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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MR.NOBLE JOSE
I YEAR M.Sc. (NURSING)
CHILD HEALTH NURSING
YEAR 2011-2013
SRI VENKATESHWARA COLLEGE OF NURSING
NO: 98, MARUTHI INDUSTRIAL ESTATE,
PEENYA 2ND STAGE,
BANGALORE - 560 058.
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE
BANGALORE, KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. NAME OF THE
CANDIDATE AND
ADDRESS
MR. NOBLE JOSE
1st YEAR M.SC. (N)
SRI VENKATESHWARA COLLEGE OF NURSING,
NO:98, MARUTHI INDUSTRIAL ESTATE,
PEENYA 2nd STAGE,
BANGALORE – 560 058
2. NAME OF THE
INSTITUTION
Sri Venkateshwara College of Nursing,
No:98, Maruthi Industrial Estate,
Peenya 2nd stage, Bangalore- 560 058
3 COURSE OF THE STUDY
AND SUBJECT
1st Year M.Sc. Nursing
Child Health Nursing
4. DATE OF ADMISSION TO
THE COURSE
16.06.2011
5 TITLE OF THE TOPIC
“A study to assess the effectiveness of structured
teaching program regarding promotion of healthy
behavior among the mothers of preschool children
in selected community areas in Bangalore.”
2
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION
“Half of the costs of illness are wasted on conditions that could be
prevented”. Dr. Joseph Pizzorriu..
Today’s children are tomorrow’s citizens. Prosperity of the nation depends upon the health
of children. Children with sound mind in sound body are essential for the future development of
the country. During the earliest years of growth and development, preschool children need
dependable attachment to parents and caregivers; they need protection, guidance, stimulation,
nurturance, and skills to cope with adversity1.
A preschool child’s development is under control of parents’ and grandparents’ direct
supervision and increasingly in the hands of near strangers such as health care providers and
teachers. In pre-schools, students learn decent human relations through the techniques of
cooperative learning and supervised service. Curiosity and thinking skills are stimulated through
study of the life sciences. Education and health are linked, each nourishing the other2.
The main conditions for fostering healthy behaviour in preschool children are personal
hygiene, physical and mental health, learning activities and proper nutrition. Schools provide
suitable health-promoting environments for improving healthy behaviour among school going
children. Preschools should provide clear examples of health-promoting behaviour, means of
social reinforcement for such behaviour and encouragement of healthful habits. They should
clarify the nature of good nutrition in the classroom and serve nutritious food in the cafeteria.
Curriculum is another aspect which helps in promoting a healthy behaviour in preschool
children. This concept of active, self-generated learning affects all aspects of the curriculum
from teacher training through classroom practice and parent involvement. Life-skills training in
Preschools can provide their students with knowledge and skills to help them make informed,
deliberate decisions. Such information, combined with training in interpersonal skills and
3
decision making, can help students to resist pressure from peers or from the media, relieve
distress without dangerous activity, learn how to make friends if they are isolated 3.
The main conditions for promoting healthy behaviour in preschool children are personal
hygiene, physical and mental health, learning activities and proper nutrition. There is no more
crucial period of life than the age up to six years. Preschool healthy behaviour is now being
recognized as clear indicator of difficulties that may persist into later childhood and that may
indicate family dysfunction. Screening is necessary to detect developmental problems in
preschool children. Therefore their positive health behaviour towards every aspects of life is
important to develop a good generation4.
6.1 NEED FOR STUDY
Preschool period is one of rapid change in developmental, social, emotional, cognitive
and linguistic abilities. The child is progressively developing more autonomy 7.Preschool
children with early emergent behavior problems are likely to evince serious behavior problems,
social skill deficits and academic difficulties later in life5.
The improvement of the health of preschool students and the settings in which they learn
also appears to enrich and improve educational outcomes. Recent major reports and studies cite
various forms of evidence which suggests that preschool children learn better if they are healthy.
Common themes run through this literature which indicates learning is faster, more
comprehensive and enjoyed by students if they are healthy. The health promoting preschool
appears to offer an approach which increases the learning capacity of students. The health
promoting school approach also appears to enrich classroom-based learning outcomes, e.g.
knowledge acquisition, decision making. Evidence in the literature indicates that learning goals
and aims expressed in educational 6.
A study was conducted to analyze the effect of mother’s employment on cognitive
outcomes of her children. A panel of children aged 4 to 15 are analyzed to explore the effect of
maternal employment on a child’s mental health outcomes. Using ordinary least squares and
fixed effects estimates, it was found that mothers who spend more time at home have children
with fewer emotional problems, they scored lower behavioural problems. They are also less
4
likely to be frequently unhappy or depressed. In addition, children with mothers spending more
time at home are less likely to hurt someone, stealing something, or skip school7.
A descriptive study was conducted on sedentary behaviour in US preschool
children. The main objective of the study was to identify correlates of objectively measured
sedentary behaviour in a diverse sample of preschool children. A total of 331 children from a
wide range of ethnic and socioeconomic backgrounds, were recruited for this study. All potential
correlates except for anthropometric data of children were measured by a parent survey.
Sedentary behaviour measured by accelerometry in preschool children. The result shows
that Girls spent more time in sedentary behaviour than boys. In the gender-specific final model,
for boys, a child's weekday TV/video games and physical activity equipment in the home were
significant correlates of sedentary behaviour .The study concluded that several factors were
identified as correlates of objectively measured sedentary behaviour in
American preschool children. However, there were no common correlates that influenced
sedentary behaviour for both boys and girls8.
A study was conducted on healthy social relationship among preschool children. It
reveals that preschool children should be able to develop the proper social skills to prevent the
emergence of health problems, emotional distress and personality disturbances. Educators must
train children and adults on how to recognize, encourage and enhance characteristics that help
children develop friendships. The study concluded that teachers, parents, older siblings and other
adults should act as role models for preschool children to develop appropriate behaviours of
affection, sensitivity and cooperation.9
From the various literatures, it is clear that there is an emphasis on age-appropriate
knowledge to preschool children which is useful to sustain one’s health and which forms a basis
for lifelong healthy practices. The focus on knowledge has shifted from an instructional approach
to reflect current understandings about how children learn. The documents and their
accompanying guides and manuals, where present, place a strong emphasis on interaction and
participatory learning methods, and on involving pupils in many outside class and community
activities which require different approaches to the teacher-dominated classroom curriculum1o.
5
Therefore the researcher found that there is a need to improve the knowledge regarding
healthy behaviours among the mothers of preschool children. In many areas there is a lack of
health education and knowledge among preschool children. There is a need to prepare a
structured teaching programme to educate the mothers of preschool children regarding
promotion of healthy behaviour. Hence, this study was undertaken.
6.2 REVIEW OF LITERATURE
“A literature review is a body of text that aims to review the critical points of current knowledge
including substantive findings as well as theoretical and methodological contributions to a
particular topic”.
A study was conducted on an innovative preschool health education programme. The
aim of the present study was to explore the effects of health education program, related to the
identification of healthy and unhealthy nutritional habits, physical activities and hygiene in
children 4-5 years of age. It reveals that 125 children participated in an education program for a
period of two months. For data collection, a specialized protocol was constructed with pictures in
order to evaluate the preschool children’s knowledge about healthy behaviour before and after
the implementation of the education program. The results of the present study showed that after
the implementation of the program the scores were higher in identifying healthy and unhealthy
nutritional habits and physical activities compared to the scores before the program. In regard to
the place of residence, children from downgraded areas presented higher performance than
children from privileged areas in identifying healthy and unhealthy physical activities and
hygiene. From the results of the present study, it concluded that taking up habits of healthy
nutrition, exercise and hygiene constitutes the main requirement for the preschool child’s healthy
development and a guarantee for a healthy adulthood11.
A descriptive study was conducted on Municipal Intentions to Promote Preschool
Children’s Healthy behaviour. It is clear that preschools are environments where children are
given opportunities to develop emotional, social and intellectual healthy capabilities,
6
characteristics that by recent research have been revealed as health protecting. The objectives of
this study were to examine the intentions of 25 Swedish municipalities to develop such
capabilities through activities in preschool and to relate these intentions to municipal socio-
economic conditions. Indicators on municipal intentions to promote preschool children’s
emotional, social and intellectual capabilities were rather frequently utilized by the 25
municipalities in this study. It concluded that promotion of physical activity, parent support, and
children’s influence in preschool were not prioritized. The extent of intended preschool activities
was not determined by municipal wealth, which might be due to a national system for equalizing
municipal resources.12
A study was conducted on the prevalence of emotional and behavioural problems
among 1488 primary school children aged 5 to 11 years in Karachi, Pakistan. It shows that
assessment of preschool children’s mental health was conducted using Strength and Difficulties
Questionnaire (SDQ). The results show that 34.4% parents rated children as falling under the
“abnormal category” on strength and difficulties questionnaire, 35.8% were reported by the
teacher. The study concluded that there is a gender difference in prevalence. Boys had higher
estimates of behaviour / externalizing problems; whereas emotional problems were more
common amongst females. If parents are employed, the prevalence of behaviour problems, were
more in boys as well as girls13.
A study was conducted on preventing anxiety and promoting social and emotional health
in preschool children .The objective of the study was to examine, for the first time, the efficacy
of The Fun FRIENDS program, a school-based, universal preventative intervention program for
preschool children. The program aims to teach children cognitive-behavioural strategies in a
play-based manner to prevent anxiety and to increase social and emotional strength. Participants
were 263 children aged four to six years attending preschool in Brisbane, Australia. Schools
were randomly allocated to an intervention group (IG) or a waiting list control group (WLG).
Parent report data revealed no significant differences between the IG and WLG on anxiety,
behavioural inhibition (BI) and social emotional strength at post-intervention. At 12-month
follow-up, improvements were found on anxiety, BI and social-emotional competence for
children in the IG. The study concluded that teacher reports revealed significant improvements at
post-intervention on BI and social-emotional strength for children who had received the
7
program. The implications of these findings are discussed, along with limitations and directions
for future research14.
A preliminary study was conducted on special education services for preschool-age
children. The objective of this study was to gather information about the structure and
organizational components of inclusive services for preschool-age children in California. The
results indicate that the availability of inclusive services and type of service delivery models vary
according to the child's age and disability. Services for preschoolers tend to fall into two
configurations: children with mild disabilities who are frequently fully included and children
with severe disabilities and low-incidence disabilities who are more often partially included or
placed in special day classes only. The services provided most frequently in inclusive programs
are related services and consultation to families, community preschools, and other agencies. The
results concluded that although inclusive services are available in many local education agencies
(LEAs) service delivery models may not be conducive to the implementation of interventions
needed to support optimal social and developmental outcomes for children15.
A study was conducted on effectiveness of the health promoting among primary school
in improving preschool child healthy behaviour. It indicates that school health programs have
been part of schooling for most of this century. This paper examines the development of the
health promotion and identifies its healthy components. It reviews the claims and evidence which
have emerged from the school health research literature which focus on primary schools.
Findings indicate health gains for primary school students are difficult to assess, and will most
likely occur if a well designed programme is implemented which links the curriculum with other
health promoting school actions, contains substantial professional development for teachers and
is underpinned by a theoretical model. The paper concludes by discussing how improvements
can be made in more accurately assessing the effectiveness of the health promoting primary
school in improving healthy behaviour16.
An epidemiological study of child and adolescent psychiatric disorders was conducted in
urban and rural areas of Bangalore, India. The psychiatric morbidity among less than 3 year old
children was 13.8 % with the most common diagnosis being breath holding spells, pica,
behaviour disorder, expressive language disorder and mental retardation. The prevalence rate of
8
psychiatric morbidity in the 4-16 year old children was 12%. Enuresis, specific phobia,
hyperkinetic disorders, stuttering and oppositional defiant disorder were the most frequent
diagnosis. Assessment of felt treatment needs indicated that only 37.5% of the families perceived
that their children had any problem17.
An integrative study was conducted on acquisition and socialization of children's health
attitudes and behaviour. It reveals an overview and synthesis of the literature documenting
various influences on the socialization and acquisition of children's health attitudes and
behaviour is the focus of this review. Cognitive-developmental approaches to understanding
preschool children's health attitudes are presented, followed by an exploration of an individual
differences perspective on children's acquisition of health attitudes and behaviour. The influence
of various socialization agents, including families, peers, schools, and the media, on children's
acquisition of health attitudes and behaviour is considered. Implications of these findings for
social policy, future research, and molding of child health attitudes and behaviour are
examined18.
A study was conducted on supporting system and certain behavioural problems in
preschool children in Malappuram district in Kerala. It was conducted on a sample of 100 pre-
school children of the age group of above four years, i.e. UKG students belonging to the
different types of preschools. Comparison of behaviour problems of boys and girls revealed no
significant difference in between the two groups. The study concluded that the children of high-
socio economic status with less behaviour problems whereas the children of low –socio
economic status were found to have the highest extent of behaviour problems.19
A study was conducted on behavior problems among preschool children. The main
objective of the study was to assess mental health among preschool children. It reveals that out
of 200 Preschool children (aged 3-6 years), 44 (22%) had behavior problems. The study
concluded that the prevalence was higher among boys and more common in children from
nuclear families and a lower socio-economic status20.
A study was conducted on physical activity for preschool children. It reveals that
alarming trends in childhood obesity even among preschool children have re focused attention on
the importance of physical activity in this age group. The aim of the study was to identify the
9
amount and type of physical activity appropriate for optimal development of preschool children
and the another purpose of this paper is to provide the scientific evidence to support a link
between physical activity and biological and psychosocial development during early childhood
(ages 2 5 years). To do so, we summarize pertinent literature informing the nature of the physical
activity required to promote healthy physical, cognitive, emotional, and social development
during these early years. Special emphasis is also placed on the nature of physical activity that
promotes healthy weight gain during this period of childhood. The paper also discusses the
strongest determinants of physical activity in preschool-age children, including the role of the
child’s environment (e.g.family, child-care and socio-economic status). We provide
recommendations for physical activity based on the best available evidence, and identify future
research needs21.
Statement of the problem
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTERED TEACHING
PROGRAME REGARDING PROMOTION OF HEALTHY BEHAVIOUR AMONG
MOTHERS OF PRESCHOOL CHILDREN IN SELECTED COMMUNITY AREAS IN
BANGALORE”.
6.3 OBJECTIVES OF THE STUDY
• To assess the pre-test knowledge regarding promotion of healthy behaviour among
mothers of preschool children.
• To assess the post-test knowledge regarding promotion of healthy behaviour among
mothers of preschool children in experimental and control group.
• To compare pre-test and post-test knowledge score regarding promotion of healthy
behaviour among mothers of preschool children in experimental and control group.
• To find out the association between post-test knowledge score regarding promotion of
healthy behaviour among mothers of preschool children with that demographic variables.
10
6.4 OPERATIONAL DEFINITIONS
1. Assess- Assess refers to process of the critical analysis and valuation and judgment of the
status or quality of preschool children with unhealthy behaviour.
2. Effectiveness- Effectiveness refers to the difference which is expected in the pre and
post-test knowledge score value of the mothers of preschool children in the promotion of
healthy behaviour.
3. Structure Teaching Programme- It refers to a systematically organized teaching
strategy to provide knowledge regarding the importance of healthy behaviour among the
mothers of preschool children.
4. Healthy behaviour-It refers to an action taken by a person to maintain, attain or regain
good health and prevent illness.
5. Preschool children-in this study the preschool children refer to the children in the age
group of 3-6 years
6.5 HYPOTHESIS OF THE STUDY.
H1:- The mean post-test knowledge score of experimental group is significantly higher
than the mean post-test knowledge score of control group.
H2:-The mean post-test knowledge score of experimental group is significantly higher
than the mean pre-test knowledge score of the experimental group.
H3:- There will be significant association between the post test knowledge scores of the
mothers of preschool children with selected demographic variable in experimental group.
11
6.5 DELIMITATIONS OF THE STUDY
The study is delimited to,
1. The sample size was 60
2.The data collection period was only 4 weeks.
3. Mothers with preschool children, who are living in selected community areas.
6.6 PILOT STUDY
The study will be conducted with 12 samples, 6 in each experimental and control group. The
purpose to conduct the pilot study is to find out the feasibility for conducting the study and
design on plan of statistical analysis.
6.7 VARIABLE
A quantity that can assume any of a set of values is called variables.
Dependent variable: Knowledge level of mother’s knowledge regarding promotion of healthy
behaviour.
Independent variable: Structured teaching programme regarding promotion of healthy
behaviour among mothers.
7.0 MATERIAL AND METHODS
7.1 SOURCE OF DATA
The data will be collected from the mothers of preschool children living in selected
community areas in Bangalore.
12
7.1.1 RESEARCH DESIGN
The quasi experimental design is non equivalent control group. So pre-test and post test which is
presented below groups
Group Pre-test Intervention Post-test
Group 1 Q1 X Q1
Group 2 Q2 - Q2
SYMPOLS USED
Group 1 - Mothers of preschool children in the experimental group.
Group 2 - Mothers of preschool children in the control group.
Q1 - Collection of demographic data and pre-test assessment of knowledge regarding
promotion of healthy behaviour.
Q2 - Post test done with the same pre-test questioners to assess the knowledge regarding
promotion of healthy behaviour. In this study experimental group received structured teaching
programme and control group did not receive any kind of intervention.
7.1.2 RESEARCH APPROACH
In evaluative research approach was selected from this study.
7.1.3 SETTING OF THE STUDY
The study will be conducted in selected community areas in Bangalore.
7.1.4 POPULATION
13
In this study the population selected for mothers, who have children aged between 3-6 years.
7.2. METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE)
Permission will be collected from selected authorities’ in a selected community area. Purposive
sampling technique will be use for the study. Purpose of the study will be explained to the
sample and consigned will be obtained. Data will be collected from using structured interview
schedule to evaluate the effectiveness of knowledge regarding promotion of healthy behaviour
among mothers of preschool children.
Data collection instruments consist of the following sections
Section ‘A’: Demographic data. Age, sex, religion, socio economic status etc.
Section ‘B’: Structured interview shedule related to assess the knowledge regarding promotion
of healthy behaviour among the mothers of preschool children.
SCORING INTERPRETATION
Items of knowledge regarding promotion of healthy behaviour among the mothers of preschool
children which consist of 30 questions.
A score of ‘one’ will be given for each correct response and score of ‘zero’ will be given
for each incorrect response.
Adequate knowledge Above 70%
Moderately adequate knowledge 50-70%
Inadequate knowledge Below 50%
14
7.2.1 SAMPLING TECHNIQUE
Non-probability convenience sampling technique for purposive sampling.
7.2.2 SAMPLE SIZE
The sample consists of 60 mothers of preschool children living in selected community
areas in Bangalore, 30 mothers in experimental group and 30 mothers in control group
respectively.
SAMPLING CRITERIA
7.2.3 INCLUSION CRITERIA
• Mothers having child between the age group of 3-6 years.
• Mothers, who are available at the time of data collection.
• Mothers, who can understand English and Kannada.
EXCLUSION CRITERIA
• Mothers, who are selected for pilot study.
• Mothers, who are not willing to participate in the study.
7.2.5 TOOL FOR DATA COLLECTION
Structured interview schedule will be used to collect the data from the mothers of
preschool children in selected community areas at Bangalore.
7.2.6 DATA ANALYSIS METHOD
15
The data collected will be analyzed by using descriptive and inferential statistics.
• Descriptive statistics: Frequency and Percentage for analysis of demographic data and
mean, mean percentage and standard deviation will be used for assessing the level of
knowledge of the mothers of preschool children.
• Inferential statistics: Chi-square test will be used to find the association between
knowledge and selected demographic variables. And paired t’ test will be used for
assessing the effectiveness of structured teaching program.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO
BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?
Yes, since the study design is quasi-experimental in nature, interventions are required.
7.4 ETHICAL CLEARENCE
Yes ethical committee’s report is here with enclosed.
The main study will be conducted after the approval of research committee of the college.
Permission will be obtained from the head of the institution. The purpose and details of the study
will be explained to the study subjects and assurance will be given regarding the confidentiality
of the data given.
8. LIST OF REFERENCES: [VANCOUVER STYLE FOLLOWED]
16
1. Rai,S C and Malik.“Healthy Behaviour among preschool children”. Nightingale Nursing
times.1992. dec; 14(4):475-478
2. Marcon, R.A. “Differential effects of three preschool models on
Inner-city 4-year-olds”. Early Childhood Research Quarterly,1992 Volume 7,page 517
—530
3. David P. Weikart, Ph.D. “Promotive and positive health behaviour in children”.
High/Scope Educational Research Foundation.pg 26-28
4. Perera H and Gunatunge C. “Screening for mental health problems in urban preschool
children- a pilot studies”. Sri Lanka Journal of Child Health 2004; 33 (2):39-42.
5. Huaqing C and Ann P. “Behaviour problems of preschool children from low income
families”. Topics in Early Childhood Special Education 2003 Dec; 23(4):188-216
6. L H St Leger.“The opportunities and effectiveness of the health promoting primary
school in improving child health”. Available from http://her.oxfordjournals.org
7. Mukherjee S. “The impact of maternal employment on child’s mental health”: Evidence
from NSLY-Child [online]. 2009 Sep. [updated Sep 2009; cited 2009 Sep 23].
Available from: URL:
http://artsci.wustl.edu/~econgr/gradconference/Papers/Mukherjee_MaternalEmp.pdf
8. Wonwoo Byun and Russel R Pate. “Correlates of objectivity measured sedentary
behaviour in US preschool children”. Pediatrics journal
9. .Elaine M Murphy. “Promoting healthy behavior”(Healthy Bulletin number 2)
10. Pahl and Paula M. “Preventing Anxiety and Promoting Social and Emotional Strength in
Preschool Children”
11. .Triantafilia and Eva Vidali-Laloumi. “An innovative health education programme”,
Research Group of Archimedes Project. Volume 4,issue 2010
17
12. Karlin Guldbrandsson and Sven Bremberg. “Municipal Intentions to promote preschool
children’s health”. Available from
http://www.springerlink.com/content/7h83h136v2624260
13. Syed EU and Haidry SE. “Prevalence of emotional and behavioral problems among
primary school children in Karachi, Pakistan multi informant survey”. Indian Journal of
Paediatrics 2009 Jun; 76(6):623-7.
14. Pahl and Paula M. “Preventing Anxiety and Promoting Social and Emotional Strength in
Preschool Children”. A Universal Evaluation of the Fun FRIENDS Program, Volume
3, Number 3, July 2010 , pp. 14-25(12
15. Maurine Ballard and Rosa Elenor . “A preliminary study of inclusive special education
services for preschool children in California”,
16. Topic-How to Promote Healthy Behaviours in Your Children. Available from
http://tips4diet.net/weight-loss-tips/how-to-promote-healthy-behaviors-in-your-
children.htmlby admin on July 1, 2010
17. Girimaji G and Bhola P. “Epidemiological study of child & adolescent psychiatric
disorders in urban & rural areas of Bangalore, India”. Indian Journal of Medical Research
2005 Jul; 122(1):67-79.
18. Barbara J. Tinsley. “Multiple Influences on the Acquisition and Socialization of
Children's Health Attitudes and Behaviou”r: An Integrative Review. Article first
published online: 28 JUN 2008
19. Kuruvilla M. “Supporting systems and certain behaviour problems of preschool children
in Malappuram district” [Internet].2002 [updated Aug 2002; cited 2008 Aug]. Available
from: URL:http://krpcds.org/report/ushap.pdf
20. .Rai S and Malik SC. “Behaviour problems among preschool children”. Indian
Paediatrics 1993 Apr; 30(4):475-478
21. Brian W. Timmons and Karin A. Pfeiff r. Physical activity for preschool children-how
much and how. Available from www.nrcresearchpress.com by 59.90.233.142 on
12/08/11.
18
9. Signature of the candidate.
10. Remarks of the guide.
11. Name and designation.
11.1 Guide
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 chairman and
principal.
12.2 Signature.
19