INTRODUCTION:

Children are notoriously fond of inserting objects into various orifices and can be hazardous and often life threatening¹. Global under 5 mortality rate is 37 in 2023². The WHO estimates that unintentional injuries, including choking, are a leading cause of mortality and morbidity among children globally. Each year, thousands of deaths are attributed to choking, with an incidence rate of 0.66 per 100,000 populations³. Foreign body aspiration is a common problem in children with significant mortality and morbidity rates⁴. Children under five years of age accounted 75% of choking fatalities⁵. Anatomical and physiological characteristics that are peculiar to children may be a reason for increased choking incidents among young children while eating. A common cause for choking is food, i.e., peanuts, meatballs, sausage, popcorn, candy, bone pieces etc. Other objects that obstruct airways include buttons, toys with small parts, toys that can fit in a child’s mouth, small balls, marbles, balloons, small hair ties, rubber bands, pen caps, small button-type batteries and refrigerator magnets⁶.

Choking varies according to the age group and different preventive and management strategies are required for different age groups to tackle this problem. Such accidents are fairly common and underscore the need for vigilance on the part of parents and child care providers. Choking incidents are not only a result of physical hazards but also a consequence of inadequate supervision and knowledge. Choking or acute airway obstruction is the emergency condition usually first dealt by general public and only then by health professionals^4,7. First Aid for choking is a life- threatening event in children that requires early diagnosis and prompt successful management⁸_.

Parents, child care givers, school personals must be trained so that a healthy child does not lose their life because of easily preventable causes. Education and awareness remain the most important weapon in preventing this fatal event4^,9,10. Choking episodes in children are a significant public health problem that can lead to serious consequences if not addressed quickly and effectively. Early diagnosis, appropriate treatment and prevention are key to ensuring the safety of children³. As it said ‘prevention is better than cure’, prevention is the most critical or key in reducing morbidity due to foreign body aspiration. Therefore, more effort on caregiver’s education is essential. More focus is needed to improve the knowledge of caregivers to prevent choking in children thereby reducing the mortality rate of children. By educating parents about the dangers and how to respond, lives can be saved and the risk of serious injury or death can be reduced.

Mother is the primary caregiver, there for more attention should be focused to assess and improve the mother’s knowledge and skills of management of choking.

Current study helps to assess the knowledge of mothers regarding management of choking in children and determines effectiveness of structured teaching program Vs Self- instructional module in increasing the knowledge on management of choking in children. Study focusses on the objective to determine the effectiveness of structured teaching program Vs Self-instructional module on knowledge regarding management of choking in children among mothers of under five children, to assess the knowledge regarding the management of choking in children among mothers of under five children and to compare the effectiveness of structured teaching programme Vs self-instructional module on management of choking in children among mothers of under five children. Thus, this study helps to know which method is efficient in increasing the knowledge of mothers.

MATERIALS AND METHODS:

Materials:

Tool was Structured knowledge questionnaire with 6 items in section A for assessment of demographic variables and section B containing 30 MCQ questions regarding the Risk factors, types of foreign bodies aspirated, signs and symptoms, emergency response and complications of choking in children. Level of knowledge is categorised as adequate (76-100%), moderate (51-75%) and inadequate (0- 50%). This tool was developed by researchers and validated by 5 experts from the field of paediatric medicine and nursing.

Methods:

Research approach and design: The study was conducted as quantitative research approach with Quasi experimental – non equivalent pre-test post- test control group design.

Variables:

Independent Variable is Structured teaching program and Self-instructional module regarding management of choking in children and the dependent variable is knowledge among mothers of under five children.

SETTING OF STUDY:

The study was conducted in outpatient and inpatient department of a tertiary care hospital in Kottayam district.

POPULATION:

The Population of the study was all the mothers, target Population was the mothers of under five children and the accessible population was the mothers of under five children attending inpatient and outpatient department of tertiary care hospital in Kottayam district.

SAMPLE:

The sample was the mothers of under five children and the sample size was 40.

SAMPLING TECHNIQUE:

Proportion in group I= 0.55, Proportion in group II = 0.85, Estimated risk difference = -0.3, Power (1- beta) % = 80, Alpha error (%) = 5, 1 or 2 sided = 2 the required sample size was estimated to be 36. Considering a 10% non-response rate, the final sample size was set at 40 mothers. In this study, non probability purposive sampling technique was used for selecting the sample from the population.

INCLUSION CRITERIA:

1. Mothers of under five children who are present in inpatient and outpatient departments.

2. Mother who are willing to participate in the study.

3. Mother who are available at the time of data collection.

EXCLUSION CRITERIA:

1. Mother who are not willing to participate in the study.

2. Mother who are sick at the time of study.

DATA COLLECTION PROCEDURE:

The pre-test was conducted for both experimental and control group after taking the institutional permission and institutional ethical committe approval. Demographic data and level of knowledge was assessed by using structured knowledge questionnaire. Structured Teaching Program was given to experimental group and self -instructional module was given to control group. At the end investigators discussed and their doubts were clarified. Post test was taken after 7 days of the intervention for both experimental and control group.

RESULTS AND DISCUSSION:

Table no 1: Description of subjects according to their demographic variables (n=40)

S. No	Demographic variables	Frequency	Percentage
Age
1	26 – 30 years	26	65%
2	31 – 35 years	10	25%
3	36 – 40 years	4	10%
Education
1	Higher secondary	4	10%
2	Graduate	19	47.5%
3	Post graduate	17	42.5%
Occupation
1	Government job	3	7.5%
2	Private job	15	37.5%
3	Business	2	5%
4	Unemployed	20	50%
Number of children
1	One	17	42.5%
2	Two	11	27.5%
3	Three	12	30%
Previous experience of mothers regarding chocking in children
1	Yes	0	0%
2	No	40	100%
Previous knowledge of mothers
1	Yes	10	25%
2	No	30	75%

Majority of mothers (65%) were in the age group of 26-30 yrs. Most of them (47.5%) were graduates and half of the mothers were unemployed. Nearly half of the subjects (42.5%) had only 1 child. None of the mothers had any previous experience of choking management and 75% mothers had no previous knowledge regarding management of choking.

Table no 2. Knowledge level of subjects regarding management of choking in children before and after Structured teaching program (STP) n=20

Level of knowledge	Pre-test		Post test		t value	p value
	f (%)	Mean ± SD	f (%)	Mean ± SD	t value	p value
Inadequate	10 (50%)	14.65 ± 5.37	0	20.55 ± 3.01	4.28	0.05
Moderate	10 (50%)		14 (70%)
Adequate	-		6 (30%)

The findings revealed that post-test of STP group 30% had adequate knowledge and none of them had inadequate knowledge where as in pre-test 50% had inadequate knowledge. The pre-test mean value was 14.65 with SD of 5.37 and in the post test mean value was 20.55 with SD of 3.01. It showed that there was a high statistically significant difference in the level of knowledge with ‘t’ value of 4.28 at p< 0.05 level which in turn indicates that STP was effective in improving the knowledge among mothers of under-five children

Table no 3. Knowledge level of subjects regarding management of choking in children before and after Self Instructional Module (SIM). n=20

Level of knowledge	Pre-test		Post test		t value	p value
	f (%)	Mean ± SD	f (%)	Mean ± SD
Inadequate	8 (40%)	16 ± 2.84	1 (5%)	18.6 ± 2.740	2.95	0.05
Moderate	12(60%)		16 (80%)
Adequate	-		3 (15%)

Findings showed that in the post test of SIM group 15% gained adequate knowledge and in pre-test 40% had inadequate knowledge. The mean pre-test knowledge scores of subjects were 16 whereas the mean post-test knowledge scores were 18.6 (t = 2.95). It showed that there was a high statistically significant difference in the level of knowledge with ‘t’ value of 4.28 at p< 0.05 level. This shows that the self-instructional module was effective in increasing the knowledge of mothers of under five children.

Table 4: Comparison of effectiveness of Structured teaching program (STP) and Self-instructional module (SIM) regarding management of choking (n=40)

Domain	Mean	Standard deviation	t value	Unpaired t value	Df	P value
SIM	18.6	2.740	2.95	3.03	38	0.05
STP	20.55	3.01	4.28	3.03	38	0.05

In the study, mean post-test knowledge score of STP group is 20.55 and t-value is 4.28 was apparently higher than SIM group the mean post-test knowledge score 18.6 and t-value is 2.95 respectively. Hence STP is more effective than SIM and the calculated unpaired T value of (3.03) which was found to be significant at p < 0.05 level which again confirms the efficiency of structured teaching programme (STP) than self-instructional module (SIM).

CONCLUSION:

The findings of the study revealed that

· Both Structured teaching program and Self-instructional module were effective in increasing the knowledge of mothers.

· Structured teaching program (STP) was found to be more effective than Self-instructional module (SIM).

ACKNOWLEDGEMENTS:

Here we extend our sincere thanks to all people who participated in the study.

CONFLICT OF INTEREST:

The author declares no conflict of interest in the study.

REFERRENCES:

1. Singh Meharban. Medical Emergencies in Children. Fifth edition. Sagar Publications, New Delhi. 2012. Page no 703.

2. Under-five mortality”. World Health Organization

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9. Bamaniya. A quasi-experimental study to assess the effectiveness of self-instructional module on first-aid management of paediatric emergencies among mothers of under five children in community area of Bhopal district. Bhopal. Women’s Health Science Journal. 2024. January 8(1): 58. DOI: 10.23880/whsj-16000208

10. Nisha Abraham, A. Maria Therese. The Comparative Study between the Planned Structured Teaching Programme (PSTP) and Self Instructional Module (SIM) on the knowledge regarding First Aid of common injuries occurring in children among school teachers working in selected schools at Gonda, U.P. Int. J. of Advances in Nur. Management. 2019; 7(3): 176-182. doi: 10.5958/2454-2652.2019.00042.8

Received on 25.10.2025 Revised on 01.12.2025

Accepted on 31.12.2025 Published on 23.02.2026

Available online from February 28, 2026

Int. J. of Advances in Nursing Management. 2026;14(1):23-26.

DOI: 10.52711/2454-2652.2026.00005

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