“A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED
TEACHING PROGRAMME ON KNOWLEDGE AND ATTITUDE
REGARDING FOOD TABOOS AMONG NORMAL PREGNANT
MOTHERS IN SELECTED HOSPITALS, AT BIJAPUR.”
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MRS SHWETHA HITNAL
OBSTETRIC AND GYNAECOLOGICAL NURSING
FIRST YEAR M.Sc NURSING
YEAR 2012-2014
BLDEA’ S SHRI B M PATIL
INSTITUTE OF NURSING SCIENCE
SOLAPUR ROAD, BIJAPUR -586103
0
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1
MRS. SHWETHA. HITNAL
NAME OF THE CANDIDATE
I YEAR M.Sc. NURSING
AND ADDRESS
SHRI B.M.PATIL INSTITUTE OF
NURSING SCIENCES, BIJAPUR586103
2.
SHRI B.M.PATIL INSTITUTE OF
NAME OF THE INSTITUTION
NURSING SCIENCES, BIJAPUR 586103
3.
COURSE OF THE STUDY AND I YEAR M.Sc. NURSING
OBSTETRICS AND
SUBJECT
GYNAECOLOGICAL
NURSING
4.
DATE OF ADMISSION TO THE 19 JUNE 2012
COURSE
5.
TITLE OF THE STUDY
“A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED
TEACHING
REGARDING
PROGRAMME
FOOD
ON
TABOOS
KNOWLEDGE
AMONG
AND
NORMAL
MOTHERS IN SELECTED HOSPITALS, AT BIJAPUR.”
1
ATTITUDE
PREGNANT
6.0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
If you want to stay healthy, eat food as medicine otherwise, you have to
eat medicine as food.
All people, whether rural or urban, have their own beliefs and attitude.
Some are based on centuries of trial and error and have positive values while
others may have negative value. This is true for food also. Some food items are
considered good and some bad at different ages of life. Food taboos are known
from virtually all human societies. Probably food taboos exist in one form or
another in every society on Earth, for it is a fact that perhaps nowhere in the world,
a people, a tribe, or an ethnic group, makes use of the full potential of edible items
in its surroundings. It is the regular avoidance of a food that turns into a tradition
which ends up eventually as a food taboo.1
Pregnancy imposes the need for considerable extra calorie and nutrient
requirements. A balanced and adequate diet is therefore, of utmost importance
during pregnancy to meet the increased needs of the mother, and to prevent
“nutritional stress”. In various studies it was seen that pregnant women in various
parts of the world are forced to abstain from nutritious foods as a part of their
traditional food habits.1
Pregnant women avoid specific foods due to several reasons. Some
pregnant women avoid foods as a result of a strong dislike (aversion) developed
following pregnancy. Other women avoid on medical grounds. In developing
countries, however, a substantial number of pregnant women avoid specific foods
due to cultural beliefs or impositions. The practice of avoidance of foods due to
cultural food beliefs is referred to as food taboos.2
2
Traditional belief and religious restrictions, prohibitions and prejudices
which make a pattern of consumption of certain foods and food products. Food
taboos are also termed as food fads and fallacies, and vary with cast and creed. As
a result of wrong and unscientific belief, a number of foods are excluded from the
list of food items by people of many religions and society.3
Most of these beliefs affect pregnant mothers. There is a common belief,
for instance that the pregnant mother should eat less to keep the size of the baby
minimum for easy delivery. This is totally misleading and dangerous. A pregnant
mother should eat one-fourth amount of food more than her normal requirement.
Since she needs to eat for her baby as well. Another food taboo prohibits intake of
water at the time of delivery of a baby. But the truth is that during delivery a
mother loses huge amount of water as sweat, along with blood and delivery fluid.
To compensate for this loss, and to save the mother from dehydration, sufficient
amount of liquid should be given.3
6.1 NEED FOR THE STUDY
Mother and child are the most appropriate section because the health of
pregnant mother and unborn child is current burning problem in nation. The
vulnerable section of society needs utmost care and attention. By helping pregnant
mother we will be helping whole family to be healthy and satisfied and which in
turn will have positive effect on society.4
Pregnancy is a critical period both for the pregnant women as well as their
babies. As the nutrition of the fetuses totally depend on their mothers, so the food
pregnant women eat will greatly affect the growth and development of their
babies. If they eat foods correctly and appropriately, then it can promote the health
3
of their babies. However, if they do not pay attention to their daily diets and eat
some foods that are not suitable for them, it may bring serious consequences on
their babies, leading to miscarriage, premature birth, stillbirth, and deformity of the
fetuses, and so on. As a result, pregnant women should pay special attention to
their daily diets. A balance and adequate diet is therefore, of utmost importance
during pregnancy and lactation to meet the increased needs of the mother.5
Pregnancy is a time of rapid physical and emotional changes in the body.
Herbs can be very useful in toning and nourishing the system to help allay
potential problems and remedy discomforts that pregnant women may experience.
In some cultures, it is common practice for pregnant women to consume traditional
tonics and herbs prepared by their elders. Certain herbal teas and herbal
preparations may contain toxic substances, which could be harmful to the fetus. So
there is necessary to provide knowledge regarding food taboo to the pregnant
mothers.6
Taboos, forbidden deeds, are prohibitions present in every culture. These
prohibitions often regulate our dietary habits. Foods that one culture perceives
as consumable might be considered unclean by another. Each religion poses its
own views on certain foods that are deemed taboo. For Hindus, the consumption of
a sacred cow is looked down upon, for Muslims the same rules apply when met
with the eating of pork by others. Similarly other religions portray different eating
habits by excluding certain items from their diet. Each religion defines the
exclusion of a food item for a variety of reasons pertaining to their beliefs and thus
one is presented with food taboos in relation to ones’ religion.7
4
The taboo against the eating of eggs by pregnant women and the
widespread belief that a pregnant woman should eat less so as to produce a small
fetus and an easy labor. In some culture fish is prohibited whereas others avoid
goats' meat. In any given situation, the cultural blocks and superstitions which
exist locally should be studied and where possible, the expectant mother should be
helped to see that such taboos are a source of danger, not only to her own health,
but also to the health of the unborn child.8
To consider the nutrition of the pregnant woman in isolation is unrealistic.
She is an adult member of the family and social group and therefore her diet will
be the same as the habitual diet of the family. The diet will not change during
pregnancy except under pressure of food taboos or cultural patterns. Superstitions
about food habits will disappear only with better education regarding food taboo
among pregnant mother.8
In Indian custom food taboo and beliefs are more common. Many studies
have been conducted on food taboo. There is a gap of research literature in the area
of knowledge and attitude assessment in Indian setting. This study will explore
some food taboos and beliefs among pregnant mothers. Hence it was felt necessary
to assess level of knowledge and attitude among normal pregnant mothers.
6.2 REVIEW OF LITERATURE
Review of literature is a key step in research process refers to the
activities involved in searching for information on a topic and developing a
comprehensive picture of the state of knowledge on that topic .This provides a
background for understanding what has already been learned on a topic and
illuminates the significant of new study.
5
THE REVIEW OF LITERATURE IS DIVIDED INTO FOLLOWING SECTION
1. Literature related to food taboos.
2. Literature related traditional and folk beliefs on food taboo.
3. Literature related to dietary practices and food taboo.
4. Literature related to misconception about food taboo.
1) Literature related to food taboos.
A cross-sectional study was conducted in Guadalajara, Mexico, to identify
food taboos among pregnant mothers. This study included 493 nursing mothers
who were interviewed during pregnancy. A chi-square test was used for finding an
association among food taboos, mother’s characteristics, and demographic
variables. Forty-seven percent avoided three or more foods. Fruits and vegetables
(62%) and legumes (20%) were the most-avoided foods. These food taboos were
associated with living more than 10 years in Guadalajara city.9
A cross-sectional study assessing the prevalence of food taboos during
pregnancy, was conducted in Hadiya Zone, Southern Ethiopia. 295 healthy
pregnant women, who attended an antenatal clinic for routine check-up, were
included in the study. A questionnaire consisting of socioeconomic information,
food taboo practice, types of foods avoided and reasons for avoidance was
administered by trained nurses. Results indicate that a little over a quarter of them
(27%) avoided at least one type of food due to food taboos. Milk and cheese were
regarded as taboo foods by nearly half of the women (44.4%) followed by linseed
and fatty meat (16% 11.1% respectively). The reasons for avoiding foods include
fear of difficult delivery (51%), discoloration of the fetus (20%) and fear abortion
(9.7%).2
6
A descriptive study was done on 5000 pregnant adolescent girls to study
the knowledge of food taboo practiced in society during pregnancy. Many (822;
32.88%) urban girls were aware of the prevalent myth in the study area that nonvegetarian diet should not be taken during pregnancy because of religious reasons;
1487 (59.48%) urban and 1228 (49.12%) rural girls opinioned that cold milk may
do some harm to the foetus. Some (15.68%) urban and 16.52% rural girls told that
taking papaya was a taboo for pregnant women as it might lead to abortion.10
A cross sectional study was conducted on 229 young women. A study
showed that hot and cold food seems to influence the choice of food during
pregnancy. 39% of them avoiding heat food and 28% of them avoiding cooling
foods. Eating non-vegetarian food was considered harmful during pregnancy.
Pork, prawns and crabs avoided most commonly. 28% of them believed that small
bony fish and red fish could affect the fetus. 20% of them avoid egg as it is
believed to be hot food. Milk is avoided by 28% of pregnant mothers as it is
considered cooling. The dominating fear was that of abortion. Other reasons for
abstaining from animal’s food were a) aversion to sight and / or smell of such
food. B) Poor digestibility. C) Fear of harming the fetus.11
2) Literature related traditional and folk beliefs on food taboo.
A study was conducted on Tradition and folk beliefs for 40 days for the
Malay pregnant mothers. During confinement great care was taken that harmful
materials, especially “cold” foods such as fruits and vegetables, and “toxic” fish,
did not enter the body. 50 women selected randomly in a Malay fishing village
were studied by participant observation. They reported that a varied normal diet
continued through pregnancy but it altered abruptly at childbirth because of dietary
restrictions. The findings showed that 83.7% (n=251) of pregnant women forbid to
7
see moon eclipse. Some pregnant women of 69.3% (n=208) keep away from
unpleasant behavior during pregnancy. 37% of participants assume certain activity
as a food taboos. Those are “restriction to eat some kind of fruits and vegetable
like pineapple, avocado, pomegranate, guava, orange squash, durian, jack fruit,
papayas, sugar cane, and eggplant”.12
A cross sectional study was conducted on traditional belief and taboos on
the feeding practices and nutritional status of pregnant women in Nwangele Local
Government Area Imo state were assessed. Structured and validated questionnaires
were used to obtain information on the socio-economic characteristics, food taboos
and feeding practices of the subjects. The results of the survey show that 54% of
the pregnant women adhere to traditional beliefs and food taboo; 38% of the
women were malnourished and 62% were within the range of the expected body
weight.13
3) Literature related to dietary practices and food taboo.
A study is conducted to determine dietary practices and food taboos
practiced by Chinese women in Kuala Lumpur. A total of 134 Chinese mothers of
children below one year were recruited from three Maternal and Child Health
Clinics and Maternity Hospital, Kuala Lumpur. Questionnaires and in-depth
interviews were used to obtain information on socioeconomic background, dietary
practices, food taboos and cooking methods during the confinement period. Food
intake was assessed by multiple 24-hour dietary recall among 34 mothers during
their confinement month. The women were aged 18 – 39 years, and 68% were of
normal weight. Most women (82%) practiced 30 days of confinement, during
which they adhered to special dietary practices. The diet was directed at attaining
(cold-hot) balance, whereby “hot” foods were most commonly used and “cold”
8
foods were avoided. Ginger, rice wine and sesame seed oil, considered “hot”
foods, were used in large amounts in the cooking. Rice, chicken and pork were
also consumed in large amounts. Most vegetables and fruits were considered
“cold” and were prohibited during confinement.14
4) Literature related to misconception about food taboo.
A cross sectional study on 339 adults was done to study the misconceptions
about food during Pregnancy. The study was conducted in the field area of Rural
Health and Training Centre, Manager, department of Community Medicine, A V
Medical College, and Pondicherry. A study results show that most of the
participants were pregnant mothers, 81 (63.7%) told that some vegetables/fruits
should be avoided during pregnancy. There was no significant difference regarding
this misconception between literates and illiterates. Most of the illiterates (91.3%)
told that Papaya should not be eaten during pregnancy in comparison to 83.9% of
literates. Most common reason for restriction of specified fruits/vegetables was
abortion.1
6.3 STATEMENT OF PROBLEM
“A study to evaluate the effectiveness of planned teaching programme on
knowledge and attitude regarding food taboos among normal pregnant mothers in
selected Hospitals, at Bijapur ”
6.4
OBJECTIVES OF THE STUDY
1. To determine pre-existing knowledge and attitude of pregnant mothers
regarding food taboos.
2. To evaluate effectiveness of planned teaching programme on
knowledge and attitude of pregnant mothers regarding food taboos
.
9
3. To determine the association between pretest & post test knowledge
score of pregnant mothers and their selected demographic variables.
4. To determine the association between pre & post attitude of pregnant
mothers with their selected demographic variables.
6.5
OPERATIONAL DEFINITIONS.
Evaluate:
It refers to determine the significant worth or quality of planned
teaching program regarding food taboos.
Effectiveness: It refers to the significant difference in post level of knowledge
score and attitude of pregnant mothers regarding food taboos.
Knowledge: It refers to awareness regarding food taboos.
Attitude: If refers to opinion, feeling and belief regarding food.
Food taboo: It refers to prohibition of food under superstition misconception and
misbelieves.
Normal pregnant mother: It refers to the mother who carries a developing fetus
(es) in her womb without having any other associated medical condition.
6.6 ASSUMPTIONS:
 Pregnant mothers may have some knowledge regarding food taboos.
 Planned teaching program will help to improve the knowledge and attitude
of pregnant mothers regarding food taboos.
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6.7
HYPOTHESIS.
Tested at 5% level of significance.
H1
: The mean post test knowledge score of pregnant mothers
will significantly higher than mean pre-test knowledge scores
regarding food taboos
H2
: There will be significant association between pretest & posttest
knowledge score of pregnant mothers regarding food taboos
with selected demographic variable.
H3
: There will be significant association between pre and post test
attitude of pregnant mother and their selected demographic
variables.
6.8
DELIMITATIONS:
The study is delimited to
1. Normal antenatal mothers including primi gravida and multi gravid.
2. Knowledge & attitude regarding food taboos among pregnant mother.
3. Time, place and cost constraint.
7.0
MATERIALS AND METHODS.
7.1.1 Source of data collection.
Data will be collected from normal pregnant mothers in selected hospitals at
Bijapur.
7.1.2
Research design.
Pre - experimental design.
7.1.3
Research approach.
An evaluative approach will be used for the study.
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7.1.4 Settings of the study.
The study will be conducted in antenatal OPD at selected hospitals at
Bijapur.
7.1.5 Population.
The population under study includes the normal pregnant mothers both
primi and multigravida attending antenatal OPD in selected hospitals at
Bijapur.
7.1.6 Variables.
Independent variables: Planned teaching programme.
Dependent variables: knowledge and attitude of pregnant mothers
Demographic variables: age, residence, duration of marriage, occupation,
obstetrical score and income.
7.2.
METHOD OF DATA COLLECTION.
7.2.1 Sampling procedure.
The sample for the study will be selected by purposive sampling technique.
7.2.2
Sample size.
In this study the sample size will be 60 normal pregnant mothers both
primi and multigravida.
7.2.3
Inclusion Criteria.
 The normal pregnant mothers both primigravida and multigravida.
 Mothers who are willing to participate in the study.
 Mothers who can understand English and Kannada.
7.2.4
Exclusion Criteria.
 Antenatal mothers who are not available at the time of data collection.
 Antenatal mothers with any medical and gynecological disorder pregnancy.
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7.2.5 INSTRUMENT USED.
Part I: Proforma for collecting demographic data consisting of age, place,
occupation, income, family type, and Pregnancy status.
Part II: Interview schedule using structured knowledge questionnaire to
assess the level of knowledge on food taboos.
Part III: five points likert scale will be used to assess the attitude of
participants on food taboos.
Part IV: Planned teaching program regarding food taboos.
.
7.2.6
DATA COLLECTION METHOD.
1. Permission will be obtained from concerned authority.
2. Purpose of conducting study will be explained to the subjects.
3. Informed consent will be obtained from the subject.
4. Data would be collected using self structured interview schedule and likert
scale to assess knowledge and attitude regarding food taboos among
pregnant mothers.
.
5. Planned teaching program will be conducted by investigator regarding food
taboos among pregnant mothers.
6. Post test will be conducted with same structured interview schedule and
likert scale
7.2.7
METHOD OF DATA ANALYSIS.
Data will be analyzed according to the objectives of the study and by using
appropriate statistical techniques and will be present in the form of tables, graphs
and diagrams. Descriptive (mean, standard deviation, percentage) and inferential
(chi-square and paired t-test) statistical methods will be used to make conclusion
regarding knowledge and attitude of pregnant mothers.
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7.2.8 Duration of the study : 4- 6 weeks
7.3
Does the study require any investigation or intervention to be conducted
on the patient or human beings?
Yes, teaching on food taboo will be the intervention on the pregnant mothers.
7.4
Has ethical clearance been obtained from your institution in case of
7.3?
Yes, Ethical clearance will be obtained from the institutions ethical
Committee.
.
14
8.0
LIST OF REFERENCES
1) Rajkumar P, Anuj M L. Taboos and misconceptions about food during
pregnancy among rural population of Pondicherry. Calicut medical
Journal. 2010; 8(2): 4
2) Tsegaye D, Nelson M, Wamboi K M. Food taboos among pregnant women
in Hadiya Zone. Ethiop Journal Health Division 1998;12(1):45-49.
3) http://www.banglapedia.org/HT/F_0142.HTM.
4) Park K. Text Book of Preventive and Social Medicine. 20th edition. M/s.
Banarasidas Banot Publishers; 2009; 450
5) http://women.ezinemark.com/food-taboos-for-pregnant-women1715d8849e5.html.
6) http://www.womens-health.co.uk/forums/pregnancy /taboo and superstitions
on food/.
7) https://wiki.geneseo.edu/plugins/viewsource/viewpagesrc.action?
Page Id=67600926.
8) www.oxfordjournals.org/our_journals/tropej/online/chapter3.pdf.
9) Maria I, Santos T, Edgar VG. Food Taboos among Nursing Mothers of
.
Mexico. Journal health population nutrition.2003 Jun;21(2):142-149.
10) Puri S K. Taboos and Myths Associated with women’s Health among
Rural and Urban Adolescent Girls in Punjab. 2006-10; 31(4):45-49.
11) Chadrani W,Srikanth K,VikramanayakeTW. Food Taboos and Beliefs among
Srilankans. Journal Nutrition Science Council Sri Lanka. 10(1):59-66.
15
12) Christine SW. Ecology of Food and Nutrition. 7(4):30-34.
13) http://www.ajol.info/index.php/jorind/article/view/66832.
14) Poh B K, Wong Y P, Norimah. Postpartum Dietary Intakes
and Food Taboos Among Chinese Women Attending Maternal and Child
Health Clinics and Maternity Hospital, Kuala Lumpur. Journal on Nutrition
2005;11(1): 1-21.
.
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