RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
NAME OF THE CANDIDATE
Ms. SAUMYA.M
AND
I st YEAR M.Sc. NURSING
ADDRESS
ALVA’S COLLEGE OF NURSING,
MOODBIDRI
2.
NAME OF THE INSTITUTION
ALVA’S COLLEGE OF NURSING,
MOODBIDRI
3.
4.
COURSE OF THE STUDY,
I st YEAR M.Sc. NURSING
SUBJECT
MEDICAL SURGICAL NURSING
DATE OF ADMISSION TO
04-06-2012
COURSE
5.
TITLE OF THE TOPIC
“ EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON
KNOWLEDGE AND PRACTICE REGARDING PULMONARY TUBERCULOSIS
AND ITS DRUG REGIMEN COMPLIANCE AMONG TUBERCULOSIS PATIENTS
ATTENDING DOTS CENTERS OF SELECTED HOSPITALS AT MANGALORE
TALUK.”
1
6
BRIEF RESUME OF THE INTENDED WORK
6.1 Need for the study
“ Obtaining knowledge will only enable me to know things,
That knowledge won't become power until I practice it”.
Lau Tzu.
Tuberculosis (TB) is a infectious disease caused by Mycobacterium Tuberculi.
The disease primarily affects the lungs and cause pulmonary tuberculosis. It can also
affect structure such as intestine, meninges, bones and joints, lymph gland, skin and
others tissue and body parts. Pulmonary tuberculosis is the most common form of
Tuberculosis, which affect the man.1
The report given by World Health Organization (WHO) in 2011,stated that
there was an estimated 8.7 million incident cases of TB (range, 8.3 million–9.0 million)
globally, equivalent to 125 cases per 100 000 population .2
India is 17th out of the 22 high burden countries in terms of TB incidence rate.
The estimated TB prevalence figure for 2010 is given as 3.1 million. It is estimated that
about 40% of the Indian population is infected with TB bacteria, the vast majority of
whom have latent rather than active.3
The government Revised National Tuberculosis Control Programmer (RNTCP)
showed the TB statistics for Karnataka covered the population of 58,800,000, out of
which 68,655 total patients are registered for treatment and 44,357 smear positive
patients are diagnosed,4,161 are smear positive retreatment relapse patients,1,078 are
smear positive re treatment failure patients,3,883 are smear positive retreatment default
patients and 82 patients with known HIV states.4
“Direct Observed Treatment Short-course( DOTS)” is a comprehensive
strategy for Tuberculosis control. It is the only strategy, which has proven effective in
controlling Tuberculosis on a mass basis. The DOTS strategy is in practice in more than
2
100 countries. India has adopted and tested DOTS in various parts of the country since
1993, with excellent results, and the Revised National Tuberculosis control programme
(RNTCP) now covers more than 120 million populations. The only effective means by
which 85 per cent cure rate or more has been shown to be achievable on a programme
basis is by application of the DOTS strategy.5
The WHO has worked with country representatives and donors to implement the
DOTS Strategy within National Tuberculosis Program in more than 100 countries.
Every element of the strategy depends on a trained and community health care workers
and volunteers with whom the strategy cannot work. Behind the workers is a
community that wants to be free from Tuberculosis. Tuberculosis control needs
community support and involvement. A successful DOTS strategy requires partnership
between the Primary Health Care’s team, other sectors and the community.5
A cross sectional study was conducted to assess the knowledge and awareness
regarding TB and its drug regimen among 88 patients from Rural Health Training
Centre, Uttar Pradesh. The result showed that majority of the patient 80.7% was aware
of symptoms of tuberculosis. About 96.6% of patients were aware that TB could be
transmitted from one person to another. As regarding the etiology of disease, 47.7%
were aware of correct etiology i.e. infective organism, 37% of patients were
aware of investigations carried out for TB and 9.1% of patients were aware about BCG
vaccination as mode of prevention for TB. Majority of the patient 95.5% believed
that TB is curable and (6 – 9 month) duration was correctly known to only 32.9% of
patient. The study revealed that although knowledge regarding symptoms, mode of
transmission, etiology was satisfactory; however there is still a great need to educate
females and illiterate individuals on priority basis.6
Knowledge is a treasure, but practice is the key to it. Knowledge is lost without
putting it into practice. Based on the studies and prevalence the investigator felt a need
to assess the knowledge and practice regarding tuberculosis and its drug regimen
among the population.
3
6.2 REVIEW OF LITERATURE:A cross sectional study was conducted to assess knowledge of patients with
tuberculosis; about their disease and misconceptions regarding TB among 170 TB
patients in Karachi, Pakistan. The results revealed that 7% patients thought TB was not
an infectious disease and 10.6% did not consider it a preventable disease. Contaminated
food was considered the source of infection by 47.6% and 57% considered emotional
trauma/stress the causative agent of TB. No counseling about preventing spread was
received by 50% patients and 57% considered separating dishes as an important means
of preventing spread. Among that 18% patients had discontinued their medications
following relief of symptoms and 23% of the respondents thought that TB could lead to
infertility and 38.8% believed that there were reduced chances of getting married
following infection. The study concluded that misconceptions concerning TB are
common while lack of knowledge on tuberculosis was alarming among Pakistani
patients.7
A study was conducted to determine patients' attitudes to tuberculosis and their
knowledge of the disease, and factors associated with treatment compliance among 135
patients in Malaysia. The study results showed that the patients had limited
understanding and knowledge about tuberculosis. There was a negative correlation
between patient age and tuberculosis knowledge score (r = -0.18, P = 0.038).
Compliance with treatment and follow-up was not affected by age, sex, ethnic group,
educational level and occupation, extent of knowledge, tuberculosis symptoms, and
hospitalization for tuberculosis or duration of the prescribed treatment regimen. The
study concluded that the Malaysian patients with newly diagnosed tuberculosis had
misconceptions and limited knowledge about the disease and its treatment. Educational
background was an important determinant of a patient's level of knowledge about
tuberculosis. Compliance was not affected by patient characteristics. The study
recommended that adequate counseling and education of patients and close relatives on
tuberculosis and the necessity for prolonged treatment may help to improve treatment
4
compliance.8
A study was conducted to determine the impact of health education campaign
on DOTS strategy among 1008 general population in New Delhi, India. The data was
collected before and one week after the campaign by structured interview schedule. A
significant increase (p>0.01) was seen in post test knowledge scores compared to
pretest knowledge scores. The study concluded that the campaign was been effective in
improving knowledge of general public.9
A survey was conducted to assess the knowledge and practice regarding
tuberculosis (TB) treatment among 390 general and private medical practitioners in
Nigeria. Of the 350 (89%) questionnaires returned, 305 (87.1%) practitioners had
treated TB cases in their hospitals. The number of regimens recorded was 85 for newly
diagnosed (ND) cases and for 45 re-treatment (RT) cases. The National Tuberculosis
Control Programme (NTCP)-approved regimen was used in 61 (20%) ND cases and 60
(19.7%) RT cases. The number of inadequate regimens prescribed were 60 (70.6%) for
ND cases and 36 (80%) for RT cases; 34 lasting less than 6 months were prescribed in
8 (9.4%) cases, and regiments lasting more than 12 months were prescribed in 10 cases
(11.7%). Other aspects of poor knowledge were exhibited by a significant number of
respondents who estimated seeing an average of 1525 TB patients each month. The
study concluded that a significant number of physicians in private practice did not
adhere to the standard norms for prescribing anti-TB treatment, did not know about the
regimen recommended by the NTCP, and often prescribed wrong regimens. It was
recommended that interventional strategies in the form of continuing medical education
in TB should be urgently organized for general and private medical practitioners if the
disease is to be controlled.10
A study was conducted to assess the community knowledge, attitude and
practices towards TB and its treatment in 6 villages of Tanzania. The results showed
that community knowledge on its cause was poor , symptoms of TB as mentioned by
community included persistent cough and weight loss. TB was reported to be
transmitted mainly through air. Focus group discussants knew that TB cure requires a 8
5
month period of treatment. The study concluded that rural communities have a low
knowledge on the causes and the transmission of TB which is a likely cause of the
delay in seeking treatment. The study suggested that an intensive appropriate
community health education is required for a positive behavioral change in TB
control.11
A questionnaire based survey was conducted to study the knowledge about
tuberculosis and national tuberculosis control program among 112 interns and post
graduate students of a tertiary care hospital, Haryana.The results showed that the
number of sputum specimens required for diagnosis under Revised National
Tuberculosis Control Programme RNTCP was responded correctly by only 57%, the
time duration in which sputum specimen should be processed was told correctly by
only 42.5%, while the sputum examination guidelines for extra-pulmonary tuberculosis
was responded correctly by only 27%. The awareness of serious forms of sputumnegative pulmonary tuberculosis was 21%, while serious form of extra pulmonary
tuberculosis was known to be only 33%. The correct categorization of tuberculosis
patients was done by only 56% of the respondents, while treatment of tubercular
meningitis was marked correctly by 69% of the respondents. This study showed a low
level of knowledge among participants despite DOTS covering the entire country at
present. This study indicated an enormous challenge and an urgent need to revamp and
reform undergraduate medical education and change in medical curriculum with need
instituting practical training at Directly Observed treatment Short Course (DOTS)
centers in the curriculum of medical students.12
A survey was conducted to assess the the level of knowledge and practice
related to TB and identify predictive factors Ethiopia. The results showed that only six
(1.6%) people described the cause of TB as being bacterial, while a wind locally known
as 'nefas' was frequently mentioned (36.1%); nearly 75% of the people correctly
described breath as a mode of TB transmission; 116 (30.7%) did not know any
measures for TB prevention and control; and half of the participants did not know that
anti-tuberculosis drugs were provided free of charge. Significant predictors of TB
knowledge were: incarceration in the Jijiga (OR 9.62, P < 0.001) and Dire Dawa (OR
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2.14, P = 0.016) prisons, those who did not consult and receive treatment for TB
symptoms (OR 2.46, P < 0.001), and prisoners without a past history of TB (OR 2.72, P
= 0.002).The study demonstrated that prisoners have a modest level of biomedical
knowledge and also suggested that as a part of the National TB Programme, health
education programmes needed to be implemented to enhance people' knowledge of
TB.13
6.3 Problem statement:Effectiveness of structured teaching programme on knowledge and practice
regarding pulmonary tuberculosis and its drug regimen compliance among tuberculosis
patient attending the DOTS centers of selected hospitals at Mangalore Taluk.
6.4 Objectives of the study:The objectives of the study are to:

assess the pre test score on knowledge and practice regarding tuberculosis and
its drug regimen among tuberculosis patients.

evaluate the effectiveness of structured teaching programme on knowledge and
practice regarding tuberculosis and its drug regimen among tuberculosis
patients.

find out the correlation between knowledge and practice regarding tuberculosis
and its drug regimen.

find out the association between the pretest knowledge scores and selected
demographic variables.

find out the association between the pre test practice score and selected
demographic variables.
6.5 Operational Definitions:Effectiveness: - In this study, it refers to extent to which the structured teaching
programme has achieved the desired result as evidence from gaining knowledge
and practice score regarding tuberculosis and its drug regimen.
Structured Teaching Programme: - In this study, a structured teaching
programme refers to systematically developed teaching programme designed for
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tuberculosis patients to provide information on tuberculosis and its drug
regimen.
Knowledge: - In this study, it refers to correct response given by tuberculosis
patients to structured knowledge questionnaire on tuberculosis and its drug
regimen
and the ability to recall instructions given in structured teaching
programme and responds towards questionnaire.
Practice:-In this study, it refers to the repeated and systematic action for the
purpose of relieving from the pulmonary tuberculosis assessed by using
checklist.
Pulmonary Tuberculosis:- It is a contagious and deadly bacterial infectious
disease that involves the lungs and can spread to other organs
Drug regimen: - In this study drug regimen refers to medication designed to
maintained to improve and maintain the health of the tuberculosis patient.
Compliance :- In this study, it is used to indicate a patient's correct following of
medical advice.
Patients:- Clients who are suffering from tuberculosis obtaining treatment in the
selected DOTS centers.
DOTS centers: - In this study, it refers to Directly Observed Treatment Shortcourse (DOTS) refers to the strategy which provides treatment to reduce the
number of tuberculosis cases.
6.6 Assumptions:The study assumes that,

Structured teaching programme enhances the knowledge and practice of
pulmonary tuberculosis and its drug regimen among TB patients.

creating health awareness among tuberculosis patients to bring better treatment
out come.
6.7Delimitations:The study is limited to:

pulmonary tuberculosis patients in selected DOTS centers Mangalore Taluk.
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6.8Projected outcome (Hypotheses):The study is based on the following hypothesis which will be tested at0.05 level
of significance:
H1:-There will be significant difference in the mean pre test knowledge score and
post test knowledge score regarding the pulmonary tuberculosis and its drug regimen
compliance among TB patients.
H2:- There will be significant difference in the mean pre test practice score and post
test practice score regarding the pulmonary tuberculosis and its drug regimen
compliance among TB patients.
H3:- There will be significant correlation between the knowledge and practice
regarding pulmonary tuberculosis and its drug regimen compliance.
H4:-There will be significant association between pretest knowledge score and
selected demographic variables.
H5:- There will be significant association between the pretest practice score and
selected demographic variables.
7.
MATERIAL AND METHOD:7.1 SOURCE OF DATA
Data will be collected from tuberculosis patients in selected DOTS centres of
Mangalore Taluk.
7.1.1 Research Design
Pre-experimental [one group pretest post test] design was adopted in this study.
Subject
Pretest
RX(Intervention) Post test
Tuberculosis
O1
X
O2
patients
7.1.2Setting
Setting consists of selected DOTS centers in Mangalore Taluk.
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7.1.3 Population
Population in the study consists of tuberculosis patients in selected DOTS
centres of Mangalore Taluk.
7.2 METHOD OF DATA COLLECTION
7.2.1 Sampling Procedure
Sampling procedure selected is non probability purposive sampling technique.
7.2.2 Sample size
Sample size consists of 60 tuberculosis patients.
7.2.3 Inclusion criteria for sampling
The tuberculosis patients who are:

between the age group of 20-60 years.

taking DOTS therapy.

willing to participate

available on 7th day

able to read and write Kannada.
7.2.4 Exclusion criteria for sampling
The tuberculosis patients who are not:

available during the study.
7.2.5 Instruments used
Tool 1: Demographic Proforma
Tool 2: Structured knowledge questionnaire on pulmonary tuberculosis and its
drug regimen compliance among tuberculosis patients.
Tool 3: Practice checklist on tuberculosis drug regimen.
7.2.6 Data collection method

Permission will be obtained from the concern authority prior to the study.

Data will be collected for a period of 6weeks.

Pretest will be conducted to assess knowledge and practice using structured
knowledge questionnaire and practice checklist.

The same day structured teaching programme will be given.

On the 7th day post test will be conducted using the same structured knowledge
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questionnaire and practice checklist.
7.2.7 Data Analysis Plan:It is done by using both descriptive and inferential statistics

Demographic data will be analyzed using frequency and percentage.

Knowledge and practice score will be analyzed by computing frequency,
percentage, mean, median, mean percentage and standard deviation.

The mean pretest and post test knowledge and practice score differences will be
analyzed by applying paired‘t’ test to find out the effectiveness of structured
teaching program.

Correlation between knowledge and practice will be determined using Karl
Pearson’s coefficient of correlation.

Association between the pretest knowledge and practice score and selected
demographic variables will be calculated by chi-square test.
7.3 Does the study requires any investigation or interventions to be conducted on
patient or other human or animals?
Yes, administration of structured knowledge questionnaire, practice checklist
and structured teaching programme.
7.4 Has ethical clearance been obtained from institution in case of 7.3?
Yes, ethical clearance has been obtained from the research ethical committee of
the concerned institution.
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8.
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http://www.tbfacts.org/tb statistics-india.html. Accessed Nov1
4.
Bhar A. Tuberculosis India2012.The Times Of India.Sat28/2012/Apr.P:1
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Delhi: Jaypee brothers medical publishers;2003.p.205-7
6.
Dr.Shrivastav D K. An assessment of knowledge and awareness regarding
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8.
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knowledge of the disease, and factors associated with treatment compliance in
Malaysia.Int J Tuberc Lung Dis 1999 Apr;3(4):300-9.
9. Firaza N, Marcelo A B, Fatmi Z,Scott R E.Knowledge and practice regarding
tuberculosis (TB) treatment among 390 general and private medical
practitioners in Nigeria.The International Journal of infectious
Diseases2011Dec;6(2):80-3
10. Mangesho P E, Shayo E, Makunde W H, Sketo G B, Mandara C I.
Community knowledge, attitude and practice towards tuberculosis and its
treatment in Central Tanzania. Tanzania Health Research Bulletin 2007
Jan;9(1):70-4
11. Mehta D ,Bassi R, Singh M, Mehta C. Ann Trop Med Public Health 2012
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Jul;5(3):206-8. Available at http://:www.atmph.org/text2012/5/3/206/98620
12 Streaton J A, Desen N, Jone S L. Sensitivity and specificity of gamma interferon
blood test for tuberculosis infection. Interna. J. Tuberculo. and lung dise1998
May;5(3):443-50.
13 Sheik F. Awareness and knowledge about Tuberculosis in the TB prisoners of
NWFP The International Journal of Tuberculosis volume 1,March 2000.
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