Effectiveness of Self-Instructional Module on Knowledge Regarding Self-Care Management of Gestational Diabetes Mellitus among Antenatal Women Visiting Selected Antenatal Clinic at Mangalore”

 

Ms. Smitha K.R¹, and Mrs. Sandhya D’Almeida²

¹M.Sc. (OBG) Nursing, Laxmi Memorial College of Nursing, A.J. Towers, Balmatta, Mangalore-575002, Karnataka, India

²Associate Professor, Obstetrics and Gynecological Nursing, Laxmi memorial College of Nursing, A.J Towers, Balmatta, Mangalore- 575002,Karnataka.India.

 

ABSTRACT:

 

 

INTRODUCTION:

Diabetes mellitus is chronic metabolic disorders due to either insulin deficiency or due to peripheral tissue resistance to the action of insulin and it is most common medical condition to affect pregnancy.  According to WHO the gestational diabetes is defined as carbohydrate intolerance resulting in hyperglycaemia of variable severity with its onset of first recognition during pregnancy.¹ Pregnancy is associated with profound changes in the fat and carbohydrate metabolism. Glucose metabolism is characterized by a low fasting plasma and elevated postprandial values in the early weeks. In later weeks carbohydrate metabolism is stressed by the rising levels of human chorionic somatotropin (hCS), prolactin, cortisol, and glucagons. These hormones cause decreased glucose tolerance and insulin resistance.³ The mother with gestational diabetes mellitus is a high risk of hypertension, pre-eclampsia, hydramnios, urinary tract infections, caesarean section and future diabetes mellitus, and some of the foetal complications are macrosomia, hypoglycaemia, prematurity and congenital anomalies. The aim of management of gestational diabetes mellitus is to control blood glucose levels to avoid maternal and foetal complications. Components of management include diet therapy, exercise, insulin therapy and diabetic education².

 

MATERIAL AND METHODS:

The conceptual framework was based on Becker and Rosenstock’s modified Health Belief Model.this model addresses the relationship between a person’s beliefs and behaviour. Ethical clearance was obtained prior to the study. The study was conducted in the Government Lady Goschen Hospital at Mangalore. A written permission was obtained from the concerned authorities. For validity the criteria checklist, the tool along with blueprint , answer keys was submitted to 9 experts along with the objectives, reliability was calculated by Cronbach alpha method and kuder Richardson method.  The internal consistency of the knowledge questionnaire was, α=0.96 and r₂₌0.736. Hence the tools were found to be reliable. The research approach used for the study was an evaluative approach.  The study was conducted in the  antenatal ward of the selected hospitals on  30 gestational diabetes women were selected by the purposive sampling technique. Informed consent was obtained from each women for participating in the study. The data was collected by using demographic proforma, structured knowledge questionnaire on self care management of gestational diabetes mellitus. After collecting data, self instructional module was administered to the subject and on 7^th day post test was conducted using the same questionnaire. The data collected was analyzed to achieve the objectives of the study and to test the research hypotheses using descriptive and inferential statistics.

 

RESULTS:

Section A :Description of the sample characteristics:

Maximum percentage (60%) of gestational diabetes mothers were in the age group 30 and above years. Least (3.3%) were in age group 18-20 years. The majority percentage (56.7%) of antenatal women were belongs to nuclear family and least (20%)were extended family. The highest percentage (76.7%) of antenatal mothers had primary school, 6.7% had secondary education and 16.7% had high school education. Majority (26.67%) of the antenatal women were unemployed and self employed, 23.33% were private and government employed. Majority (46.66%) of antenatal mothers had family income of below Rs. 2,000, 13.33% had Rs. 2,001-4,000 and 20% had Rs. 4,001-6,000. Maximum percentage (56.6%) of antenatal mothers belonged to Hindu religion and least (16.7%) belonged to christen religion and 26.7% belong to Muslim. majority of 70%% of mothers are had no family history of GDM and remaining 30% of woman’s had family history of GDM. Maximum percentage (60%) of antenatal mothers poor knowledge regarding gestational diabetes mellitus. remaining percentage (40%) mothers having some knowledge regarding gestational diabetes mellitus and sources of information were news paper, TV, relatives, health personnel (25%). The investigator felt that the mean and median of post-test knowledge scores (17.7±5.06) as significantly higher than the mean pre-test knowledge scores (11.63±4.49), t₂₉₌2.045,p<0.005.

 

Section B: Description of the knowledge of antenatal women regarding self-care management of gestational diabetes mellitus

 

The knowledge scores were assessed with a structured knowledge questionnaire and are presented in the form of tables and figures.

 

 

 

Table 1: Frequency, percentage distribution of knowledge scores of antenatal women regarding self-care management of Gestational Diabetes Mellitus N=30

 

Table 2: Range, mean, median, standard deviation and mean percentage of pre-test and post-test knowledge scores of antenatal women with gestational diabetes mellitus N=30

 

Data in table 2 show that the post-test knowledge score range (9-24) was significantly higher than the mean their pre-test knowledge score range (2-22). The data also depicts that the mean and median of post-test knowledge scores (17.7±5.06) was significantly higher than the mean pre-test knowledge scores (11.63±4.49).

 

Section C: Effectiveness of the Self Instructional Module (SIM) on self-care management of gestational diabetes mellitus:

This section deals with the effectiveness of self instructional module on knowledge regarding self-care management of gestational diabetes mellitus. This is assessed by comparing the pre-test and post-test knowledge scores and the result has been presented in the following headings

Comparison of the pre-test and post-test knowledge scores of antenatal women on self-care management of gestational diabetes mellitus

To find out the significance of difference between the mean pre-test and post-test knowledge scores, paired’t’ test is used. In order to test the statistical difference between the mean pre-test and post-test scores the following null hypothesis is formulated.

 

H₀₁: There is no significant difference between the mean pre-test and the post-test knowledge scores of antenatal women with gestational diabetes mellitus.

 

 

 

Table 3: Mean, mean difference, standard deviation and ‘t’ value of the pre-test and the post-test knowledge scores antenatal women with gestational diabetes mellitus. N=30

 

t₂₉=2.0045, p<0.05 *Significant

 

The data in Table 3 shows that the mean post-test knowledge scores (17.7±5.06) was significantly higher than the pre-test knowledge scores (11.63±4.49. The calculated t value (3.81*) was higher than the table value (t₂₉=2.0045) at 0.05 level of significance. Hence, the null hypothesis H0₁ was rejected and the research hypothesis was accepted. Thus it is concluded that SIM is effective in improving knowledge regarding self-care management of GDM among antenatal women.

 

Section D: Association of the post-test knowledge scores with the demographic variables

This section deals with the findings of the selected demographic variables like age, educational status, occupation, income, family history, previous knowledge and source of information. The chi-square test was used to find the association of level of knowledge with selected demographic variables.

 

The following null hypothesis H0₃ is stated,

H0₃:          There is no significant association of the post-test knowledge score with the demographic variables.

 

 

Table 4: Chi-Square test showing association of post-test knowledge score with selected demographic variables N=30

P value ( p<0.05) significant p value >0.05 not significant

 

The data in Table 4 shows that there was no significant association with age, income, educational status, occupation, family history and previous knowledge. Hence the null hypothesis was accepted at 0. 05 level of significance.

 

DISCUSSION:

In the present study Maximum percentage (60%) of antenatal women was in the age group 30 and above years. Least (3.3%) were in age group 18-20years. The majority percentage (56.7%) of antenatal women were belongs to nuclear family. least (20.0%) of women belongs to extended family. The highest percentage (76.7%) of antenatal mothers had primary school education, and least (6.7%) of women had secondary education. Majority (26.67%) of the antenatal mothers was unemployed and self employed 23.33% were private and government employed. Majority (46.67%) of antenatal mothers had family income of below Rs. 2,000, least (13.33%) had Rs. 2,001-4,000. Maximum percentage (56.6%) of antenatal mothers belonged to Hindu religion and least (16.7%) belonged to christen religion. Most (70%) of mothers are had no family history of GDM and remaining 30%of women had family history of GDM. Maximum percentage (60%) of antenatal mothers poor knowledge regarding gestational diabetes mellitus. Remaining (40%) mothers were having some knowledge regarding gestational diabetes mellitus and sources of information were news paper, T.V, relatives, health personnel 25%each.

 

A similar  experimental study was carried out to determine the incidence of GDM and to assess the effect of various contributing factors. The study was conducted on 1071 pregnant women for GDM at 24-28 years in Iran in 2010. The study shows that the incidence of GDM was 10.2% in Iran resulting in very low incidence. The study reveals that a family history of diabetes has a strong co-relation with the occurrence of diabetes.³

 

In this present study Pre-test knowledge scores of 30 respondents ranged from 2-22. The mean pre-test score was 11.3. This indicates that the subjects had inadequate knowledge on self-care management of gestational diabetes mellitus. Where as in the post-test scores of 30 respondents ranged from 9-24. The mean post-test score was 17.7. It indicates that knowledge score is increased in post-test. This shows the effectiveness of the SIM in terms of gaining knowledge score. An area-wise mean percentage, both for pre-test and post-test was computed. Mean percentage score of the pre-test was highest (36.5%) in the area of general knowledge and lowest (11.5%) in the area of risk factors. Mean percentage of post- test score was maximum (83.3%) in the area of signs and symptoms and lowest (51.18%) in the area of exercise and insulin. Thus the findings suggest that SIM was effective in terms of gain in knowledge.

 

Further, to know the statistical significance between pre-test and post-test, paired ‘t’ test was computed. The ‘t’ value (t₂₉=2.0045, p<0.05) showed that there was a highly significant difference between pre-test and post-test knowledge scores. Area wise ‘t’ value was computed, which again indicated that there was significant gain in knowledge in each area at 0.05 level of significance. These results proved that the SIM conducted by the investigator has helped the subjects to improve their knowledge on self-care management of gestational diabetes mellitus. On the whole the study showed that SIM is an effective teaching strategy. The findings of this study showed that in pre-test, 20% of the sample had good knowledge and 54.34% of the sample had average knowledge and 26.66% of the sample had poor knowledge on self-care management of GDM.

 

The findings of study were similar to a qualitative study which was conducted among 50 antenatal women in Australia to explore the pregnant women knowledge about the self-care management of gestational diabetes mellitus. A purposive sample of 50 antenatal women over 30 years old participated in this study. Overall, 17.5% women had good knowledge, 60% had fair knowledge and 25% women had poor knowledge about healthy diet, physical activity. This study finding concluded that the population have inadequate knowledge regarding self-care management of gestational diabetes mellitus. The lack of dietary and lifestyle knowledge demonstrated in this study may suggest that women need more appropriate heath information on diet and exercise during antenatal care.⁴

 

The present study results revealed that there was no significant association of knowledge scores with demographic variables (table value of χ²=3.84 and 5.99, P<0.005) like age, religion, occupation, monthly income, family history.

 

A similar quasi-experimental study conducted in Thailand. The study was the effectiveness of a Self-regulation Program on Diet Control, Exercise, and Two-Hour Postprandial Blood Glucose Levels in Thais with Gestational Diabetes Mellitus. The Chi-square test revealed the rate at which the experimental group subjects controlled their diet, exercise and two-hour postprandial blood glucose levels, at weeks two, four and six of the program, to be significantly greater than in the control group (27%, p<0.001). These findings illustrate the self-regulation program was effective in helping the experimental group subjects to control their diets, exercise and blood glucose levels.⁵

 

REFERENCES:

1.       Steppe E. High risk pregnancy and delivery. 4^th ed. Philadelphia: W. B. Saunders Company; 2000. P. 217-40.

2.       Dutta DC. Textbook of obstetrics. 6^th ed. Calcutta: New Central Agency (P) Ltd.; 2004. P. 284.

3.       Holand VR, DeSouza MA. Incidence of GDM. American Journal of Epidemiology 2004;159:663-70.

4.       Reece EA, Sivan E, Francis G, Homko CJ. Pregnancy outcomes among women with and without diabetic microvascular disease (White's classes B to FR) versus non-diabetic controls. Am J Perinatol 1998;15(9):549-55.

5.       Kudin J, Weldron DM. Improvement in nutrition knowledge and retention about gestational diabetes mellitus. [online]. Available from: URL:htt//www.pubmed.com/gestational-diabetes-mellitus.119.82.92/article

 

 

Received on 16.11.2014           Modified on 10.12.2014

Accepted on 16.12.2014           © A&V Publication all right reserved