"A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLED REGARDING
PROTECTIVE
EFFECT OF BILINGUALISM ON
ALZHEIMERS DISEASE AMONG MONOLINGUAL
ADULTS BETWEEN THE AGES OF 35-50
YEARS AT SELECTED RURAL
COMMUNITIE AT
TUMKUR"
PROFORMA FOR REGISTRATION OF SUBJECT FOR THE
DISSERTATION
SUBMITTED BY
MISS MINU VARGHESE
MENTAL HEALTH PSYCHIATRIC NURSING
2011-2013
SRI SIDDARTHA COLLEGE OF NURSING
AGALAKOTE, B.H. ROAD
TUMKUR
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1
NAME OF THE CANDIDATE
& ADDRESS
MISS MINU VARGHESE
I YEAR M.Sc. NURSING
SRI SIDDARTHA COLLEGE
OF NURSING
AGALAKOTE,TUMKUR
2
NAME OF THE
INSTITUTION
SRI SIDDARTHA COLLEGE
OF NURSING,
B.H ROAD,TUMKUR
3
COURSE OF THE
STUDY& SUBJECT
MASTER OF SCIENCE IN
NURSING
MENTAL HEALTH PSYCHIATRIC
NURSING
4
DATE OF ADMISSION
6th JULY 2011
5
TITLE OF THE TOPIC
"A
2
STUDY
TO
ASSESS
THE
EFFECTIVENESS
OF
STRUCTURED
TEACHING
PROGRAMME ON KNOWLEDGE
REGARDING
PROTECTIVE EFFECT OF
BILINGUALISM
ON
ALZHEIMERS
DISEASE
AMONG
MONOLINGUAL
ADULTS BETWEEN THE
AGE GROUP OF 35-50 YEARS
AT
SELECTED
RURAL
COMMUNITIES
IN
TUMKUR”
BRIEF RESUME OF THE INTENDED WORK
6. INTRODUCTION
“Language exerts hidden power, like a moon on the tides”
RitaMae Brown
Despite the past century’s fascination with measuring every facet of life ‘little is
known about the middle years (age between35-50 years).After all, living in to middle age is
a relatively recent phenomenon in human history. Although the pressing nature of agerelated ill health precipitated a welcome and much needed boom in information about aging,
there reunited a paucity of knowledge about the middle years1.
Alzheimer’s disease was first described by a German Psychiatrist and
Neurologist, Dr Aloes -Alzheimer, in 1906, on a middle- aged patient suffering from
Dementia. It was after the death of the patient, by autopsy, that Alzheimer was able to
demonstrate abnormal changes in the brain. Alzheimer’s disease (AD) is also called the
death of mind. The AD is cruel disease which not only destroys person’s mind but also robs
him or her of memories. It is a progressive degenerative disease which attacks the tissues of
the brain and results in impaired memory, thinking, behaviour and emotions. The process is
gradual and is often associated with loss of the individual’s ability to care for him or
herself2.
3
Bilingualism is an intriguing field Researchers across the world are racing
towards a cure for Alzheimer’s disease. As prevalence rates climb, their focus has broadened
from treatment to prevention strategies. Although there are no magic solutions, tantalizing
new evidence suggests it may be possible to prevent or delay the onset of Alzheimer’s
disease through a combination of healthful habits. Scientists with the Rot man Research
Institute at the Bay crest Research Centre for Aging and the Brain have found the first
evidence that another lifestyle factor, bilingualism, may help delay AD symptoms3.
Due to globalization and multiculturalism, the world has seen a rapid increase of
bilingual or multilingual speakers. Throughout the world people have grasped the
importance of acquiring a second or third foreign language, indicates that there are more
bilingual people in the world than there are monolingual people4. Since the mid-twentieth
century, bilingualism has been offering a broad spectrum of research possibilities. For
instance, the positive influence of bilingualism on children and the correlation between
bilingualism and cognitive decline have already been examined5. Over the last decades,
Ellen Bialystok, a research professor of psychology at York University in Toronto, has
proven to be a pioneer in this field of study. They examined the effect of lifelong
bilingualism on the onset of symptoms of AD. Results showed that bilingualism has a
protective effect in delaying the onset of AD by four years6.
The term of ‘bilingualism’, - and that of ‘multilingualism’, too - is used
frequently. “bilingualism is the ability to use two or more languages sufficiently to carry
4
on a limited casual conversation”. They believe that the interpretation of bilingualism may
differ from one individual to another .It indicates that there are at least twenty dimensions of
language to determine whether a person is bilingual7. When the people have acquired a
minimum level of competences, such as reading, writing and
speaking, in a foreign
language, they will be bilingual8.
Bilingualism is an intriguing field of study for many researchers. There are “two
intrinsic values in studying bilingualism”. First, “studying bilingualism tells us something
about the genetic potential of humans”. Second, “simply living in a community where two
or more languages are spoken is a part of the human experience”9. Thus, the status of
languages spoken within the community is an important factor in studying bilingualism. The
possible benefits of bilingualism have raised many questions during the latter half of the
twentieth century.
Until the 1950s, researchers mainly focused on behavioural
consequences of bilingualism. Later, the cognitive implications of bilingualism were
considered. Peal and Lambert were the first to establish the positive effects of
bilingualism10. Later on various studies have clearly indicated that bilingualism has positive
effect on cognitive function.
The objective of this dissertation is to give an insight regarding these new areas
of studies as well as encourage monolingual adult for learning a new language to fight with
AD.
5
6.1 NEED FOR STUDY
Over the past 50 years careful research was able to show that Alzheimer’s
disease occurs more commonly in the elderly than in those in middle age. It affects 5-10 %
of those over 65 years of age and more than 20 % of those over 80 years. As the proportion
of people over 65 years is gradually increasing more cases of AD will accumulate and it
may turn in to a greater public health problem. In the USA and other western countries AD
has become the 4th leading cause of death (after heart diseases, cancer and stroke) among
adults around the age of 75. AD is becoming a problem in developing countries as well.
Even a 2-year delay in onset of Alzheimer’s disease (AD) would reduce the
prevalence in the USA by 1.94 million after 50 years, and delays as short as 6 months could
have substantial public health implications11. Many of the factors predisposing a person to
AD are biological. So the search for methods to delay onset has focused largely on
pharmacological and other biologically-based therapies12.There is growing evidence,
however, that some environmental factors can maintain cognitive functioning in older adults
and mitigate the effects of illnesses that produce AD.Notably,research on“cognitive reserve”
has demonstrated that lifestyle factors, such as physical activity, stimulating leisure
involvement, and social engagement play a role in post ponding the onset of AD and other
dementias.
The report, released in September 2009 by Alzheimer's disease International,
says more than 35 million people worldwide have Alzheimer's disease or other types of
6
dementia, according to the most in-depth attempt yet to assess the brain-destroying illness.
The updated count is about 10 per cent higher than predicted just a few years ago, because
earlier research underestimated Alzheimer's growing impact in developing countries.
Barring a medical breakthrough, dementia will nearly double every 20 years. By 2050, it
will affect 115.4 million people, the report suggests. Alzheimer's is the most common form
of dementia and affects one in 20 Canadians over 65 — about 290,000 people. The number
rises to one in four in those over 85. Close to 75 per cent of Canadians with Alzheimer's are
women. According to researchers at the Johns Hopkins Bloomberg School of Public Health
in Baltimore, by 2050 the number of cases around the world will quadruple to around 106
million people. '71,000 Canadians under the age of 65 are living with Alzheimer's disease or
a related dementia. Approximately 50,000 are 59 or younger13.
The overall notion is that some factors allow a person to function within a
normal cognitive range, despite the presence of brain pathology that would usually be
associated with dementia. For example, Mortimer (1997) found that between 10 and 40% of
autopsy cases -showing brain pathology exceeding the criteria for AD had shown no signs
of cognitive impairment before death. Similarly a population-based study carried out by the
UK Medical Research Council found that more than 30% of individuals with mild and
severe AD pathology at autopsy had shown no previous signs of cognitive impairment14.
Importantly, most of the studies included in the review found significant effects
of the protective variable in question after co-varying out age and other brain-reserve
7
measures. One surprising conclusion of the review was that “it is evident that mentally
stimulating leisure activity is the most robust brain-reserve measure, since all these studies
showed a significant protective effect even after controlling for age, education, occupation
and other potential confounds”
13
.They found an overall decrease in incident dementia of
46% after a median follow-up interval of 7.1 years; these figures are based on a total of over
29,000 individuals from 22 studies. It is important to note the authors’ caution that higher
levels of behavioural brain reserve may simply delay the onset of dementia, rather than
reduce incidence in an absolute manner. In a comparison piece, the same authors conducted
a review of studies of longitudinal cognitive change and factors ameliorating cognitive
decline in the elderly14. This second review was based on a new sample of 18 studies
involving more than 47,000 individuals; the main finding was that higher levels of
behavioural brain reserve were related to decreased rates of cognitive decline.
A longitudinal study was conducted on 2004, also found strong evidence for the
role of social, mental, and physical activities in protecting against all types of dementia.
Similarly, they concluded that “more education and a more cognitively complex occupation
predict higher cognitive ability in old age than would be expected for a person’s childhood
ability and accumulated brain burden”15.
According to the 1981 Census, out of a total population of 685.2 million, in the
world, 44 million people were aged 60 years and over. In the 1991 census the number of
elderly was about 55.3 million, that is, 6% of the total population of 844.3 million. The
8
number of people over 60 years is expected to touch the 60 million mark by the end of this
century. Although there is no exact figure of AD patients in India, recent surveys in south
India report that the rate of Dementia of the people over 60 years varied from 2.7% to3.4%,
a figure almost identical to the western countries16.
From these reviews, it seems clear that the prevalence rate of AD is rising
gradually as well as the complex mental activity across the lifespan can acts to at least delay
the incidence of Alzheimer’s. So it is essential to find out the types of mental activity yield
this protective function as well as the mechanism linking mental activity to its
neuroprotective function. The recent report contributes some solution for this by
demonstrating a further type of mental activity that may be associated with a delay in the
appearance of the symptoms of dementia and Alzheimer’s. The activity in question is the
constant use of two languages over many years; Bilingualism has been shown to enhance
attention and cognitive control in both children17 and older adults18.
In these studies, lifelong bilinguals who use both languages in their daily lives
showed an advantage in a variety of tasks involving attention control. The suggested
interpretation is that the use of two languages requires a mechanism to control attention to
the relevant language and ignore or inhibit interference from the competing language. This
experience provides continual practice in attention control and results in its earlier
development in children, improved functioning in adults, and slower decline in older age.
9
Therefore, bilingualism might contribute to cognitive reserve and protect older adults from
decline in the context of dementia and AD. This hypothesis was examined.
A Canadian study regarding Bilingualism and Dementia reports that speaking
two languages can help delay the onset of Alzheimer’s symptoms by as much as 5 years18.
This could be good news in India, where many people know multiple languages and can
therefore choose to actively speak more than 1 language and acquire the claimed protection.
Research on the correlation between bilingualism and Alzheimer’s has only
started recently. Most studies mainly focus on the effects of neurological, social and
environmental factors on the onset of AD. Their investigation indicated that some
environmental factors may postpone the onset of symptoms and illnesses that produce
dementia. For instance, sustained mental activity, and hence higher brain reserve, can
protect against dementia and cognitive decline in elderly individuals19.
A Canadian study regarding effects of bilingualism on the memory of elderly
people - found that bilingualism enhanced attention and cognitive reserve in older adults.
The eye movement study showed few differences between monolingual and bilingual
subjects. Nonetheless, older bilingual subjects scored significantly higher during a key press
response test. The behavioural study, therefore, indicated advantages in older bilingual
subjects20. In a consecutive study, they investigated how dementia was influenced by
bilingualism. They examined the effect of lifelong bilingualism on the onset of dementia in
10
old age. The study was conducted among 184 Canadian patients diagnosed with dementia
and their caregivers. 51% of all patients were bilingual. To be considered as bilingual,
patients had to have spent a majority of their lives using two languages. Results of this study
showed that on average bilingualism delays the onset of dementia by an average of 4.1 years
concluded that there is no difference between the results for men and those for women21.
Even though a comparison of the level of education showed that bilinguals had
often had less education, educated monolinguals showed few advantages over uneducated
bilinguals. Apart from the level of education, the primary occupation of the patients was
compared. Results indicated that bilinguals with the same occupational status as
monolinguals developed the first symptoms of dementia at a later age. Some knowledge of
another language is not sufficient to be considered as being bilingual. Furthermore, they
mention that this study may be seen as subjective since most data relies on reports of the
patient, family members or caretakers. They nevertheless conclude that the research has
indicated that bilingualism can be considered as a possible factor to protect against dementia
and AD and cognitive decline in elderly individuals.
These reviews are, therefore, the motivation to conduct a structured teaching
program among monolingual adults between the age group of 35-50 years at rural
community in Tumkur, in order to improve their knowledge regarding this new area of
study, as well as motivate them to learn a new language towards off Alzheimer’s and helps
to keep the brain young.
11
6.2 REVIEW OF LITERATURE
“Literature review is a critical summary of research
on a topic of interest, often prepared to put a research problem in
context or as the basis for an implementation project”.
Polit and Hungler
A secondary analysis was conducted about the ‘positive Effects of Bilingualism
in the Adult Mind and Brain’, on September 23, 2011 a by Dr. Judith F. Kroll, Director of
Center for Language Science Pennsylvania State University, and found the past 20 years of
research shows that the cognitive development of bilingual children is advantaged relative to
their monolingual counterparts, that bilingualism confers positive consequences, in the
domain of executive function and attention control, and that life as a bilingual provides
protection against the typical cognitive declines observed in old age.22
A secondary analysis was conducted in City University of New York Graduate
Center by Loraine K. obler, Ph.D, distinguished professor program in Speech- LanguageHearing Sciences on August 19, 2010.He analysed more than 150 reviews since 1985
regarding bilingualism and Dementia/AD. The suggested interpretation is that the use of two
languages requires a mechanism to control attention to the relevant language and ignore or
inhibit interference from the competing language. These experiences provide continual
practice in attention control and results in its earlier development in children, improved
functioning in adults, and slower decline in older age. Therefore, bilingualism might
12
contribute to cognitive reserve and protect older adults from decline in the context of
dementia and AD23.
A study was conducted in Canada between 2007-2010 regarding lifelong
bilingualism and Dementia/AD. Data were collected from 211 consecutive patients
diagnosed with probable Alzheimer’s disease (AD). Patients’ age at onset of cognitive
impairment was recorded, as was information on occupational history, education, and
language history, including fluency in English and any other languages. Following this
procedure, 102 patients were classified as bilingual and 109 as monolingual. They found that
the bilingual patients had been diagnosed 4.3 years later and had reported the onset of
symptoms 5.1 years later than the monolingual patients. The groups were equivalent on
measures of cognitive and occupational level, there was no apparent effect of immigration
status, and the monolingual patients had received more formal education. There were no
gender differences. The data confirm results from an earlier study, and thus they concluded
that lifelong bilingualism confers protection against the onset of AD. The effect does not
appear to be attributable to such possible confounding factors as education, occupational
status, or immigration.24
A study was conducted in Karnataka, India between 2008-2010 to qualify the
cognitive-linguistic performance in persons with dementia as compared to healthy elderly.
There were 80 participants: 20 persons with diagnosis of mild dementia (10 monolinguals
and 10 bilinguals) and 60 healthy elderly (30 monolinguals and 30 bilinguals). A diagnosis
13
of probable dementia was made according to DSM IV criteria. Each patient attended a
geriatric clinic at National Institute of Mental Health and Neurosciences (NIMHANS)
where they underwent thorough medical screening in order to rule out any other treatable
pathology that could explain their impairment. Healthy elderly participants were not
suffering from any neurological or psychological illness likely to impair performance and
were not complaining of memory or other cognitive difficulties. There were no significant
differences in the distribution of males and females (p> 0.05). Also the participants in the
dementia group exhibited similar cognitive decline despite having different types of
dementia25.
A comparison survey was conducted in Jammu district, North India, between
2007 and 2008, to ascertain the prevalence of dementia (AD) in the population aged 60
years and above, and to compare prevalence of dementia (AD) in the different populations
of Jammu district. They conducted two stage cross-sectional epidemiological studies of
1,856 subjects aged 60 years and above, using cognitive and functional ability screening and
clinical evaluation. The overall prevalence of dementia in the 60 years and over population
was 1.83%, with a small gender difference. The prevalence of dementia in ethnic Dogra
population of Jammu district, North India was lower (1.83%) in comparison to the migrant
Kashmiri Pandit population residing in the same District, as well as the prevalence of
dementia increased with advancing age. Individuals with age 85 and above showed the
14
highest prevalence with females recording slight increase. Significant prevalence of
dementia was reported only afterage 75 years and above26.
A pilot study was conducted in the
Flemish Community of Belgium to
investigating the effects of bilingualism on subjects diagnosed with dementia. The survey
was aimed at both monolingual and multilingual subjects diagnosed with any form of
dementia. In order to obtain a representative sample of both subject groups, approximately
sixty rest homes or nursing homes in Belgium were contacted by telephone. They measured
the significance of the correlation between monolingual and bilingual subjects, and the age
of onset of dementia by means of an Independent Samples t-test. The study shows a
considerable difference in age of onset between Belgian and Canadian subjects. Bialystok et
al. (2007) indicated that their monolingual subjects developed the first symptoms of
dementia at 71.4 years whereas in this study, monolinguals showed the first symptoms of
dementia at 78.8 years. Canadian bilingual subjects developed the first symptoms of
dementia at 75.5 years compared to 79.1 years for Belgian bilingual subjects. Thus, they
assume that Canadians are more likely to develop the onset of dementia at an earlier age
than Belgians27.
A study was conducted St. Michael's Hospital in Canada, in order to find the
correlation between Alzheimer’s and bilingualism. The researchers studied the CT scans of
40 patients whose cognitive skills – including attention, memory, planning and
15
organizational abilities - were found on testing to be similar. Half the patients were fluently
bilingual while the other half spoke only one language. The scans of the bilingual patients
showed twice as much atrophy in areas of the brain known to be affected by Alzheimer's. So
they concluded that the bilingual people are constantly using their brain and keeping it
active, which may contribute to overall brain health. That's why many physicians encourage
older people to do crossword puzzles or Sudoku. Previous observational studies have found
that bilingualism delays the onset of Alzheimer's symptoms by up to five years, but this was
the first to find physical proof through CT scans28.
A study was conducted by San Diego State University, York University, and
Wellesley College between 2007 and 2008
regarding cognitive control in bilinguals, to
know whether Bilinguals often outperform monolinguals on nonverbal tasks that require
resolving conflict from competing alternatives. The regular need to select a target language
is argued to enhance executive control. They investigated whether this enhancement stems
from general effect of bilingualism or from a modality constraint that forces language
selection. They compared the performance of 15 monolinguals, 15 bimodal bilinguals, and
15 unimodal bilinguals on a set of flanker tasks. There were no group differences in
accuracy, but unimodal bilinguals were faster than the other groups; bimodal bilinguals did
not differ from monolinguals. These results trace the bilingual advantage in cognitive
control to the unimodal bilingual’s experience controlling two languages in the same
modality.29
16
A door-to-door survey was conducted to investigate the prevalence, psychosocial
correlates and risk factors of various dementing disorders in an urban population in Kerala,
southern India on 2005. They selected sample from the city of Kochi (Cochin) by using
cluster sampling, to identify residents aged ≥65 years . Of 1934 people screened with a
vernacular adaptation of the Mini-Mental State Examination, all those scoring at or below
the cut-off of 23 were evaluated further and those with confirmed cognitive and functional
impairment were assigned diagnoses according to DSM-IV criteria. Identified cases were
categorised by ICD-10 criteria. Ten per cent of those screened as negative were evaluated at
each stage. The prevalence of dementia was 33.6 per 1000 (95% CI 27.3-40.7). Alzheimer's
disease was the most common type (54%) followed by vascular dementia (39%), and 7% of
cases were due to causes such as infection, tumour and trauma. According to this survey
Dementia (AD) is an important health problem of the elderly population30.
A study was conducted in the Memory Clinic at Bay crest in Toronto, Canada,
between 2002 and 2005 to
examine the effect of lifelong bilingualism on maintaining
cognitive functioning and delaying the onset of symptoms of dementia in old age. The
sample was selected from the records of 228 patients referred with cognitive complaints. In
addition to a medical history, physical examination, and mental status evaluation, patients
were usually assessed with CT, SPECT, and screening blood tests. The final sample
consisted of 184 patients, of whom 91 were monolingual and 93 were bilingual. There were
66 patients in each language group diagnosed with probable AD, comprising 73% of
monolinguals and 71% of the bilinguals diagnosed with dementias. The bilinguals showed
17
symptoms of dementia 4 years later than monolinguals, all other measures being equivalent.
Additionally, rate of decline in Mini-Mental State Examination (MMSE) scores over the 4
years subsequent to the diagnosis was the same for a subset of patients in the two groups,
suggesting a shift in onset age with no change in rate of progression31.
An article reports the findings of a 3-year epidemiological survey for dementia
in an urban community-resident population in Mumbai (Bombay), India, wherein the
prevalence of all types of dementia was determined. From a potential pool of 30,000
subjects aged 40 years or more, 24,488 (male = 11,875; female = 12,613) persons completed
self-report or interviewer-rated protocols based on the Sandoz Clinical Assessment Geriatric
Scale, but 5,512 (18.37%) persons refused to participate. The prevalence rate for dementia in
those aged 40 years and more was 0.43% and for persons aged 65 and above was 2.44%.
Seventy-eight individuals had a CDR of [greater-than-or-equal] 1 yielding an overall
prevalence rate of 0.32%, and a prevalence rate of 1.81% for those aged 65 years and older.
The overall prevalence rate for Alzheimer's disease (AD) in the population was 0.25%, and
1.5% for those aged 65 years and above. The prevalence of AD and other dementias is less
than that reported from developed countries but similar to results of other studies in India.
Prevalence of
the dementia syndrome increased with age. AD was the most common
dementia and the prevalence was higher in women than in men32.
18
STATEMENT OF THE PROBLEM.
“A Study To Assess The Effectiveness Of
Structured Teaching
Programme On Knowledge Regarding Protective Effect Of Bilingualism On
Alzheimer’s Disease Among Monolingual Adults Between The Age Group Of 35-50
Years At Selected Rural Communities In Tumkur.”
6.3 OBJECTIVES OF THE STUDY:
1.
To assess the pre-test level of knowledge regarding the protective effect
of bilingualism on Alzheimer’s disease among monolingual adults between the age group of
35-50 years.
2.
To assess the pre-test level of knowledge regarding the protective effect
of bilingualism on Alzheimer’s disease among monolingual adults between the age group of
35-50 years.
3.
To evaluate the effectiveness of structured teaching programme by
comparing pre-test and post–test scores.
4. To determine the association between the post-test level of knowledge with
selected socio-demographic variables among monolingual adults between the age group of
35-50 years.
19
6.4 RESEARCH HYPOTHESIS:
H1: The mean post-test knowledge level of mono lingual adults age group between 35-50
years, regarding the protective effect of bilingualism on Alzheimer’s disease will be
significantly higher than the mean pre-test knowledge level of mono lingual adults.
H2: There will be significant association between the knowledge level and socio
demographic variables.
6.5 OPERATIONAL DEFINITIONS:
ASSESS: It refers to gathering information about knowledge level of mono lingual adults
age group between 35-50 years, regarding the protective effect of bilingualism on
Alzheimer’s disease.
EFFECTIVENESS:It refers to the extent to which the structured teaching programme will
be helpful in gaining knowledge regarding protective effect of bilingualism on Alzheimer’s..
STRUCTURED TEACHING PROGRAMME: It is a systematically developed programme
with teaching aids designed to impart knowledge regarding protective effect of bilingualism
on Alzheimer’s.
BILINGUALISM: it refers to adults knowing more than one language to read and write.
MONOLINGUALISM: it refers to adults knowing only one language to read and write.
ALZHEIMERS: it is a progressive degenerative disease which attacks the tissues of the
brain and results in impaired memory, thinking, behaviour and emotions.
20
6.6 ASSUMPTIONS
1. The adults may have low level of knowledge regarding protective effect of
bilingualism on Alzheimer’s disease before doing structured teaching programme.
2. Structured teaching programme may improve their knowledge.
6.7 DELIMITATION
•
Study is limited to only 60 samples in each group.
•
Study is limited to monolingual adults’ age group between 35-50 years.
•
Study is limited to 6 weeks.
21
7. MATERIALS AND METHODS OF THE STUDY:
7.1 SOURCE OF DATA:
The data will be collected from monolingual adults age group between 35-50
years at selected rural community in Tumkur..
7.2 METHODS OF DATA COLLECTION:
Data will be collected by using structured questionnaire after obtaining prior
permission from the authority.
7.2.1 TYPE OF STUDY/RESEARCH APPROACH:
Experimental approach will be chosen to conduct the study.
7.2.2 RESEARCH DESIGN:
One group pre-test post-test pre-experimental design is chosen for
conducting the study.
22
7.2.3 VARIABLES OF THE STUDY:
1.
Dependent variable: Knowledge level regarding protective effect of
bilingualism on Alzheimer’s disease among monolingual adults age group between 3550 years..
2.
Independent variable: Structured teaching programme.
3.
Attributing variable: demographic variables such as age, sex, family,
place of living urban/rural etc.
7.2.4. SETTINGS OF THE STUDY
The study will be conducted at selected areas in Tumkur.
7.2.5 POPULATION
The population will comprise at selected area in Tumkur.
7.2.6 SAMPLE AND SAMPLE SIZE:
Sample size of the study is 60 monolingual adults between the age group of 3550 years.
23
7.2.7 SAMPLING TECHNIQUE:
Simple Random sampling technique by using lottery method will be used
to select the samples.
7.2.8 CRITERIA FOR SELECTION OF SAMPLE:
Inclusion criteria:
1.
Both males and females.
2.
Monolingual adults aged between 35 and 50 years.
Exclusion criteria:
1.
Monolingual adults who are not willing to participate.
2.
The individual who got other severe illness.
3.
Monolingual adults who are not available/absent at the time of data
collection.
7.2.9 FOLLOW UP
The post-test will be conducted after one week of pre-test.
7.2.10 COMPARISON PARAMETER
Yes, the pre-test and post-test level of knowledge will be compared within the
group.
24
7.2.11 DURATION OF STUDY
The study will be planned to conduct within 6-8 weeks of duration.
7.2.12 INSTRUMENT:
Instruments consist of two sections:
• Section A: Demographic profile of the monolingual adult between the age
group of 35-50 years.
• Section B: Questionnaire; It consist of questions to assess the knowledge
regarding correlation of bilingualism and Alzheimer’s among monolingual adult
between 35-50 years at selected rural area in Tumkur.
7.2.13 METHOD OF DATA ANALYSIS AND PRESENTATION
The data collected through structured questionnaire will be carefully
recorded and
analysed through following techniques.
Descriptive analysis
1. Frequency and percentage analysis will be used to describe the demographic
characteristics of monolingual adult.
2.
Descriptive analysis such as mean, range standard deviation and mean score per
cent will be used to assess the knowledge regarding correlation of bilingualism and
Alzheimer’s among monolingual adult between 35-50 years.
25
3. Inferential statistics
•
Paired t - Test will be carried out to assess the statistical significance and
compare the pre
•
and post-test knowledge score .
The Chi -Square analysis will be used to determine the association between
knowledge and selected demographic variables.
7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE
ON
CONDUCT
PATIENTS OR OTHER HUMAN OR ANIMALS?
Yes, this study involves the intervention of structured teaching programme.
7.4
HAS
ETHICAL
CLEARANCE
BEEN
OBTAINED
FROM
YOUR
INSTITUTION?
Ethical clearance will be obtained from Institutional Ethical Committee (IEC)
and
the permission will be obtained from the P.H.C. for data collection. A pilot study
will be conducted to assess the feasibility and main study will be conducted after getting
the consent from the subject.
26
8. LIST OF REFERENCES REFERENCE
1.
Saritha Bhalotra MD,PhD .A National study of wellbeing at Midlife .The new England
journal of medicine 2004.
2.
Ms Malhothra A K. Caring in Alzheimer’sDisease. The Nursing Journal Of India 1999;
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9
SIGNATURE
OF
THE
CANDIDATE
10
REMARK OF THE GUIDE
11
NAME AND DESIGNATION
11.1 GUIDE
THE STUDY IS SIGNIFICANT
Mr ANPU. T. ASSISTANT PROFESSOR
11.2 SIGNATURE
11.3 CO GUIDE IF ANY
Mrs MILY THOMAS
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT
Mr ANPU.T.
11.6 SIGNATURE
12.1 REMARKS OF PRINCIPAL
THE STUDY IS SIGNIFICANT
12.2 SIGNATURE
.
..
32
.
33