A Study to assess the effect of Structured Teaching Programme on the level of knowledge and practice on administration of Insulin among Diabetic patients and their caregivers admitted in Jubilee Mission Medical College and Research Institute, Thrissur
1III Year BSc(N) Students, Jubilee Mission College of Nursing, Thrissur.
2Lecturer, Jubilee Mission College of Nursing, Thrissur.
3Lecturer, Jubilee Mission College of Nursing, Thrissur.
4,5Professor, Jubilee Mission College of Nursing, Thrissur.
*Corresponding Author E-mail: jeril.g46@gmail.com
ABSTRACT:
A study to assess the effect of structured teaching program on the level of knowledge and practice on administration of insulin among diabetic patients and their care givers in selected wards of JMMC&RI, Thrissur. Objectives: to assess the level of knowledge and practice on administration of insulin among diabetic patients and their care givers before and after intervention, to compare the level of knowledge and practice on administration of insulin among diabetic patients and their caregivers before and after intervention and to associate the pre-test level of knowledge and practice in administration of insulin among diabetes patients and their care givers with selected socio demographic and clinical data variables. Methodology: The study was conducted among 30 diabetes patients on insulin therapy using pre-experimental one group pre-test post-test design. Samples were selected by purposive sampling technique. The tool used for the study had 3 sections: Section A - Socio demographic and clinical data variables where the items include age, gender, marital status, educational status, occupation, monthly income, family history of diabetes mellitus, duration of illness, duration of insulin treatment, person administering insulin, any prior teachings on insulin administration and its source; Section B - Structured knowledge questionnaire; Section C - Structured practice checklist. Result: On data analysis it reveals that 14(46.7%) belongs to the age group of 61-80 years, 19(63.3%) are male, 29(96.7%) are married, 11(36.7%) have high school education, 18(60%) were unemployed‚ 14(46.7%) samples have family history of diabetes mellitus, 13(43.3%) have diabetes for less than 5 years and 4(13.3%) have duration of 11-15 years, 13(43.3%) take insulin for less than 1 year, 14(46.7%) administered insulin by themselves, 23(76.7%) had prior knowledge on insulin administration. The mean post-test knowledge score (19.46) of diabetic patients was higher than the mean pre-test knowledge score (10.2). The computed ‘t’ value (-19.631 ) showed a significant difference between the pre- test and posttest knowledge scores. The mean post-test practice score (19.60) of 30 diabetic patients was found to be significantly higher than their pre-test practice scores. There was a statistically significant relationship between the knowledge and practice level after structured teaching program (P<0.001). There was no significant association between knowledge and practice with selected socio demographic and clinical data variables. The teaching program was accepted by all subjects and showed their interest to learn the administration of insulin.
KEYWORDS: Diabetic mellitus, insulin, knowledge and practice on insulin administration, diabetic patients and caregivers.
INTRODUCTION:
Diabetic mellitus is a chronic multi system disease characterized by the hyper-glycemia related to abnormal insulin production, impaired insulin utilization or both1.The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs2.According to WHO Diabetes Mellitus is an iceberg disease and its prevalence in adults is around 4% worldwide. It is projected that the disease prevalence will be 5.4% by the year 20253.The number of adults with diabetes in the world will rise from 135 million in 1995 to 300 million in the year 20254. WHO declared that India is the capital city of Diabetes Mellitus. Now it is growing at 19.5% per year5. A national study was conducted on diabetes in Delhi and found that about 2% of the 12000 people surveyed in Indian villages were found to be diabetic6.In urban areas of south India the prevalence of diabetes has reached early 20%7. Diabetes is a major public health problem that is approaching Epidemic proportion globally8. Kerala is the diabetes capital of India with a prevalence of diabetes as high as 20% double the national average of 8%9. Glycemic control and prevention of complication will reduce the cost of treatment and diabetes related mortality10. Diabetic patients develop complications due to unawareness of the disease, treatment and non-compliance to treatment regimen11.There is need to improve knowledge and skills of diabetic person about selfinsulin administration to prevent further complications andpromote health12. Thus education can gradually change people from their wrong unhealthy perceptions and practices.13
A study to assess the effect of structured teaching program on the level of knowledge and practice on administration of insulin among diabetic patients and their caregivers admitted in Jubilee Mission Medical College and Research Institute, Thrissur.
1. Assess the level of knowledge and practice on administration of insulin among diabetic patients and their caregivers before and after intervention.
2. Compare the level of knowledge and practice on administration of insulin among diabetic patients and their caregivers before and after intervention.
3. Associate the pre-test level of knowledge and practice on administration of insulin among diabetic patients and their caregivers with selected socio demographical and clinical data variables.
H1: There will be significant difference between pre-test and posttest knowledge and practice score after intervention.
H2: There will be significant association between pretest knowledge and practice of administration of insulin and selected demographic and clinical data variables.
Research Approach:
Quantitative approach was used in this study.
Research Design:
Pre experimental, one group pre test post-test design was used for the study.
Independent Variables:
Structured teaching program on administration of insulin.
Dependent Variables:
Level of knowledge and practice in administration of insulin.
Setting of The Study:
Study was conducted in selected ward of jubilee mission college and research institute, wards are nephro ward, male and female medical and surgical ward.
Patients with diabetic mellitus on insulin therapy and their caregivers in selected wards of JMMC & RI
Sample and Sample Size:
A sample of 30 patients with diabetic mellitus.
Sampling Technique:
Purposive sampling technique was used to collect the data.
DESCRIPTION OF DATA COLLECTION:
Tool 1: It consist of socio demographic and clinical data variables of patients. Coding was done to determine the sample characteristics and association between socio-demographic and clinical data variables with the level of knowledge of patients.
Tool 2: A structured questionnaire with 20 multiple choice questions was developed by the researcher to assess the knowledge regarding administration of insulin. Each correct answer carried 1mark, wrong answer carried zero mark. It was prepared in English and translated in the Malayalam and was validated before pilot study.
Tool 3: Structured practice checklist with 20 items marked as yes or no to asses the ability of patients in performing administration of insulin. The tool consisted of three areas such as preparation of articles, administration of insulin and after care of the articles.
Permission was obtained from the concerned authority. Those subjects who fulfill the inclusion criteria was enrolled in the study after taking informed written consent from the participants. Pretest was assessed from 30 sample by administering knowledge questionnaire and practice checklist. Approximate duration for pretest was 30 minute. After pretest, structured teaching program was conducted for participants on administration of insulin by using charts, flash-cards, and leaflet and demonstration of insulin injection for 30 minutes. Post test was conducted on third day of teaching using the same questionnaire and checklist among the participants.
Data Analysis and Interpretation:
Table 1: Distribution of samples according to sociodemographic and clinical data variables (n=30)
|
Sociodemographic and Clinical Data Variables |
Frequency |
Percentage (%) |
|
I) Age |
|
|
|
20 – 40 |
3 |
10 |
|
41 - 60 |
13 |
43.3 |
|
61 - 80 |
14 |
46.7 |
|
>80 |
0 |
0 |
|
II) Sex |
|
|
|
Male |
19 |
63.3 |
|
Female |
11 |
36.7 |
|
III) Marital status |
|
|
|
Married |
29 |
96.7 |
|
Unmarried |
1 |
3.3 |
|
Sociodemographic and Clinical Data Variables |
Frequency |
Percentage (%) |
|
IV) Education status |
|
|
|
Illiterate |
4 |
13.3 |
|
Primary education |
10 |
43.3 |
|
Secondary education |
11 |
36.7 |
|
Graduate |
3 |
10 |
|
Post graduate |
2 |
6.7 |
|
V) Occupation |
|
|
|
Unemployment |
18 |
16 |
|
Labour or Coolie |
2 |
6.7 |
|
Private |
10 |
33.3 |
|
Technical |
0 |
0 |
|
Professional |
0 |
0 |
|
VI) Monthly income |
|
|
|
Below 5000 |
16 |
53.3 |
|
5000 – 10,000 |
10 |
33.3 |
|
Above 10,000 |
4 |
13.3 |
|
VII) Family history |
|
|
|
Yes |
14 |
46.7 |
|
No |
16 |
53.3 |
|
VIII) Duration of illness |
|
|
|
Upto 5 years |
13 |
43.3 |
|
6 – 10 years |
7 |
23.3 |
|
11 – 15 years |
4 |
13.3 |
|
>15 years |
6 |
20 |
|
IX) Duration of Insulin treatment |
|
|
|
>1 year |
13 |
43.3 |
|
Sociodemographic and Clinical Data Variables |
Frequency |
Percentage (%) |
|
1 – 5 years |
9 |
30 |
|
6 – 10 years |
7 |
23.3 |
|
11 – 15 years |
1 |
3.3 |
|
>15 years |
0 |
0 |
|
X) Insulin administration at home |
|
|
|
Self |
14 |
46.7 |
|
Family member |
8 |
26.7 |
|
Hospital staff |
8 |
26.7 |
|
Others |
0 |
0 |
|
XI) Prior teaching on Insulin administration |
|
|
|
Yes |
23 |
76.7 |
|
No |
7 |
23.3 |
|
XII) Source |
|
|
|
Media |
18 |
60 |
|
Awareness classes |
7 |
23.3 |
|
Others |
5 |
16.7 |
|
XIII) Comorbid conditions |
|
|
|
Hyper lipidemia |
3 |
10 |
|
Hyper tension |
12 |
40 |
|
Cardiac problems |
2 |
6.7 |
|
Others |
5 |
16.7 |
|
None |
8 |
26.6 |
Inference:
Table shows that 14(46.7%) belongs to the age group of 61-80 years, 19(63.3%) are male, 29(96.7%) are married, 11(36.7%) have high school education, 18(60%) were unemployed, 14(46.7%) samples have family history of diabetes mellitus, 13(43.3%) have diabetes for less than 5 years and 4(13.3%) have duration of 11-15 years, 13(43.3%) take insulin for less than 1 year, 14(46.7%) administered insulin by themselves, 23(76.7%) had prior knowledge on insulin administration.
Table 2(a). Frequency and percentage distribution of sample according to pre-test and post test level of knowledge on administration of insulin among diabetic patients and their caregivers. (n=30)
|
Components |
Adequate knowledge |
Moderate knowledge |
Inadequate knowledge |
|||||||||
|
Pretest |
Posttest |
Pretest |
Posttest |
Pretest |
Posttest |
|||||||
|
|
F |
% |
F |
% |
F |
% |
F |
% F |
% |
F |
% |
|
|
Diabetics |
11 |
36.6 |
30 |
100 |
13 |
43.3 |
0 |
0 |
6 |
20 |
0 |
0 |
|
Insulin |
6 |
20 |
30 |
100 |
17 |
56.6 |
0 |
0 |
7 |
23.3 |
0 |
0 |
|
Administration of insulin |
27 |
90 |
30 |
100 |
2 |
6.66 |
0 |
0 |
1 |
3.33 |
0 |
0 |
|
Overall |
11 |
36.7 |
30 |
100 |
1 |
3.3 |
0 |
0 |
18 |
60 |
0 |
0 |
Inference: Table shows that in pre-test on level of knowledge, 11(36.6%) have adequate knowledge, 1(3.3%) have moderate knowledge, 18(60%) have inadequate knowledge. On post-test, the level of knowledge was 30(100%). So it indicated that all were aware about knowledge on insulin administration after the structured teaching program.
Table 2(b) Frequency and percentage distribution of sample according to pre-test and post test level of practice on administration of insulin among diabetic patients and their caregivers. (n=30)
|
Components |
Very Good |
Good |
Average |
Poor |
||||||||||||
|
|
Pretest |
Posttest |
Pretest |
Posttest |
Pretest |
Posttest |
Pretest |
Posttest |
||||||||
|
|
F |
% |
F |
% |
F |
% |
F |
% |
F |
% |
F |
% |
F |
% |
F |
% |
|
General Measures |
22 |
73.33 |
30 |
100 |
5 |
16.6 |
0 |
0 |
2 |
6.66 |
0 |
0 |
1 |
3.3 |
0 |
0 |
|
Aftercare |
27 |
90 |
30 |
100 |
2 |
6.66 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
1 |
0 |
0 |
|
Overall |
2 2 |
73.3 |
3 0 |
100 |
6 |
20 |
0 |
0 |
1 |
3.3 |
0 |
0 |
1 |
3.3 |
0 |
0 |
Inference: The table shows that in pre-test, the level of practice on selected variables, 22(73.34%) was very good, 6(20%) of samples had good practice, 1(3.3%) had average, 1(3.3%) had poor practice. On post-tests, 30(100%) of samples had very good level of practice. It indicated that all were aware about the practice of insulin administration after the structured teaching program (n=30)
Figure 1 shows components of mean knowledge score before and after structured teaching program Inference: mean pre-test knowledge score is higher than mean pre-test knowledge score (n=30)
Figure 2 shows components of mean practice score before and after structured teaching programme Inference: mean post-test practice score is higher than mean pre-test practice score
Table 3(a):- Association between pre test level of knowledge and selected sociodemographic variables (n=30)
|
Socio demographic and clinical data variables |
Chi- square |
df |
P value |
|
Age |
2.222 |
1 |
0.136 |
|
Gender |
1.172 |
1 |
0.279 |
|
Education |
2.356 |
1 |
0.125 |
|
Duration of illness |
1.833 |
1 |
0.176 |
|
Duration of insulin |
1.833 |
1 |
0.176 |
Table shows that there is no association between knowledge with selected socio demographic and clinical data variables
Table 3(b):- Association between pre test level of practice with selected sociodemographic variables with chi- square, degree of freedom and p value. (n=30)
|
Socio demographic and clinical data variables |
Chi-square |
df |
P value |
|
Age |
0.274 |
2 |
0.872 |
|
Gender |
1.926 |
2 |
0.372 |
|
Education |
1.903 |
2 |
0.386 |
|
Duration of illness |
1.367 |
2 |
0.506 |
|
Duration of insulin |
1.784 |
2 |
0.410 |
Table shows that there is no association between practice and selected sociodemographic and clinical data variables
In pretest, regarding the level of knowledge on administration of insulin among diabetic patients and their caregivers, 27(90%) of the sample had adequate knowledge, 2(6.66%) had moderate knowledge and 1(3.33%) had inadequate knowledge and in post test level, 30(100%) of sample had adequate knowledge regarding diabetes condition. In pre test regarding the level of practice on administration of insulin in after care of the articles, 27(90%) of sample had very good level of practice, 2(6.66%) of sample had good level of practice, 0(0%) had average practice and 1(1%) of sample had poor level of practice and post test revealed that 30(100%) of sample had very good level of practice in both after care and general measures.
Mean post-test knowledge and practice score is higher than mean pre-test score of knowledge and practice. Also there is a statistically significant relationship between the knowledge and practice level after structured teaching program (P<0.001). Hence, H1: There will be significant difference between pre-test and post test knowledge and practice score after intervention, is accepted. There was no significant association between knowledge and practice with selected socio demographic and clinical data variables. Hence, H2: There will be significant association between pretest knowledge and practice of administration of insulin and selected demographic and clinical data variables, is rejected.
This study is supported by a cross sectional study conducted by AbyotEodaleGurmu, FitsumSebsibeTeni conducted a study to assess the knowledge, attitude and practice among diabetic patients on insulin therapy towards the disease and their medication in North Western Ethiopia. It includes structured interview with 150 diabetic patients who are self administering insulin as their part of therapy. Majority (61.3%) were men and those in the age group of 14-29 years (47.3%). Among those who experienced hypoglycemia 135(90%) knew the home management of hypoglycemia, effect of insulin. More than three quarter (78%) reported they were comfortablewith their insulin therapy. More than half (54.7%) of the participant had their blood sugar level monitored every month. (30.7%) of the patients reported they had missed their insulin due to different reason at different times. Insulin storage appropriateness is associated with the educational level.14 Similarly in present study, the association of level of knowledge and practice on self administration of insulin among diabetic patients and their caregivers with selected sociodemographic and clinical data variables were found. The values of chi-square, degree of freedom, p value of the association between pretest level of knowledge and practice with selected socio demographic variables were found. P<0.05 was considered to be significant. Hence, there is no association between knowledge and practice with selected socio demographic and clinical data variables.
The data was collected using structured questionnaire and structured practice checklist. Data analysis was done using descriptive statistics. The findings of the study were, in the pre test, out of 30 subjects 13(43.33%) were having inadequate knowledge, 17(56.66%) were having moderate knowledge, 0(0%) had adequate knowledge and 22(73.33%), 6(20%), 1(33.3%) and 1(33.3%) was having very good, good, average and poor practice score respectively. The mean post-test knowledge score (19.46) of diabetic patients was higher than the mean pre-test knowledge score (10.2). The computed ‘t’ value (-19.631) showed a significant difference between the pre- test and posttest knowledge scores. The mean post-test practice score (19.60) of 30 diabetic patients was found to be significantly higher than their pre-test practice scores. There was a statistically significant relationship between the knowledge and practice level after structured teaching program (P<0.001). There was no significant association between knowledge and practice with selected socio demographic and clinical data variables.
1. Lewis, S.L Hei Kemper. Essential of all Medical Surgical Nursing. Noida: Elsevier publication 1335-1365.
2. AR Umarkar, AK Raut, SS Sonone, SS Pawar, RS Deshmukh, NV Bharude. Dibetes in India: A Review. Research J. Pharmacology and Pharmacodynamics. 2011; 3(6): 345-352.
3. Park K. Preventive and social medicine. 19th edition. Jabalpur: M/s BanarsidasBhanot Publishers; 2015
4. Neha Patel, Ravindra H.N. Impact of Health Education Programme on knowledge regarding prevention of complications of diabetic mellitus among diabetes veterans at selected old age home of Baroda. Asian J. Nur. Edu. and Research 5(3): July- Sept.2015; Page 405-412. doi: 10.5958/2349-2996.2015.00081.6
5. Dr. Ram Bhat. India: Diabetic capital of the world. Udayavani 2004 Dec 12; Vol 3 (50).
6. Raman P. Diabetes Mellitus in India. Journal of General Medicine 2002; 14: 11-15
7. M. Sathyakala. Knowledge of Self-Care Management among Patient with non Insulin Dependent Diabetes Mellitus. Int. J. Nur. Edu. And Research. 2018; 6(2):133-134. Doi: 10.5958/2454-2660.2018.00031.5
8. Ranijeyasudha M., Archana, Jeenath Justin Doss. K. A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge regarding Life Style Modification of Diabetic Mellitus among Rural Population in selected areas at Rajkot. Asian J. Nursing Education and Research. 2020; 10(1):28-30. doi: 10.5958/2349-2996.2020.00007.5
9. Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res. Mar 2007; 125(3):217-230.
10. Surendranath; A, Nagaraju B, Padmavathi GV, et a. A Study to assess the knowledge and attitude of insulin self administration among patients with diabetes.
11. Sincy Wilson, Sr. Symphoria. A Study to assess the effect of awareness Programme on Compliance to Insulin Therapy among Patients with Diabetes Mellitus (DM) in a Selected Community Health Centre, Thrissur District. Asian J. Nur. Edu. And Research.2016; 6(4): 464-
12. Himani Patel, Daxaben P. Patel. A Descriptive Study to Assess the Knowledge and Attitude regarding Self Administration of Insulin Injection among Diabetes Mellitus patient in selected Hospital of Visnagar City, in view of Information Booklet. Asian Journal of Nursing Education and Research. 2021; 11(4):499-2. Doi: 10.52711/2349-2996.2021.00119
13. Smita Sunil Gawade, Nikita, Varsha, Geetanjali, Mamata, Vaishali. A Study to Assess the Factors Hindering in self Insulin Administration among Diabetic Individuals. Asian J. Nursing Education and Research. 2019; 9(2):248-250. Doi: 10.5958/2349-2996.2019.00052.1
14. EodaleGurmu, A. and SebsibeTeni, F., 2014. Knowledge, attitude and practice among diabetic patients on insulin therapy towards the disease and their medication in north western ethiopia. [online] Ijpsr.info. Available at: http://www.ijpsr.info/docs/IJPSR14-05-10-023.pdf [Accessed 10 October 2014].
Received on 24.03.2022 Modified on 01.07.2022
Accepted on 12.10.2022 ©A&V Publications All right reserved
Int. J. of Advances in Nur. Management. 2022; 10(4):334-338.
DOI: 10.52711/2454-2652.2022.00075