between attitude
among students towards mentally ill person with their selected demographic variables.
HYPOTHESIS
H0: There is no significant difference between the
knowledge and attitude of students towards person suffering from mental illness
after planned teaching measures at p<0.05 level of significance.
H1: There is significant difference between the pre-test
and post-test knowledge and attitude of students towards person suffering from
mental illness after planned teaching measure at p<0.05 level of
significance.
LIMITATIONS:
·
The study was limited
to those students only who were readily aware in the selected school.
·
Non-probability
convenient sampling was done which restrict the generalization in the study.
ETHCAL ASPECT:
1. Approval from institutional ethical
committee was taken.
2. Prior permission from school authorities
was be taken.
3. Informed consent of the subjects was taken
prior to the study.
CONCEPTUAL FRAMEWORK:
Good research usually integrates research
findings into an orderly, coherent system. Such integration typically involves
linking research and existing knowledge through review of prior research on the
topic and by identifying or developing an appropriate conceptual framework.
The theoretical framework of the study is based upon
Imogene King Goal attainment theory. The major elements of the theory of goal
attainment are seen in the interpersonal system in which two people, who are
usually stranger, come together in a health care organization to help and be
helped to maintain a state of health that permits functioning in roles.” The
theory’s focus on interpersonal system reflects Kings belief that the practice
of nursing is differentiated from that of other health professions by what
nurses do with and for individuals. Each of the individuals involved in an
interaction brings different ideas, attitude and perceptions to the exchange. The
individuals come together for a purpose and perceive each other; each makes a
judgment and takes mental action or decide to act. Then each reacts to the
other and to the situation (perception, judgment, action, reaction).
According to this theory the importance of mutual
participation in interaction that focuses on the needs and welfare of the
client and of verifying perceptions while planning and activities to achieves
goals are carried out together.
SUMMARY:
The chapter deals with the analysis of the data and
its interpretation using descriptive and inferential statistics. All relevant
information regarding research findings has been covered in this chapter.
MAJOR FINDINGS OF THE STUDY:
Section I- Data on demographic variables among
mentally ill person.
Demographic variables of the present study show, out
of 50 subjects, 20 (40%) were of 13-14-year age group and 30 (60%) subjects
were of 15-16 year in age group.
22 (44%) subjects were male and most of the subjects
were female that is 28 (56%).
Out of 50 subjects most of was belonged to Hindu
religion that was 24 (48%), Muslim religion that was 8 (16%) subjects and 18
(36%) subjects belonged to Buddhist religion.
In education status of subject’s father1 (2%) was
illiterate 5 (10%) had primary school education, 36 (72%) had higher secondary
education and only 8 (16%) had education up to graduation
In education status of mother most of subjects’ mother
had higher school education 37 (74%) then 7 (14%) had up to graduation
education then 5 (10%) had primary school education and 1 (2%) had illiterate.
Most of the subjects belonged to nuclear family 30
(60%), to joint family were 19 (38%) and only 1 (2%) was to extended family.
Most of the subjects got information from school that
is 37 (74%) remaining 13 (26%) got information from mass media.
Section II- Assessment of knowledge among students
towards mentally ill person.
The findings show that,
In pre-test 49 (98%) subjects had poor knowledge
(1-15) only 1 (2%) subject had satisfactory knowledge (16-23) related to mental
illness, nobody has good knowledge.
In post-test, out of 50 subjects 20 (40%) subjects had
satisfactory knowledge (1-15) whereas 30 (60%) subjects had good knowledge
(24-30) related to mental illness.
Section III- Assessment of attitude among students
towards mentally ill person.
The findings show that,
In pre-test, 37 (74%) subjects had unfavorable
attitude (<50%) and very few subjects 13(26%) had moderately favorable
attitude (51-75%).
In post-test 38 (76%) subjects developed moderately
favorable attitude (51-75%) whereas 12 (24%) subjects developed favorable
attitude (>75%) towards mentally ill person.
Section IV- Effectiveness of planned teaching on
knowledge and attitude among students towards mentally ill person.
The mean pre-test knowledge score was 9.06 with the
standard deviation of 2.39whereas in post-test it was 23.68 with the standard
deviation of 2.20.
The mean difference in pre-test and post-test
knowledge scores was 14.62. The calculated ‘t’ value was 40.375. It shows that
the calculated ‘t’ value was much higher than the tabulated value 2.01.
It shows that there was a significant improvement in
the knowledge of students towards mentally ill person after planned teaching.
The mean post-test attitude score was 47.92 with the
standard deviation 5.75 whereas in post-test it was 68.52 with the standard
deviation 6.744.
The mean difference in pre-test and post-test attitude
scores was 20.5. The calculated ‘t’ value was 26.74 whereas the tabulated value
is 2.01, It show that calculated ‘t’ value is much higher than tabulated ‘t’
value.
It shows that planned teaching was effective in
improving student’s attitude towards mentally ill person.
Thus the null hypothesis (H0), “There
is no significant difference between the knowledge and attitude of students
towards person suffering from mental illness after planned teaching measures at
p< 0.05 level of significance” is rejected and research hypothesis(H1),
“There is significant difference between the pre-test and post-test knowledge
and attitude of students towards person suffering from mental illness after
planned teaching measure at p< 0.05 level of significance”, is accepted.
Section V- Association between the knowledge among students
towards mentally ill person with their selected demographic variables.
The calculated chi square value of the knowledge in
association to age was 0.02 which was low than the tabulated value at df= 1 at
p<0.05, so knowledge was not significantly associated with age.
Calculated chi square value for gender was 0.016,
which was less than the tabulated value at df=1 at p<0.05, so knowledge is
not significantly to gender.
Calculated chi square value for religion was 0.026,
which was less than the tabulated value at df= 2 at p<0.05, so knowledge is
not significantly associated to religion.
The calculated chi square value for education status
of father was 0.004, which was less than tabulated value at df= 3 at p<0.05,
so knowledge is not significantly associated to education status of father.
The calculate chi square value for education status of
mother was 0.0034, which was less than tabulated value at df= 3 at p<0.05,
so knowledge was not significantly associated to education status of mother.
The calculated chi square for type of family was
0.012, which was less than tabulated value at df= 2 at p<0.05, so knowledge
is not significantly associated to type of family.
The calculated chi square for source of information
was 0.0048, which was less than tabulated value at df= 1 at p<0.05, so
knowledge was not significantly associated with source of information.
Section VI- Association between the attitude among
students towards mentally ill person with their selected demographic variables.
The calculated chi square value for age in year was
0.0032 which was less than the tabulated value at df= 1 at p<0.05, so
attitude was not associated with age in year.
The calculated chi square value for gender was 0.516
which was less than tabulated value at df= 1 at p<0.05, so attitude was not
associated with gender.
The calculated chi square value for religion was
0.2026 which was less than tabulated value at df= 2 at p<0.05, so attitude
was not associated with religion.
The calculated chi square value for education status
of father was 0.0155 which was less than tabulated value at df= 3 at p<0.05,
so attitude was not associated with education status of father.
The calculated value for education status of mother
was 0.0046 which is less than tabulated value at df= 3 at p<0.05, so
attitude was not associated with education status of mother.
The calculated value for type of family was 0.574
which is less than tabulated value at df= 2 at p<0.05, so attitude was not
associated with type of family.
The calculated value for source of information was
0.209 which is less than tabulated value at df= 1 at p<0.05, so attitude was
not associated with source of information.
DISCUSSION:
The basic aim of the current study was to evaluate the
effectiveness of planned teaching about knowledge and attitude of students
towards person suffering from mental illness; in selected school. The study had
been conducted by using Quasi-experimental design at selected school. The total
sample size was 50.
The structured questionnaire was administered to
assess knowledge level of students towards mentally ill person and attitude
assessed by 4 point Likert scale. The response was analyzed through descriptive
statistics (mean, frequency, percentage) and inferential statistics (paired ‘t’
test and Chi-square).
The findings of the study were discussed to the
objectives to assess level of knowledge among students towards mentally ill
person. Mean pre-test score 9.06 and 23.68 for post-test whereas standard
deviation 2.39 was more than post-test 2.2047.
Second objective of the present study was to assess
the level of attitude among students towards mentally ill person. The mean
pre-test attitude score was 47.92 with the standard deviation 5.75 whereas in
post-test it was 68.52 with the standard deviation 6.744.
The third objective was to assess the effectiveness of
planned teaching of planned teaching on level of knowledge and attitude among
students towards mentally ill person. Mean difference was pre-test and
post-test attitude for knowledge was 14.62 and ‘t’ value was 40.375 which was
more than tabulated value. Attitude mean difference scores was 20.5
respectively. Calculated ‘t’ value was 40.375 for knowledge and 26.74 foe
attitude whereas the tabulated value was 2.01, It showed that calculated ‘t’
value is much higher than tabulated ‘t’ value. It showed that planned teaching
was effective in improving student’s attitude towards mentally ill person.
Fourth objective of present study was to find out
association between knowledge among students towards mentally ill person with
their selected demographic variables. (Age in year, gender, religion, education
status of father, education status of mother, type of family and source of
information). The results showed there was no significantly association between
knowledge with their selected demographic variable.
Fifth objective of present study was to find out
association between attitude among students towards mentally ill person with
their selected demographic variables. The result showed there was not
significantly association between attitude with their selected demographic
variables,
Thus the null hypothesis (H0), “There
is no significant difference between the knowledge and attitude of students
towards person suffering from mental illness after planned teaching measures at
p< 0.05 level of significance” is rejected and research hypothesis(H1),
“There is significant difference between the pre-test and post-test knowledge
and attitude of students towards person suffering from mental illness after
planned teaching measure at p< 0.05 level of significance”, is accepted.
IMPLICATIONS OF THE STUDY:
The findings of the present study have implications
not only in the field of nursing but also in the allied areas. The information
obtained could be utilized by the curriculum planners, education and
administrators in order to integrate mental illness planned teaching into the
educational as well as training programs for mental illness remains as a
national priority and major problems in India as Indian people have stigma and
unfavorable attitude towards mentally ill person. The findings of the study may
be helpful for the future studies.
Nursing Services
· Regular health education program should be
carried out by hospital nurse in school area, society area, health canters,
especially in village areas where stigma and unfavourable attitude towards
mentally ill person.
· The mental health educator can assess need
of the students, community people regarding various aspects of mental illness
and provide more services for health check-up, admission knowledge, encourage
to take advantage of health services through camps and educational program at
village level.
· Provide healthy environment to school
areas, in family as well as all communities to avoid mental illness and related
complication as India will suffer related major mental illness by year 2020 if
we cannot provide mental health knowledge to people.
· Organize mental health teaching planned
camps to identify mental illness sign and symptoms, types of diseases and treatment
for child to elderly people.
· Mental health nurses can suggest and
organize the planned teaching to follow healthy life style measure, yoga,
exercise, stress management which will promote healthy mental life.
· Mass health education campaigns should be regularly
carried out by the health teams to provide education on mental illness and
related preventive measures.
Nursing Education
Health personnel may ignore theory and practice while
interacting with students to gain knowledge and assess their attitude towards
person with mentally ill. So, nursing educator should motivate students to:
· Ensure that nursing students learned to
reduce stigma and gain knowledge regarding various type of mental illness.
· Nursing educators need to lay emphasis on
mental illness which should include- warning signs of mental illness,
aetiology, types of mental illness, signs and symptoms of mental illness,
admission and discharge procedure and preventive measure aspects.
· Nurse educators need to lay emphasis on
mental illness which should include- teacher should teach regarding the various
aspect of mental illness using creative Audio and visual aids like poster, flip
chart, power point presentation and the actual devices so that they can educate
the students in schools, colleges and community people by motivating them
through awareness programmed to people towards mental illness.
· Provide adequate exposure to students where
mental persons treated like mental hospital.
· Conducting in services education program
for nurses, school teachers, health personnel’s, non-medical and para-medical
students on mental illness.
Nursing Administration
· Nurse administrators should take the
initiative in organizing education planned teaching, education programs for all
hospital workers regarding various aspects of mental illness so that they can
easily identify mentally ill people and provide preventive measures at primary
level.
· Appropriate teaching and learning material
needs to be prepared and made available for nurses.
· Helping in early identification of mental
symptoms of people from other setting by providing proper tools and aids.
· Provide opportunity for nurses to attend
training programme on mental illness.
Nursing Research
· Nursing research should be conducted to
assess the knowledge and attitude of students towards person suffering from
mental illness and need to find out related problems even in psychiatry have
all aspects to treatment.
· Develop health education planned related to
mental illness for students to improve knowledge and develop favourable
attitude towards mentally ill person.
· More research will have needed on promotion
on mental health and preventive measures at early level at home remedies in
routine life style from child to elderly people. It can help in findings to all
mentally healthy and unhealthy individual’s better alternatives for at crisis
phases and at the time of when they are on risk of becoming victim of mentally
ill.
· Disseminate findings through the
conference, seminars publication in professional, national and international
journals and World Wide Web.
LIMITATION:
· The study was limited to those students
only who were readily available in the selected school.
· Non-probability convenient sampling was
done which restrict the generalized in the study.
RECOMMENDATIONS:
· The study can be replicated on small
sample; and on various setting so that findings can be generalize to a large
population.
· Formal education program should be
organized in all primary schools, colleges and at primary health centre.
· Such studies can be carried out using other
teaching strategies like education program, e-learning, self-instruction module
and computer assisted instruction on mental illness.
· Comparative studies can be conducted to
ascertain the knowledge and attitude of mental illness among rural and urban
people, primary care givers and all faculty of students.
· The study can be replicated with large
sample size.
· The study can be conducted on family
members.
CONCLUSION:
After the detailed analysis, this study leads to the
following conclusion.
Planned teaching on mental illness was found to be
effectiveness in improving the knowledge and attitude of school students.
Students of selected school had a significant gain in knowledge and improvement
in attitude regarding mental illness.
Association was not found between age in year, gender,
religion, education status of father, mother, type of family, source of
information about mental illness.
Based on the above findings, it was concluded
undoubtedly that the written prepared material by the investigator in the form
of planned teaching helped students to improve their knowledge and develop
favorable attitude towards mentally ill person.
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RESEARCH METHODLOGY:
