A Quasi Experimental Study on Effectiveness of Structured Teaching Programme on Knowledge Regarding Complementary Modalities of Hypertension among Hypertensive Patients in Selected Rural areas of District Jalandhar, Punjab 2012.

 

Mrs. Mandeep Kaur

Assistant Professor, Department of Medical Surgical Nursing, Cardio-Vascular and Thoracic Nursing, Sri Guru Ramdas College of Nursing, S.G.R.D. Institute of Medical Sciences and Research, Amritsar

*Corresponding Author’s Email: mandeepkaurkaler1984@gmail.com

 

ABSTRACT:

Hypertension remains an important health challenge. Various factors might have contributed to this rising trend of hypertension. Moreover, the global burden of disease is already very high as the people are spending lots of money on drugs. Therefore it seems to be a necessity to create awareness in people regarding complementary modalities. Complementary modalities play an important role in the management of hypertension.  The research design selected for the study was Quasi-experimental (Non equivalent control group pre test post test) design. The study was conducted in the month of January, 2012 on 60 hypertensive patients (30 in experimental and 30 in control group). Convenience sampling was employed to collect data. Structured knowledge questionnaire was administered through semi-structured interview schedule. Structured teaching programme was administered to experimental group to increase their knowledge regarding complementary modalities of hypertension. Data was analyzed by descriptive statistics and inferential statistics. In comparison of pre test and post test the mean score of pre test is 14.16 and  in post test 26.85, ‘t’ value= 18.18 and found statistically significant at 5% level of significance  in case of experimental group. In control group pre test mean was 14.30 and post test mean was 15.06, ‘t’ value found not statistically significant. The post test knowledge scores of experimental group were significantly higher than the control group, therefore, H1 was accepted and H0 was rejected. It shows that structured teaching programme was effective. In conclusion near about 64% hypertensive patients in experiment and control group had poor knowledge regarding complementary modalities of hypertension. Therefore, structured teaching programme had helped hypertensive patients in experiment group to increase knowledge regarding complementary modalities of hypertension. It is recommended that education programmes should be organised at community level.

 

KEYWORDS: Hypertension, Structured teaching programme, Complementary modalities.

 

 

INTRODUCTION:

Hypertension (HTN) is a modern day’s epidemic and it is becoming a public health emergency worldwide, especially in the developing countries.1 Hypertension stand true in today’s scientifically advanced scenario where every man is too busy to take some time out, even for himself. Hypertension affects approximately 1 billion individuals worldwide. Risk factors like aging, overweight, family history, smoking, stress, alcohol intake, sedentary life style, diabetes mellitus.2 Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India.3 It is seen that majority of the hypertensive patients remain asymptomatic, that’s why hypertension is known as silent killer1.

 

Its diagnosis is difficult; It is possible only through routine health check-ups, active surveys or screening programmes. Initial management of hypertension uses a two-pronged approach, with emphasis on lifestyle measures and add-on drug management. The National Institute of Health classifies Complementary and Alternative Medicine (CAM) into five major categories- Alternative medical systems, Mind-body interventions, Biologic-based therapies, Manipulative and body-based methods and Energy therapies.4 In the present study the investigator has chosen some of the methods out of first three categories.

 

Complementary modalities play an important role in the management of hypertension. Indian Herbs such as Ginger acts as a vasodilator. Turmeric can make blood vessels stronger, prevent clots, lower cholesterol levels and improve blood flow, Garlic as well as onions have antihypertensive and anti-clotting properties. According to Lanzotti V, Italy, 2006, Onion and garlic are used in the treatment and prevention of a number of diseases, including coronary heart disease, obesity, hypercholesterolemia and hypertension.5

 

A regular programme of aerobic exercises and physical activity as cycling, jogging and regular aerobic physical activity for 30 minutes five days per week6. Yoga exercises- Easy pose (Sukhasana), Anuloma Viloma and The Vishnu mudra.7 Yoga reduces blood pressure, anxiety, promotes well-being and improves quality of life. Its safety profile is excellent.8

 

In hypertensive individuals, lifestyle modification is recommended as initial therapy in hypertension before initiation of drug therapy and as an adjunct to medication in persons already on drug therapy.9 Life style modifications include smoking cessation, alcohol moderation, relaxation therapy, behavioral techniques, meditation, listening soft music, weight reduction.6 Kaushik RM, Mahajan SK, Rajesh V, Uttaranchal, India, 2006, Mental relaxation and slow breathing resulted in a fall in blood pressure, heart rate and respiratory rate.10  If hypertension is not controlled or prevented there are chances of coronary artery disease, heart attack, heart failure, stroke, kidney diseases, cerebro-vascular disease, and retinal damage.7 All the above information confirmed the fact that hypertension is on the rise. Therefore, by adoption of complementary medicine we can cure many diseases and reduce the economic burden of disease.

 

OBJECTIVES:

·         To assess the pre test knowledge of hypertensive patients regarding complementary modalities of hypertension.

·         To develop and implement structured teaching programme.

·         To assess the post test knowledge of hypertensive patients regarding complementary modalities of hypertension.

·         To find out association between knowledge score with selected socio-demographic variables.

 

Hypothesis:

H1- The post test mean knowledge score of experimental group will be significantly higher than post test mean knowledge score of control group.

H0- The post test mean knowledge score of experimental group will not be significantly higher than post test mean knowledge score of control group.

 

Delimitations:

The study was delimited to hypertensive sample in selected rural areas of district, Jalandhar.

The study was delimited to 60 hypertensive sample.

 

MATERIAL AND METHODS:

Research design:

The research design selected for the study was Quasi-Experimental (Non equivalent control group pre test post test) design.

 

Research setting:

The study was conducted in the month of January, 2012 in village Salempur Masandan and Tehlan, district Jalandhar (Punjab).

 

Target population:

The target population includes hypertensive patients residing in selected rural areas of district Jalandhar (Punjab).

 

Sample:

Hypertensive patients residing in selected rural areas of district Jalandhar was comprised of sample of the study.

 

Sample size:

A total of 60 hypertensive patients (30 hypertensive patients in Experimental group in village Salempur Masandan and 30 hypertensive patients in control group in village Tehlan) of district Jalandhar (Punjab).

 

Conceptual framework:

 

Figure-1: Conceptual Framework Based on Modified King’s Theory of Goal Attainment

 

 

Sampling technique:

Non-probability, Convenience sampling was employed.

 

Development and description of tool:

The self constructed tool was used through semi- structured interview schedule. The tool is divided in two sections. Section-A: Socio-demographic data. Section-B: Tool was prepared which has 30 questions.  The reliability of tool was 0.98, which indicated that tool was highly reliable.

 

Ethical considerations:

Written permission from Principal, College Ethical Clearance Committee, S.G.L. Nursing College, Semi, Jalandhar, village Sarpanch and written informed consent was taken from research sample.

 

Data collection procedure:

Study was conducted at Village Salempur Masandan and Tehlan of district Jalandhar in January, 2012. In this study, investigator selected questioning method through semi- structured interview schedule for data collection. Pre test knowledge was assessed through structured knowledge questionnaire. After getting pre test, structured teaching programme regarding complementary modalities of hypertension was administered to experimental group on the same day.

 

Post test was taken of both groups after seven days to assess the effectiveness of the structured teaching programme. After administration of post test pamphlets on the knowledge regarding complementary modalities of hypertension were provided to the control group.   

 

 

RESULTS:

Table-1 Frequency and Percentage distribution of socio- demographic  Variables among Experimental and Control group  N=60  

  

EXPERIMENTAL GROUP                                                                                                                             CONTROL GROUP

SOCIO-DEMOGRAPHIC VARIABLES

 n

 %

  n

   %

1.AGE ( IN YEARS)

Upto 35

  

03

 

10.00

 

02

 

06.76

36-50

08

26.67

11

36.67

51-65

15

50.00

13

43.33

Above 65

04

13.33

04

13.33

2.GENDER

Male

 

17

 

56.66

 

17

 

56.66

Female

13

43.33

13

43.33

3.EDUCATION

Illiterate

 

07

 

23.33

 

11

 

36.67

Educated

23

76.67

19

63.33

4.DIETARY HABITS

Vegetarian

 

18

 

60.00

 

13

 

43.33

Non-Vegetarian

-

-

-

-

Mixed diet

12

40.00

17

56.67

5.INCOME (MONTHLY)

Upto 5000/-

 

03

 

10.00

 

07

 

23.33

5001-20000/-

17

56.67

18

60.00

20001 and above

10

33.33

05

16.67

6.FAMILY HISTORY OF HYPERTENSION

Yes

 

09

 

30.00

 

10

 

33.33

No

21

70.00

20

66.67

7.SUBTANCE ABUSE

Smoking

 

01

 

03.33

 

03

 

10.00

Alcohol

06

20.00

03

10.00

Any other

02

06.76

03

10.00

No substance abuse

21

70.00

21

70.00

 

Table-1 depicts that in both groups, majority of patients were in age group of 51-65 years, most were males, majority were educated, high number were vegetarian, more were having income of 5001-20000/-, most were having no family history of hypertension and not having any substance abuse.

 

Table-2 indicates that in Experimental group maximum score was attained by only 13.33% patients, 23% patients have average and 63.34% of patients fallen in poor level of knowledge. Whereas among Control group, maximum 66.66% patients were in poor level of knowledge and same number of patients 16.67 were in average and good level of knowledge score.

 

Table-3 describes that in experimental group maximum score was attained by 73.33%, 26.67% have average and no patients have poor level of knowledge score. And, among control group, only 23.33% patients had good knowledge score, 26.67% have average and maximum 60%of patients have poor knowledge. Thus, the post test level of knowledge of experimental group was significantly higher than the control group. Therefore, H1 was accepted and H0 was rejected. It shows that structured teaching programme was effective.

 

Table-2 Frequency and percentage distribution of hypertensive patient’s pre test level of knowledge regarding complementary modalities of hypertension among Experimental and Control group.                                                                                                  N=60

Level of

Knowledge

Score

Experimental Group

Control Group

 

n

%

n

%

Good

26-30

04

13.33

05

16.67

Average

16-25

07

23.33

05

16.67

Poor

≤15

19

63.34

20

66.67

Maximum score-30 ; Minimum score-0

 

TABLE-3 Frequency and percentage distribution of hypertensive patient’s post test level of knowledge regarding complementary modalities of hypertension among Experimental and Control group.                                                                                  N=60 

Level of knowledge

Score

Experimental Group

Control Group

 

n

%

n

%

Good

 26-30

22

73.33

07

23.33

Average

 16-25

  ≤15

08

-

26.67

-

05

18

26.67

60.00

Poor

 

Table-4 Comparison of frequency and percentage of pre test and post test level of knowledge among Experimental and Control group.                                                                                                                                                                                                          N=60

                                                                          Experimental Group                                  Control Group 

Level of Knowledge

Score                 

Pre test                          Post test

Pre test                     Post test

 

n

%

n

%

n

%

n

%

Good

26-30

04

13.33

22

73.33

07

23.33

05

16.67

Average

16-25

07

23.33

08

26.67

05

16.67

05

16.67

Poor

 ≤15

19

63.34

00

00

18

60

20

66.67

 

 

Table-4 indicates that, among experimental group, there were only 13.33% patients who have good level of knowledge in pre test, while the number was greatly increased by 73.33% in  post test.  In the average level of knowledge, a very less improvement was found as the number in pre test was 23.33% and in post test 26.67%. In addition to it, in poor level of knowledge, the number in pre test was 63.34%. Whereas, no patient have poor level of knowledge in post test. Among Control Group, in good level of knowledge score, there were only 23.33% patients in pre test, while the number was decreased by 16.67% in post test.  In average level of knowledge it was16.67% in pre test and same in post test.  In addition to it, the number of patients who came in poor level of knowledge in pre test was 60% whereas, the number in post test was 66.67%.

 

Figure-2: Bar diagram showing percentage of level of knowledge in pre test and post test among Experimental and Control group

 

 

In association males and educated patients have more knowledge in experimental group. But, structured teaching programme have equal effect in both genders, illiterate and educated patients among both group.

 

DISCUSSION:

Objective-I:

The findings of the present study revealed that in experimental group 13.13% of hypertensive patients had good knowledge score, 23.33% of hypertensive patients had average knowledge score and maximum number of hypertensive patients 63.34 had poor knowledge score. In control group 16.67% of hypertensive patients had good knowledge score, 16.67% of hypertensive patients had average knowledge score and maximum number of hypertensive patients 66.66 had poor knowledge score. Whereas, findings of the study conducted by Maninder Kaur to assess the level of knowledge regarding non-pharmacological treatment among hypertensive patients in Civil Hospital at Jagadhri, Findings have shown that 41% of patients had high level of knowledge, 48% of patients had moderate level of knowledge, 10% of patients had mild level of knowledge and 1% of patients had low level of knowledge.11

 

Objective-II:

In the present study structured teaching programme on complementary modalities of hypertension was administered to Experimental group and no teaching programme was administered to control group.

Objective-III:

The findings of the present study revealed that in experimental group 73.33% of hypertensive patients had good knowledge score, 26.67% of hypertensive patients had average knowledge score and no one had poor knowledge score. In control group 23.33% of hypertensive patients had good knowledge score, 26.67% of hypertensive patients had average knowledge score and maximum number of hypertensive patients 60% had poor knowledge score. In comparison of pre test and post test the mean score of pre test was 14.16 and  in post test 26.85, ‘t’ value= 18.18 and found statistically significant, ‘t’ value > 1.96 at 5% level of significance in case of experimental group. In control group pre test mean was 14.30 and post test mean was 15.06, ‘t’ value = 0.997 and found not statistically significant. These findings were in accordance to the study conducted by S. Kanchana Smathi M., Jeyanthi Kuppusamy and Uma C conducted a study on effectiveness of exhibition on level of knowledge regarding hypertension among clients with hypertension at selected setting, Chennai. The overall knowledge in pre-test revealed that 23.33% inadequate knowledge, 56.67% had moderately adequate knowledge and 20.2% had adequate knowledge on hypertension. The overall post test level of knowledge showed that 66.67% had adequate, 33.33% had moderate and no patient had inadequate knowledge. The comparison of pre and post test level of knowledge revealed that the calculated ‘t’ value = 6.238 was great than the table value. This showed that high statistical significant degree of freedom at < 0.001 level.12

 

Objective-IV:

In present study age (in years), gender, education, dietary habits, income (monthly), family history of hypertension and substance abuse were taken as socio demographic variables and revealed that education was significant demographic variable in pre test among experimental group while education is not significant in post test among experimental group. Gender was also significant variable in pre test among males in experimental group. Otherwise, there was no socio demographic variable which is significantly associated with pre test and post test rather than education and gender among experimental group. On the other side, in case of control group there is no is significant association found in pre test and post test with selected socio demographic variables. These findings were in accordance to the study conducted by S. Kanchana Smathi M., Jeyanthi Kuppusamy and Uma C conducted a study on effectiveness of exhibition on level of knowledge regarding hypertension among clients with hypertension at selected setting, Chennai. Improvement in post test was found and no significant association of mean improved level of knowledge with selected demographic variables was noted.12

 

CONCLUSION:

The final conclusion of study had revealed that in pre test experiment and control group approximately 60% of patients have poor knowledge in pre test. In comparison of pre test and post test the mean score of pre test is 14.16 and  in post test 26.85, ‘t’ value= 18.18 and found statistically significant, ‘t’ value > 1.96 at 5% level of significance  in case of experimental group. This indicates that the difference between the pre test and post test mean of experimental group was a true difference and has not occurred by chance. Thus H1 is accepted.  In control group pre test mean is 14.30 and post test mean is 15.06, ‘t’ value = 0.997 and not statistically significant, thus H0 is accepted. Therefore structured teaching programme on complementary modalities of hypertension was useful in providing knowledge to hypertensive patients. So, there is need to improve the knowledge towards this silent killer by organizing special programmes. Hypertensive patients’ knowledge regarding complementary modalities of hypertension is very important for their health protection and promotion. Structured teaching programme had helped hypertensive patients in Experimental group to increase knowledge regarding complementary modalities of hypertension. Therefore, structured teaching programme had really helped them to improve their knowledge regarding complementary modalities of hypertension.

 

RECOMMENDATIONS:

On the basis of findings of the study the following recommendations are offered for future research.

·         The study can be replicated on the larger sample to strengthen and generalize the findings.

·         A descriptive study can be conducted to assess the knowledge and attitude of hypertensive patients regarding complementary modalities of hypertension.

·         Quasi Experimental studies can be conducted on the effectiveness of Dietary Approach to Stop Hypertension (DASH) diet.

·         Experimental studies can be conducted on the effectiveness of specific complementary modalities of hypertension and its effect on blood pressure readings.

 

REFERENCES:

1.     M.M. H, V.K. Desai and A. Kavishwar. A Study On Effect Of Life Style Risk Factors On Prevalence Of Hypertension Among White Collar Job People Of Surat. The Internet Journal of Occupational Health [Serial online] 2011; Volume 1 (1). Available from; URL: http://www.ispub.com/journal/the-internet-journal-of-occupational-health.html.

2.     Kyrou I, Chrousos GP, Tsigos C. Stress, visceral obesity, and metabolic complications. Annals of the New York Academy of Sciences [Serial online] 2006 November; 1083: 77–110.

3.     Gupta R, Guptha S, Department of Medicine, Fortis-Escorts Hospital, Jaipur, India. rajeevg@satyam.net.in [Serial online]. 

4.     National Centre for Complementary and Alternative Medicine. What is CAM? 2009 [Serial online]. Available from; URL: nccam.nih.gov/health/what is cam/D347.pdf.

5.     Lanzotti V, Italy. The analysis of onion and garlic. 2006 Apr 21; 1112 (1-2): 3-22. Available from; URL: http://www.ncbi. nlm.nih.gov/pubmed/16388813.

6.     Mosby. Medical Surgical Nursing, Assessment and management of Clinical problems. 7th ed. Elsevier: p. 772-776, 769-770,778; 2011.

7.     Patel C, Marmot MG, Terry DJ, Carruthers M, Hunt B, Patel M. Trial of relaxation in reducing coronary risk: four year follow up. Br Medical Journal (Clin Res Ed) [Serial online]. 1985; 290:1103–1106.

8.     Mamtani R, Mamtani R, USA, 2005 May, A study on Ayurveda and yoga in cardiovascular diseases. 2005 May-Jun;13 (3):155-62. Available from; URL : http://www.ncbi.nlm. nih.gov/pubmed/15834238.

9.     Bhatt SP, Guleria R, Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India. Non-pharmacological management of hypertension. Available from; URL: http://www.ncbi.nlm.nih.gov/pubmed/18025751. 2007 Nov.

10.   Kaushik RM, Kaushik R, Mahajan SK, Rajesh V, Uttaranchal, India. A study on Effects of mental relaxation and slow breathing in essential hypertension. 2006 Jun;14 (2):120-6. Available from; URL:http://www.ncbi.nlm.nih.gov/pubmed/16765850

11.   Maninder Kaur, Swami Vivekanand Nursing College, Jagadhri. A study to assess the level of knowledge regarding non-pharmacological treatment among hypertensive patients in Civil Hospital at Jagadhri. Kurukshetra University. 2009.

12.   S. Kanchana Smathi M., Jeyanthi Kuppusamy and Uma C. A study on effectiveness of exhibition on level of knowledge regarding hypertension among clients with hypertension at selected setting, Chennai. Nightingale Nursing Times. 2010.

 

 

 

Received on 26.02.2016          Modified on 16.03.2016

Accepted on 25.04.2016          © A&V Publication all right reserved

Int. J. Adv. Nur. Management. 2016; 4(2): 141-147.

DOI: 10.5958/2454-2652.2016.00032.9