INTRODUCTION:

The burden of asthma is becoming greater as communities adopt western lifestyles and become urbanised. (GINA)

Asthma is a chronic inflammatory disease of the airways that causes airway hyper responsiveness, mucosal oedema and mucus production. It differs from other obstructive lung disorders in that it is largely reversible, either spontaneously or with treatment. This inflammation ultimately leads to recurrent episodes of asthma symptoms; cough, chest tightness, wheezing and dyspnoea. Patients with asthma may experience symptom free periods alternating with acute exacerbations that last from minutes to hours or days. Asthma is the most common chronic disease of childhood and can occur at any age.¹

According to British Broadcasting Corporation (BBC) published article between 100 and 150 million people around the globe, roughly the equivalent of the population of the Russian Federation suffers from asthma and this number is rising. World-wide, deaths from this condition have reached over 180,000 annually. Around 8% of the Swiss population suffers from asthma as against only 2% some 25-30 years ago. In Germany, there are an estimated 4 million asthmatics. In Western Europe as a whole, asthma has doubled in ten years. According to the University college of Belgium (UCB) Institute of Allergy in Belgium, in the United States, the number of asthmatics has leapt by over 60% since the early 1980s and deaths have doubled to 5,000 a year. There are about 3 million asthmatics in Japan of whom 7% have severe and 30% have moderate asthma. In Brazil, Costa Rica, Panama, Peru and Uruguay, prevalence of asthma symptoms in children varies from 20% to 30%.In Kenya, it approaches 20%. India has an estimated 15-20 million asthmatics. In India, rough estimates indicate prevalence between 10% and 15% in 5-11 year old children.²

Allergy is the strongest predisposing factor for asthma. Chronic exposure to airway irritants or allergens also increases the risk of asthma. Common allergens can be seasonal (grass, tree and weed) or perennial (mold, dust, roaches, animal dandler). Common triggers for asthma symptoms and exacerbations include airway irritants (air pollutants, cold, heat, weather changes, strong odors or perfumes, smoke), exercise, stress or emotional upset, sinusitis with postnasal drip, medications, viral respiratory tract infections and gastrooesophageal reflux. Most people who have asthma are sensitive to a variety of triggers. A person’s asthma changes depending on the environment activities, management practices and other factors.¹

A Metered Dose Inhaler (MDI) is a device that delivers a specific amount of medication to the lungs, in the form of a short burst of aerosolized medicine that is usually self-administered by the patient via inhalation. It is the most commonly used delivery system for treating asthma, Chronic Obstructive Pulmonary Disease (COPD) and other respiratory diseases. The medication in a Metered Dose Inhaler is most commonly a bronchodilator, corticosteroid or a combination of both for the treatment of asthma and COPD.³

It has long been appreciated that many patients have difficulties with inhalers. More than 75% of patients with COPD experience difficulty using MDI. There are also other devices that pose difficulties for many patients. Furthermore, some studies show that patients may not maintain a proper technique over time. Inhalation technique should therefore be assessed, reviewed, and verified on a periodic basis to ensure appropriate drug delivery and subsequent efficacy.⁴

Despite pharmacological advances, it remains the only treatable disease of the western world with increasing morbidity. One theory for this increasing morbidity is patient’s improper technique in the use of MDI and lack of instruction by health care workers. It has been recognized in several studies that both patients and physicians have had little training in the proper use of MDI, and patients may not be fully benefiting from their MDI usage.⁵

It is now widely accepted that a demonstration of the inhalation technique is the most effective way to teach and assess patient skills. However, several studies have shown that many health care professionals have a poor understanding of the devices and are unable to demonstrate the correct technique themselves. It is obvious that to maximize the benefits of inhaled medication, it is essential that the health care professional has the required knowledge and ability to successfully choose the most appropriate device and be an effective teacher.⁴Despite increased knowledge regarding pathology of asthma and the development of better medications and management plans, the death rate from this disease continues to increase. For most patients, asthma is a disruptive disease, affecting school and work attendance, occupational choices, physical activity and general quality of life.⁵

NEED FOR THE STUDY:

Mortality due to asthma is not comparable in size to the day-to-day effects of the disease. Although largely avoidable asthma tends to occur in epidemics and affects young people, the human and economic burden associated with this condition is severe. The costs of asthma to society could be reduced to a large extent through combined international and national action. Worldwide, the economic costs associated with asthma are estimated to exceed those of TB and HIV/AIDS combined.²

Metered Dose Inhalers (MDIs) are pressurized hand-held devices that use propellants to deliver doses of medication to the lungs of a patient. These delivery devices are critically important to public health and are used to administer various active ingredients for a range of medical conditions. MDIs play a particularly significant role in the treatment of asthma and Chronic Obstructive Pulmonary Disease (COPD). The MDI accounts for 70% of all inhalation therapy.⁶

A descriptive and cross sectional study was conducted among medical personnel to assess the knowledge and technical skills to use meter dose inhaler in Kathmandu Valley. The study showed that the average knowledge of medical personnel is 42.8% and technique is 59.18%. No significant difference was observed between male and female in terms of knowledge and technique. However significant difference was observed in the age category ≤ 30 years (48.3%) and > 30 years (38.6%) in terms of knowledge. It was observed none of the medical personnel knew correctly, how to count the number of dose in MDI. Study concluded that medical personnel lack knowledge and technical skill of using MDI and recommended trainings and workshops should be organized to upgrade knowledge and technical skills.⁷

A scientometric analysis was conducted in National Academy of Medical Science (NAMS) New Delhi to analyze the research output in asthma in India during the period from 1999 till 2008. Statistics revealed that India ranks 15^th position among the top 23 countries in asthma research, with its global publication share of 1.27% (862papers), registering an average citation per paper of 3.43 and achieved an h-andex of 33 during 1999-2008. Study concluded that Indian research output on asthma is quite low in the global context as reflected from its publication output per thousand population (0.001) and its world publication share (1.27%) during 1999-2008.⁸

Most of the studies emphasize the need of formal education regarding regular checking of inhalation technique and proper teaching by health care providers to be crucial for optimum use of most inhaler devices. The investigator through his personal experience while working has seen the difficulty faced by persons using MDI in the absence of proper and adequate teaching and also India’s global contribution towards research studies on asthma is very low. Hence the investigator felt that there is a need to conduct a structured teaching programme to provide an effective aid for the patients with bronchial Asthma regarding proper use of MDI and its precautions and bridge the gap between current knowledge and technique.

OPERATIONAL DEFINITIONS:

Effectiveness:

In this study, it refers to extent to which the structured teaching programme has achieved the desired result as evidenced from gaining knowledge and technique score regarding the MDI among bronchial asthma patients.

Structured Teaching Programme:

In this study, a structured teaching programme refers to systematically developed teaching programme designed for bronchial asthma patients to provide information on MDI.

Knowledge:

In this study, it refers to correct response given by bronchial asthma patients to structured interview schedule on selected aspects of knowledge regarding the metered dose inhalers among bronchial asthma patients.

Techniques:

In this study, it includes the steps to be followed while using MDI to obtain maximum effect as measured by observation checklist.

Metered Dose Inhalers:

In this study, it refers to a device that helps deliver a specific amount of medication to the lungs usually by supplying a short burst of aerosolized medicine that is inhaled by the patient.

Bronchial asthma:

In this study, it refers to a chronic inflammatory disease of airways which results in hyper responsiveness of airways.

Patients:

In this study, it refers to clients who are admitted in the hospital with bronchial asthma between the age group of 31 to 60 years.

Assumptions:

The study assumes that,

· Structured teaching programme will helps to enhance the knowledge of bronchial asthma patients regarding MDI.

· Structured teaching programme will help to adapt proper technique in using MDI.

· Creating health awareness among bronchial asthma patients helps to bring better treatment outcome.

Delimitations:

The study is limited to

bronchial asthma patients using MDI in selected hospitals of Mangalore Taluk.

Projected Outcome (Hypotheses):

The study is based on the following hypotheses which will be tested at 0.05 level of significance

H₁:-There will be a significant difference in the mean pre-test and post-test knowledge score regarding the metered dose inhalers among bronchial asthma patients.

H₂:- There will be a significant difference in the mean pre-test and post-test technique score regarding the metered dose inhalers among bronchial asthma patients.

H₃:- There will be significant correlation between knowledge and techniques score.

H₄:-There will be a significant association between pre-test knowledge score and selected demographic variables.

H₅:- There will be significant association between pre-test technique score and selected demographic variables.

Conceptual frame work:

A conceptual frame work is a group of concepts and a set of propositions that spells out the relationship between them. Conceptual frameworks play several interrelated roles in the progress of science. Their overall purpose is to make scientific findings meaningful and generalizable.⁹

The study is based on the concept that administration of STP to bronchial asthma patients regarding MDI to enhances their knowledge and technique. The investigator adopted Wiedenbach’s helping art of clinical nursing theory (1964) as a base of developing the conceptual frame work. This is prescriptive theory, which directs action towards an expected goal.¹⁰

The conceptual model of nursing practice according to this theory consists of 3 steps as follows:

Step -1: Identifying the need for help.

Step -2: Ministering the need for help

Step -3: Validating that the need for help was met

Step -1: Identifying the need for help:

It is crucial to nursing profession that a need-for-help be based on the individual perception of his own situation.¹¹

In this study the determination of the need for help is by the process of sample selection on the basis of the inclusive criteria followed by the pre assessment of knowledge and technique of bronchial asthma patients regarding MDI in selected Hospitals of Mangalore Taluk.

Step -2: Ministering the need for help:

This refers to the provision of required help to fulfill the identified need. It has two components

1. Prescription

2. Realities.

Prescription:

Prescription is a directive to activity. It specifies both the nature of the action that will mostly lead to fulfillment of the nurse’s central purpose and thinking process that determines it.¹²

In this study it refers to development, validation, and administration of STP.

Realities:

Realities consist of all factors that are at play in a situation in which nursing actions occur at any given moment.¹²

In this study it refers to the factors that influence the knowledge and technique in the particular situation.

It includes,

Agent:

who is practicing nurse or her delegate is characterized by personal attributes, capacities, capabilities and most importantly commitment and competence in nursing.¹⁰

In this study agent is the researcher or Investigator

Recipient:

the patient, is characterized by personal attributes, problems, capacities, aspirations and most important the ability to cope with concerns or problems being experienced.¹⁰

In this study refers to bronchial asthma patients in selected Hospitals of Mangalore Taluk.

Goal: is the desired outcome the nurse wishes to achieve.¹⁰

In this study it refers to determine the effectiveness of a STP on knowledge and technique regarding MDI among bronchial asthma patients.

Means and activities:

comprise the activities and device through which the practioner is enabled to attain her goal.¹⁰

In this study refers to Administration of STP to bronchial asthma patients in selected Hospitals of Mangalore Taluk.

Step -3:

Validating that the need for help was met.

This is accomplished by means of the post-assessment of knowledge and technique is followed by the findings.

MATERIALS AND METHODS:

Methodology of the research indicates the general pattern for organising the procedure for empirical study together with the method of obtaining valid and reliable data for problem under investigation.⁴²

The methodology adopted for the study includes research approach, research design, setting of the study, population, sampling technique, development and description of the instrument for data collection, development of STP, procedure for data collection and plan for data analysis.

Research approach:

In view of accomplishing the objectives, that is developing and evaluating the effectiveness of STP on knowledge and technique regarding MDI among bronchial asthma patients, an evaluative research approach was considered the best.

Research design:

A research design is the overall plan for obtaining answers to the questions being studied and for handling some of the difficulties encountered during the research process.¹³

The research design adopted for present study was pre experimental one group pre-test post-test design, to determine the knowledge and technique by using structured interview schedule and observational checklist

Group

Day 1

Pre-test (O₁)

Day 1

Intervention (X)

Day 7

Post-test (O₂)

Bronchial asthma patients

Assess the knowledge

and technique using

structured interview schedule and observation checklist.

Administration of structured teaching programme regarding MDI

Re assess the knowledge and practice using same tools.

Schematic representation of research design Variables:

Variables are qualities, properties or characteristics of person, things or situation that change or vary.⁴³

Dependent variable:

A dependent variable is the response or the outcome that the researcher wants to explain or predict.⁴³

In the present study the dependent variables are knowledge and technique regarding MDI among bronchial asthma patients.

Independent variable:

An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable.¹⁴

In the present study the independent variable is structured teaching programme on MDI.

Demographic variables:

Are those variables that cannot be manipulated, changed, or controlled and reflect the characteristics of the study population.⁴³

In this study demographic variables are the age, gender, religion, type of family, educational status, occupation, income, duration of illness, duration of MDI usage, family history and source of information.

Research setting:

Setting is the physical location and conditions in which data collection takes place in a study.¹⁵

The study was conducted in selected hospitals of Mangalore Taluk (annexure3 and 4).

Population:

The term population means all the possible elements that could be included in research.⁴⁵

In this study population consists of bronchial asthma patients in selected hospitals of Mangalore Taluk.

Sample:

A sample is a subset of the population that is selected for a particular study and the members of a sample are the subject.⁴⁵

The study sample consists of 60 bronchial asthma patients in selected hospitals of Mangalore Taluk.

Sampling technique:

Sampling is process of selecting subjects who are representative of the population being studied.⁴⁵

The sampling technique used for the study was non-probability purposive sampling. Out of the total population defined all those who met the criteria, 60 subjects were selected for the study.

RESULTS:

Organisation of the study findings:

The data were coded, tabulated, analysed and interpreted using descriptive and inferential statistics. The data were presented under the following headings

Section I: Demographic data.

Section II: Distribution of subjects according to their knowledge and technique scores.

Section III: Evaluation ofeffectiveness of structured teaching programme in terms of gain in knowledge and technique score.

Section IV: Evaluation of relationship between knowledge and technique.

Section V: Association between pre-test knowledge score and selected demographic variables

Section VI: Association between pre-test technique score and selected demographic variables

Section I: Demographic data:

This section deals with the demographic characteristics of the 60 bronchial asthma patients in terms of frequency and percentage.

Table 1a: Frequency and percentage distribution of subjects according to selected demographic variables n=60

SL. No.	Variables		Frequency (f)		Percentage (%)
1	Age in years
a	31-40		13		21.7
b	41-50		29		48.3
c	51-60		10		16.7
d	>60		8		13.3
2	Gender
a	Male		47		78.3
b	Female		13		21.7
3	Religion
a	Hindu		22		36.7
b	Christian		14		23.3
c	Muslim		12		20.0
d	Others		12		20.0
4	Type of family
a	Nuclear		46		76.7
b	Joint		14		23.3
5	Educational status
a	No formal schooling		11		18.3
b	Primary school		18		30.0
c	Secondary school		20		33.3
d	Higher secondary		5		8.3
e	Diploma		5		8.3
f	Graduate		1		1.8
g	Post graduate		0		0
6	Occupation
a	Profession		5		8.3
b	Business		29		48.3
c	Agriculture		9		15.0
d	Coolie		9		15.0
e	House wife		8		13.4
f	Other		0		0
7	Monthly income of the family in rupees
a	< 5,000	9		15.0
b	5,001-10,000	26		43.3
c	10,001-15,000	11		18.3
d	15,001-20,000	9		15.0
e	>20,000	5		8.4
8	Duration of illness in years
a	< 1	3		5.0
b	2	2		3.3
c	3	13		21.7
d	4	15		25.0
e	>5	27		45.0
9	Duration of using MDI in years
a	< 1	6		10
b	2	15		25
c	3	13		21.7
d	4	14		23.3
e	>5	12		20
10	History of asthma
a	Yes	29		48.3
b	No	31		51.7
	If yes, specify the relation
a.1	Grand parents	12		41.4
a.2	Father	17		58.6
a.3	Mother	0		0
a.4	Husband	0		0
a.5	Wife	0		0
a.6	Siblings	0		0
a.7	Child	0		0
11	Previous information regarding MDI
a	Yes	44		73.3
b	No	16		26.7
	If yes specify
a.1	Mass media	0		0
a.2	Health professional	44		100
a.3	Friends	0		0
a.4	Relatives	0		0
a.5	Any other	0		0

Data presented in the table 1a, 1b and 1c depicts the distribution of bronchial asthma patients according to age, sex, religion, type of family, education, occupation, monthly income, duration of illness, duration of using MDI, family history of asthma and previous information.

Age:

Among bronchial asthma patients 21.7% belonged to the age group of 31-40, 48.3 belonged to the age group of 41-50, 16.7% belonged to the age group of 51-60 and 13.3% were >60.

Gender:

Majority of bronchial asthma patients (78.3%) were males and 21.7% were females

Religion:

Among bronchial asthma patients (36.7%) were Hindus, 23.3% were Christians, 20% were Muslim and 20% belonged to other religion.

Type of the family:

Majority of bronchial asthma patients (76.6%) belonged to nuclear families and 23.3% belonged to joint families.

Educational Status:

Among the bronchial asthma patients 18.3% had no formal education, 30% had primary education, 33.3% had secondary education, 8.3% had higher secondary and diploma education, and 1.8% were graduates and no one had post graduation.

Occupational Status:

Among the bronchial asthma patients 8.3% were professionals, majority of them were businessmen, 15% were agriculturists and coolie, 13.3% were house wives and no one from others.

Monthly income (in rupees):

Among the bronchial asthma patients 15% had monthly income of rupees < 5,000, 43.3% had income of 5,001-10,000, 18.3% had income of 10,001-15,000, 15% had income of 15,001-20,000 and 8.3% had income of >20,000.

Duration of illness (in years):

Among the bronchial asthma patients 5% had illness since <1 year, 3.3% had illness since 2 years, 21.7% had illness since 3 years, 25% had illness since 4 years and 45% had illness since >5 years.

Duration of using MDI (in years):

Among the bronchial asthma patients 10% were using since <1 year, 25% were using since 2 years, 21.7% were using since 3 years, 23.3% were using since 4 years and 20% since >5 years.

History of asthma:

Among the bronchial asthma patients 48.3% had history and 51.7% had no history of bronchial asthma

Previous information regarding MDI:

Among the bronchial asthma patients 73.3% had source and 26.7% had no previous of information regarding MDI.

Section IV: Evaluation of relationship between knowledge and technique.

Table 10: Correlation between pre-test knowledge and technique score n=60

Variables	Mean	SD	r value	Remarks
Knowledge	7.51	2.01	-0.180	Negative correlation
Technique	6.63	1.00	-0.180	Negative correlation

Table value r₍₅₈₎=0.236;p<0.05

Data from the table 10 reveals that there was negative correlation between pre-test knowledge and technique r_(cal)= -0.18, table value r₍₅₈₎=0.236;p<0.05) of bronchial asthma patients regarding MDI. Hence the null hypothesis was rejected and research hypothesis was accepted.

Table 11: Correlation between post-test knowledge and technique score n=60

Variables	Mean	SD	r value	Remarks
Knowledge	18.28	2.75	0.839	positive correlation
Technique	9.18	1.20	0.839	positive correlation

Table value r₍₅₈₎=0.236;p<0.05

Data from the table 11 reveals that there was positive correlation between pre-test knowledge and technique (r_(cal)= 0.839, table value r₍₅₈₎=0.236;p<0.05) of bronchial asthma patients regarding MDI. Hence the null hypothesis was rejected and research hypothesis was accepted.

Section V: Association between pre-test knowledge score and selected demographic variables

Table 12a: Association between pre-test knowledge score and selected demographic variables n=60

Sl no	Demographic variables	Pre-test knowledge score		c² (df)
Sl no	Demographic variables	Median < 8	Median >8	c² (df)
1	Age in years
a	31-40	7	5	6.84 (3)
b	41-50	22	7
c	51-60	7	10
d	>61	2	0
2	Gender
a	Male	29	18	0.24 (1)
b	Female	9	4	0.24 (1)
3	Religion
a	Hindu	13	8	2.49 (3)
b	Christian	7	7
c	Muslim	11	3
d	Others	7	4
4	Type of family
a	Nuclear	31	15	1.39 (1)
b	Joint	7	7	1.39 (1)
5	Education
a	No formal	5	6	4.93 (6)
b	Primary	14	4
c	Secondary schooling	11	9
d	Higher secondary	3	2
e	Diploma,	4	1
f	Graduate	1	0
g	Post graduate	0	0

Table 12b: Association between pre-test knowledge score and selected demographic variables n=60

Sl no	Demographic variables	Pre-test knowledge score		c² (df)
Sl no	Demographic variables	Median < 8	Median >8	c² (df)
6	Occupation
a	Professional	5	1	1.81 (5)
b	Business	17	11
c	Agriculture	6	3
d	Coolie	6	3
e	Housewife	4	4
f	Others	0	0
7	Monthly income in rupees
a	< 5000,	5	3	6.68 (5)
b	5001-10,000,	18	14
c	10,001-15,000	11	1
d	15,001-20,000	4	3
e	>20,000	0	1
8	Duration of illness in years
a	<1	3	0	8.35 (4)
b	2	0	2
c	3	7	7
d	4	10	2
e	>5	18	11
9	Duration of using MDI in years
a	<1	4	2	4.83 (4)
b	2	6	9
c	3	9	3
d	4	10	4
e	>5	9	4
10	Is there any history of asthma
a	Yes	16	13	1.61 (1)
b	No	22	9	1.61 (1)
11	Previous information
a	Yes	28	17	0.09 (1)
b	No	10	5	0.09 (1)

Table value c²(1)=3.84, c²(2)=5.99, c²(3)=7.81, c²(4)=9.4, c²(5)=11,c²(6)=12.60 P<0.05,*= significance

The data presented in the Table 12a and 12b shows that there is no association between the knowledge and any of the selected demographic variables. Thus it is interpreted that pre-test knowledge of bronchial asthma is not influenced by any of the selected demographic variables. Hence the research hypothesis is rejected and nul hypothesis is accepted.

Section VI: Association between pre-test technique score and selected demographic variables

Table 13a: Association between pre-test technique score and selected demographic variables n=60

Sl no	Demographic variables	Pre-test knowledge score		c² (df)
Sl no	Demographic variables	Median < 8	Median >8	c² (df)
1	Age in years
a	31-40	12	0	4.75 (3)
b	41-50	22	7
c	51-60	12	5
d	>61	2	0
2	Gender
a	Male	37	10	0.22 (1)
b	Female	111	2	0.22 (1)
3	Religion
a	Hindu	16	5	0.51 (3)
b	Christian	11	3
c	Muslim	12	2
d	Others	9	2
4	Type of family
a	Nuclear	36	10	0.37 (1)
b	Joint	12	2	0.37 (1)

Table 13b: Association between pre-test technique score and selected demographic variables n=60

Sl no	Demographic variables	Pre-test knowledge score		c²(df)
Sl no	Demographic variables	Median < 8	Median >8	c²(df)
5	Education
a	No formal	9	2	2.89 (6)
b	Primary	15	3
c	Secondary schooling	14	6
d	Higher secondary	4	1
e	Diploma,	5	0
f	Graduate	1	0
g	Post graduate	0	0
6	Occupation
a	Professional	5	1	2.89 (5)
b	Business	24	4
c	Agriculture	6	3
d	Coolie	6	3
e	Housewife	7	1
f	Others	0	0
7	Monthly income in rupees
a	< 5000,	7	1	1 (4)
b	5001-10,000,	25	7
c	10,001-15,000	10	2
d	15,001-20,000	5	2
e	>20,000	1	0
8	Duration of illness in years
a	<1	2	1	6.62 (4)
b	2	2	0
c	3	14	0
d	4	10	2
e	>5	20	9
9	Duration of using MDI in years
a	<1	5	1	4.57 (4)
b	2	14	1
c	3	10	2
d	4	11	3
e	>5	8	5
10	Is there any history of asthma
a	Yes	24	5	0.26 (1)
b	No	24	7	0.26 (1)
11	Previous information
a	Yes	33	12	5 (1)
b	No	15	0	5 (1)

Table value c²(1)=3.84, c²(2)=5.99, c²(3)=7.81, c²(4)=9.4, c²(5)=11,c²(6)=12.60 P<0.05,*= significance

The data presented in the Table 13a and 13b shows that there is no association between pre-test technique and any of the selected demographic variables. Thus it is interpreted that pre-test technique of bronchial asthma patients is not influenced by any of the selected demographic variables. Hence the research hypothesis is rejected and null hypothesis is accepted.

DISCUSSION:

MDI is a relatively simple device that delivers the drug directly to the lungs and acts very fast in relieving the asthma symptoms, but successful use of MDI is dependent on a number of important issues. The medical practitioner especially staff nurses who constantly coming across the patients with bronchial asthma using MDI need to know how to use the MDI effectively and need to teach patients regarding recommended technique of MDI usage.

The findings of the study had been discussed with reference to the objectives and hypothesis stated in introduction and in relation with the findings of other studies.

Demographic data:

The findings of this study demonstrated that among 60 bronchial asthma patients surveyed, 48.3% belonged to age group of 41-50, majority of the subjects (78.3%) were male, maximum subjects (36.7%) were Hindus, majority of them belonged to nuclear family, most of them (33.3%) had secondary education, maximum (48.35) were in the field of business, most (43.3%) of their family monthly income was 5,001-10,000 rupees, most (45%) of them had illness >5 years, most (23.3%) of them were using MDI since 4 years, many of them (51.7%) had the family history of bronchial asthma, and majority of them (73.3%) had the previous information.

Knowledge of the bronchial asthma patients regarding MDI:

Findings of the study revealed that in the pre-test majority of the subjects (80%) had average knowledge and 15% had poor knowledge whereas in the post-test majority (83.4%) of bronchial asthma patients acquired very good knowledge, 13.3% acquired good knowledge and 3.3% acquired average knowledge regarding MDI.

The mean percentage of pre-test knowledge score was 37.5%, whereas post-test knowledge score was 91.4%.

Technique of the bronchial asthma patients regarding MDI:

Findings of the study revealed that in the pre-test majority of the subjects (80%) had average technique and 20% had good technique whereas in the post-test 51 (85%) bronchial asthma patients acquired good technique and 15% of bronchial asthma patients acquired average technique regarding MDI.

The mean percentage of pre-test technique score was 66.3% and post-test technique score was (91.8%).

Effectiveness of structured teaching programme:

The findings of the study showed that ‘t’ value computed between pre-test and post-test knowledge score is statistically significant (t_(cal) = 35.33, table value t₍₅₉₎ = 1.67, p<0.05) and t’ value computed between pre-test and post-test technique score is statistically significant(t_(cal)=15.57table value t₍₅₉₎ = 1.67, p <0.05). this shows that there is significant difference between the mean pre-test and post-test knowledge score and there is significant difference between the mean pre-test and post-test score of bronchial asthma patients regarding MDI, it shows that Structured Teaching Programme (STP) was effective in increasing the knowledge and technique of bronchial asthma patients regarding MDI.

A prospective study was conducted to determine the improvement in patient’s MDI technique could be achieved in the Emergency Department (ED) among 115 patients at California in USA. Mean age was 34.9±13.1 years and mean years using MDI was 5.7±3.8. The results revealed that subjective improvement in technique was reported by 110 patients (96%) with a mean pre-test score of 7.4±1.5 and post-test score of 9.2±1.1 (p<0.0001, 10 point scale). Objective improvement was achieved in 113 patients (98%) with a mean pre-test score of 3.9±1.3 and post-test score of 5.8±1.0 (p<0.0001, 7 point scale), corresponding to a 30% improvement in technique (95% CI: 22,39) and 44 patients (38%) reported never having been shown proper MDI technique by a health care professional, and 112 patients (97%) found the instruction sheet helpful. The study concluded that rapid objective and subjective improvement of MDI technique from both patients and physicians perspective is possible in the ED with the use of an illustrated instruction sheet, and requires minimal effort from the treating emergency physician.⁸

Relationship between knowledge and technique of bronchial asthma patients:

The study reveals that there was negative correlation between pre-test knowledge and technique (r_(cal)= -0.180, table value r₍₅₈₎=0.236;p<0.05), whereas there was positive correlation between pre-test knowledge and technique (r₍₅₈₎= 0.839, table value r_(cal)=0.236;p<0.05) of bronchial asthma patients regarding MDI

Association between pre-test knowledge score and selected demographic variables:

The findings of the study revealed that there was no association between pre-test knowledge score and selected demographic variables.

Association between pre-test technique score and selected demographic variables:

The findings of the study revealed that there was no association between pre-test technique score and selected demographic variables.

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Received on 21.03.2016 Modified on 25.04.2016

Int. J. Adv. Nur. Management. 2016; 4(3): 223-234.

DOI: 10.5958/2454-2652.2016.00051.2

Area	Max possible score	Pre-test knowledge		Post-test knowledge		Mean % actual gain score	Mean % possible gain score	Modified gain score
Area	Max possible score	Mean+SD	Mean %	Mean+SD	Mean %	Mean % actual gain score	Mean % possible gain score	Modified gain score
General information (K1)	6	2.36+0.99	39.3	5.7+0.58	95	55.7	60.7	0.91
Functioning of MDI (K2)	2	1.7+0.52	85	1.8+0.60	90	15	15	0.33
Factors affecting the effective usage of MDI (K3)	3	0.83+0.92	27.6	2.66+0.87	88.6	70.7	72.4	0.84
Important tips for effective use of MDI (K4)	5	1.28+0.83	25.6	4.31+1.25	86.2	67.4	74.4	0.81
Techniques of using MDI (K5)	4	1.20+0.68	30	3.78+0.88	94.5	67.5	70	0.92

Areas	Pre-test knowledge		Post-test knowledge		‘t’ value
Areas	Mean	SD	Mean	SD	‘t’ value
General information	2.3	0.99	5.78	0.58	*22.79
Functioning of MDI	1.78	0.52	1.8	0.60	*3.79
Factors affecting the effective usage of MDI	0.83	0.92	2.66	0.87	*13.75
Important tips for effective use of MDI	1.28	0.84	4.31	1.25	*20.38
Techniques of using MDI	1.20	0.68	3.78	0.88	*27.07

Level of knowledge	Pre-test knowledge score		Post-test knowledge score
Level of knowledge	Frequency (f)	Percentage (%)	Frequency (f)	Percentage (%)
Poor	9	15	0	0
Average	48	80	2	3.3
Good	3	5	8	13.3
Very good	0	0	50	83.4

Level of knowledge	Pre-test technique score		Post-test technique score
Level of knowledge	Frequency (f)	Percentage (%)	Frequency (f)	Percentage (%)
Poor	0	0	0	0
Average	48	80	9	15
Good	12	20	51	85

Knowledge score	Maximum possible score	Range	Mean	Median	Mean%	SD
Pre-test	20	1-11	7.5	8	37.5	2.01
Post-test	20	10-20	18.28	19	91.4	2.75

Technique score	Mean	Standard deviation	Mean difference	‘t’ value	Remark
Pre-test	6.63	1.0	3.2	٭15.57	Significant
Post-test	9.18	1.20	3.2	٭15.57	Significant