A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME

ON ANOREXIA NERVOSA AMONG THE ADOLESCENTS

IN A SELECTED SCHOOL,BANGALORE.

M.SC. NURSING DISSERTATION PROTOCOL SUBMITTED TO

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA,BANGALORE.

BY

MRS.T MARY GRACE

M.SC NURSING 1ST YEAR

2009-2011

UNDER THE GUIDENCE OF

HOD,Department of Child Health Nursing

NATIONAL COLLEGE OF NURSING

SRI GANGHADAKAVAL

HEGGANAHALLI CROSS

VISHWANEEDAM POSTMAGADI ROAD BANGALORE-91

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

1 NAME OF THE CANDIDATE ANDADDRESS

MRS.MARY GRACE.T1ST YEAR M.SC NURSING,NATIONAL COLLEGE OF NURSING, SREE GANDHADAKAVALU,HEGGANAHALLI CROSS,SUNKADAKATTE ROAD,BANGALORE,KARNATAKA.

2 NAME OF THE INSTITUTION NATIONAL COLLEGE OF NURSING, SREE GANDHADAKAVALU,HEGGANAHALLI CROSS,SUNKADAKATTE ROAD,BANGALORE,KARNATAKA.

3 COURSE OF THE STUDY AND SUBJECT

M.SC NURSING,1ST YEAR,CHILD HEALTH NURSING

4 DATE OF ADMISSION TO THE COURSE

15TH OCTOBER 2009

5 TITLE OF THE COURSE“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHINGPROGRAMME ON ANOREXIA NERVOSA AMONG ADOLESCENTS IN A SELECTED SCHOOL AT HEGGANAHALLI,BANGALORE.”

6.0 BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION:

“Anorexia Nervosa is the biopsychosocial disorder mirroring a society with specific tensions and contradictions :the bourgeois family,supportive yet suffocating,and all the paradoxical hypocrises of modern attitudes towards youth, food,femininity,beauty and sexuality, are whipped up by the media and by multi-million pound food and style industries.” ROY PORTER.1

Anorexia is a Greek word meaning “loss of appetite” and the term “Anorexia Nervosa” Can be roughly translated as “loss of appetite due to anxiety.”Anorexia nervosa is an eating disorder and a serious mental health condition. People with anorexia have problem with eating.They are very anxious about their weight and keep it as low as possible by strictly controlling and limiting what they eat.Many people with anorexia will excessively exercise to lose weight.2

The modern day pressures of an ideal “size zero” body image created by the media and fashion industry are mainly aimed at women.Females in western societies may have increased exposure and therefore vulnerability.This is supported by the fact that in sub-cultures where the demand for thinness is endemic, for example dances and models, there is significantly increased risk of eating disorders such as Anorexia Nervosa, modern pressures to ‘look good’ seem to propogate eating habits.3

A more general adaptation to a changing society, that spans both genders, may be occurring.Urbanisation of an environment brings with it a change in eating patterns,food choices and meal times for both sexes that may lead to increase in weight consciouscess.4

Anorexia is an emotional disorderthat focus on food, but it is actually an attempt to deal with perfectionism and a desire to control things by strictly regulating food and weight . people with anorexia often feel that their self-esteem is tied to how thin they are.5

Anorexia is increasingly commom,especially among young women in industrialized countries where cultural expectations encourage women to be thin.Fueled by popular fixations with thin and lean bodies.5 People with anorexia have an extremefear of gaining weight, which causes them to try to maintain a weight far less than normal. They will do almost anything to avoid gaining weight, including staving themselves or exercising too much.People with anorexia have a distorted body image –they think they are fat (even when they are extremely thin)and won’t maintain a proper weight.5

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A body image distortion with an intrusive fear of being fat propagates the starvation.It is thought that the reasons people with anorexia are so concerned about their weight are they:

Think they are fat or overweight Have a strong fear of being fat Want to be thin.

Some people with anorexia will also binge eat,where they eat a lot of food in a short space of time.They then try to get rid of the food from their body by vomiting or using laxatives(medictation that causes the bowels to empty ; normally used in the treatment of constipation). The symptoms of anorexia usually begin gradually, such as adopting a restrictive diet,then often quickly spiral out of control. 2

NEED FOR STUDY:

Anorexia Nervosa was considered to be “a curiosity and a rarity.”Since then ,its incidence has risen in the USA and Europe to something like one in 200among females of the 15-19 age group.By now, the phenomenon of eating disorder has assumed a global spread that includes the affluent east asian countries in South America,especially Argentina and Chile. It has spread to china,too,in contradiction to the traditional value the Chinese place on plumpiness as a sign of health .6

The current estimate of the 12 month prevalence of Anorexia nervosa in European people over 19 years is apprpximately 0.2-0.7% with one population study estimating the mean incidence in the UK at 4 in 100000 in people aged 15-19years, This eating disorder mainly affects women,1 in 250 in the UK as opposed to 1 in 2000 men,and in fact the female prevalence of Anorexia nervosa in some western countries is reported to be as high as 5.7%.Specific risk factors seem to include high parental expectations,certain personality traits including a premorbid perfectionism and psychiatric conditions including Obsessive Complusive disorders and various affective disorders.A recent UK study reported that social classess 1 and 2 are by far the most vulnerable sub-groups in society to be affected by Anorexia nervosa.3

Both the incidence and prevalence appeared to increase dramatically In the 1970s,and this seemed to occur only in the developed world, namely North America and Europe. Anorexia nervosa was almost unheard of in the developing world until around the 1990s, when research began to emerge describing cases in India ,Mexico and Nigeria.The possibility that the disorder seems to be ever more prevalent in countries as they become more affluent and urban encourages the popular theory that Anorexia nervosa may be a disorder of the developed world. If this is indeed the case,as the world becomes increasingly developed,one can only expert an increase in this eating disorder in future years making it necessary to consider public health prevention strategies.3

As late as the mid-80s, noted Indian epidemiologist Sridhar Sharma had found a very Low prevalence of the disorder in India.Now ,anorexia nervosa is a significant in the country .

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And then we have our unique traditions of religious fasting and protest fasting.6

Although the prevalence of anorexia nervosa has increased worldwide in recent years,the numbers suffering is still not large in absolute numbers.But given the age and potential of the population which is afflicted, it represents a series and often devastating affliction,with tragic implications for the young sufferer and her family.6

The developing world shows different statistics in comparison. In 2004 it was reported that in a cumulative period of 320 years of practice,Kenyan psychiatricts had seen just twenty cases. One Study in a Indian child and adolescent psychiatry unit recorded an overall prevalence of general eating disorder as 1.25% with only 14.6% of those suffering from anorexia nervosa,and Korean statistics suggest their national prevalence is approximately 0.5%-1.0%.3

Most cases of anorexia develop in girls,with 1 in every 200 women being affected. Symptoms of anorexia usually first develop during the teenage years, at the average age of 15. However,the condition can develop at any time,including childhood.2

The cause of anorexia is unknown, but most experts believe the condition results from a combination of biological,psychological and environmental factors. The long term malnutrition associated with anorexia can cause a range of serious complications such as:Osteoporosis,Kidney disease,Heart failure.2

Anorexia also affects 1 in every 2000 men.Some experts are concerned that the number of men with the condition may be increasing .2

Adolescents are highly influenced by television &internet with super slim models idolizing them.There is immense emphasis on being thin by the society as well .Therefore nurse plays an important role in helping adolescents from becoming victims of anorexia nervosa.By imparting knowledge to parents and adolescents we can overcome this problem. So the investigator felt it necessary to do research on this topic.

REVIEW OF LITERATURE

“ Review of literature is a body of text that aims to review the critical points of current knowledge and or methodological approaches on a particular topic. Review of literature are secondary sources, and as such, do not report any new or original experimental work.”

Anorexia nervosa is a condition characterized by extreme loss of weight associated with

an unrealistic fear of weight gain and a distorted body image.In a study conducted at Massachusetts ,more than 90%of young adolescents with anorexia nervosa were found to have bone loss significant enough to meet the WHO criteria for osteoporosis.Anorexic adolescents are at risk for a number of serious, even life-threatening health problems.Loss of bone mass is a significant complication in most adolescents with anorexia,but it was not previously known whether it resulted from estrogen deficiency or overall malnutrition.The study shows that regaining and maintaining a healthy weight is key to preventing or reducing bone loss and it is hoped that the results will motivate anorexic adolescents to get the treatment they need.So it does seem that being comfortable with one’s body has other advantages besides not having to diet!(Source:The Hindu).7 A recent survey suggests that in the younger age group( 15-19 years )of people affected 25%of them are boys. Current statictical estimates done in the U k suggests that 1%of women between tht ages of 15-19 years suffer from anorexia.4

A recent Ghanaian study investigated secondary school girls who had been diagnosed with anorexia nervosa and reported that their pathological process did not involve a classic strive for western slimness. It was discovered these girls were exerting an extreme form of control over their lives as a way of achieving perfectionist moral and academic standards. This suggests anorexia nervosa occurs in parts of the developing world for reasons that are unrelated to developed western culture.9

The current study describes detailed eating behaviours,dieting behaviours,and attitudes about shape and weight in 4023 women ages 15-19 years.The survey was delivered on-line and participants were identified using a national quotasampling procedure.Results showed that disordered eating behaviours, extreme weight were widely endorsed by adolescents in this age group. 31% of adolescents without a history of anorexia nervosa or binge eating reported having purged to control weight,and 74.5% of women reported that their concerns about shape and weight interfered with their happiness.Thereby unhealthy approaches to weight control and negative attitudes about shape and weight are pervasive even among women without eating disorders.The development of effective approaches to address the impact of these unhealthy behaviours and attitudes on the general well-being and functioning of adolescents is required.7

A recent American epidemiological study addressing cross cultural attitudes as a contributing factor to the developing of eating disorders found that white females had less favourable attidutes regarding body image (p<0.02)17. until recently African American women were less likely to develop an eating disorder than their white American peers however the statisticts are equalizing. Women in ethnic minorities are at increased risk of developing Anorexia nervosa when exposed to Western values18 suggestating that socio-cultural differences with respect to body perfection and the ideal shape might be important in the development of eating disorder.9

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A study conducted to examine the presence and severity of eating disorder pathology in students representing South Africa's ethnically and culturally diverse population. A questionnaire survey, which involved the Eating Attitude Test was administered to 1,435 South African college students (739 Caucasian and 696 non-Caucasian) from six universities in two urban centers. Black students scored significantly higher than the other ethnic groups on these measures. In addition, a comparable percentage of black and Caucasian female students had scores within the clinical range on these scales. Male students scored consistently lower than female students. This study's findings challenge the notion that eating disorders are primarily a Western, Caucasian phenomenon and raise the possibility that the risk of eating disorders may increase in developing societies. (Am J Psychiatry 1998; 155:250–254)

A Study conducted to examine whether anorexia nervosa emerges in societies

undergoing socioeconomic transition, the authors studied the incidence of anorexia nervosa on the Caribbean island of Curaçao. The authors contacted the full range of community health

and service providers on Curaçao, including dietitians, school counselors, and all 82 general practitioners. They also studied inpatient records for 84,420 admissions to Curaçao General Hospital and two private hospitals in 2005–2008. Probable-incident subjects were interviewed. Results showed the incidence rates in 2005–2008 per 100,000 person-years for anorexia

nervosa on Curaçao were 1.82 (95% confidence interval [CI]=0.74–2.89) for the total population and 17.48 (95% CI=4.13–30.43) for the high-risk group of 15–24-year-old females. No cases were found among the majority black population. For the Curaçao mixed and white population, the incidence rate per 100,000 person-years for anorexia nervosa was 9.08 (95% CI=3.71–14.45). The overall incidence of anorexia nervosa on Curaçao is much lower than in

the affluent societies of the United States and Western Europe. Within Curaçao, sociocultural factors appear to be associated with differential incidence rates of anorexia nervosa. The incidence of anorexia nervosa among the majority black population is nil, while the incidence among the minority mixed and white population on Curaçao is similar to that of the United States and the Netherlands. 11

PROBLEM STATEMENT

“ A Study to assess the effectiveness of structured teaching programme on anorexia nervosa among the adolescents in selected school at hegganahalli, Bangalore.”

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OBJECTIVES OF STUDY

1. To assess the pre-test knowledge score regarding anorexia nervosa among adolescents in selected school at hegganahalli, Bangalore.

2. To assess the post-test knowledge score regarding anorexia nervosa among adolescents in selected school at hegganahalli,Bangalore.

3. To compare pre-test&post-test knowledge score regarding anorexia nervosa among adolescents in selected school at hegganahalli, Bangalore.

4. To assess the effectiveness of planned health teaching on anorexia nervosa among adolescents at selected school,hegganahalli, Bangalore.

5. To find out the association between knowledge and selected demographic variables such as age, sex,education( of adolescents &parents),occupation of parents, income of the family, residence(urban or rural), type of diet.

OPERATIONAL DEFINITIONS

Effectiveness :Ability to achieve stated goals or objectives, judged in terms of both output

and impact.

Health teaching programme: It’s a planned programme which comprises consciously

Constructed opportunities for learning involving some form of communication designed to improve health literacy ,improving knowledge and developing life skills which are conductive to individual & community health .

Adolescents: Adolescents refers to children of age group between 15-19 years .

Anorexia nervosa: Anorexia nervosa is an eating disorder characterisied by self starvation due to a fear of gaining weight.

HYPOTHESIS

H1-The mean post test knowledge score will be significantly higher than the pre-test knowledge score regarding anorexia nervosa among adolescents.

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H2- There will be significant association between knowledge and demographic variables such

as age,sex,education(of adolescents&parents),occupation of parents, income of the family, residence(urban or rural),type of diet.

ASSUMPTION

1.Adolescents have limited knowledge regarding Anorexia nervosa

2. Planned health teaching is useful strategy for learning to enhance knowledge regarding Anorexia nervosa

DELIMITATION

The study is delimited to adolescents (15-19 years).

The data collection is delimited to 4 weeks

PROJECTED OUTCOME

The study will enable the adolescents to practice dietary pattern & thereby help them to overcome anorexia nervosa

MATERIALS AND METHODS

SOURCE OF DATA

Adolescents who are in the age group between 15-19 years

METHOD OF DATA COLLECTION

Permission will be obtained from the samples before collecting data.questionarries (yes /no) will be administered to assess the knowledge regarding Anorexia nervosa.Interview will be conducted between 9am-2pm.Data will be collected from 5 samples per day.The duration of 30

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minutes will be spend per each subject.

SAMPLING CRITERIA

INCLUTION CRITERIA

Adolescents (15-19years)of age Those willing to participate Those who know kannada/english

EXCLUCTION CRITERIA

Children below 15 years of age Children suffering with other gastrointestinal disorders(such as peptic ulcer,abdominal

cancer,etc)

RESEARCH DESIGN

One group pre-test post-test experimental design Rearch approach –Evaluation

VARIABLES UNDER STUDY

INDEPENTENT VARIABLE

In this study the independent variable is the planned teaching programme on anorexia nervosa

DEPENDENT VARIABLE

The dependent variable in the study is knowledge score.

SETTING

The study will be conducted at hegganahalli Bangalore.

POPULATION

Adolescents who are between 15-19 years of age.

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SAMPLE

Adolescents (15-19)years of age at KTG School

SAMPLE SIZE

The sample will consist of 100 adolescents at hegganahalli,Bangalore.

SAMPLING TECHNIQUE

The convenient sampling technique will be used in this study

TOOL OF RESEARCH

Appropiate structured questionnaire for checking knowledge regarding Anorexia nervosa will be constructured and validated by experts and it will be used to collect the needed data

SECTION A:

Deals with the demographic variables of the adolescents such as age,sex,education(of adolescents&parents),occupation of parents, income of the family, residence(urban or rural),type of diet.

SECTION B:

Includes 20 yes/no questionnaires with a scoring of 20.

COLLECTION OF DATA

1, A prior formal permission will be obtained from the municipal corporation authority,at Hegganahalli ,Bangalore for collecting the required data.

2,Informed consent will be obtained from the adolescents in selected sclool at hegganahalli,Bangalore.

3,Structured questionnaire will be administered to collect the data regarding knowledge of adolescents regarding Anorexia nervosa.

4, Duration of data collection is 4 weeks,where data from 5 samples per day will be collected and a duration of 30 minutes will be spend per each subject.

METHODS OF DATA ANALYSIS AND PRESENTATION

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1,Descriptive and inferential statistics will be used

2,Mean ,Median will be used to explain demographic variables

3, Paired “t” test will be used to find out the effectiveness of planned teaching programme.

4, Chi square test will be used to find the association between the perceived knowledge level of adolescents and selected demographic variables.

Does the study require any investigation or intervention to be conducted on parents or other humans or animals?if so,please describe briefly.

YES, The study requires implantation of planned teaching programme to be conducted on adolescents at hegganahalli in bangalore .

Has Ethical clearance been obtained from your institution in case of the above?

1,Ethical clearance will be obtained from the research committee of National College Of Nursing

2,Permission will be obtained from the municipal corporation authority of Hegganahalli in Bangalore.

3,Consent will be obtained from the adolescents who are willing to participate in the study.

BIBILIOGRAPHY

1.Roy porter, “ANOREXIA NERVOSA- OVER VIEW”, &EARLY HISTORY”,2009.

2,Health A-Z, “ANOREXIA NERVOSA-INTRODUCTION”,2010.

3. Garner DM, Garfinkel PE. “ SOCIOCULTURAL FACTORS IN THE DEVELOPMENT OF ANOREXIANERVOSA”. Psychological Medicine 2004;10(4):647-56.

4, Rathner G, Messner K , ‘ DETECTION OF EATING DISORDERS IN A SMALL RURAL TOWN - AN EPIDEMIOLOGIC-STUDY’ . Psychological Medicine 2003;23(1):175-84..

5,Steven D. Ehrlich, NMD, ‘private practice specializing in complementary and alternative medicine”, Phoenix, AZ. 2008.

6,Mohinder singh, “YOU CAN NEVER BE TOO RICH OR TOO THIN,” The Tribune,on line edition,chandigarh,India,2001.

7,Reba-Harrelson L, ‘PATTERNS AND PREVALENCE OF DISTORTED EATING AMD WEIGHT CONTROL BEHAVIOUR IN WOMEN AGES 15-19 YEARS”,Department of psychiatry,university of north Carolina at chapel,Hill,NC.USA. 2005.

8. Katzman MA, Not your "typical island woman": Anorexia nervosa is reported only in subcultures in Curacao. Culture Medicine and Psychiatry2004;28(4):463-92.

9. Bennett D, ‘ Anorexia nervosa among female secondary school students in Ghana.”

British Journal of Psychiatry 2004;185:312-17

10. Daniel le Grange , ‘Eating Attitudes and Behaviors in 1,435 South African Caucasian and Non-Caucasian College Students,” American journal of psychiatry, USA, 2001

.11..Han w .Hock, ‘ The incidence of Anorexia nervosa on Curaco.” American Journal of Psychiatry 2005;162:748-752

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF

11.1 QUIDE

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

12 12.1 REMARKS OF THE PRINCIPAL

12.2 SIGNATURE