“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING HOME

CARE MANAGEMENT OF ARTHRITIS AMONG RHEUMATOID

ARTHRITIS PATIENTS ATTENDING OUT-PATIENT DEPARTMENT

AT SELECTED HOSPITAL, NELAMANGALA.”

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

2011-2013

SUBMITTED BY, SUBMITTED TO,Ms. TEENA MELVIN DAS MR. T. VIJAYKUMAR

1st YEAR M.Sc NURSING PRINCIPAL

MEDICAL SURGICAL NURSING HARSHA COLLEGE OF NURSING

HARSHA COLLEGE OF NURSING NH - 4, NELAMANGALA

NH-4, NELAMANGALA, BANGALORE.

BANGALORE.

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION

1NAME OF THE CANDIDATE

AND ADDRESS

Ms. TEENA MELVIN DAS

1ST YEAR M.SC. NURSING,

HARSHA COLLEGE OF NURSING,

NELAMANGALA,

BANGALORE.

2 NAME OF THE INSTITUTIONHARSHA COLLEGE OF NURSING,

NELAMANGALA,

BANGALORE

3COURSE OF THE STUDY

AND SUBJECT

1st YEAR M.Sc NURSING

MEDICAL SURGICAL NURSING

4DATE OF ADMISSION TO

THE COURSE05-09-2011

5

TITLE OF THE TOPIC“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING THE HOME

CARE MANAGEMENT OF ARTHRITIS AMONG RHEUMATOID

ARTHRITIS PATIENTS ATTENDING OUT-PATIENT DEPARTMENT AT

SELECTED HOSPITAL, NELAMANGALA”

2

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Time And health are two precious assets that we don’t recognize and appreciate

until they have been depleted.”  ~Denis Waitley

A disease or medical condition is an abnormal condition of an organism that

impairs bodily function associated with specific symptoms and signs. It may be caused by

external factors, such as infectious disease or it may be caused by internal dysfunctions

such as auto immune diseases. Illness and sickness are generally used as synonyms for

disease .However the term occasionally used to refer specifically to the patient’s personal

experience of his or her disease1.

Diffuse connective tissue diseases refer to a group of disorders that are chronic in

nature and characterized by diffuse inflammation and degeneration in the connective tissue.

The diffuse connective tissue diseases have unknown causes and are thought to be the result

of immunological abnormalities, they include RA, SLE, scleroderma2.

Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect

many tissues & organs but principally attacks the joints produce an inflammatory synovitis

that often progresses to destruction of articular cartilage and ankylosis of the joints. It also

produces diffuse inflammation in lungs, pericardium, pleura & sclera. About 1% of the

world’s population is afflicted by rheumatoid arthritis, women three times more often than

men. Onset is more frequent between the ages of 40 and 50.It can be disabling and painful,

which can lead to substantial loss of functioning and mobility.2

Rheumatoid arthritis affects the quality of the life. The complications of Rheumatoid

arthritis include joint distraction, heart failure, lung disease, low or high platelets, spine

instability etc. Affected joints may worsen the ordinary tasks of the day to day life.

Rheumatoid arthritis complications of this disease may shorten survival in some individuals.3

3

Although there is no known cure for most forms of arthritis, treatment

designed for individual patient can reduce/eliminate symptoms and limit functional

impairment. The goals of contemporary management of arthritis extend beyond pain control

to the enhancement of patients’ functional status and health-related quality of life. Patient

education regarding joint protection and avoidance of excessive joint loading is important for

this patient. Physical measures like hot pack, paraffin bath or occupational therapies may be

helpful.4

6.1 NEED FOR THE STUDY:

The increasing number of older people in Indian society has been well

perceived. Proportion of older people is growing faster than of any other age group. While

population ageing is a success story of socioeconomic development and good public health

practice, it has also lead to economic and social crisis due to crumbling support system, with

increased demand for health and welfare services. The elderly (people above the age of 60

years) comprise 7.5 percent of India’s total population, and by 2021 that number will be 137

million and making health care available and accessible to them is one of the health priorities

of the country.5

India now has the second largest aged population in the world. The small-family norm

means that fewer working, younger individuals are called upon to care for an increasing

number of economically unproductive, elderly persons 75% population living in the rural

areas. According to the findings of the 60th NSSO Round, the proportion of aged persons who

cannot move and are confined to their bed or home ranges from 77 per 1000 in urban areas to

84 per 1000 in rural areas.6

The prevalence of rheumatoid arthritis was studied in the adult Indian population. As

the first step, a house-to-house survey of a rural population near Delhi was conducted by two

trained health workers. The target population comprised 44,551 adults (over 16 years old).

The health workers identified the possible cases of rheumatoid arthritis (RA) using a

4

questionnaire. These cases were then further evaluated by the authors using the 1987 revised

ARA criteria for the diagnosis of RA. A response rate of 89.5% was obtained and 3393

persons were listed as possible cases of RA by the health workers. Of these, 299 satisfied the

revised ARA criteria for the diagnosis of RA, giving a prevalence of 0.75%. Projected to the

whole population, this would give a total of about seven million patients in India. 7

In India, the prevalence of rheumatoid arthritis (0.75%) is similar to that in the West.

In China, Indonesia, and the Philippines, in contrast, rheumatoid arthritis appears rare

(prevalence below 0.4%), in both urban and rural settings. The rarity of rheumatoid arthritis

in rural Africa contrasts with the high prevalence of the disease in Jamaica, where over 2% of

the adult population are affected. In a study in Latin America, rheumatoid arthritis was the

reason for seeking medical advice in 22% of rheumatology clinic patients. These differences

probably reflect variations in the interactions between genetic and environmental factors.8

Scientists estimate that about 2.1 million people, or 1 percent of the U.S. adult

population, have rheumatoid arthritis. About 1 percent of the U.S. population (about 2.1

million people) has rheumatoid arthritis. 2.5 million Americans (NWHIC); 1% of US

population (NIAMS) has rheumatoid arthritis. What causes the chronic inflammation

characteristic of RA isn’t known, but various theories point to infectious, genetic, and

endocrine factors. Currently, it’s believed that a genetically susceptible individual develops

abnormal or altered immunoglobulin (Ig) G antibodies when exposed to an antigen. This

altered IgG antibody isn’t recognized as “self,” and the individual forms an antibody against

it — an antibody known as RF. By aggregating into complexes, RF generates inflammation.

Eventually, cartilage damage by inflammation triggers additional immune responses,

including activation of complement. This in turn attracts polymorphonuclear leukocytes and

stimulates release of inflammatory mediators, which enhance joint destruction.9

The Accredited Social Health Activist (ASHA) will be trained in geriatric care and the

out-patient medical service which serves as the base for home health service will be

enhanced. One of the aspects of home health service for the geriatrics is health education

about the home remedies.10

Although health care professionals can prescribe or recommend treatments to help

patients manage their rheumatoid arthritis, the real key to living well with the disease are the

patients themselves. Research shows that people who take part in their own care report less

5

pain and make fewer doctor visits. They also enjoy a better quality of life.Patient education

and arthritis self-management programs, as well as support groups, help people to become

better informed and to participate in their own care. An example of a self-management

program is the Arthritis Self-Help Course offered by the Arthritis Foundation and developed

at a NIAMS-supported Multipurpose Arthritis and Musculoskeletal Diseases Center. (See the

Arthritis Foundation listing in “For More Information.”) Self-management programs teach

about rheumatoid arthritis and its treatments, exercise and relaxation approaches,

communication between patients and health care providers, and problem solving. Research on

these programs has shown that they help people:

▪ understand the disease

▪ reduce their pain while remaining active

▪ cope physically, emotionally, and mentally

▪ feel greater control over the disease and build a sense of confidence in the ability to

function and lead full, active, and independent lives.11

The investigator herself came across many people suffering from arthritis and who are

reluctant to know about home remedies for rheumatoid arthritis in outpatient department in

her clinical experience. Investigator had also seen her grandmother suffering from rheumatoid

arthritis. As there are many elderly people in the society and at least one person is seen in

each family, the attention given to them is less. So, the elderly people need to be educated on

the home remedies for rheumatoid arthritis. The investigator felt the need of education and

has taken up the present study to create awareness among rheumatoid arthritis patients

regarding rheumatoid arthritis.

6.2 REVIEW OF LITERATURE

6

The review of literature is traditionally considered as a systematic critical review of

the most important published scholarly literature on a particular topic. A through literature

review focuses on prior research, provides a foundation on which to

base knowledge. According to Polit and Hungler (1999) “Review of literature is a critical

summary of research on a topic of interest generally prepared to put a research problem in

context to identify gaps and weakness in prior studies so as to justify a new

investigation”. There are three sections included in Review of Literature. They are

SECTION A – Review on knowledge regarding Joints

SECTION B – Review on knowledge regarding Rheumatoid arthritis

SECTION C – Review on Home remedies of Rheumatoid Arthritis and prevention of its

complications.

SECTION D - Review on effectiveness of Structured Teaching Programme

SECTION A – Review on Knowledge regarding Joints

The musculoskeletal system provides an important function of our body. It provides

form, stability and movement to the body. A main part of the musculoskeletal system is the

joint. The word joint is used to describe how bones are connected to other bones and muscle

fibres' using connective tissue such as tendons and ligaments.12

Joints consist of bones, muscles, cartilage, tendons, ligaments and other connective

tissue. Muscles keep the bones in place and also through contraction or extension help move

the bones. Cartilage prevents the bone ends from rubbing directly on to each other. Cartilage

is not as hard and rigid as bone, but is stiffer and less flexible than muscle. Tendons are bands

of fibrous tissue that connect muscles to bones. Ligaments are bands of fibrous tissue that

connect the ends of bones together to form a joint.12

7

Most joints in the human body are freely movable and have much more complex

structures than the immovable or even the slightly movable types. The articular (adjoining)

ends of bones in a freely movable joint are covered with a thin layer of "articular cartilage,"

which is resistant to wear and produces a minimum of friction when it is compressed as the

joint is moved. Joint bones are held together by a tubular "joint capsule" that has two distinct

layers. The outer layer consists mostly of dense, white, fibrous connective tissue, the fibers of

which are attached to the periosteum around the outside ring of each bone of the joint near its

articular end. The outer fibrous layer of the capsule, therefore, completely encloses the other

parts of the joint. It is flexible enough, though, to allow movement and strong enough to help

prevent the articular surfaces from being pulled apart. Bundles of strong, tough collagenous

fibers called "ligaments" reinforce the joint capsule and help to bind the articular ends of the

bones together. Some ligaments appear as bulges in the fibrous layer of the capsule, while

others are "accessory structures" located outside the capsule. In either case, these structures

also prevent too much movement at the joint, because the ligament is relatively inelastic and

becomes tightly drawn whenever a normal limit of movement has been achieved in the

joint. 13

The inner layer of the joint capsule consists of a shiny, vascular lining of loose

connective tissue called "synovial membrane." The membrane covers all of the surfaces

within the joint capsule, except the areas which are covered by cartilage. Some freely

movable joints are partially or completely divided into two compartments by disks of

fibrocartilage called "menisci" located between the articular surfaces. Such a disk is attached

to the fibrous layer of the joint capsule at the sides, and its free surface projects into the joint

cavity. Certain freely movable joints also have closed, fluid-filled sacs called "bursae"

associated with them. Each bursa has an inner lining of synovial membrane, which may be

continuous with the synovial membrane of a nearby joint cavity. Bursae act as cushions and

aid the movement of tendons which glide over such bony parts or over other tendons. The

names of the bursae indicate their locations; for example, a "suprapatellar bursa," a

"prepatellar bursa," and a "infrapatellar bursa".13

There are two major types of joints: synarthroses and diarthroses. Synarthroses are

joints connected by fibrous tissue. Diarthroses are synovial joints, where two bones are bound

together by a joint capsule, forming a joint cavity. In synovial joints, there is a nourishing

lubricating fluid called synovial fluid.14

8

There are two types of synarthroses: fibrous joints and cartilaginous joints. In fibrous

joints, bones are united by fibrous tissue. There are three types of fibrous joints: gomphosis,

suture, and syndesmosis. A gomphosis joint occurs where one bone fits into another bone.

The articulating edges are bound together by connective tissue, and the bony surfaces in the

articulation are close together A syndesmosis joint connects two bones through connective

tissue and is found throughout the human body.14

In cartilaginous joints, bones are connected by either fibrocartilage or hyaline

cartilage. There are two types of cartilaginous joints: symphyses and synchondroses. A

symphysis is a cartilaginous joint where the connecting entity is fibrocartilage. The

symphysis is stable but it allows limited motion. A synchondrosis is a joint where the

articulating surfaces are close together, yet are bound by hyaline cartilage.14

A diarthroses has a synovial component. The bones are connected to a joint capsule

that surrounds the bones and creates a joint cavity. Ligaments also attach bone-to-bone

stabilizing the joint and making the diarthrotic joint stable, yet mobile. . Making the

diarthroses even more unique from the synarthroses is the addition of synovial fluid. The

synovial fluid provides lubrication within the joint Synovial-type joints can be further

classified into three categories: uniaxial, biaxial, and triaxial. In summary, the diarthroses is

complex, with ligaments and capsule providing stability, disks or menisci aiding in

congruency, and synovial fluid providing lubrication.14

SECTION B – Review on knowledge regarding Rheumatoid arthritis

T.Makelainen.et.al.(2008) conducted a study to describe RA patients understanding

of their disease and its treatments. The study included 252 RA patients participated in the

survey. The knowledge level of the patients and their physical functioning were measured

using self reported Questionnaire and the datas were analyzed using descriptive and non-

parametrical statistical method. The results obtained that the total score of patient knowledge

9

Questionnaire ranged from 2 to 29.The patient’s were knowledgeable regarding the etiology,

signs and symptoms, blood test, physical exercise ,facts relating to joint protection, how to

use Anti rheumatic drugs and non steroidal non inflammatory drugs. Among them the young

patients, women with long disease duration knew the most. Thus the study concluded stating

that RA patients knowledge of their disease & its treatment varied from poor to good.15

Elly M Van Der Wardt.et.al. (2000) conducted a study to gain insight into the

general public's knowledge and perceptions regarding rheumatic diseases in the Netherlands.

A questionnaire was sent by mail to a random sample of 1800 Dutch homes; the response was

658. Questions mainly focused on knowledge, attitudes, behavioural intentions and use of the

mass media with regard to rheumatic diseases. The respondents gave the right answer to a

mean of 8.2 statements out of 17 true/false statements regarding factual knowledge of

rheumatic diseases. Respondents particularly underestimated the prevalence of rheumatic

diseases and were unaware of several rheumatic disorders. Thus the study concluded that the

public in general do not know very much about rheumatic diseases, but they do have a

moderate desire for more information about them.16

Barlow JH .et.al. (1998) conducted a study to assess the

knowledge in patients with rheumatoid arthritis: a longer term follow-up of a randomized

controlled study of patient education leaflets. Despite the wide availability of disease-related

leaflets, their impact on patients' knowledge and well-being has rarely been evaluated. A

randomized controlled study of a 'Rheumatoid Arthritis' leaflet revealed

increased knowledge among the intervention group after 3 weeks. In addition, the leaflet was

viewed as a source of reassurance. The purpose of the follow-up study was to determine

whether the increase in knowledge was maintained in the longer term and to examine

psychological well-being. Eighty-four patients (42 intervention and 42 control) completed the

6 month follow-up. There were no significant changes (P > 0.01) in mean outcome measures

over the period 3 weeks-6 months for either the intervention or control groups.Patients in the

intervention group retained the increase in knowledge observed at 3 weeks.17

SECTION C – Review on Home remedies of Rheumatoid Arthritis and prevention of its

complications.

10

Põlluste K.et.al. (2012) conducted a study on assistive devices, home adjustments

and external help in rheumatoid arthritis. To explain the determinants of adaptation

with disease and self-management of patients with rheumatoid arthritis (RA) in Estonia,

focusing on the use of assistive devices, home adjustments and the need for external help. A

random sample (n = 1259) of adult Estonian RA patients was selected from the Estonian

Health Insurance Fund Database. The patients completed a self-administered questionnaire,

which included information about their socio-demographic and disease characteristics, the

costs of care, quality of life, use of assistive devices, home adjustments and the need for

external help. Regression analysis was used to analyze the predictors of patient's adaptation

with disease and self-management. Twenty-six percent of the respondents used assistive

devices, 20% had made home adjustments and 37% needed external help. The study

concluded that disability and physical impairment are the most important determinants of the

use of various technical aids and home adjustments. These factors, along with the female

gender and single status of the patient, predict help-dependence.18

Hewlett S.et.al. (2011) conducted a study on self-management of fatigue

in rheumatoid arthritis: a randomized controlled trial of group cognitive-behavioral therapy to

investigate the effect of group cognitive behavioral therapy (CBT) for fatigue self-

management, compared with groups receiving fatigue information alone, on fatigue impact

among people with rheumatoid arthritis (RA).Two-arm, parallel randomised controlled trial

in adults with RA, fatigue ≥ 6/10 (Visual Analogue Scale (VAS) 0-10, high bad) and no

recent change in RA medication. Group CBT for fatigue self-management comprised six

(weekly) 2 h sessions, and consolidation session (week 14). Control participants received

fatigue self-management information in a 1 h didactic group session. Primary outcome at 18

weeks was the impact of fatigue measured using two methods (Multi-dimensional

Assessment of Fatigue (MAF) 0-50; VAS 0-10), analysed using intention-to-treat analysis of

covariance with multivariable regression models. Of 168 participants randomised, 41

withdrew before entry and 127 participated. There were no major baseline differences

between the 65 CBT and 62 control participants. At 18 weeks CBT participants reported

better scores than control participants for fatigue impact: MAF 28.99 versus 23.99 (adjusted

difference -5.48, 95% CI -9.50 to -1.46, p=0.008); VAS 5.99 versus 4.26 (adjusted difference

-1.95, 95% CI -2.99 to -0.90, p<0.001). Standardised effect sizes for fatigue impact were

MAF 0.59 (95% CI 0.15 to 1.03) and VAS 0.77 (95% CI 0.33 to 1.21), both in favour of

11

CBT. Secondary outcomes of perceived fatigue severity, coping, disability, depression,

helplessness, self-efficacy and sleep were also better in CBT participants. Thus the study

concluded that the Group CBT for fatigue self-management in RA improves fatigue impact,

coping and perceived severity, and well-being.19

Home   D .et.al. (2009) conducted a study on the role of early intervention and self-

management of Rheumatoid Arthritis The National Institute of Health and Clinical Excellence

issued guidance on the management of RA in adults while the King's Fund and National

Audit Office have reported on the services that are available for people with RA. This paper

will provide an overview of these reports and their implications for primary care. The role of

early identification, referral and diagnosis will be explained as well as the treatment options

available. The role of self-management and how community nurses can facilitate self-

management will be discussed.20

Chiou AF.et.al. (2009) conducted a cross-sectional study on Disability and

pain management methods of Taiwanese arthritic older patients to investigate the prevalence

of disability, factors influencing disability and pain self-management techniques employed by

older arthritis patients in Taiwan. Disability was found in 11% of Taiwanese individuals

diagnosed with either rheumatoid arthritis or osteoarthritis. Those in disability reported more

severe disease activity, pain, depression and lower life satisfaction. Hierarchical multiple

regression analysis revealed that 31-46% of the total variance of disability could be explained

by age, gender, marriage, joint pain score, diagnosis, disease activity, depression and pain

management. Patients with rheumatoid arthritis had significantly higher levels of

disability, disease activity during the preceding six months, more depression and less life

satisfaction than patients with osteoarthritis. Thus the study concluded that higher disability

was explained by older age, female, unmarried, diagnosed with rheumatoid arthritis, more

joint pain, more disease severity, more depression and more use of

pain management strategies in arthritis patients.21

SECTION D - Review on effectiveness of Structured Teaching Programme

Fati Abourazzak.et.al. (2009) conducted a study on Long-term effects of therapeutic

education for patients with rheumatoid arthritis. 39 RA patients participated in a 3 day

educational programme. Effects were evaluated after 3 yrs in 33 patients comparatively to the

12

baseline based on variables: knowledge of RA, Disease activity(DAS28),functional

impairment (HAQ) and quality of life ,Arthritis impact measurement scale 2 (AIMS2),also

compared patient knowledge in educational programme participants and in 38 controls with

RA. The results stated that patient knowledge was significantly improved compared to

baseline than in controls. DAS28 was lower in educational group after 3 yrs than at baseline

with no change in HAQ,AIMS2.Thus the study concluded that the educational programme

can produce lasting improvement in knowledge of disease and may help to control the

activity of RA.22

T.Uhlig.et.al. (2008) conducted a study to determine whether there was a secular

change from 1994-2004 among patients within the setting of Oslo Rheumatoid Arthritis

Register(ORAR).The Datas were collected from all living patient in the ORAR by giving a

postal questionnaire in 1994,1996,2001& 2004,including the modified Health Assessment

Questionnaire(MHAQ),Arthritis Impact Measurement scale2 (AIMS2) and Visual analogues

scale for the assessment of disease severity, pain & fatigue. Mixed model approach was used

for longitudinal analysis adjusting for age, sex, and co-morbidity& disease duration. The

results were that the health status in the population with RA was consistently improved in all

dimensions of health. Thus the study concluded that health status in RA improved from 1994

to 2004, due to better &more aggressive treatment.23

T.M.Spigell.et.al. (1987) conducted a study to evaluate an inpatient RA patient

education program to determine whether patient knowledge improved and whether the

improvement persisted after discharge. The patient’s knowledge was assessed by a multiple

choice and true false test given upon admission, after education and 4 months following

discharge. The result was obtained that the treatment group increased their knowledge by 40

%( p<.05) on post intervention Questionnaire where as control group had no significant

improvement in knowledge. Thus the study concluded that inpatients demonstrated increase

in knowledge of physical therapy even they were involved in numerous diagnostic &

therapeutic interventions that could have distracted from educational programme.24

6.3 STATEMENT OF THE PROBLEM:

13

A study to assess the effectiveness of structured teaching programme on knowledge

regarding home care management of arthritis among rheumatoid arthritis patients attending

outpatient department at selected hospital, Nelamangala.

6.4 OBJECTIVES OF THE STUDY

1. To assess the knowledge regarding the home care management among rheumatoid

arthritis patients by conducting a pre-test.

2. To evaluate the effectiveness of structured teaching programme on rheumatoid

arthiritis and home care management among the rheumatoid arthritis patients attending the

outpatient department by comparing the pre test and post test knowledge scores.

3. To find out the association between pre test knowledge of rheumatoid arthritis

patients regarding the home care management with selected demographic variables.

4. To evaluate the post test knowledge regarding home care management of rheumatoid

among rheumatoid arthritis patients after structured teaching programme.

6.5 OPERATIONAL DEFINITIONS

Evaluate: Refers to significance of systematic determination of merit, worth,

significance of structured teaching programme on rheumatoid arthritis.

Effectiveness: Refers to the extent to which the structured teaching programmes on

rheumatoid arthritis has achieved the desired effect in improving the knowledge of

adults as assessed by structured questionnaire.

Structured Teaching Programme: Refers to systematically planned group instructions

by lecture cum discussion method designed to provide information regarding rheumatoid

arthritis such as meaning, causes, signs and symptoms, and home care management.

14

Knowledge: It is the understanding of information about a subject that has been obtained

by experience or study. In the present study, knowledge refers to understanding of

information about home care management of rheumatoid arthritis in adults which has

been measured by structured knowledge questionnaire.

Home remedies for rheumatoid arthritis: It refers to selected set of prophylactic

measures one can readily make in the home environment to reduce the pain and

problems related to arthritis. For example application of garlic paste on the affected area,

hot application to the joints and rubbing sandalwood paste etc.

Rheumatoid arthritis: Rheumatoid arthritis (RA) is an inflammatory disease that causes

pain, swelling, stiffness, and loss of function in the joints. It occurs when the immune

system, which normally defends the body from invading organisms, turns its attack

against the membrane lining the joints.

Variable: Variable is an entity or characteristics which will vary during the observations.

6.6 ASSUMPTIONS

1. The researcher assumes that the patients undergoing screening, lack knowledge

regarding self care and home care management of rheumatoid arthritis.

2. The structured teaching programme will improve the knowledge on home care

management among patients.

3. Patients will practice home care management.

6.7 HYPOTHESIS

H0–There is no significant difference between the post test knowledge scores and the

pretest knowledge scores regarding the home care management of rheumatoid arthritis

among rheumatoid arthritis patients.

H1-There is a significant difference between post test knowledge and the pre test

knowledge scores of rheumatoid arthritis patients regarding the home care management.

H2-There is a significant association between the pretest knowledge score of rheumatoid

arthritis patients regarding the home care management with selected demographic

variables.

15

6.8 VARIABLES OF THE RESEARCH

Independent variable: Structured Teaching Programme.

Dependent variable: Knowledge on rheumatoid arthritis.

Demographic variables: Age, education, marital status, socio economic status, source of

information, occupation etc.

6.9 DELIMITATIONS OF THE STUDY

Small sample size so may not be generalized to larger population with different level of

literacy.

Lack of follow up on the practice of the home care management as per structured

teaching programme.

Teaching module is limited to structured teaching programme.

7.0 MATERIALS AND METHODS

Methodology helps researcher to project a blue print of research undertaken. This

includes a series of steps from problem identification to the data collection.

7.1 SOURCES OF DATA

The data will be collected from the rheumatoid arthritis patients attending outpatient

department.

RESEARCH APPROACH

The research approach for the present study is an evaluative research approach.

RESEARCH DESIGN

16

The research design adopted for present study is quasi experimental, one group pretest

and post test design.

SETTING OF THE STUDY

The study will be conducted at selected hospital of Nelamangala.

POPULATION

Population in the study consists of rheumatoid arthritis patients attending outpatient

department in selected hospital of Nelamangala.

SAMPLES SIZE

The sample of the study will consist of 60 patients.

SAMPLING TECHNIQUE

The proposed sampling technique adopted for the present study is simple

non-probability sampling technique.

SAMPLING CRITERIA

INCLUSION CRITERIA

o Rheumatoid Arthritis patients who are present during data collection.

o Rheumatoid Arthritis patients who are willing to participate in the research.

o Rheumatoid Arthritis patients who can understand and communicate in English or

Kannada.

o Age group of 21 - 60

o Patients without disability in seeing and hearing

EXCLUSION CRITERIA

O Rheumatoid Arthritis patients who are not willing to participate in this study.

O Rheumatoid Arthritis patients who are not present during data collection.

O Rheumatoid Arthritis patients who cannot understand and communicate in Kannada or

English.

17

7.2 METHODS OF DATA COLLECTIONTOOL FOR DATA COLLECTION

The tool for the proposed study is self administered structured questionnaire which

would be developed by researcher with the help of extensive literature and expertise

opinion.

METHOD OF DATA ANALYSIS AND INTERPRETATION

The data collected will be spread into a master sheet for easy statistical analysis.

Descriptive statistics:

To describe data collected by percentage, mean, mode, median and standard deviation.

Inferential statistics:

1. Independent (unpaired)‘t’ test to find difference between the mean knowledge scores

of the adults.

2. Chi square test to determine the association between the selected demographic

variables and the knowledge level of Rheumatoid Arthritis patients regarding home care

management of rheumatoid arthritis.

DURATION OF THE STUDY

The research is intended to complete within a time frame of 6-8 weeks.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTIONS TO BE CONDUCTED ON ADULTS OR OTHER

HUMAN OR ANIMAL?Yes, educational intervention planned for the study group is enough.

7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM

YOUR INSTITUTION?

18

.

Yes, Ethical clearance will be obtained from the respective institution where the data

collection to be done, the hospital.

The informed consent will be obtained from the samples for their willingness to participate in

the study.

Sample’s privacy and self esteem will be respected and maintained throughout the study and

information will not be disclosed or shared with anybody else.

8.0 LIST OF REFERENCES

1. Disease from wikipedia, the free encyclopedia.CMAJ 136(8):811–3.

URL:http://en.wikipedia.org/wiki/disease#cite_note-0#cite_note-0

2. URL:http://en.wikipedia.org/wiki/rheumatoid_arthritis#cite_note-pmid17045630-

40#cite_note-pmid17045630-40

3. Available from www.nationalarthritis.com

4. Chaturvedi VP. Musculoskeletal problems in Geriatric populations In : Geriatrics

Update 200,. Proceedings of Indo-US conference on Geriatrics Feb 2001,, New Delhi.

OP Sharma (ed) Geriatric society of India. 2001; 97-106.

19

5. Available from Homeremedies.guide.com

6. Srivastava R.K. Multicentric study to establish epidemiological data on health

problems in elderly: a Govt. of India and WHO collaboration programme. Ministry of

Health & Family Welfare, Government of India 2007.

7. Malaviya AN, Kapoor SK, Singh RR, Kumar A, Pande I. , Prevalence of

rheumatoid arthritis in the adult Indian population, 1993;13(4):131-4,

PMID:8310203

8. Mijiyawa M, Epidemiology and semiology of rheumatoid arthritis in Third World

countries,1995 Feb;62(2):121-6, PMID:7600065

9. Fromhttp://www.wrongdiagnosis.com/artic/

handout_on_health_rheumatoid_arthritis_niams.htm

10. Available from http://www.thehindu.com/2007/12/27/stories.

11. Handout on Health : Rheumatoid Arthritis (2009)

www.niams.nih.gov/health_Info/Rheumatic_Disease/default.asp

12. www.kidport.com/reflib/science/HumanBody/.../JointStructure.htm

13. www.innerbody.com/image_skelbov/ligm20_new_bov.htm

14. www.enotes.com › Health

15. Mäkeläinen P, Vehviläinen-Julkunen K, Pietila AM, Rheumatoid arthritis patient’s

knowledge of the disease and its treatment. 2008 Aug;7(1):31-44.

16. Elly M Van Der Wardt, Erik Taal, Johannes J Rasker. The general public’s knowledge

and perceptions about rheumatic diseases. Ann Rheum Dis 2000:59:32-8.

17. Barlow JH, Wright CC, Knowledge in patients with rheumatoid arthritis: a longer

term follow-up of a randomized controlled study of patient education leaflets, 1998

Apr;37(4):373-6, PMID:9619885

18. Põlluste K , Kallikorm R, Mättik E, Lember M. , Assistive devices, home adjustments

and external help in rheumatoid arthritis, 2012;34(10):839-45. Epub 2011 Oct 24,

PMID:22023483

19. Hewlett S , Ambler N, Almeida C, Cliss A, Hammond A, Kitchen K, Knops B, Pope

D, Spears M, Swinkels A, Pollock J, Self-management of fatigue in rheumatoid

arthritis, 2011 Jun;70(6):1060-7, PMID:21540202

20. Home   D , Carr M, Rheumatoid arthritis: the role of early intervention and self-

management,  2009 Oct;14(10):432-6, PMID:19966683

20

21. Chiou AF , Lin HY, Huang HY, Disability and pain management methods of

Taiwanese arthritic older patients, 2009 Aug;18(15):2206-16, PMID:19583652

22. Fati Aboourazzak. Fati A, Laila EM, Dorothée H, Rita L, Najia H,et al.

Long-term effects of therapeutic education for patients with rheumatoid arthritis,

2009 Dec;76:648-53

23. Uhlig T, Heiberg T, Mowinckel P, Kvien TK. Rheumatoid arthritis is milder in the

new millenium:health status in patients with rheumatoid arthritis 1994-2004.

2008;67:1710-15.

24. Spiegell TM  K, Knutzen KL, Spiegel JS. Evaluation of an inpatient rheumatoid

arthritis patient education programme, London, 1987 Sep;6:412-6:412-6

9. Signature of the candidate:

10. Remarks of the guide:

11. Name & Designation

21

11.1 Guide:

11.2 Signature:

11.3 Co-Guide:

11.4 Signature:

11.5 Head of the Dept:

11.6 Signature:

12.Principal

12.1 Remarks of the Principal:

12.2 Signature:

22