1
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
FOR
DISSERTATION
Mrs. ANN MARIA JOSE
FIRST YEAR M.SC (NURSING)
COMMUNITY HEALTH NURSING
YEAR 2011-2013
INDIAN ACADEMY COLLEGE OF NURSING
HENNUR CROSS
BANGALORE – 560043
2
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
FOR
DISSERTATION
1.
2.
3.
Mrs. ANN MARIA JOSE
NAME OF THE CANDIDATE 1ST YEAR M.Sc (NURSING)
AND ADDRES
INDIAN ACADEMY
COLLEGE OF NURSING,
HENNUR CROSS,
BANGALORE – 560 043
NAME OF THE INSTITUTION
INDIAN ACADEMY
COLLEGE OF NURSING,
BANGALORE-560043
COURSE OF THE STUDY AND 1ST YEAR M.Sc (NURSING),
SUBJECT
COMMUNITY HEALTH
NURSING
4.
5.
DATE OF ADMISSION TO THE
COURSE
02/11/2011
TITLE OF THE STUDY
“A STUDY TO ASSESS THE
EFFECTIVENESS OF
INFORMATION BOOKLET
ON KNOWLEDGE
REGARDING
NUTRITIONAL DEMANDS
DURING PREGNANCY
AMONG ANTENATAL
MOTHERS IN SELECTED
RURAL AREAS AT
BANGALORE.”
3
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Health of pregnancy is wealth of the Nation. There is chance for the welfare
of the world only when the condition of women improves.”
-Swami Vivekanandan
We normally think of our nutrition as personal, affecting only our own lives. This
isn't always the case though. The woman who is pregnant, or who may be, must
understand that her nutrition today will be critical to the health of her child throughout
life. The nutrition demands of pregnancy are extraordinary because the growth of a whole
new person requires all the minerals and other nutrients, and most in larger amounts.1
During pregnancy, a woman must establish nutritional habits that will optimally
nourish both the growing fetus, and herself. She must be well nourished at the outset
because in early pregnancy the embryo undergoes rapid and significant developmental
changes that depend on her prior balance of minerals, vitamins, and other dietary
concerns. Fathers-to-be are also encouraged to consider their nutrition status.1
Pregnant mother should eat three meals a day with a few snacks to keep blood
sugars stable and accommodate for the limited room stomach has to expand as the baby
grows. Eating smaller, more frequent meals also helps to manage nausea during the first
trimester. She should not diet or limit carbohydrates or fats or be on any type of
restrictive diet, unless recommended by your doctor. Pregnant mother need the calories
and fat in a well-balanced diet to feed the growing fetus. If it might be hard to eat a wellbalanced diet, try to get enough calories and fluids and take your prenatal vitamin.
4
The demands of pregnancy necessitate additional dietary requirements.
Obviously, additional energy (caloric) intake is required to support recommended weight
gain. Because energy requirements in pregnancy are increased by 17% over the nonpregnant state, a woman of normal weight should consume an additional 126 kJ/d (300
kcal/d. A sample diet for normal pregnancy is based on the food pyramid and should
include 6-11 servings of grains; 3-5 servings of vegetables; 2-4 servings of fruit; 3-4
servings of dairy; 2-3 servings of meats, beans, or nuts; and 1 serving of sweets. Total
energy intake should vary by BMI, but the average recommendation is 10,460 kJ/d (2500
kcal/d).3
The average weight gained by healthy pregnant eating without restriction is 12.5
kg (27.5 lb). This weight gain represents two major components: 1) the products of
conception: fetus, amniotic fluid and the placenta and 2) maternal accretion of tissues:
expansion of blood and extracellular fluid, enlargement of uterus and mammary glands
and maternal stores (adipose tissue).4
Current recommendations for weight gain during pregnancy
Weight-for-height category
Recommended total gain, kg (lb)
Low (BMI < 19.8)
12.5–18 (28–40)
Normal (BMI 19.8–26.0)
11.5–16 (25–35)
High (BMI > 26–29)
7–11.5 (15–25)
Low weight gain is associated with increased risk of intrauterine growth
retardation and perinatal mortality. High weight gain is associated with high birth weight
5
and secondarily with increased risk of complications related to fetopelvic disproportion.
Current recommendations for weight gain during pregnancy are higher for thin women
than for women of normal weight and lower for short obese women. Water-Soluble
nutrients and metabolites are present in lower concentrations in pregnant than in
nonpregnant women whereas fat-soluble nutrients and metabolites are present in similar
or higher concentrations.5
Nutrition in the womb is the process that delivers to the fetus what it needs to
grow and develop into a healthy baby. A fetus receives its nutrition from two sources.
The first source of nutrients is from the mother’s diet before and during pregnancy. Most
people understand this.6
The least known and probably more important source of nutrients is the mother’s
body. All bodies undergo a turnover process. Turnover is the ever-changing state of
breakdown and renewal of muscle, fat and bone which releases protein, fat and calcium
into the bloodstream. In a pregnant woman these nutrients are important sources of food
for a growing baby. Mothers who have good turnover rates for themselves are able to
provide well for their babies. A mother acquires her body composition and turnover
throughout her whole lifetime as a fetus, child, girl, adolescent and adult. The mother’s
turnover and her diet work in harmony to provide nutrition in the womb through the
placenta.6
Our knowledge on the effect of maternal dietary adequacy for the success of
pregnancy is far from complete as is the role that dietary supplement may play. Birth
weight and infant growth measures are the principal indicators of reproductive success
used in scientific studies. This understanding is essential for the development of
6
meaningful public health policies and recommendations directed at reproducing women
for ensuring appropriate nutrient intake from food and the safe and effective use of
dietary supplements for nutrients that are limited in the maternal diet. In this study the
physiological adjustments and nutritional requirements of pregnant women and the
possible role of dietary supplementation in meeting requirements for nutrients likely to be
limiting in the diet are discussed.6
6.1 NEED FOR THE STUDY
I found good evidence linking poor maternal nutrition to several leading causes of
infant mortality, including birth defects, preterm birth, fetal growth restriction, and
maternal complications of pregnancy (preeclampsia, anemia, infections/ inflammation).
Maternal foliate and B12 deficiencies have been associated with neural tube defects,
while deficiencies in B vitamins, vitamin K, magnesium, copper, and zinc have also been
linked to other birth defects. Low pre-pregnancy body mass index (BMI) and poor
gestational weight gain are associated with greater risk for preterm birth and fetal growth
restriction.5
Maternal nutrition can also mediate or modulate several of the major pathways
(e.g., inflammatory) leading to spontaneous preterm birth. While the contribution of
specific nutrient deficiencies to preeclampsia remains unclear, maternal nutrition can
potentially play an important role in the pathogenesis of preeclampsia by affecting
endothelial function, ameliorating oxidative stress, modulating inflammatory response,
and improving insulin action. In light of the importance of abnormal implantation and
placentation in the pathogenesis of preeclampsia, periconceptional nutrition may be of
7
paramount importance. Nutritional deficiencies of iron, foliate, and vitamins A, B6, and
B12can cause anemia. Vitamin A and other micronutrient deficiencies have been
implicated in maternal infections, and antioxidants can potentially play a major role in
modulating inflammation and oxidative stress from maternal infections. The growing
body of research on fetal programming of adult diseases further elevates the clinical and
public health significance of maternal nutrition.7
A poor pregnancy diet can lead to various nutritional deficiencies. During
pregnancy, you need plenty of folic acid, calcium and iron. Kids Health indicates that
pregnant women will need to exceed the usual 1000 mg of calcium recommended for
adult women.8 This is to ensure that your body's needs are not compromised in order to
meet the calcium needs of the baby. Iron is important because your body needs it to make
the hemoglobin that transports oxygen to your body and to your fetus. Folic acid prevents
your fetus from developing defects of the spine and spinal cord. A prenatal vitamin will
fill in nutritional gaps, but it is always best to get your vitamins and minerals from whole
foods.9
Indian Information
In India nearly 20 % of pregnancies end in miscarriages, premature births and
soon infant mortality is also very high 75/ 1000 live births in 2007 due to poor
nourishment of mothers which in turn leads to poor health and resistance towards
diseases in the newly born child.10
The government of India introduces various nutritional programs in its policy
from time to time. Most of these are supplementary nutrition programs are like mid-day
8
meal program, Balwadi nutrition Program, nutritional vitamin A prophylaxis program
and nutritional anemia control program. To be effective, the nutritional programs should
be comprehensive and emphasize upon improvement in general health and quality of life
of population, control of infections and effective nutritional education besides provision
of nutritional supplementation.10
Women in developing countries are always in a state of precarious iron balance
during their reproductive years. Their iron stores are not well developed because of poor
nutritional intake, recurrent infections, menstrual blood loss, and repeated pregnancies.
Gender discrimination in a country like India results in girls lacking access to a balanced
diet, adequate healthcare, and proper education. Thus the average Indian woman enters
her reproductive years, and particularly pregnancy, with iron and foliate deficiency.10
In India During the first 2 trimesters of pregnancy, iron-deficiency anemia
increases the risk for preterm labor, low-birth-weight babies, and infant mortality and
predicts iron deficiency in infants after 4 months of age. It is estimated that anemia
accounts for 3.7% of maternal deaths during pregnancy. Therefore it is important to
diagnose and treat anemia to ensure the optimal health of the mother and the newborn.10
In Indian nearly 73.5, 2.7, 43.6, 73.4, 26.3, and 6.4 percent PW were deficient in
zinc, copper, magnesium, iron, folic acid and iodine, respectively. The highest concurrent
prevalence of two, three, four and five micronutrient deficiency was of zinc and iron
(54.9%); zinc, magnesium and iron (25.6%); zinc, magnesium, iron and folic acid (9.3%)
and zinc, magnesium, iron, folic acid and iodine (0.8%), respectively. No pregnant
woman was found to have concomitant deficiencies of all the six micronutrients. Dietary
intake data revealed an inadequate nutrient intake. Over 19% PW were consuming less
9
than 50% of the recommended calories. Similarly, 99, 86.2, 75.4, 23.6, 3.9 percent of the
PW were consuming less than 50% of the recommended folic acid, zinc, iron, copper,
and magnesium. The consumption of food groups rich in micronutrients (pulses,
vegetables, fruits, nuts and oil seeds, animal foods) was infrequent. Univariate and
Multivariate logistic regression analysis revealed that low dietary intake of nutrients, low
frequency of consumption of food groups rich in micronutrients and increased
reproductive cycles with short interpregnancy intervals were important factors leading to
micronutrient deficiencies.11
In recent years, different Government programs like ICDS, MCH etc, have been
introduced to improve the nutritional status of women. National Nutritional Anemia
Prophylaxis Program (NNAPP) was initiated in 1970 with the aim to bring down
prevalence of anemia to 25% (National Nutritional Policy, IX Plan). The daily dosage of
elemental iron for prophylaxis and therapy has been increased to 100 mg & 200 mg
respectively under Child Survival and Safe Motherhood Program (CSSM).12
Worldwide information
In the United States, approximately 300-500 women die every year from giving
birth, 11% of infants are born too early, 7.4% have low birth weight, and 7 of every 1000
live births die within the first year of life. These are stunning statistics; however, there are
many things an expectant mother can do to reduce these statistics, so they recommended
the following during pregnancy (Grosvenor & Smolin, 2006).13
10
 The first trimester does not see a significant increase in calorie expenditure, but
the second and third trimester energy and nutrition needs would be met by eating
a second lunch or breakfast daily.
 During the second trimester, calories should be increased by an additional 340
calories per day;
 During the third trimester, calories should be increased by an additional 452
calories per day. Protein is responsible for new cell building, so pregnant woman
need an additional 25 grams of protein daily during the second and third
trimesters.
 According to the Food Guide Pyramid, pregnant women need one additional
serving of milk, vegetables, meat, and bread, with no increase in fruit servings for
a 25 year old woman. (Grosvenor & Smolin, 2006)
 Due to the increase in blood volume, the creation of amniotic fluid, and
prevention of constipation, which equals around six to nine liters of water, water
needs increase from 2.7 liters to 3 liters a day (including the water received from
food).
 Vitamin and mineral needs increase during pregnancy; needs are usually met
through increases in dietary consumption and supplementation.
Roughly 47% of non-pregnant women and 60% of pregnant women have anemia
worldwide, and including iron deficiency without anaemia the figures may approach 60
and 90% respectively. In the industrial world as a whole, anemia prevalence during
pregnancy averages 18%, and over 30% of these populations suffer from iron deficiency.
The poor are more affected.11
11
According to WHO, in developing countries, the prevalence of vitamin deficiency
among pregnant women is 56% (WHO, 1992). The prevalence of vitamin deficiency in
India is 60 -70% (Park, 2005).12
The family and community will feel satisfied and secured life when the women take
initiative in caring themselves. So that, the women should have appropriate and adequate
knowledge on nutritious diet, exercise and minor ailment occurs during pregnancy.
Hence, the investigator planned to conduct a study to improve their knowledge on
nutritional demand to promote health during pregnancy.
12
6.2 REVIEW OF LITERATURE
According to Burns (1997), the literature review is an essential component of the
research as it aids researcher in formulating the research plan. By definition, the review
of literature is broad, comprehensive, in-depth, systematic and critical, audiovisual
material and personal communication. The primary purpose of the literature review is to
give broad background knowledge or understanding of limitation that is available related
to research problem of interest. It is also help the researcher to conduct his or her actual
study. The literature review include both research and non research literature.
For the present study the review of literature is organized under the following
headings.
1
Literature related to knowledge of pregnant mothers regarding
nutritional requirements during pregnancy.
2
Literature related to importance of adequate nutrition
among
pregnant mothers.
3
Literature related to the effectiveness of educational programmes on
nutritional requirements among pregnant mother.
I. Literature related to knowledge of pregnant mothers regarding nutritional
requirements during pregnancy.
Fowles, Eileen R, (2007), conducted a study for Comparing Pregnant Women's
Nutritional Knowledge to Their Actual Dietary Intake. The purpose of this study was to
describe differences between low-and middle-income pregnant women's general
nutritional knowledge, usual dietary intake and weight gain. A descriptive design
employing a questionnaire with a convenience sample of women (N = 109) from both
13
childbirth education classes and a free prenatal clinic. This study concluded that most
women had inadequate general nutritional knowledge, and their dietary intake did not
meet all the nutritional requirements of pregnancy.14
Abdulbari Bener, (2006) conducted a study on maternal knowledge, attitude and
practice on dietary demands among Arabian Qatari women. The aim of this study was to
determine the level of knowledge about the dietary demands during pregnancy in a
sample of women in the child-bearing age. A multistage sampling design was used and a
representative sample of 1800 Qatari women aged between 18 and 45 years were
surveyed during the period June to November 2004. One thousand four hundred and
eighty women (82.2%) expressed their consent to participate in this study. Educated
women were aware of the importance of the dietary intake during pregnancy. The study
findings suggested possible avenue for intervention to increase awareness and dietary
intake during pregnancy.15
Michael J Dibley, (2009) conducted a study to assess the knowledge regarding
dietary intake among pregnant women in a rural area of western China. 1420 pregnant
women were recruited from rural area of western China. Information was collected at the
end of their trimester with an interviewed-administrated semi-quantitative food frequency
questionnaire (FFQ). These results reveal that the majority of pregnant had inadequate
knowledge regarding dietary intakes of nutrients that are essential for pregnancy.16
LIU Dong-ying, WANG Lin-jing, (2007), conducted survey and analysis on
nutritional knowledge, attitude and practice of pregnant women in Guangzhou. The
objective of the study was to to investigate the levels of nutritional knowledge, attitude
and practice(KAP)of pregnant women in Guangzhou and the influencing factors, so as to
14
provide scientific evidence for developing nutrition education programs for pregnant
women in future. A questionnaire survey about nutritional knowledge, attitude and
practice(KAP)was carried out among 169 pregnant women in two hospitals of
Guangzhou. Most subjects lacked a overall understanding of nutritional knowledge and
had some unhealthy dietary practices. However, they held a positive attitude towards
nutrition, and desired to acquire more knowledge of nutrition and health. It is suggested
that more nutrition education should be implemented by taking acceptable measures for
pregnant women and their families, so as to make them know more nutritional knowledge
and take healthy dietary practices.17
Mahmood S, (2010), conducted a study to assess the nutritional knowledge and
practices in pregnant and lactating mothers in an urban and rural area of Pakistan.
Nutritional knowledge and practices in 100 pregnant and 100 lactating women were
assessed in an urban and rural area of Lahore. A structured questionnaire was used for the
purpose. Eight-four percent of mothers had knowledge that diet should be changed by
increasing, adding or avoiding some special food items in the diet during pregnancy and
lactation, but only 65.5% practiced them. The reasons for this deficient knowledge and
practice of dietary intake are lack of nutritional knowledge and poor economy. This study
concluded that improving nutritional knowledge and dietary practices of population in
general and vulnerable groups in particular through media and MCH services on the use
of locally available low cost nutritious foods and to avoid undue food restrictions.18
Jassie .S (2010), “ A descriptive study was done on Knowledge and attitude of
pregnant mothers regarding diet during pregnancy among 75 pregnant mothers in
selected maternity centers of Madurai “ . Researcher used structured interview schedule
15
and Likert attitude scale to assess the Knowledge and attitude of mothers. Researcher
found out that 36 (48 % ) of mothers had inadequate knowledge and 39 ( 62 %) of
mothers had adequate knowledge. 38 ( 50.6 % ) of mothers had unfavorable attitude and
37 ( 49.4 % ) of mothers had favorable attitude towards pregnancy diet. High positive
correlation found between knowledge and attitude scores of mothers about diet during
pregnancy. Significant association ( P < 0.01) was found between knowledge score of
mothers with their education and family monthly income . Significant association ( P <
0.01 ) was found between attitude score of mothers with their education and previous
breast feeding experiences.19
II. Literature related to importance of adequate nutrition
among pregnant
mothers
Paul, A.A (2008) , studied that The importance of maternal dietary energy intake on
pregnancy and lactation in rural Gambian women. Maternal weight gain and the
accumulation of subcutaneous fat were significantly lower when the last trimester of
pregnancy fell during the time of heaviest farm work and lowest energy intakes. The
birth-weight of babies was also significantly correlated with differences in energy intake
throughout the year. During early lactation breast milk yields were significantly related to
same alterations in the subcutaneous fat stores. Undernourished nursing women there
could be a competition for dietary energy between the depleting maternal subcutaneous
fat organs and the mammary glands at the expense of milk production.20
Saccomandi, D (2009), conducted study regarding Importance of dietary
supplements for the pregnant mother: influence on the trace element content of milk.
Milk production is a complex process where nutritional factors interact with structural
16
hormonal and behavioral influences. The study was carried out on women living in
Ferrara and its surrounding area. 32 women were selected and 22 completed it. The effect
of dietary zinc, copper and iodine supplements on the milk concentration of these
micronutrients was studied. The present results indicate that in healthy, well-nourished
women, whose diet is adequate, the levels of zinc, copper and iodine in milk are not
influenced by short-term supplementary intakes and that the milk levels of the trace
elements studied are maintained over different levels of intake.21
Fiona Mathews, (2009) conducted a study to assess the importance of
maternal nutrition on outcome of pregnancy. The objective of the study was to
assess the importance of maternal diet during pregnancy. 693 pregnant nulliparous
white women with singleton pregnancies who were selected from antenatal booking
clinics with stratified random sampling. This study concluded that maternal
nutrition had important effects on the placental or birth weight of infants born at
term.22
Carlos A Camargo, (2007) conducted a study to assess the importance of
maternal intake of vitamin D during pregnancy. The participants were 1194 mother
in Project Viva—a prospective pre-birth cohort study in Massachusetts. We assessed
the maternal intake of vitamin D during pregnancy from a validated food-frequency
questionnaire. The result of the study showed that higher maternal intake of vitamin
D during pregnancy may decrease the risk of recurrent wheeze in early childhood.23
17
III. Literature related to the effectiveness of educational programmes on
nutritional requirements among pregnant mother.
Maxwell J, (2010) conducted a randomized community intervention trial to increase
awareness and knowledge of the dietary requirements in women of child-bearing age.
1197 women interviewed prior to the intervention, they were selected from Local
Government Areas in the state of Victoria, Australia. Only 70% of women who were
aware of dietary intake during pregnancy. Printed information recommending dietary
intake to decrease the risk nutritional deficiency was disseminated to women of childbearing age. The result of the study suggested that the provision of printed educational
material can increase awareness of nutritional demands among women of child-bearing
age.22
W. L. Wrieden, (2009), conducted a study to assess the effectiveness of nutrition
education intervention programme for pregnant teenage women. An intervention was
designed incorporating seven informal food preparation sessions, which allowed
opportunities for discussion of nutritional, and other topics (e.g. food safety and wellbeing in pregnancy). Midwives in a community centre setting led the sessions. The result
of the study concluded that the nutrition education programme was effective in increasing
their knowledge regarding nutritional intake during pregnancy.23
Andrew G Symon, (2008) conducted a qualitative study of pregnant teenagers’
perceptions of the acceptability of a nutritional education intervention. The aim of the
study was to assess the feasibility of nutritional education intervention sessions for
pregnant teenagers. 100 pregnant teenagers aged 16–18 years selected from two
community centres and one maternity unit in Tayside, Scotland. Data were collected
18
using semi-structured tape-recorded group interviews. This study suggested that
nutritional education programme of pregnant teenagers was effective in increasing their
knowledge on nutritional demands during pregnancy.24
AG Kafatos, (2011) conducted a study to assess the effects of an educational
intervention on nutrition during pregnancy in Greece. An intervention program was
undertaken to assess dietary habits and improve the knowledge regarding nutritional diet
among pregnant women in the rural county of Florina, northern Greece. The results
indicate that nutrition counseling during pregnancy can improve dietary intake and
maternal weight gain.25
Gholam Reza Sharifirad, (2010) conducted a study to assess the effectiveness of
Nutrition Education Program on nutritional requirements during pregnancy. In this quasiexperimental controlled study, 110 pregnant women referred to urban health centers in
Gonabad in 2009 were included in two case (54) and control (56) groups. Pre-test data
was collected in two studied groups during their first pregnancy care visit by a selfadministrated questionnaire. The intervention was two educational sessions in case and
control groups based on nutritional diet and Post-test data was collected in the last
pregnancy care visit. This study proved that the nutritional education was successfully
effective to increase their knowledge regarding nutritional requirements during
pregnancy.26
Shwete Joshi. ( 2008 ), conducted a study on “A study to determine the effectiveness
of planned health teaching on Knowledge related to nutritional requirements among
pregnant mothers”. The research approach used for this was quasi experimental . Non
probability convenient sampling was used . The sample size was 50 pregnant mothers.
19
The pretest knowledge score was 57.4% and the post test score was 80.94%. Significant
difference ( p value > 0.05 ) between pretest and post test score was statistically tested
using paired ‘t’ test and it was found significant ( t=22.6). There was highly significant
association between pretest knowledge score and mother’s education.27
6.3(A) STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of information booklet on knowledge
regarding nutritional demands during pregnancy among antenatal mothers in selected
rural areas at Bangalore.”
6.3(B) OBJECTIVES OF THE STUDY
 To assess the pre-test level of knowledge of antenatal mothers regarding nutritional
demands during pregnancy.
 To evaluate the effectiveness of information booklet on nutritional demands during
pregnancy among antenatal mothers.
 To compare the pre-test and post test level of knowledge of the antenatal mothers
regarding nutritional demands during pregnancy.
 To demonstrate the association between pretest level of knowledge of antenatal
mothers regarding nutritional demands during pregnancy with their demographic
variables.
6.3(C )OPERATIONAL DEFINITION
Assess
It refers to evaluation of desired or intended outcome of the study.
20
Effectiveness
It refers to the extent to which the information booklet has achieved the desired
outcome.
Information booklet
It refers to a structured learning material prepared in Kannada language by the
researcher to provide information regarding nutritional demands to the antenatal mothers.
Nutritional demands
It refers to a preparation intended to supplement the diet and provide nutrients,
such as vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may
not be consumed in sufficient quantities in a person's diet.
Antenatal mothers
It refers to a woman who is carrying a developing embryo or fetus within the
body.
Rural area
It refers to areas that are not urbanized, though when large areas are described.
They have a low population density, and typically much of the land is devoted
to agriculture and has less pollution.
6.3(D) RESEARCH HYPOTHESIS
 There is a significant difference between pretest and post test level of knowledge
among antenatal mothers after receiving information booklet on nutritional
demands during pregnancy.
 There is significant association between pre-test level of knowledge of antenatal
mothers with selected demographic variables.
21
6.3(E)ASSUMPTIONS
 antenatal mothers may have less knowledge on nutritional demands during
pregnancy.
 Teaching enhances the knowledge of antenatal mothers regarding nutritional
demands during pregnancy.
 Gained knowledge by antenatal mothers may influence practice of diet during
pregnancy.
6.3(F) LIMITATION
 This study is limited to antenatal mothers residing in selected rural areas at
Bangalore.
 This study is limited to antenatal mothers who are willing to participate in the
study.
 This study is limited to only 60 antenatal mothers residing in selected rural areas
at Bangalore.
22
7. MATERIALS AND METHODS
This chapter gives a description of the sources of data, research approach,
research design, variables, the setting of the study, population, sampling, research tool,
and methods of data collection and plan for data analysis.
7.1 Sources of data
Data will be collected from antenatal mothers residing in selected rural areas at
Bangalore.
7.2 Methods of data collection
I.
Research design
Quasi experimental design is selected in this study.
II.
Research approach
One group pre-test post-test approach.
III.
Research variables
a. Dependent variables
Knowledge of antenatal mothers regarding nutritional demands.
b. Independent variables
Information booklet regarding nutritional demands during pregnancy among
antenatal mothers.
c. Demographic variables
Characteristics
of
pregnant
mothers
such
as
age,
socioeconomic status and income.
IV.
Setting
Study is planned to conduct in selected rural areas at Bangalore.
educational
status,
23
V.
Population
All antenatal mothers residing in selected rural areas at Bangalore
VI.
Sample
The antenatal mothers residing in selected rural areas at Bangalore who met inclusion
criteria. For pilot study sample size will be 6. For main study the sample size will be 60.
VII.
criteria for sample selection
a) Inclusion criteria
 Antenatal mothers residing in selected rural areas at Bangalore.
 Antenatal mothers who can communicate freely in Kannada or English.
 Antenatal mothers who are willing to participate in the study.
b) Exclusion criteria
 Antenatal mothers who are not willing to participate in the study.
 Antenatal mother who are having mental illness.
VIII.
Sampling Technique
In this study the samples are selected by non probability convenience sampling
technique.
IX.
Tool for data collection
The structured questionnaire schedule consists of following sections.
Section A; Demographic proforma includes sample number, age, sex, educational status,
occupation, income and socioeconomic status.
24
Section B;
Questionnaire on knowledge
This consists of questionnaires to assess the knowledge of antenatal
mothers
regarding nutritional demands during pregnancy.
X.
Methods of data collection
After obtaining permission from concerned authority an informed consent from
samples will be collected and the researcher will collect data from samples.
Phase 1
Pretest will be conducted to assess knowledge of antenatal mothers on nutritional
demands during pregnancy by using a self administered questionnaire.
Phase 2
Information booklet on nutritional demands during pregnancy will be distributed
to the antenatal mothers.
Phase 3
After 1 week post test will be administered to assess the level of knowledge on
nutritional demands during pregnancy to the same subject by using same questionnaire.
Duration of the study will be 4 weeks.
XI.
Plan for data analysis
The data will be analyzed by means of descriptive and inferential statistics.
a) Descriptive statistics
Mean, median, mode, standard deviation, percentage distribution, will be used to
assess the knowledge of antenatal mothers on nutritional demands during pregnancy.
25
b) Inferential statistics
Chi-square test will be used to associate knowledge of mothers regarding
nutritional demands during pregnancy with selected demographic variables.
XII.
Projected outcomes
After the study, the investigator will able to know the knowledge of antenatal
mothers on nutritional demands during pregnancy. Based on the findings Information
booklets will be given to antenatal mothers. It will help them to improve their nutritional
status during pregnancy period.
7.3 Does the study require any investigation or intervention to the patient or other
human being or animal?
No
7.4 Has ethical clearance been obtained from the concerned authority to conduct the
study?
Yes
a)
Permission will be obtained from the Medical Officer of PHC of selected rural
areas at Bangalore.
b)
Informed consent will be obtained from the antenatal mothers residing in
selected rural areas at Bangalore to participate in the study with their own
knowledge.
c)
The permission will be obtained from the nutritionist for preparing nutritional
requirements during pregnancy.
26
8. LIST OF REFERENCES
1. T. J. Clark, (2008), Pregnancy and Nutrition, Volume: 1, Page No: 68-72,
http://www.tjclarkinc.com/pregnancy_nutrition.htm
2. Bennel V. Rata, Brown Lindak, “Tex book midwives”, (2002), 2nd edition,
Churchil livingstone, London, Pp:755-758.
3. Burbber and Suddarth, “The Lipincott manual of nursing practice”, (2005),
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9. Signature of the candidate
:
10. Remarks of the guide
:
11. Name and designation of
11.1 Guide
:
11.2 Signature
:
11.3 Co-guide
:
11.4 Signature
:
11.5 Head of the department
:
11.6 Signature
:
12. Remarks of the Principal
:
12.1 Signature
: