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EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON THE ILL-EFFECTS OF TOBACCO USE AMONG ADOLESCENTS IN A SELECTED HIGH SCHOOL, MANGALORE

by RENU SHUKLA

Dissertation submitted to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka In partial fulfilment of the requirements for the degree of

Master of Science in Nursing(Psychiatric Nursing)Under the guidance of

Prof. (Mrs.) Mallika AsithDepartment of Psychiatric Nursing

Dr. M. V. Shetty Institute of Health Sciences Mangalor e 2008

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Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis titled Effectiveness of planned teaching programme on the ill-effects of tobacco use among adolescents in a selected high school, Mangalore is a bonafide and genuine research work carried out by me under the guidance of Mrs. Mallika Asith, Dr. M. V. Shetty Institute of Health Sciences, Mangalore.

Date : Place : Mangalore Renu Shukla

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CERTIFICATE BY THE GUIDE

This is to certify that the dissertation titled Effectiveness of planned teaching programme on the ill-effects of tobacco use among adolescents in a selected high school, Mangalore is a bonafide research work done by Renu Shukla in partial fulfilment of the requirement for the degree of Master of Science in Nursing (Psychiatric Nursing).

Mrs. Mallika Asith, M. Sc. (N) Date: Place: Mangalore Head of the Department Psychiatric Nursing Dr. M. V. Shetty Institute of Health Sciences

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ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION

This is to certify that the dissertation titled Effectiveness of planned teaching programme on the ill-effects of tobacco use among adolescents in a selected high school, Mangalore is a bonafide research work by Renu Shukla under the guidance of Mrs. Mallika Asith, HOD, Department of Psychiatric Nursing.

Seal & Signature of HOD Mrs. Mallika Asith

Seal & Signature of the Principal Prof. (Mrs.) B. V. Kathyayani

Date: Place: Mangalore

Date: Place: Mangalore

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COPYRIGHT

Declaration by the candidate

I hereby declare that the Rajiv Gandhi University of Health Science, Karnataka shall have the rights to preserve, use and disseminate this dissertation/thesis in print or electronic format for academic/research purpose.

Date : Place : Mangalore

Renu shukla

Rajiv Gandhi University of Health Sciences, Karnataka

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ACKNOWLEDGEMENT

I praise and thank Almighty for his abundant blessings showered during the course of the study. I owe a deep sense of gratitude to those who have contributed to the successful completion of this endeavour. I am immensely thankful to Dr. M. Ramgopal Shetty, the secretary of Dr. M. V Shetty memorial trust for giving me an opportunity to undertake the post graduation course in this esteemed institution. One looks back with appreciation to the brilliant teachers, but with gratitude to those who touched our human feelings My heartfelt thanks to my guide Mrs. Mallika Asith, Associate Professor, Dr. M. V. Shetty Institute Of Health Sciences, for her expert guidance, vigilant supervision, personal interest and patience in helping me to complete this study successfully. I am greatly indebted to her for making my research experience rich and rewarding. My heartfelt thanks to Prof. (Mrs.) B. V. Kathyayani, Principal, Dr. M. V. Shetty Institute of Health Sciences, for her encouragement, inspiration, support as well as for providing all facilities for successful completion of this study. I owe my sincere thanks with gratitude and respect to my co-guide Mrs. K.Shanthakumari, Vice Principal, Dr. M. V. Shetty Institute of Health Sciences, for her valuable guidance and ongoing encouragement. An understanding heart is everything in a teacher... My sincere and special word of thanks to Ms. Rajesh. and Ms. Madhumitha, Lecturers, Dr. M. V. Shetty

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Institute of Health Sciences, for their ongoing support and encouragement throughout my study. I extend my sincere thanks to Mrs. Shilpakala K., Lecturer in Statistics, Dr. M. V. Shetty Institute of Health Sciences, and to Mrs. Sucharita for her help and guidance in all the statistical analysis involved in the study. I am grateful to Ms. Remya V.S., Lecturer, Dr. M. V. Shetty Institute of Health Sciences, Ms. Savitha Vas, Assistant Lecturer in Nursing for the valuable suggestions and timely help. Acknowledgement is extended to the principals of the schools for permitting me to conduct the study in their schools and my deepest thanks to the participants for extending their cooperation without which it would have been impossible for me to get relevant data for my study. I extend my heartfelt gratitude to all the experts who have contributed with their valuable suggestions in validating the tool and planned teaching programme. A word of appreciation to all the staff of the library, IHS for their sincere help and whole hearted cooperation. Words are not enough to express gratitude to my beloved husband

Dr R.K. Tripathi and my daughter Palak for their constant support, interest, encouragement, sacrifice as well as prayers. The blessings of the almighty are innumerable I have been blessed with supportive family consisting of my in-laws, mother, brother, sister and nephews who are the essence of my existence.

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My sincere thanks to all my classmates and friends specially Sharad, Sofia, Shuba and Pathima Voilet for making me successful in all the encounters and difficulties faced during the study. A word of appreciation to Mr. Roshan and his assistant for their timely help and co-operation in working of this thesis to its present order. Last but not the least my gratefulness is extended to all those who have directly or indirectly helped me in the completion of this study.

Renu shukla

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LIST OF ABBREVIATIONS USED

PTP : N: SD : VHS : WHO :

Planned teaching programme Sample size Standard deviation Very highly significant World Health Organisation

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ABSTRACTA study to determine the effectiveness of planned teaching programme on ill effects of tobacco use among adolescents in a selected high school, was carried out by Renu shukla in partial fulfilment for the award of Master of nursing at Dr MV Shetty Institute of health sciences, Mangalore. The objectives of the study were to : 1. identify the pre-existing knowledge of adolescents regarding the ill-effects of tobacco using a structured questionnaire. 2. design and administer a planned teaching programme on the ill-effects of tobacco. 3. find the effectiveness of teaching programme using the same structured questionnaire. The conceptual framework was based on Penders Health Believe Model. The study attempted to examine the following hypothesis. H1: The mean post-test knowledge scores of adolescents regarding ill-effects of tobacco use will be significantly higher than their mean pre-test knowledge scores. Independent variable was an intervention in terms of planned teaching programme (PTP) on ill effects of tobacco use among adolescents between the age group of 12-16years. Dependent variable was change in knowledge on ill-effects of tobacco use as measured by a structured knowledge questionnaire. Extraneous

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variable were the students age, place of living, family history of tobacco use and exposure to mass media. The research approach used was evaluative approach with one group pre test , post test pre experimental design. The study was conducted in a selected high school at Mangalore. The researcher used a simple random sampling technique for the selecting the location of data collection and selecting the required number of samples. The data was obtained by using demographic Performa and structured knowledge questionnaire on ill effects of tobacco use. The content validity of the developed tool was established by nine experts and necessary modification were made as suggested by them. Reliability of knowledge questionnaire was made by split half method, spearmen brown prophecy formula. Obtained reliability coefficient was 0.82. The investigator also developed the planned teaching programme on ill effects of tobacco use and benefits and the steps of giving up tobacco. A criteria checklist was developed and nine experts validated the content against the criteria check list. Pilot study was conducted among five students who fulfilled the sampling criteria in government high school, Kavoor, Mangalore. Data collection for the main study was conducted in Pompoi High School at Mangalore from 31 September. Results Findings revealed that the mean post-test score was significantly higher than their mean pre-test score. The calculatedt value (t=27.649 p70 Percentage Percentage range of score 24 48 40 70 26 52 No. of respondents

Assessment of level of knowledge of the students shows that highest percentage (52%) of the students had average knowledge regarding ill-effects of tobacco use; and 48% of the students had poor knowledge regarding ill-effects of tobacco use.

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Section B: Area-wise analysis of knowledge scores of the students Table 2: Description of area wise Mean, SD, Mean percentage of knowledge score N = 50 Sl. No. 1. 2 3 4 5 6 7 Knowledge SD Mean % area Concept20.5 of tobacco Causes of tobacco use 54.00 Types and forms of 47.33 03 1.42 0.642 tobacco use Ill effects of tobacco use 07 3.36 1.675 48.00 ( physical) Ill effects of tobacco use 07 3.70 1.446 52.857 ( psychological ) Benefits03 1.62 0.878 54.00 of giving up tobacco Steps in44.00 up tobacco giving 04 1.76 0.916 Max. possible score 04 04 Mean score 0.82 2.16 0.850 0.934

Analysis shows that adolescents had highest mean percentage (54%) of the knowledge score in the area, causes of tobacco use which had mean and SD 2.160.934 and equal percentage in the area of benefits of giving up tobacco which had mean and SD 1.62 0.878. Whereas least mean percentage was found in the area of concept of tobacco 20.5% which had mean and SD 0.82 0.850. The mean

percentage of in the area of types and forms of tobacco use was 47.33% which had mean and SD 1.42 0.642. The mean percentage in the ill-effects of tobacco use (physical) was 48% which had mean and SD 3.36 1.675. The mean percentage in the psychological aspects of ill-effects of tobacco use was 52.857% which had mean and SD 3.70 1.446 whereas in the area of steps in giving up tobacco the mean percentage was found to be 44% with the mean and SD 1.76 0.916.

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Section C: Item-wise analysis of knowledge scores of the studentsTable 3: Distribution of percentage of correct responses of students on ill-effects of tobacco use Sl. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Correct responses Item

No. % 22 6

Tobacco contains nicotine 42 Tobacco is addictive 12 Tobacco smoke releases harmful chemicals which 9 18 covers the lung surface The4 8 when tobacco use usually begins is around age 10years Tobacco use in adolescence is influenced by peer 23 46 group Tobacco use is more common among poor & 14 28 illiterate people Children of tobacco users rarely follow their 30 60 parents in their habits Smoking variety and smokeless variety are two 22 44 types of tobacco use Zarda, 50 25 gutkha and snuff are the examples of smoking variety Tobacco can be taken in many ways as chewing, 24 48 smoking, orally, nasally, behind the lip and along the gum Bad30 60 red eyes, headache, giddiness are the breath, delayed effects of tobacco use Tobacco smoke enters lungs by inhalation through 19 38 nose Chewing tobacco can lead to oral cancer and lung 18 36 cancer Children of smokers can develop asthma 42 Non-smokers who inhale the smoke cannot 50

11. 12. 13. 14. 15.

21 25

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experience breathing difficulty 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. One13 26 cigarette/beedi reduces seven minutes of your life Babies 40 to tobacco user mother suffer from 20 born coughing and wheezing Excessive smoking during pregnancy can cause 9 18 abortion Smoking can cause tuberculosis 32 Tobacco use can lead to anxiety and depression 36 Tobacco users have good decision making capacity 60 Tobacco use improves sleeping pattern 44 Tobacco use improves concentration and memory 48 Tobacco use has a relaxing effect on the brain 34 Chewing tobacco leads to decreased sense of smell 27 54 and taste Tobacco dependents refuse to stop tobacco even 24 48 after having serious physical illness It is46 to stop smoking suddenly easy Giving up smoking is good to self and others 36 Tobacco use adversely affects overall performance 19 38 of physical and mental activities Giving up tobacco use improves self-confidence 38 Bad25 50 from mouth will always be there even breath after quitting tobacco It is23 46 necessary to have will power and motivation to quit tobacco When a tobacco user plans to quit he should keep it 29 58 a secret Chewing gum, toffee and cardamom are 19 38 alternatives for tobacco use Simple34 17 exercises like walking can reduce the desire for smoking 19 23 18 16 18 30 22 24 17

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Item-wise analysis of the correct responses regarding ill-effects of tobacco use revealed that 42% of the students had knowledge that Tobacco contains nicotine; 12% knew that Tobacco is addictive and 18% knew that the Tobacco smoke releases harmful chemicals which covers the lung surface; 8%of the students knew that the age when tobacco use usually begins is around 10years; 46.00 % of the students had knowledge that Tobacco use in adolescence is influenced by peer group; 28%remarked that tobacco use is more common among poor & illiterate people.

Children of tobacco users rarely follow their parents in their habits was remarked by 60% of the respondents. For the item Smoking variety and smokeless variety are two types of tobacco use, 44% of the students responded correctly. 50% of respondents knew that Zarda, gutkha and snuff are not the examples of smoking variety. 48% of the respondents knew that tobacco can be taken in many ways as chewing, smoking, orally, nasally, behind the lip and along the gum.60% of the respondents knew that Bad breath, red eyes, headache, giddiness are the delayed effects of tobacco use; 38.% of the respondents knew that tobacco smoke enters lungs by inhalation through nose; 36% of the students responded correctly that chewing tobacco can lead to oral cancer and lung cancer;42% of the respondents knew that Children of smokers can develop asthma; 50% of the respondents knew that Nonsmokers who inhale the smoke can experience breathing difficulty.

Item-wise analysis of correct responses regarding ill-effects of tobacco use reveals that 26% of students knew that One cigarette reduces 7 minutes of life; 36% students responded correctly to item no.20 60%students knew that the tobacco users have good decision making capacity . forty-four percent of students knew that tobacco

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use impairs sleepingof effectiveness of PTP on Ill-effect of tobaccocorrect response Part III: Evaluation pattern. 48.00% of the respondents had given and testing tobacco use improves concentration and memory Thirty-four percent of the student Hypothesis gave correct response that tobacco use has a relaxing effect on the brain; 54% of the Section A: Quartiles of the that chewing tobaccoknowledge scores sense of smell and taste; respondents knew pre-test and post-test leads to decreased 48% of the respondents knew that Tobacco dependents refuse to stop tobacco even 100 after having serious physical illness and 46% students responded correctly to item Pre-test 90 no.27. Thirty-six percent of the students knew that Giving up smoking is good to self 80Post-test and others7038% of the respondents knew that Tobacco use adversely affects overall ; e 60 g performance of physical and mental activities; 38%of the respondents knew that Percenta 50 Giving up40 tobacco use improves self-confidence; 50% of the respondents gave Median = 14 Median = 26 30 correct response for the item that Bad breath from mouth will always be there even 20 after quitting tobacco; 46% of the respondents knew that It is necessary to have will 10 Q3 Q1 Q2 Q1 Q2 power and motivation to quit tobacco;58% responded correctly for the item that when 0 10 12 14 20 22 a tobacco user0plans to quit he should16 18a secret; 38% of24 respondents knew 32 keep it the 26 28 30 Scores that Chewing gum, toffee and cardamom are alternatives for tobacco use and 34% of the respondents knew that Simple exercises like walking can reduce the desire for smoking.

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Figure 14: Less than Ogives of pre-test and post-test knowledge scores The cumulative frequency distribution of pre-test and post-test knowledge scores are shown in the ogive. The data presented in the ogives shows significant difference between the pre-test and post-test knowledge scores. The pre-test median score was 14 whereas post-test median score was 26 showing a difference of 12. The ogive plotted shows that the first quartile score of post-test is higher than third quartile score of pre-test. This indicates that there is significant increase in the knowledge of students regarding ill-effects of tobacco use.

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Section B: Area-wise effectiveness of PTP Table 4: Area-wise effectiveness of PTP with mean, SD and mean percentage of pre-test and post-test knowledge scores of students

Effectiveness (y-x) Pre-test (x) Maxi. Area Possible Mean score Mean SD % % Concept of 0 tobacco Causes of 7.33 tobacco use Types and 4 forms of tobacco use Ill effects of 0 tobacco use (Physical) Ill effects of 63 tobacco use (psychological) Benefits of 0 giving up tobacco Steps in giving 0 up tobacco 04 04 03 0.820.850 2.160.934 1.420.642 20.5 54.00 47.33

Post-test (y) Mean SD 3.580.609 1.840.738 1.880.385 Mean % Mean SD Mean 69.0

89.50 2.760.241 61.33 0.320.196 62.67 0.460.257

15.3

07

3.361.675

48.00

7.200.571

90.00 3.841.104

42.0

07

3.701.446

52.857 5.001.629

71.42

1.30.183

18.5

03

1.620.878

54.00

3.400.571

85.00 1.780.307

31.0

04

1.760.916

44.00

3.340.848

83.50 1.580.068

39.5

Data from table 4 shows that effectiveness of PTP in the area of concept of tobacco with highest mean percentage of 69% and mean and SD 2.76 0.241 whereas effectiveness of PTP in the area of causes of tobacco use with mean percentage 7.33% and with mean and SD 0.32 0.196. The effectiveness of PTP in the area of Types and forms of tobacco use with mean percentage of 15.34% and with mean and SD

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0.460.257. The effectiveness of PTP in the area of Ill effects of tobacco use (Physical) with mean percentage of 42% and mean and SD 3.84 1.104 whereas the effectiveness of PTP in the area of Ill effects of tobacco use (Psychological) with mean percentage of 18.563 and with mean and SD 1.3 0.183. The effectiveness of

PTP in the area of Benefits of giving up tobacco with the mean percentage of 31% and mean and SD 1.780.307 whereas the effectiveness of PTP in the area of Steps in giving up tobacco with mean percentage of 39.50% and mean SD 1.580.068. However the result revealed that the overall percentage of post-test knowledge was more compared to the percentage of the pre-test knowledge. Hence it is observed that the PTP was effective in enhancing the knowledge of students regarding illeffects of tobacco use.

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Section C: Item-wise effectiveness of PTP among the students on ill-effects of tobacco use.

Table 5: Effectiveness of PTP based on item-wise correct responses of the students in pre test and post test with regard to ill-effect of tobacco use Pre-test Post-test Effectiveness Items No. % No. % No. % Tobacco contains nicotine 50 Tobacco is addictive 80 Tobacco smoke releases harmful 9 18 45 90 36 72 chemicals which covers the lung surface The age8when tobacco use 4 41 82 37 74 usually begins is around 10years Tobacco use in adolescence is 38 influenced by peer group Tobacco use is more common 52 among poor & illiterate people Children of tobacco users rarely 20 follow their parents in their habits Smoking variety and smokeless 36 variety are two types of tobacco use Zarda, gutkha and snuff are the 10 examples of smoking variety Tobacco can be taken in many 42 ways as chewing, smoking, orally, nasally, behind the lip and along the gum Bad breath, red eyes, headache, 10 giddiness are the delayed effects of tobacco use Tobacco smoke enters lungs by 52 inhalation through nose Chewing tobacco can lead to 58 23 46 42 84 19 14 28 40 80 26 30 60 40 20 10 22 6 44 12 47 46 94 92 25 40

Sl. No. 1. 2. 3.

4. 5. 6. 7.

8.

22 44 40 80 18

9. 10.

25 50 30 60 5 24 48 45 90 21

11.

30 60 35 70 5

12. 13.

19 38 45 90 26 18 36 47 94 29

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oral cancer and lung cancer 14. 15. Children of smokers can develop 48 asthma Non-smokers who inhale the 10 smoke cannot experience breathing difficulty One cigarette/beedi reduces 66 seven minutes of your life Babies born to tobacco user 52 mother suffer from coughing and wheezing Excessive smoking during 9 18 46 92 37 74 pregnancy can cause abortion Smoking can cause tuberculosis 62 Tobacco use can lead to anxiety 54 and depression Tobacco users have good 5 10 decision making capacity Tobacco use improves sleeping 12 pattern Tobacco use improves 8 concentration and memory Tobacco use has a relaxing 24 effect on the brain Chewing tobacco leads to 36 decreased sense of smell and taste Tobacco dependents refuse to 34 stop tobacco even after having serious physical illness It is easy to stop smoking 4 suddenly Giving up smoking is good to 60 self and others Tobacco use adversely affects 54 overall performance of physical and mental activities Giving up tobacco use improves 50 self-confidence Bad breath from mouth will 14 always be there even after 16 32 47 94 31 18 36 45 90 27 30 60 35 70.0 0 22 44 28 56 6 24 48 29 58 4 17 34 29 58 12 27 54 45 90 18 21 42 45 90 24 25 50 30 60 5

16. 17.

13 26 46 92 33 20 40 46 92 26

18. 19. 20. 21. 22. 23. 24. 25.

26.

24 48 41 82 17

27. 28. 29.

23 46 25 50 2 18 36 48 96 30 19 38 46 92 27

30. 31.

19 38 44 88 25 25 50 32 64 7

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quitting tobacco 32. It is necessary to have will 36 power and motivation to quit tobacco When26tobacco user plans to a quit he should keep it a secret Chewing gum, toffee and 52 cardamom are alternatives for tobacco use Simple exercises like walking 44 can reduce the desire for smoking 23 46 41 82 18

33. 34.

29 58 42 84 13 19 38 45 90 26

35.

17 34 39 78 22

The findings reveal that highest percentage (80%) effectiveness was observed for the item Tobacco is addictive. Least percentage (4%) was observed for item number twenty-seven. Part IV: Testing of hypothesis To evaluate the effectiveness of planned teaching programme, a null hypothesis and alternative hypothesis was formulated. H0: There is no significant difference between the pre-test and post-test mean knowledge score of students regarding ill-effects of tobacco use. H1: The mean post-test knowledge scores of the students regarding ill-effects of tobacco use will be significantly higher than the mean pre test knowledge score. The hypothesis was tested using paired t test. The value of t was calculated to analyse the difference in knowledge of the students regarding ill-effects of tobacco use.

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Table 6: Significance of difference between pre-test and post-test knowledge scores Mean effectiveness 0.43691 t value 27.649 Table value 2.662 Level of

Areas significance Ill-effectsPof tobacco use < 0.005

Findings revealed that the mean post-test score was significantly higher than their mean pre-test score. The calculatedt value (t=27.649 p