INTRODUCTION:

One of the most famous definitions of Health Promotion comes from the World Health Organization which is the “process of enabling people to increase control over, and to improve, their health”. Health promotion pushes a person forward towards the optimum goal of health. Health Promotion refers to the efforts to promote positive health.¹

The most famous modern definition of health was given by W H O, and it states "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."Most people accept that health can be divided into two broad aspects - physical and mental health. Physical health means a good body health, which is healthy because of regular physical activity (exercise), good nutrition, and adequate rest. Mental health refers to people's cognitive and emotional well-being.²

The health promoting lifestyle is defined as “a multidimensional pattern of self-initiated actions and perceptions that serve to maintain or enhance the level of wellness, self-actualization and fulfillment of the individual”.³

In India the situation is quite alarming. The disease profile is changing rapidly. The World health Organization (WHO) has identified India as one of the nations that is going to have most of the lifestyle disorders in the near future. Nowadays, not only are lifestyle disorders becoming more common, but they are also affecting younger population. Hence, the population at risk shifts from 40+ to maybe 30+ or even younger. Already considered the diabetes capital of the world, India now appears headed towards gaining another dubious distinction of becoming the lifestyle-related disease capital as well. A study conducted jointly by the All India Institute of Medical Sciences and Max Hospital shows the incidence of hypertension, obesity and heart disease is increasing at an alarming rate, especially in the young, urban population. According to doctors say, a sedentary lifestyle combined with an increase in the consumption of fatty food and alcohol is to blame cases of obesity, diabetes, and hypertension etc. ⁴

Health Promotion Practices plays a big role in continuously enhancing positive health. As a nurse, it is one of our major responsibilities to ensure that the health promotion practices known to people are correct and makes a significant, positive contribution to the optimum well-being of the people. As a professional, it is expected that one has the knowledge and skills to meet the needs of an individual or group. This puts the people in the position to trust that the “professional will keep the given entity’s best interest as the primary goal and will strive to meet their needs. ⁵

NEED FOR THE STUDY:

A sedentary life style is a way of living in which a person does not engage in sufficient physical activity for what is generally considered healthy living. It is marked by prolonged period of sitting whether it is around the TV or computer screen anything else. People living a sedentary life style overlook physical activity and are involved in activities that are rarely require any amount of physical stress. There are lot of research conducted on the effects of life style on individuals across the globe, and the researches revealed that coronary artery diseases, hypertension, hyperlipidemia, obesity, diabetes, cancer, osteoporosis, depression are the common life style disorders.⁶

According to the Global status report on non communicable diseases 2010 by World Health Organization (WHO) non communicable diseases (NCDs) are the leading causes of death globally, killing more people each year than all other causes combined. Of the 57 million deaths that occurred globally in 2008, 36 million were due to NCDs, comprising mainly cardiovascular diseases, cancers, diabetes and chronic lung diseases. NCDs are caused, to a large extent, by four behavioral risk factors that are: tobacco use, unhealthy diet, insufficient physical activity and the harmful use of the alcohol. ⁷

Almost 6 million people die from tobacco use each year, both from tobacco use and second-hand smoke. Smoking is estimated to cause about 71% of lung cancer, 42% of chronic respiratory disease and nearly 10% of cardiovascular diseases. ⁸

Approximately 3.2 million people die each year due to physical inactivity. People who are insufficiently physically active have a 20% to 30% increased risk of all-cause mortality. Approximately 2.3 million die each year from the harmful use of alcohol, accounting for about 3.8% of all deaths in the world. Raised blood pressure is estimated to cause 7.5 million deaths, about 12.8% of all deaths. At least 2.8 million people die each year as a result of being overweight or obese. Risks of heart disease, stroke and diabetes increase steadily with increasing body mass index (BMI).Raised cholesterol is estimated to cause 2.6 million deaths annually; it increases the risks of heart disease and stroke. At least 2 million cancer cases occur per year.⁸

New Government Report by the US government in 2002, stated that nearly 50 million adults between the ages of 20 and 74 are obese and more than 108 million adults (61%) are either obese or overweight; 12.6 million people have coronary artery disease; 1.1 million people suffer from heart attack each year.⁹

According to the article –Diabetes and its alarming numbers (2010), more than 220 million people worldwide have diabetes.15 In 2005; an estimated 1.1 million people died from diabetes .WHO projects that diabetes will double between 2005 and 2030. The article also states that 1 of 3 adults in US is likely to have diabetes by 2050.Currently 1 in 10 US adults have diabetes.¹⁰

India has the highest number of diabetic patients in the world. The International Diabetes Federation (IDF), revealed that India is the diabetes capital of the world, 50.8 million people suffering from the condition.IDF also states that the number of diabetic patients is expected to go up to 84% of adult population by 2030.Decreasing activity increases the risk of developing certain types of cancers such as breast cancer, colon cancer and other malignant tumors. Physical inactivity can cause the risk of dying from cancer by 45% in men and 28% in women.12Prolonged inactivity causes bones to lose their strength as they are no longer challenged to support body structure. ¹⁰

Regular physical activity reduces the risk of cardiovascular disease including high blood pressure, diabetes, breast and colon cancer and depression. Adequate consumption of fruit and vegetables reduces the risk for cardiovascular diseases, stomach and colorectal cancer.¹¹

STATEMENT OF PROBLEM:

A study to assess the effectiveness of Self instructional module (SIM) on knowledge of healthy lifestyle among sedentary workers from selected Banks of Belagavi.”

OBJECTIVES:

1. To assess the pre test knowledge of sedentary workers regarding healthy lifestyle.

2. To evaluate the effectiveness of self instructional module (SIM) on knowledge regarding healthy lifestyle.

3. To determine the association between the pre test knowledge scores with selected demographic variables.

4. To develop an Self instructional module (SIM) regarding healthy lifestyle.

HYPOTHESIS OF THE STUDY:

H1: There will be significant difference between the pre-test and post-test knowledge scores of sedentary workers regarding the healthy lifestyle.

H2: There will be significant association between the pre test level of knowledge and selected demographic variables.

OPERATIONAL DEFINITIONS:

1. Assess: It refers to evaluate the knowledge of sedentary workers.

2. Effectiveness: It refers to extent to which the self instructional module (SIM) on healthy lifestyle achieves the desired effect in improving the knowledge among sedentary workers as evidenced by gain of knowledge scores.

3. Self instructional module (SIM) : It refers to booklet giving information regarding healthy lifestyle to prevent sedentary lifestyle diseases.

4. Healthy lifestyle: It refers to way of living of individuals to maintain or enhance the level of wellness, self-actualization and fulfillment of the individual.

5. Sedentary workers: In this study it refers to Bank Employees who sits most of the time in front of the desk with little exercise.

Assumptions:

1. The Bank Employees may have some knowledge regarding healthy lifestyle.

2. Improving the knowledge of Bank Employees can reduce lifestyle diseases among them.

REVIEW OF LITERATURE:

A quasi experimental study was conducted in Switzerland on effects of a sedentary lifestyle physical activity intervention on stages of change and energy expenditure in sedentary employees. Data were collected before and after a 4 month intervention period in 6 offices (211 samples). Participants completed a 7 day recall questionnaire on physical activities. The result of the study showed that between precontemplation/ contemplation, preparation and action/ maintenance there was a significant difference of more than 850 kcal of energy expenditure.¹²

A study was conducted in California on rapid reduction of serum cholesterol and blood pressure by 12 day, very low-fat and strictly vegetarian diet. The study samples included 500 men and women. The result of the study showed that during the 12 day period cardiac risk factors improved; reduction of total cholesterol of 11%, of blood pressure 6% and weight loss of 2.5kg for men and 1 kg for women, HDL cholesterol decreased 19% in 66 subjects.¹³

A cross-sectional correlational study conducted in China on an application of the health promotion model to explore the relationship among health concepts, perceived health status and health promoting lifestyle of the Southeast Asian women In Taiwan. A convenient sample of 195 Southeast Asian female foreign spouses was undertaken for the study. The participants were asked to complete demographic data, Hung (1997) health concept scale, Lu (1996) self-perceived health status scale and Cheng (1997) health promoting lifestyle profile. The study result revealed that in the health promoting lifestyle, the highest scores were the interpersonal support, followed by self-actualization, nutrition, stress management, health responsibility, while the lowest score was the area of exercise. A significant relationship between personal background factors and health promotion lifestyle was found.¹⁴

Researchers from Umeå University in Sweden compared death rates from breast cancer in women who got screened and those who didn't between 1986 and 2005. The women were screened through a national program that offered mammograms every 18 months or 2 years to women in certain Swedish counties. The death rate from breast cancer was 29% lower in the women who got mammograms compared to those who didn't. The benefit was greater in women age 45-49 than in those age 40-44.¹⁵

A cross sectional study was conducted in Finland on physical exercise and psychological well-being. A total of 3403 participants ( 1856 women and 1547 men ), ranging in age between 25 and 64, completed questionnaire concerning their exercise habits and perceived health and fitness, Beck Depression Inventory, State –Trait Anger Scale, Cynical Distrust Scale and Sense of Coherence inventory . The result of the study shows that individual who exercised at least two or 3 times a week experienced significantly less depression, anger, stress and cynical distrust.¹⁶

Figure 1- Conceptual framework as per Pender’s Revised Health Promotion Model (HPM)

METHODOLOGY:

Research Design:

The research design refers to the researcher’s overall plan for obtaining answer to the research questions and it spells out strategies that the researcher adopted to develop information that is accurate, objective and interpretable.¹⁷ A one group pre-test post-test research design has been used to attain the objectives of the present study.

Research Setting :

Setting refers to the area where the study is conducted. It is the physical location and condition in which data collection takes place in a study.¹⁷ The setting of the study is, Syndicate & Canara Bank Nehru Nagar, Belagavi.

Population:

The population referred to as the target population, which represents the entire group or all the elements like individuals or objects that meet certain criteria for inclusion in the study. ¹⁷

In this study, the population comprises of all Bank Employees of Syndicate & Canara Bank Nehru Nagar, Belagavi.

Variable:

Variables are concepts at various levels of abstraction that are measured, manipulated or controlled in the study. ¹⁷

Independent variable

An independent variable is that which is believed to cause or influence the dependent variable, in experimental research by the manipulated (treatment) variable. ¹⁷

In this study, independent variable refers to the Self Instructional Module (SIM).

Dependent variable

The variable is hypothesized to depend on or be caused by another variable, (the independent variable) the outcome variable of interest. ¹⁷

In this study, dependent variable refers to the knowledge of healthy life style among sedentary workers.

Demographic variables

In this study demographic variables includes age, gender, education, family income, marital status, hours of work, intake of junk foods, habit of doing exercise, and job stress of Bank Employees.

Sample and sampling technique:

Sample refers to the subset of a population that is selected to participate in a particular study. The investigator planned to select Bank Employees working in Syndicate & Canara Bank Nehru Nagar, Belagavi, who are available at the time of data collection, who fulfill the inclusion criteria, and who are willing to participate in the study by using convenient sampling technique.

In the present study, 30 Bank Employees working in Syndicate & Canara Bank Nehru Nagar, Belagavi were selected as samples for the research study.

Description of the Tool

Structured questionnaires consist of 2 parts i.e. Part I and part II

Part I: Consists of items on demographic variables like, age, gender, education, family income, marital status, hours of work, intake junk foods, habit of doing exercise and job stress .

Part II: Consists of 30 knowledge items related to healthy lifestyle:

- Health promotive and preventive aspect (19 items)

- Meaning and common lifestyle disease (3 items)

- Causes and symptoms of life style diseases (8 items)

Ethical clearance

Ethical clearance was obtained.

Reliability

The reliability of the tool is computed by using Spearman Brown’s prophecy formula, where ‘r’ value obtained was 0.76 which showed that the tool was reliable.

RESULT:

Section I:

Demographic Characteristics

· Majority of the Bank Employees 09(30%) were between the age group of 22-26 years and 37-40 years where as age group 27-31 years and 32-36 years had 06(20%).

· Majority of the Bank Employees 20(66.66%) were males and 10 (33.33%) were females

· Majority of the Bank Employees 22(73.33%) were Post graduate and 08 (26.67%) were Graduate.

· Majority of the Bank Employees 21(70.00%) have family income in between 1-3 lakhs were as 8(26.67%) had 3-5 lakhs and 01(3.33%) had Less than 1 lakh.

· Majority of the Bank Employees 23(76.87%) are married and 07(23.3%) are single .

· Majority of the Bank Employees work 21(70.00%) work 6-8 hours a day where as 9 (30%) work for 9-12 hours a day.

· Majority of the Bank Employees 17(43.53% had junk foods less than 3 times a week, and 13(56.64%)had habit of having junk foods daily.

· Half of the Bank Employees 15(50%) do exercise 3 days per week, and rest half 15(50%) do exercise 5 days per week. and no one does exercise daily.

· Majority of the Bank Employees 26(86.67%) had the feeling of being stressed with the job and 4(13.33%) Bank Employees had no job stress.

Section II:

Majority 66.67 % of the Bank Employees had inadequate knowledge and 16.67% had moderate knowledge before administration of self instructional module (SIM). After administration self instructional module (SIM) majority 60% of Bank Employees had reported adequate knowledge and 33.33% Bank Employees were reported moderate knowledge.

Figure 2:-Knowledge level of Bank Employees regarding healthy lifestyle in pre test and post test

Table 2:-Association of pre test knowledge scores of Bank Employees with selected demographic variables n = 30

Demographic Variables		Category	Sample	Respondents Knowledge						χ ²value	Cal	df
				Poor		Average		Good
				f	(%)	f	(%)	f	(%)
Age Group (years)		22-26 yr	9	2	6.66	6	20	1	3.3	3.39	7.82	NS
		27-31 yr	6	1	3.3	4	13.3	1	3.3
		32-36 yr	6	1	3.3	5	16.6	0	00
		37-40 yr	9	1	3.3	5	16.6	3	10
Sex		Male	20	3	10	13	43.3	4	13.3	0.523	3.84	NS
Sex		Female	10	2	6.6	7	23.3	1	3.33	0.523	3.84	NS
Educational status	Graduate		08	03	10	04	13.3	01	3.33	3.40	5.9	NS
Educational status	Postgraduate		22	02	6.6	16	53.3	04	13.3	3.40	5.9	NS
Family income	< 1 lakh		01	00	00	01	3.3	00	00	17.53	7.82	S
	1-3 lakhs		21	02	6.6	15	50	04	13.33
	3-5 lakhs		08	03	10	04	13.3	01	3.3
	> 5 lakhs		00	00	00	00	00	00	00
Marital status	Single		07	03	10	03	10	01	3.3	4.54	3.84	S
Marital status	Married		23	02	6.6	17	56.6	04	13.3	4.54	3.84	S
Hours of work in a day	6-8 hours		21	05	16.6	15	50	01	3.3	8.40	3.84	S
Hours of work in a day	9-12 hours		09	00	00	05	16.6	04	13.3	8.40	3.84	S
Intake of junk foods per week	Less than 3times per week		17	02	6.6	12	40	03	10	0.67	3.84	NNS
Intake of junk foods per week	Daily		13	03	10	08	26.6	02	6.6	0.67	3.84	NNS
Habit of doing exercise	3 days /week		00	00	00	00	00	00	00	12.4	5.9	S
	5 days / week		00	00	00	00	00	00	00
	Daily		15	03	10	07	23.3	05	16.6
	Not at all		15	02	6.6	13	43.3	00	00
Job stress	Yes		26	05	16.6	17	56.6	04	13.3	2.84	3.84	NS
Job stress	No		04	00	00	03	3.3	01	3.3	2.84	3.84	NS

S - Significant at 0.05 level of significance, NS - Non significant

NURSING IMPLICATION:

The findings of the study can be used in the following areas of nursing profession.

1. Nursing Practice

Nurses are the key persons of the health team, who play a major role in health promotion and maintenance. The result of this study can serve as a basis and framework in developing and implementing programmes pertaining to health promotion especially to those sedentary workers working in Banks.

2. Nursing Education.

As a nurse educator, there are abundant opportunities for nursing professionals to educate the sedentary workers from Banks. This study enriches the health promotion literature by providing a documentation of the knowledge of healthy lifestyle among sedentary workers from Banks. Findings of the study can be used as a reference material in teaching Health Promotion in the college of nursing.

3. Nursing Administration

Nursing administrators should take interest in motivating the nursing personnel to improve their professional knowledge and skill by attending the health conferences, workshops, seminars and training program on health promoting lifestyle. The nursing administrator should arrange regular in-service education program on healthy lifestyle.

4. Nursing Research

Research provides nurses credibility to influence decision making, policy and protocol formulation regarding healthy lifestyle among sedentary Bank employees. Findings of the present study can be used as a document, reference material and a guide to future researchers who wish to conduct a similar study. This study can be as a building block for subsequent research that can raise questions that would entail a more complex research.

LIMITATIONS OF THE STUDY:

Only one domain that is knowledge was considered in the present study.

The study was conducted in selected Banks, which restricts the generalization.

The sample size was limited to 30 Bank employees.

The researcher could not get a standardized tool to assess the knowledge of Bank employees. The researcher them self developed the tool.

RECOMMENDATIONS:

On the basis of the findings of the study following recommendations have been made:

1. A similar study can be replicated on large sample to generalize the findings.

2. A similar study can be conducted in different setting.

3. A similar study can be conducted and evaluated using alternative teaching strategies like video assisted teaching method, structured teaching programme.

4. A study on knowledge, attitude and practice on health promoting lifestyle among sedentary workers can be conducted to find out the interrelationship between knowledge, practice and attitude.

5. A similar study can be undertaken with a control group design.

CONCLUSIONS:

On the basis of the findings, the investigator concluded that the bank employees have inadequate knowledge regarding Healthy lifestyle. The study strongly suggests that it is very important to enhance the knowledge of the sedentary workers of banks to Prevent and control diseases caused by unhealthy lifestyles.

REFERRENCES:

1. Naidoo Jennie, Jane Wills. Public Health and Health Promotion: Developing Practice. 2nd ed. Bailliere Tindall; 2005

2. Christain Nordqvist. What Is Health? What Does Good Health Mean? : National: Health Service (NHS). UK: The Mayo Clinic, Wikipedia, HHS, 2009.Available from: URL: http://www.medicalnewst oday.com/articles/1 50999.php

3. Robert D Galloway. Health Promotion: Causes, Beliefs and Measurements. Clin Med Res. 2003 July; 1(3): 249–258. Available from: URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069052/

4. Life-Style Disorders – Indian Scenario. Available from: URL: http://www.indg.in/health/lifestyle-disorders/

5. Edelman arole, Carol Lynn Mandle. Health Promotion Throughout the Life Span. 7th ed. St.Louis, Mo: Mosby; 2010.

6. Health effects of sedentary lifestyle. Available from: URL: http://www.lifemojo.com/lifestyle/health_effects_of_a_sedentary lifestyle_44282279.

7. Global status report on noncommunicable diseases 2010. Available from: URL: http://www.who.int/nmh/publications/ncd_report2010/en/

8. Benefits of physical activity. New Government Report. USA: 2002.Available from: URL:http://seniorjournal.com/News/Fitness/2-06-20-30000Die.htm

9. Jim Steinberg. Diabetes and its alarming numbers. 2010 Nov. Avalable from: URL: http://dailyme.com/story/2010111100001986/diabetes-alarming-numbers.html

10. Dr. Rajiv Gupta. Diabetes in India current status. Express healthcare. 2008 Aug. Available from: URL:http://www.expresshealthcare .in /200808/diabetes 02.shtml

11. Polit F Denise, Hungler P Bernadette. Ursing research :principles and methods. 6th ed. Philadelphia: Lippincott publications;1999.

12. Dr. Rajiv Gupta. Diabetes in India current status. Express healthcare. 2008 Aug. Available from: URL:http://www.expresshealthcare .in /200808/diabetes 02.shtml

13. Rajesh Mahapatra. Lifestyle diseases hit India’s IT workers. The Guardian. 2007 Sep. Available from: URL: http://www.guardian.co.uk/world/2007 /sep/14/business.india

14. Polit F Denise, Hungler P Bernadette. Ursing research:principles and methods. 6th ed. Philadelphia: Lippincott publications;1999.

15. Sylvia Titze,Brian W Martin, Roland Seiler, Willibald Stronegger, Bernard Marti.Effects of a lifestyle physical activity intervention on stages of change and energy expenditure in sedentary employees. Psychology of sport and exercise. 2001 Apr; 2( 2): 103-116. Available from: URL: http://www. sciencedirect. com/science/article/pii/S1469029200000169

16. Fu-Ming Chiang. An Application of the Health Promotion Model to explore the Relationship among Health concepts, Perceived Health Status and Health Promoting Life Style of the Southeast Asian Women in Taiwan. Unpublished MSc nursing thesis.2007. Available from: URL: http://ethesys.fy.edu.tw/ETD-db/ETD-search/view_etd?URN=etd-0725107-192414

17. Polit F Denise, Beck, Tatono Cheryl, Nursing Research Principles and Methods, Lippincott Williams and Wilkins:2004.

Received on 16.01.2015 Modified on 13.02.2015

Int. J. Adv. Nur. Management 3(2): April- June, 2015; Page 131-138

Pre test		Post test		Mean difference	t Value	Df	Inference
Mean	SD	Mean	SD
14.8	5.3	20.2	18	5.4	13.65	59	S