INTRODUCTION:

Children's mental disorders affect many children and families. Boys and girls of all ages, ethnic/racial backgrounds, and regions of the United States experience mental disorders.

Based on the National Research Council and Institute of Medicine report (Preventing mental, emotional, and behavioural disorders among young people: progress and possibilities, 2009) that gathered findings from previous studies, it is estimated that 13 –20 percent of children living in the United States (up to 1 out of 5 children) experience a mental disorder in a given year and an estimated $247 billion is spent each year on childhood mental disorders. Because of the impact on children, families, and communities, children's mental disorders are an important public health issue in the United States.

Identifying mental disorders in children can be tricky for health care providers. Children differ from adults in that they experience many physical, mental, and emotional changes as they progress through their natural growth and development. They also are in the process of learning how to cope with, adapt, and relate to others and the world around them.

Furthermore, each child matures at his or her own pace, and what is considered "normal" in children falls within a wide range of behaviour and abilities. For these reasons, any diagnosis of a mental disorder must consider how well a child functions at home, within the family, at school, and with peers, as well as the child's age and symptoms.

Under the ICDS scheme, one trained person is allotted to a population of 1000, to bridge the gap between the person and organized healthcare, and to focus on the health and educational needs of children aged 0-6 years. That person is Anganwadi worker. Today in India, about 2 million anganwadi workers are reaching out to a population of 70 million women, children and sick people, helping them become and stay healthy. Anganwadi workers are the most important and oft-ignored essential link of Indian healthcare.

NEED FOR THE STUDY:

Prevalence of mental disorders among children has been reported to be 14-20% in various studies. According to World Health Report 2000, 20% of children and adolescents suffer from a disabling mental illness worldwide and suicide is the third leading cause of death among adolescents. The issue of childhood psychiatric morbidity is more serious in middle and low income countries because these countries have a much larger proportion of child and adolescent population; much lower levels of health indices; poorer infrastructure and resources to deal with problems.

In recent years, there have been several population studies giving fairly reasonable estimates on the prevalence of child and adolescent mental disorders (CAMD) in low and middle income countries. Reported rates are 17.7% in 1-15 yrs old in Ethopia; 15% among 5-10 yrs olds of Bangladesh; 12.7% in 7-14 yrs olds urban Brazilian school sample and 7% in 7-14 yrs rural Brazilian school and 6.9% in 4-17 yrs. Puerto Rican community based sample. Studies from India have revealed the prevalence rates to be 12.5% in 0-16 yrs community based sample from Bangalore; 9.4% in 8-12 yrs olds from a community sample in Kerala and 6.3% in 4-11 yrs old school children in Chandigarh. Overall rates of CAMD in India and other middle and low income countries range between 6%-15% which are on the lower side as compared to reported rates from certain western countries such as Canada 18.1%, Germany 20.7%, Switzerland 22.5%, USA 21%. It is also known that many more children have problems that can be considered “sub threshold” since these may not meet the diagnostic criteria.

In 1975, Indian government initiated Integrated Child Development Service (ICDS) scheme to check maternal and child malnutrition and ill-health and it emerged as one of the world’s largest program for early childhood development. Under the program, a trained female known as Anganwadi (Courtyard) Worker (AWW) along with an assistant (Anganwadi helper-AWH), worked in an Anganwadi Centre (AWC), each catering to fixed numbers of community members based on certain predetermined criteria. Together, they were responsible for bridging the service utilization gap between the vulnerable groups and healthcare system. One of the objective of the program was to monitor the mental health status of the children below 6 years, by doing proper mental status assessment; laying the foundation for proper psychological, physical and social development of the child through preschool education; reducing the incidence of mental disease burden through proper referral; and enhancing the capacity of mothers to take care of themselves as well as their children through health education.

There are 100 child guidance clinics across nation. The largest service for children is provided at NIMHANS, Bangalore. This centre caters to nearly 1000 mentally retarded and 800 child psychiatric cases a year. It has 4 psychiatrists, 3 clinical psychologists, 2 psychiatric social workers and 5 nurses. It offers 3 months training in child mental health at post graduate level, there is little commitment a serious of concern about the child mental health. There is no available survey of the facilities offered in the so called 100 or so child mental health services across the country, but anecdotal information is that the services are poorly manned and more often than not headed by people who have little training in child psychiatry. This reveals the lack of health care professionals and infrastructure to cater to the needs of these children. Therefore anganwadi workers who are already taking care of the toddlers and pre-schoolers become the available alternative. Therefore she should be adequately trained in early detection of psychiatric disorders and promotion of mental health among this age group.

STATEMENT OF THE PROBLEM:

A pre experimental study to evaluate the effectiveness of structured teaching program on knowledge regarding Mental Health and its problems in children among Anganwadi Workers in selected villages of district Sonipat, Haryana

OBJECTIVES OF THE STUDY:

To assess the pre-test and post-test knowledge regarding mental health and its problems in children among anganwadi workers

To evaluate the effectiveness of structured teaching program regarding mental health and its problems in children among anganwadi workers

To find out association between pre-test knowledge of anganwadi workers regarding mental health and its problems in children with their selected demographic variables

OPERATIONAL DEFINITION:

Effectiveness:

It refers to the extent to which structured teaching program has achieved the desire effect in improving the knowledge regarding mental health and its problems in children among anganwadi workers.

Structured teaching program:

Referred to systematically planned and formulated teaching program designed to provide information about mental health and its problems in children among anganwadi workers.

Knowledge:

It refers to the level of understanding, awareness and ability of anganwadi workers regarding mental health and its problems in children.

Mental health:

Mental health is a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

Anganwadi worker:

CONCEPTUAL FRAMEWORK:

For the present study the conceptual frame work was selected based on the open system model. Bertlanffy and J, W Kenny’s model was adopted. Systems theory may be considered as a specialization of systems thinking and a generalization of systems science. First proposed by Ludwig von Bertalanffy (1901-1972) as General Systems theory. General systems theory is a general science of 'wholeness'. Systems theory has been applied in developing nursing theories and conducting nursing research.

METHODOLOGY:

The methodology employed in the present study comprises of the research design, setting, sample and sampling techniques, tool for data collection, data collection procedure and procedure for data analysis.

Research Design:

Research design used for this study is One group Pre-test and Post-Test Design

Where:

O1 – Pre – test

X – Structured Teaching Programme program on knowledge regarding Mental Health and its problems in children.

O2 – Post – test

Setting:

The study was conducted at Gohana block of Sonipat, Haryana. This block was situated around 25 KM away from the Ved Nursing College, Baroli. Panipat. In Gohana block there are 6 circles (Rukhi, Lath, SP Majra, Khanpur, Bhainswal, and Gohana urban). There were 26 Anganwadi Workers in each circle. In present study the researcher selected 3 circles (Rukhi, Lath, and Bhainswal) from Gohana block.

Sample:

Sample for the present study was the Anganwadi worker’s working in Gohana, Block. Sonipat District. Haryana. Who will meet the inclusion criteria.

Criteria for sample selection:

Inclusion Criteria:

1. Anganwadi Workers who are working in the Gohana block.

2. Anganwadi workers who will be present during data collection period.

3. Anganwadi Workers who can read and write Hindi language.

Exclusion Criteria:

1. The Anganwadi Workers who are not present during data collection period.

2. The Anganwadi Workers who are not interested to participate in the study.

Sampling technique:

For the present study, the researcher selected Non – Probability sampling method. Consecutive sampling technique was used to select samples.

Sample size:

Sample size for the current study was 60 anganwadi workers.

Tool for Data Collection:

For the current study the researcher developed knowledge questionnaire on Mental Health and its problems in children. this tool consist of three sections.

Section – A: Demographic variables.

Section – B: Structured knowledge questionnaire on Mental Health and its problems in children.

Section – C: Scoring and Interpretations.

Validity and Reliability of the Tool:

Before collecting the study the tool is validated from three experts in psychiatric nursing and two from community health nursing. The reliability of the tool was done by means of test – retest method. The Karl Pearson Coefficient of correlation method was used to find out the reliability score. It was found to be 0.87. This shows that the tool is highly reliable.

Pilot Study:

Pilot study was conducted in Anganwadi Centre, Village Dhanana, Kathura block, Sonipat in the month of February 2018. After obtaining permission from the Child Development and Project Officer, the study was found to be feasible at the end of the pilot study.

Data Collection Procedure:

Data collection period was for 4 weeks. The researcher went to the Women and Child Development Office of Gohana block in mini secretariat of Gohana in the month of February 2018 and assembled the anganwadi workers of Gohana block and introduced herself, about the data collection procedure and purpose of it. Data were collected by means of self-reporting questionnaire method. The samples were divided in three groups (one group contains 20 anganwadi workers).and collected data.

At 1^st day researcher had taken the pre-test to assess the knowledge regarding mental health and its problems in children. Followed by this structured teaching programme on mental health and its problems in children were given. Each session lasts for one hour. Post test was conducted on 7^th day in a similar way of the pre-test as like the method implemented for collecting pre – test score.

Data Analysis:

The collected data were analysed through descriptive and inferential statistics.

DATA ANALYSIS AND INTERPRETATION:

The analysed data were interpreted according to the objectives of the study and it was explained below in detail under various sections.

Section –I: Distribution of samples according to socio – demographic variables.

From the table – 1 it was understood majority of the samples 21 (35.00%) were in age 36 – 45 years. Education of the samples shows majority 41 (68.34% had secondary level of education. Little above three fourth of the samples 46 (76.66%) were married. Majority of the samples 25 (41.67%) had more than two children. with regard to experience majority 36 (60%) of the samples had more than 10 years of experience. An overwhelming majority of the samples 52 (86.67%) had previous knowledge regarding mental health problems among children from books and magazines.

Table I: Frequency and Percentage Distribution of Samples According to Socio – Demographic Variables. (n = 60)

S. No

Demographic Variable

Frequency

(f)

Percentage

(%)

Age (Years)

a. 25 – 35

b. 36- 45

c. 46 – 55

d. 56 - 60

20.00

35.00

33.33

11.67

Educational Status

a. Secondary

b. Senior – Secondary

c. Diploma

68.34

23.33

08.33

Marital Status

a. Married

b. Divorced / Separated

c. Widow

76.66

8.34

15.00

Number of Children

a. One

b. Two

c. More than two

18.33

40.00

41.67

Year of Experience

a. Less than 5 years

b. 5 – 10 years

c. More than 10 years

15.00

25.00

60.00

Source of Information

a. Mass Media

b. Books / Magazines

c. Peer Groups

11.66

86.67

01.67

Section – II of the study discusses the pre and post – test level of knowledge regarding mental health and its problems in children.

Table II: Frequency and Percentage Distribution of Samples According to Pre - Test and Post – Test Level of Knowledge (N=60)

S. No	Level of Knowledge	Pre – Test f (%)	Post – Tes f (%) t
1.	Inadequate Knowledge	35 (58.33)	0 (0)
2.	Moderate Knowledge	23 (38.33)	7 (11.7)
3.	Adequate Knowledge	2 (3.34)	53 (88.3)

From the table – II it was understood that during pre – test majority of the samples 35 (58.33%) had inadequate level of knowledge and in post – test there was an overwhelming majority of the sample had adequate level of knowledge 53 (88.3%).

Section – III of the present study discusses the effectiveness of structured teaching programme regarding mental health and its problems in children among anganwadi workers

Figure 2: Percentage Distribution of Samples According to Pre – test and Post – Test Level of Knowledge

Table III: Mean, Mean Difference, Standard Deviation and ‘t’ value of samples (N = 60)

Test

Mean

Mean Difference

Standard Deviation

‘t’ value

‘P’ value

Pre-Test

13.28

20.03

3.67

22.02

(df=59)

0.00*

Post-Test

33.31

5.33

From Table – III it was found the Mean Pre-Test score was 13, 28 and mean Post-Test score was 33.31. the mean difference was 20.03. the pre-test standard deviation score was 3.67 and the post-test standard deviation score was 5.33. the ‘t’ test value was 22.02 for the degree of freedom 59. The ‘P’ value was 0.00 which was less than 0.05 level. So the null hypothesis was rejected and alternate hypothesis was accepted i.e. the structured teaching program was effective.

Section – IV shows the level of assertion between pre-test knowledge and selected sociodemographic variables

From the Table – IV it was interpreted that there was a statistically significant association between pre – test knowledge and age, the chi-square value for age is 11.21 and the ‘P’ value was 0.04 this value was less than the ‘P’ value of 0.05. Hence we reject the null hypothesis and accept the alternate hypothesis, i.e. There was a significant association between pre – test knowledge and age of the samples.

Table – IV: Level of Association between Pre – Test Knowledge and Selected Socio – Demographic Variables (N = 60)

S. No

Demographic Variables

Level of Knowledge

χ 2 Value

‘P’ Value

Inadequate

Moderate

Adequate

Age (Years)

a. 25 – 35

b. 36 - 45

c. 46 – 55

d. 56 - 60

11.2*

0.04

Educational Status

a. Secondary

b. Senior – Secondary

c. Diploma

9.17^NS

0.06

Marital Status

a. Married

b. Divorced/Separated

c. Widows

3.96^NS

0.41

Number of Children

a. One

b. Two

c. More than two

1.88^NS

0.76

Year of Experience

a. Less than 5 Years

b. 5 – 10 year

c. More than 5 year

1.98^NS

0.74

Source of Information

a. Mass Media

b. Books / Magazines

c. Peer Groups

1.03^NS

0.90

*= Significant at 0.05 level, NS = Not Significant

DISCUSSION:

The results of the data analysis in the study were discussed along with the supportive studies.

In the current study with regard to pre – test majority of the samples were having inadequate level of knowledge regarding mental health and its problems in children and 35 (58.33%). Samples who had moderate level of knowledge were 23 (38.33%). Very less number of sample 2 (3.34%) were having adequate level of knowledge.

With regard to post – test in the present study majority of the samples were having inadequate level of knowledge regarding mental health and its problems in children and an overwhelming majority of the samples were having adequate level of knowledge 53 (88.30%). Less number of samples were having moderate level of knowledge 7 (11.70%). None of the sample were having inadequate level of knowledge.

The above findings of the present study were supported by the following studies.

Marudhar (2018) assessed the effectiveness of planned teaching programme on mental illness among adolescents. The pre-test out of 60 subjects, 1 had poor knowledge, 49 subjects had average knowledge and 18 subjects had good knowledge on mental illness. In the post test there were no subjects with poor knowledge, majority of subjects 51 had good knowledge and only 9 had average knowledge.

Uma Maheswari S. (2016) done a study to assess the effectiveness of structured teaching programme on knowledge and attitude regarding the identification and management of behavioural problems of school age children among mothers. It showed that the overall knowledge had markedly increased after structured teaching programme this shows that the structured teaching programme was effective.

Table – III: shows the Mean Pre-Test score was 13,28 and mean Post-Test score was 33.31. the mean difference was 20.03. the pre-test standard deviation score was 3.67 and the post-test standard deviation score was 5.33. the ‘t’ test value was 22.02. The ‘P’ value was 0.00 which was less than 0,05 level.

The findings of the present study are similar to the other studies which had done in the past.

Naganandhini R (2016) The aim of the study was to find the Effectiveness of Computer Assisted Teaching Programme on the Knowledge regarding Specific Developmental Disorders of Scholastic Skills in Children among B.Ed Students. The mean percentage of post-test knowledge score (81.45%) was higher than the mean percentage of pre-test knowledge score (45.1%). The calculated ‘t’ value is greater than the table value (0.05, 49df) = 1.96. It showed a significant difference between mean pre and post-test knowledge scores. Calculated χ2 value is showed significant association between occupations of Mother of respondents in their post-test knowledge scores.

In the present study the researcher found there was a significant association between pre – test knowledge and age (χ2 = 11.2, ‘P’ value 0.04). This finding was supported by the study conducted by Marudhar (2018) a study to assess the effectiveness of planned teaching programme regarding knowledge of mental illness among adolescents.

CONCLUSION:

From this study finding, it was concluded that structured teaching programme was effective in improving the knowledge of Anganwadi workers regarding Mental Health and its problems in children. The researcher recommends the use of Anganwadi (Courtyard) Worker (AWW) along with an assistant (Anganwadi helper-AWH) in the child mental health services. This will be more beneficial in early identification and prevention of mental health problems among children.

REFERENCE:

1. Biederman J, Rosenbaum JF, Bolduc-Murphy EA, Faraone SV, Chaloff J, Hirshfeld DR, et al. A 3-year follow-up of children with and without behavioral inhibition. J Am Acad Child Adolesc Psychiatry. 1993 Jul;32(4):814–21.

2. Aman M. A study to assess the effectiveness of planned teaching programme regarding knowledge of mental illness among adolescents. 2018 Jan 29;1.

3. Kessler RC, Amminger GP, Aguilar‐Gaxiola S, Alonso J, Lee S, Ustun TB. Age of onset of mental disorders: A review of recent literature. Curr Opin Psychiatry. 2007 Jul;20(4):359–64.

4. Belfer ML. Child and adolescent mental disorders: the magnitude of the problem across the globe. J Child Psychol Psychiatry. 2008 Mar;49(3):226–36.

5. Bayer JK, Hiscock H, Ukoumunne OC, Price A, Wake M. Early childhood aetiology of mental health problems: a longitudinal population-based study. J Child Psychol Psychiatry. 2008 Nov;49(11):1166–74.

6. Maheswari SU. Effectiveness of structured teaching programme on knowledge and attitude regarding the identification and management of behavioral problems of school age children (6-12 years) among mothers in Anagaputhur, Chennai. International Journal of Pharma and Bio Sciences [Internet]. 2016 Sep [cited 2020 Feb 14];Volume 7 Issue 3. Available from: http://ijpbs.net/abstract.php?article= 5234

7. Sanders MR, Ralph A, Sofronoff K, Gardiner P, Thompson R, Dwyer S, et al. Every family: a population approach to reducing behavioral and emotional problems in children making the transition to school. J Prim Prev. 2008 May;29(3):197–222.

8. Mental health of young people: a global public-health challenge. - PubMed - NCBI [Internet]. [cited 2020 Feb 14]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17434406

9. Prevalence of psychopathology among children and adolescents. - PubMed - NCBI [Internet]. [cited 2020 Feb 14]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9619142

10. Costello EJ, Farmer EM, Angold A, Burns BJ, Erkanli A. Psychiatric disorders among American Indian and white youth in Appalachia: the Great Smoky Mountains Study. Am J Public Health. 1997 May;87(5):827–32.

11. PEER-Reviewed-Refereed A. Shanlax International Journal of Education. :295

12. Davis E, Sawyer MG, Lo SK, Priest N, Wake M. Socioeconomic risk factors for mental health problems in 4-5-year-old children: Australian population study. Acad Pediatr. 2010 Feb;10(1):41–7.

13. Bayer JK, Rapee RM, Hiscock H, Ukoumunne OC, Mihalopoulos C, Clifford S, et al. The Cool Little Kids randomised controlled trial: population-level early prevention for anxiety disorders. BMC Public Health. 2011 Jan 5;11:11.

Received on 14.01.2020 Modified on 02.03.2020

Int. J. Nur. Edu. and Research. 2020; 8(3):373-379.

DOI: 10.5958/2454-2660.2020.00080.0