BEHAVIOR CHANGE COMMUNICATION ON KNOWLEDGE AND …

I

“A STUDY TO EVALUATE THE EFFECTIVENESS OF

BEHAVIOR CHANGE COMMUNICATION ON KNOWLEDGE

AND PRACTICE REGARDING PREVENTION OF STROKE

AMONG EARLY DETECTED HYPERTENSIVE PATIENTS

ATTENDING OPD’S AT TERTIARY CARE HOSPITAL,

DHARWAD”.

BY

Ms. KOTAPURI. PRATHYUSHA

DISSERTATION

Submitted to

SHRI DHARMASTHALA MANJUNATHESWARA UNIVERSITY,

DHARWAD, KARNATAKA

In partial fulfillment of the requirements for the degree of

MASTER OF SCIENCES IN MEDICAL SURGICAL NURSING

Under the Guidance of

MRS. RENUKA.BAGEWADI M.Sc(N)

Assistant Professor, Medical-Surgical Nursing

SDM UNIVERSITY Institute of Nursing Sciences

Dharwad-580009

Karnataka, INDIA.

2021

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Dedicated to my beloved

Late Ms. Munigeti. Steffy Debora

You’re always remembered

VII

ACKNOWLEDGEMENT

I take this opportunity to put down on paper, my gratitude to numerous people who

stood by my side, guiding, helping and encouraging me in this achievement.

First and foremost I thank the Lord Almighty for the abundant mercy and continuous

grace showered upon me to complete this study successfully.

I owe my philosophical honor to Poojya Shri D. Veerendra Heggadeji , Chancellor,

SDM University Dharwad, for giving me this opportunity to undertake this study in

this esteemed Institution.

I convey my deepest thanks Dr. Niranjan Kumar, Vice-Chancellor SDM Hospital

Dharwad for giving me this opportunity to undertake this study.

It‟s my immense pleasure and privilege to express my deep sense of gratitude to

Prof. David. A. Kola M.Sc (N) SDMU IONS, for his inspiration, motivation, constant

guidance, valuable suggestions whose enthusiasm and guidance inspired me to work

tirelessly and come up with the best results. My mentor, whose keen interest in giving

the best to his Students, indeed blessed to be guided by him.

I‟m extremely grateful to my guide. It gives me immense pleasure in extending my

heartfelt thanks to Mrs. Renuka. Bagewadi M.Sc (N) ,Assistant Professor, Medical

Surgical Nursing, SDMU for her support, encouragement, guidance, valuable

suggestions and constant support which helped me to complete the study successfully.

I convey my gratitude to my co-guide Mr. Tilak. Joshi M.Sc (N), Department of

Community Health Nursing. For his valuable guidance encouraging and helping me to

complete this study.

I express my heartfelt thanks to all my teachers of SDMIONS for their valuable

suggestions, constant support and guidance to carry out my study successfully.

I express my gratitude to Dr. Kiran. Aithal Prof & HOD, Dept. General Medicine

SDMCMSH and Dr. S. B. Javali Statistician for their guidance and suggestions in the

completion of this study.

VIII

My heartfelt thanks to Librarian Akshara Library and Library staff, Nursing office

Staff SDMUINS for providing me their timely assistance and encouragement

throughout the study.

I convey my deep sense of thanks to my Parents Mr. K. L. Nathan & Mrs. Sumathi,

Mr. P. Shyam Rao & Mrs. Annamary, for their motivation, encouragement and

support throughout my studies & enabled me to complete my study successfully.

Date: Signature of the candidate

Place: Dharwad (Ms. Kotapuri. Prathyusha)

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LIST OF ABBREVIATION USED

BCC - Behavior Change Communication

HTN - Hypertension

OPD‟s - Out patient department

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ABSTRACT

Background of the study

Stroke is the second major leading cause of mortality worldwide. It is one of

the public health concerns. The incidence of stroke in general population is 154 per

1,00,000 in India. 12% of strokes occur in above 40 years. 34% of strokes occur in

people younger than 65years old. The most effective way to reduce the morbidity and

mortality in stroke is prevention by teaching.

Objectives

To assess the existing knowledge and practice of early detected hypertensive

patients regarding prevention of stroke.

To evaluate the effectiveness of BCC regarding prevention of stroke.

To find the association between pre-test knowledge and practice scores with

selected socio-demographic variables.

Methods

Conceptual framework of the study, an Integrative Model of Behavior Prediction

Fishbein. M. & Yzer. MC. (2003) was applied to Pre-experimental one group pre-test

and post-test research design using Non probability purposive sampling technique 40

early detected hypertension patients were selected. Pre-test was conducted using

structured knowledge questionnaire and practice checklist followed by intervention

(BCC) session on maintenance of positive health. On 7th day post-test was conducted

using the same tool. Results were analyzed using descriptive and inferential statistics.

Results

In the post-test majority 35(87.5%) had adequate knowledge and 2(5%)

moderate knowledge while in the pre-test 25(62.5%) had inadequate knowledge and

10(25%) had moderate knowledge. Depicted that majority 20(50%) had poor practice

in pre-test where as in post-test 31(77.5%) had practice towards maintenance of

positive health. Therefore these results proved the effectiveness of BCC on improving

knowledge and practice in prevention of stroke.

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Interpretation & Conclusion

The study concludes that, there was significant increase in Knowledge and practice in

maintenance of positive health. Hence, BCC is proved to be effective in bringing the

change.

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TABLE CONTENTS

SL.NO CONTENT PAGE NO

1 INTRODUCTION 1-4

2 OBJECTIVES 5-10

3 REVIEW OF LITERATURE 11-20

4 METHODOLOGY 21-28

5 RESULT 29-41

6 DISCUSSION 42-45

7 CONCLUSION 46-48

8 SUMMARY 49-51

9 BIBLIOGRAPHY 52-55

10 ANNEXURES 56-117

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LIST OF TABLES

SL.NO TABLES PAGE NO

1 Frequency and percentage distribution according to Socio

demographic variables

30-31

2 Mean, Standard deviation and Mean percentage of Pre and

Post–test Knowledge scores

35

3 Mean, Standard deviation and Mean percentage of pre and

post -test practice scores

35

4 Levels of Knowledge scores 36

5 Levels of Practice scores 36

6 Comparison of pretest and post- test knowledge scores by

dependent „t‟ test

37

7 Comparison of pretest and post -test practice scores by

dependent „t‟ test

37

8 Association between Pre- test Knowledge with selected Socio

demographic Variables

39

9 Association between pre- test level of Practice with

demographic variables

40-41

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LIST OF FIGURES

SL.NO FIGURES PAGE

NO

1 Conceptual framework of the study 11

2 Schematic representation of the research process 29

3 Comparison of pre-test and post-test knowledge score by

dependent paired „t‟ test

37

4 Depicting that post-test knowledge is higher than pretest

knowledge

37

5 Showing the percentage of post-test skill practice is higher than

pretest practice by paired „t‟ test

37

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LIST OF ANNEXURES

ANNEXURE CONTENT PAGE NO

1 Consent Form for the patients 55-56

2 Letter requesting Opinion & suggestion from expert

for validity of the tool

57-58

3 Content validation Certificate 59

4 Evaluation criteria checklist for validation of tool 60-62

5 Letter seeking permission 63

6 Letter seeking Research permission 64

7 List of the Experts 65

8 Structured knowledge question and knowledge practice

checklist English version

66-74

9 Lesson plan English version 75-95

10 Structured knowledge question and practice checklist

Kannada version & Lesson plan Kannada version

96-117

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1. INTRODUCTION

“Sometimes what you don’t know can kill you,

but putting knowledge into action can save your life”

-ASH

Hypertension is a most leading cause of death among adult population, the reasons are

either these adults are unaware of their condition or negligence / non-compliance with

the treatment regimen. Assuming one day missing the medication does not impact

much on health. Not recognizing it brings many complications and sometimes leading

to morality too. Where in, Hypertension is the most important modifiable risk factor

to prevent complications such as coronary heart disease (the leading cause of death),

stroke (the second leading cause), congestive heart failure, end-stage renal disease,

and peripheral vascular disease. Therefore, Health Care Professional must not only

identify and treat patients with hypertension but also promote a healthy and

preventive strategy to decrease the prevalence of hypertension in the general

population.1

Looking into gravity of the situation health care professionals specially nurses play a

vital role in sustaining the life of this population and preventing life threatening

complications. Indian Council of Medical Research (2015) mentions that among all

complications related to Hypertension Stroke is a major cause for loss of life, limbs

and speech in India, claiming 9.3lakh cases of stroke and 6.4lakhs deaths due to

stroke among less than 45 years of age. Annually deaths as well as disability are

counted together, then India have lost 63lakhs of disability-adjusted life in 2004.

Estimate reports that 1.6million cases of stroke occurred in India annually, at least

one-third of them become disabled.2

WHO estimates (2015) suggest that by 2050, 80% stroke cases in the world would

occur in low-middle-income countries mainly India and China. This is the reason why

India has now come out with national guidelines for Stroke Management. Prepared by

Dr. Kameshwar Prasad, director of AIIMS' clinical epidemiology unit, along with

doctors from Nizam's Institute of Medical Sciences Hyderabad, Command Hospital

Lucknow and PGI Chandigarh, the guidelines cover the management of stroke from

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onset to chronic care and focus is on patients with first stroke or recurrent strokes.

These guidelines may be used by all health professionals/ health care planners

involved in the management of the patients with stroke. The secondary objectives of

the guidelines are to identify areas of gaps in knowledge and practice stimulates

research in each area though these guidelines are available, but have not reached to

the people.2

WHO report (2009) on “Why health communication is important in public health

because there are many threats to global public health (through diseases and

environmental calamities) are rooted in human behavior . Effective communication is

vital for an orchestrated response to a public health crisis. Communication as defined

by Adler and Rodman refers to the process of human beings responding to the

symbolic behavior of other persons. The three major components: communication is

human, communication is a process and communications are symbolic highlighted.2

Hence Communication serves an instrumental role that helps acquire knowledge and

practice in fulfilling ritualistic function, it reflects individuals as members of a social

community. Health communication attempts to persuade the affected group to engage

in certain behavior through accessing information. Intervention measures to change

behaviors in the affected group in an area of concern and must be fully supported by

both the government and nongovernmental organizations.3

NEED FOR THE STUDY

“We are the Custodians of our bodies, we must take action to employee healthy

lifestyle habits to prevent, reduce and or manage disease and illness”

- Bridgette L Collins

Stroke is one of the major leading causes of death and disability worldwide. About

70% of strokes are occurring in low-middle class countries, and high blood pressure is

the main risk factor of stroke that happens due to its poor recognition of stroke

prevention methods. Furthermore over the four decades, the stroke incidence in low-

middle class countries has doubled. Even though stroke is preventable through the

simple modifiable risk factors, recent literature shows that people with hypertension

were four times more likely to have stroke than those with normal blood pressure.

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Additionally, about 80% of people who have high blood pressure were attacked by

stroke.4

According to the World Health Organization report (2017) in Ethiopia, stroke was the

second leading cause of death. (6.23%) and it was a massive financial burden not only

for patients but also for society as a whole. Therefore equipping the public with

appropriate knowledge and practice will be the key tip in stroke prevention activities.4

Health risks are influenced by human behavior thus affecting other aspects of life. For

instance, a society that is invaded with health problems is at risk of being

underdeveloped thus the need of behavior change. Behavior change has become a

central aim of the public health and health promotion interventions, as the influence of

prevention within the health services has increased. It is a very important aspect in

health communication and issued as an intervention measure across a wide range of

health problems. Behavior change communication (BCC) is an interactive process of

any intervention with Individuals, communities and / or societies (as integrated with

an overall program) to develop communication strategies to promote positive

behaviors which are appropriate to their settings. Strategic use of communication to

promote positive health outcomes is based on proven theories and models of behavior

change.5

Behavior Change Communication is a process of working with individual through

different communication channels to promote positive health behaviors and support

them to maintain positive health behaviors taken on. Behavior change is a complex

process motivated by many factors including, a person‟s awareness of the need to

change, understanding of the benefits of such change, belief and confidence in his

ability to change. Behavior change communication employs a systematic process that

involves formative research and behavior analysis, communication planning,

implementation, and monitoring and evaluation. In addition, the audiences are

carefully segmented, messages and materials are pre-tested, and both mass media and

interpersonal channels are used to achieve defined behavioral objectives. To be

successful BCC must move people from awareness to action by motivating them to

believe that health benefits will be obtained by changing behavior and by increasing

individual‟s sense of controls over his own health behavior choices.6

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According to Newson et al. (2013) “Behavior change is positioned as in reducing the

risk of illness and individual‟s adaption towards avoiding it”. Furthermore health

transition is influenced by determinants and behavior change for a better need.7

Milgromisist that any successful communications program aimed at changing

behavior must be grounded in theory. She further states health programs and

companion communications campaigns should find components of at least one

behavior-change theory. Most of the studies revealed that change of behavior differ

across range of factors. Individual perceptions, beliefs or emotions affect decision-

making towards behavior change. Interpersonal factors such as family influences like

social support and relationship also affects individual decision-making. Community

norms influence how people make decision regarding health issues. Structural factors

such as the economic status of the country, political climate laws enforcement and

policies also affects behavior change of an individual. Some behaviors are so tightly

woven into social norms (e.g. smoking) that an ecological approach targeting the

individual, as well as their community and broader environment, is critical.8

Descriptive study conducted on Knowledge regarding prevention of stroke in

Kottayam with a total number of (1248) people surveyed. 476(38.1%) were prevalent

in hypertension. Among the randomly selected 60 people with hypertension,

47(78.3%) of the patients had inadequate knowledge,13(21.7%) had moderate

knowledge and none of them had adequate knowledge regarding prevention of stroke.

Most of the people had poor knowledge on hypertension and prevention of stroke.

Study concluded that though there was more prevalence of hypertension and most of

them had inadequate knowledge on prevention of stroke and there is a need to make

the people aware about the complications of hypertension and its prevention aspects.9

The investigator from her personal experience during her clinical postings and review

of literatures' identified that most of the patients with hypertension admitted in

hospital were not aware of the various risk factors leading to hypertension and its

complications which could have been easily prevented. If they have adequate

knowledge about blood pressure and have a positive attitude towards blood pressure

control. Hence, the investigator felt the need to conduct a study to evaluate the

effectiveness of behavior change communication on knowledge and practice

regarding prevention of stroke among early detected hypertensive patient.

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2. OBJECTIVES

The objective or research project summarizes what is too be achieved by the

study. This chapter deals with the objectives of the study, operational definitions and

hypothesis of the study, limitations and conceptual framework.

OBJECTIVES OF THE STUDY



To evaluate the effectiveness of Behaviour change communication regarding

prevention of stroke.

To find the association between pre-test knowledge, practice scores and


OPERATIONAL DEFINATIONS

Behaviour Change Communication (BCC)

In this study Behavior Change Communication is a process of working with

individual through different communication channels to promote positive

health behaviors and support them to maintain positive health behaviors taken

on. Behavior change is a complex process motivated by many factors

including, a person‟s awareness of the need to change, understanding of the

benefits of such change, belief and confidence in his ability to change.

Behavior change communication employs a systematic process that involves

formative research and behavior analysis, communication planning,

implementation, and monitoring and evaluation.

Knowledge

In this study knowledge refers to bringing awareness among study subjects

regarding to the diet, drug and exercises to be practiced in maintenance of

normal level of blood pressure at any given point of time for prevention of

stroke. Further the attempt will be made by the investigator to enhance the

knowledge by subjecting them to the validated structured teaching program

delivered through the process of behaviour change communication.

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Practice

In this study practice refers to application of gained knowledge to the

activities of daily living in controlling and maintaining normal blood pressure

by using a tool designed, developed and validated by investigator for

preventing the stroke includes

Maintenance of healthy dietary pattern.

Taking the medicine, right dose at right time as prescribed.

Doing regular physical exercises and reducing the stress as learned

through structured teaching program delivered by the investigator.

Early detected hypertensive patients

In this study, early detected hypertensive patients refers to confirmed

diagnosis of hypertension certified by physician and on treatment with in 1

year at the time of data collection.

Evaluate the effectiveness

In this study, evaluate the effectiveness refers to the statistical comparison

made between the pre and post-test knowledge and practice responses

received from study subjects to know the impact of behaviour change

communication in prevention of stroke.

HYPOTHESIS

H1: The mean post-test knowledge scores of patients with hypertension

attending OPD's will be significantly higher than the mean pre-test knowledge

scores at 0.05 level of significance.

H2: There will be significant association between pre-test knowledge scores

and selected social-demographic variables.

H3: The mean post-test practice scores of patients with hypertension attending

OPD's will be significantly higher than the mean pre-test practice scores at

0.05 level of significance.

H4: There will be significant association between pre-test practice scores and

selected social-demographic variables.

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VARIABLES UNDER STUDY

INDEPENDENT VARIABLES: Behavioral change communication

regarding prevention of stroke among early detected hypertensive patients.

DEPENDENT VARIABLES: Knowledge and practice of hypertensive


LIMITATIONS

The study is conducted with sample size in a limited period considering the

selective aspects. Hence the results of the study cannot be generalized.

CONCEPTUAL FRAME WORK

The conceptual framework is the soul of every research project. It includes

more than one theory as well as concepts and empirical findings from the literatures.

It is used to show the relationship among ideas and how to relate to the research

study. It is a representation of a system, made of the composition of concepts which

are used to help people know, understand, or stimulate a subject the model represents.

Where in Nursing is the resource in the environment that can influence the health of a

person through use of the process of inquiry, caring and practice which increases the

quality of interaction.

Introduction

The conceptual framework applied to the study is by taking the concepts of

Integrative theory. The theory incorporates the elements of 3 widely used theories

(which guide the proposed study to appreciate the effect of Behavior Change

Communication Intervention). As the theory proposes that human being is the system

and is always in complex interaction and influence of the interaction directs the

system to behave accordingly.

Hypertension is not the disease. It can be controlled through lifestyle

modification and not merely by the drugs.

In the present generation more number of adults is affected by hypertension

which has mainly influenced by life styles. Hence to guide the proposed study An

Integrative Model of Behavior Prediction Fishbein, M. & Yzer, MC. (2003).

Therefore the proposed study intended to know the impact of Behavior Change

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Communication on lifestyle modification in preventing anticipated complication

mainly the stroke.

This model consists of the following concepts which are explaining the

interrelationship between the concepts directing towards maintenance of positive

health.

Distal Variables

Behavioral beliefs and outcome valuations

Normative beliefs and motivation to comply

Efficacy beliefs

Attitudes

Perceived norms

Self-efficacy

Skills

Intention

Environmental constraints

Behavior

INPUT

In the proposed study subjects are hypertensive patients whose physiological

condition influenced by the distal variables. Such as demographics, culture, attitude,

personality and media leading to maladaptive behavior and affecting the complains.

* In this study Behavioral beliefs refers to non-adhering to the prescribed treatment

and not maintaining dietary regimen and lifestyle required for positive health.

* Normative beliefs refer to the lack of motivation, Acceptance of self and Evaluation

of self-behavior of the subjects.

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* In this study Efficacy beliefs refers to maladaptive behavior influenced by socio

demographic variables and subjects are Inevitable towards positive thoughts and

positive health.

In the present study subjects were selected and explained regarding the

procedure thereafter informed consent was taken from the subjects, meanwhile pre-

test was conducted with the help of structured knowledge questionnaire and practice

checklist.

THROUGHPUT

With these predictions and with the help of pretest the investigator made an

attempt to identify the causes of the behavior such as

* In this study Attitudes refers to the mixed feelings of the subjects as they may

follow, decide to take medication regularly in maintaining the balance required for

positive health.

* In this study Perceived norms refers to voluntary responses towards a particular

action in maintaining healthy life.

* In this study Self efficacy refers as subjects are encouraged to take the corrective

actions to reach the goal by the investigator, peer group and family members.

Based on the findings of the input, interventions were designed, developed

related to attitudes, perceived norms & self-efficacy. Hence developed to change the

attitude in maintaining healthy behavior and follow the instructions of physician and

investigator. Meanwhile Behavior Change Communication session was conducted

and continuous contact was maintained in order to reinforce the information and clear

the doubts if any.

BCC

It refers to, giving information to the subjects regarding lifestyle modification (drug,

diet and exercise) helps to modify their behavioral beliefs, attitudes for a healthy

outcome.

One is to one ratio contact continued till the post test.

Group discussion to motivate each other.

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Teaching by lecture cum discussion method, using AV aids (Charts,

pamphlets) regarding Hypertension and prevention of stroke.

So as to improve the knowledge and practice skills of the subjects to obtain a

better health.

Post-test will be implemented by using the same structured knowledge

questionnaire and knowledge practice checklist skill to know the impact of

behavior and effectiveness of BCC session.

* In this study Skill refers to practicing the lifestyle modification which includes drug,

diet and exercise and the practices implemented by the study subjects after the BCC

session.

* In this study Intentions refers to achieve a desired outcome treatment to maintain a

healthy lifestyle and achieve practical skills in appropriate learning experiences with

responses to clarification of doubts and subjects determination to achieve positive

health.

* In this study Environmental constraints refers to subject‟s positive attitude to elicit a

change.

OUTPUT

It refers to the study subjects gain in knowledge and practice in prevention of

stroke related to their behavior and practice towards maintaining a positive health

with complete lifestyle modification and gets acquainted in maintaining a good

quality of life by substituting negativity with positive outcome.

In this study the effectiveness of BCC session is tested by interrelated

elements such as input, throughput and output from the post test conducted.

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Distal variables

Demographics

age

education

occupation

monthly income

type of family

diet

family history

Culture

Myths and beliefs affecting

quality of life.

Attitudes

Emotional instability

influenced by conditioned

response.

Personality

Impact of personality in

maintaince of healthy

lifestyle.

Other individual variables

Maladaptive behavior and

compliance.

Exposure to media

Influence of media and peer

group

Behavioral beliefs and

outcome valuations

-non adhering to the

prescribed treatment.

-not maintaining dietary

regimen and lifestyle

required to positive

health.

Normative beliefs and

motivation to comply

-lack of motivation

-Acceptance of self.

-Evaluation of self.

Efficacy beliefs

-Maladaptive behavior

influenced by socio

demographic variables.

-Inevitable towards

positive thoughts and

positive health.

Attitudes

-subjects may follow,

decide to take

medication regularly.

Self-efficacy

- Subject are

encouraged to take

the corrective

actions to reach the

goal.

Intention

1. To achieve a desired

outcome.

2. Treatment modalities to

follow.

3. Maintain a healthy

lifestyle.

4. Achieve practical

skills.

5. Appropriate learning

experiences in responses

to clarification of doubts.

Skills

1. Practicing the

lifestyle modification

which includes drug,

diet and exercise.

An Integrative Model of Behavior Prediction Fishbein,M. & Yzer,MC.(2003).

Environmental constraints

1. Modifying the cause.

2. Eliciting the behavior

patterns.

Behavior

1. Positive

reinforcement

towards health

with complete

lifestyle

modification.

2. Gets

acquainted in

maintaining a

good quality of

life.

3. Substitute

negativity with

positive

outcome.

INPUT THROUGHPUT

P

O

S

T

T

E

S

T

B

C

C

Perceived norms

-voluntary responses

towards a particular

action in

maintaining healthy

life.

OUTPUT

Figure- 1

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3. REVIEW OF LITERATURE

Review of literature is the key step in the research process and comprehensive

summary of previous research studies. It helps to lay the foundation by being

supportive study. The investigator search of the existing literature and organizing as

follows under various sub sections:

a) Literature related to knowledge and practice of early detected

hypertensive patients regarding prevention of stroke.

b) Literature related to effectiveness of Behaviour change communication

regarding prevention of stroke.

c) Literature related to association between pre-test knowledge and practice

scores with selected socio-demographic variables.

a) Literature related to knowledge and practice of early detected

hypertensive patients regarding prevention of stroke.

A cross sectional study was conducted on “High blood pressure among

primary care patients with known hypertension”. This study recurred 530

completed surveys, 26% of respondents did not know that most of the time

people with high Blood pressure do not feel it. 22% either were not sure

whether anything could be done to prevent high blood pressure or believe that

there is nothing that can be done. 19% either believe taking medications will

cure high Blood pressure or not sure whether it will. 22% (95%CI 19-26) of

respondents had overall lower hypertension knowledge. The study concluded

that patients may need to be taught the difference between curing hypertension

and treating it will medications. Efforts to educate the public that lifestyle

modifications can prevent hypertension and that it usually causes no

symptoms need to continue.10

A cross- sectional study was conducted on “Knowledge, attitude and

practice of hypertension among hypertensive patients” at Puducherry, India

(October to December 2018). 200 hypertensive patients were selected as

samples. The questionnaire given consists of 16 questions on knowledge-5,

Attitude-5, Practice-6. In this study 40.5% were males and 59.5% were

females. The results revealed that74% had knowledge regarding hypertension,

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attitude 94%, physical activity 77%, and only 9% were practicing exercise.

The study concluded that lacks of knowledge, positive attitude and practice

was observed except for practice of regular exercise.11

A cross-sectional study was conducted on “To assess knowledge,

attitude and practices regarding lifestyle risk factors in patients with

hypertension” at PIMS Jalandhar, Punjab. Samples of 200 hypertensive

patients were selected. A simple random technique is used. Out of 200 patients

110 (55%) were females, 90(45%) were males. 170 were already on

hypertensive treatment and 30 were newly diagnosed. A Pre-Experimental

One Group Pre-test Post-test research design is used. The result shows that

159 (79.5%) had knowledge about hypertension, 169 (84.5%) knew about

preventive measures. Attitude 198 (99%) were ready to take preventive

measures. Practice 137 (68.50%) have decreased salt intake. 45 (22.5%)

patients were consuming alcohol and tobacco. The study concluded there is a

need to increase awareness and generate motivation through IEC campaigns to

encourage communities to adopt a lifestyle with regular activity.12

A study conducted on (2019) “Effectiveness of hypertension

prevention program on Information among Employees” at Tamilnadu, India.

A selected of 120 samples with hypertension. Aim of the study was to prevent

hypertension by Intervention Programme through awareness regarding

lifestyle modification and maintaining normal blood pressure. Purposive

sampling technique is used. The result suggests that difference between the

pre-test and post-test knowledge score was high in paired t test (11.69) than

the table value t (118) _>3.37, p> 0.001. Significant difference between pre-

test and post-test knowledge score at 0.1%level. The study concluded that it

helps to determine the need for continuing education programme.13

A cross- sectional study conducted on “Assess the prevalence of

hypertension and knowledge regarding the prevention of stroke” at Chennai

Tamilnadu. Simple random sampling technique was used, 1248 people were

selected randomly. The result showed that out of 60 samples 47 (78.3%) has

inadequate knowledge, 13 (21.7%) has moderate knowledge and none had

adequate knowledge regarding prevention of stroke. The study concluded that

there is a need to make people aware about the complications and prevention

aspects.14

14

A comparative survey design study conducted on “Awareness and

attitude towards stroke and its prevention among hypertensive and non-

hypertensive” at Ernakulum, Kerala (2017). Non-probability convenient

sampling technique was used. 140 samples were selected out of these 70 were

hypertensive and 70 were non-hypertensive. The data collection tool consists

of structured questionnaire with awareness 20 questions; 10statements were of

attitude towards stroke and its prevention. The result shows that the awareness

score non-hypertensive (12) was relatively higher than the hypertensive (12),

similarly attitude score hypertensive people (32) were relatively higher than

(31) non-hypertensive. The study reveals that awareness regarding stroke and

prevention was average even among hypertensive hence there is a need for

education for high risk Group.15

A study conducted on “Knowledge, attitude and practice of general

population towards Hypertension at Gandhinagar Gujarat. Random sampling

technique was used. 500 were the samples selected. Validated questions were

adopted. The data collection tool consists of 20 questionnaires, of which 8

questions on knowledge, 5 on attitude and 6 questions were on practice. The

result showed that Attitude (45.2%), practice (5%) and (98%) had knowledge.

Hence, the study concluded that they had good knowledge but, poor attitude

and practice, there is a need for health education, repeated reinforcement and

motivation to bring positive change in attitude and practice.16

A cross sectional study was conducted in the age group of 30-59 years

males attending Medicine Outpatient Department in Sri Ramachandra Medical

College and Hospital, Chennai in November 2013 using an interview

schedule. Result shows that Among 100 males with hypertension, 34% were

in the age group of less than 50 years and 64% had hypertension for less than

5 years. Nearly 84% had knowledge about influence of smoking and alcohol

on hypertension and 82% had knowledge about at least 3 dietary factors which

control hypertension. About 70% of males were aware that more than 30

minutes of physical activity/day is needed to control hypertension. 89% were

physically active for more than 30 minutes/day, 72% did not consume alcohol,

89% were nonsmokers but 25% were adding extra salt in their diet and none of

15

them increased fiber intake. Study concludes that Dietary modification

practices were less among hypertensive males.17

Prospective family-based cohort study, 573 families were included

with 997 participants aged >30 years. Self-structured and standardized

questionnaire tool was used. Study results revealed that prevalence of

hypertension was 43%. Higher in women than men (43.7% vs. 41.4%). In

total, 78% (86.2% in women, 62.9% in men) were aware of their hypertension.

Among those aware, 60.4% (63.5% in women, 52.6% in men) of the

participants were on treatment, and hypertension was controlled in 75.1%

(77.5% women, 68% in men) of them treatment. Prevalence was less in

regular exercise versus those who did moderate exercise (32% vs. 45.7%) and

among nonsmokers versus smokers (42.2% vs. 46.6%). Study concludes

prevalence of hypertension in Kerala is high. Although awareness is quite

high, there is a need to improve the people with hypertension taking

treatment.18

A cross-sectional study assessed knowledge, attitude and practice of

exercise for blood pressure control among Nigerian patients with

hypertension. 150 (male, 66 and female, 84) patients with 20 years and older

participated. A structured questionnaire on socio-demographic, knowledge,

attitude and practice of exercise for blood pressure control was selected Data

were analyzed using descriptive and inferential statistics at 0.05 Alpha level.

90 (60.0%) had poor exercise practice. A majority, 101 (67.3%) had poor

knowledge of exercise, 39 (26.0%) had positive attitude towards exercise.

There were significant associations between knowledge of exercise and level

of education (28.337; p=0.001), attitude ( 38.297; p=0.001) and practice of

exercise (12.757; p=0.001) respectively. Significant association was found

between knowledge and socio-economic status (χ2=19.192; p=0.001)

and attitude (χ2=25.634; p=0.001). Study concluded Practice was low

which was significantly influenced by poor knowledge and negative attitude

towards exercise practice for blood pressure control.19

16

b) Literature related to effectiveness of Behaviour change communication

regarding prevention of stroke.

A cross-sectional study was conducted with 333 adults of

hypertension; samples were selected using multistage sampling. Interview

method was obtained with structured questionnaires. The questionnaires used

in this study included the Health-Promoting Lifestyle Profile II (HPLP II),

Hypertension Knowledge-Level Scale (HK-LS), Self-Rated Abilities for

Health Practices Scale (SRAHP), Barriers to Health-promoting Behavior

Scales (BAS), Benefits to Health-Promoting Behavior Scales (BES),

Multidimensional Scale of Perceived Social Support (MSPSS) and Situational

Influences Questionnaire (SIQ). Using multiple linear regressions data was

analyzed. Result showed that 36.9% variation in health-promoting behavior

among adults with hypertension with six variables education, knowledge, self-

efficacy, perceived barriers, social support and situational influences

(adjusted R2 = 0.369). Study concluded good-quality education will increase

the level of health-promoting behavior. Situational influences and support

from family and friends can also influence the adult's attempts to change their

health behaviour.20

A study conducted with 322 adult hypertensive participants who had

been on treatment for at least three consecutive months were randomized into

two groups. Using semi-structured questionnaire an interview and clinical

parameters were measured on pre- and post-intervention. The intervention

group was given teaching regarding lifestyle behaviors, regular exercise,

eating adequate fruits and vegetables, moderate alcohol intake and cessation of

smoking. Results shows that Post-intervention, among the intervention group

22.4%, 71.4% and 100%, as compared with the control group at 6.2%, 41.0%

and 87.6%, met recommendations for physical activity, fruit and vegetable

consumption and alcohol consumption. The difference in each category was

statistically significant (p < 0.001). However, the difference in smoking habits

between the two groups (83.9% vs. 79.5%) was not statistically significant (p

= 0.313). study concluded Lifestyle modifications had an effective treatment

modality for hypertension. It is desirable that primary care physicians devise

https://www.sciencedirect.com/topics/nursing-and-health-professions/cross-sectional-study

https://www.sciencedirect.com/topics/nursing-and-health-professions/multiple-linear-regression-analysis

17

and implement clinical and public health strategies that promote and maintain

a combination of pharmacologic interventions and lifestyle modifications.21

A cross-sectional study was conducted among 205 hypertensive

patients in Durame and Nigist Elleni Mohamed Memorial General Hospitals in

Sothern Nation and Nationality People Representative (SNNPR), Using

simple random technique samples were selected. The study revealed that 56

(27.3%) of the patients practiced recommended lifestyle modifications. The

study found that age (Adjusted Odds Ratio [AOR] = 0.27, 95% Confidence

Interval [CI]:0.13-0.61), educational status (AOR = 2.00,95% CI:1.33-6.75),

monthly income (AOR = 2.46, 95% CI:1.32-4.63), years since diagnosis

(AOR = 2.48, 95%CI: 1.32-4.69), and co-morbidity (AOR = 0.28,95% CI:

0.13-0.61) were factors significantly associated with lifestyle modification

practice (p < 0.05). Study concluded lifestyle modification practices among

hypertensive patients were low in this study. Therefore, Patients should be

educated on the recommended lifestyle modifications that may help patients to

control f their blood pressure.22

A cross-sectional study was conducted with 350 participants using BP

readings from three consecutive months. Purposive technique was used with a

structured interview pretested questionnaire with components derived from the

World Health Organization. Result shows mean age was 67± 11.38 years.

Males made up 35% of the participants and BP control was achieved in 41.4%

of the patients. Only 5.1% of the participants reported adherence to all the

recommended lifestyle behaviors. Low adherence rates were reported for diet,

medication, and physical activity. Bivariate analysis showed that BP (p< 0.1).

Logistic regression analysis revealed that participants BP by 40% (AOR: 0.6;

95% CI: 0.4– 0.9).Study concluded that there was Overall, adherence to the

recommended lifestyle behaviors which are known to be effective in

controlling BP was poor. Health workers should include comprehensive health

education messages on the importance of compliance with dietary, medication,

and physical exercise recommendations when counseling patients..23

A descriptive cross sectional study design was conducted in Lumbini

Medical College Teaching Hospital (LMCTH). A total of 63 patients attending

18

Medical outpatient clinic who were diagnosed as hypertensive at least two

months before the interview were included. Data were collected from 22nd

February 2015 to 21st March 2015 by interview method using a questionnaire

consisting of a combination of structured and semi-structured questions. The

study revealed that non-vegetarian decreased from 95.2% to 74.6% after

diagnosis. Lifestyle modification criteria like amount of salt intake, smoking,

and alcohol consumption were significantly reduced whereas physical exercise

and stress reduction activity were significant increased. Study concluded

Majority of the patients has changed their lifestyle after diagnosis of

hypertension.24

A cross sectional study involving adult hypertensive patients who

presented during a medical screening exercise. Structured pre-tested

questionnaire was used for data collection with 101 individuals. Results show

that 58 (57.4%) males and 43 (42.6%) females. Mean age was 56.7±12 years

with a range of 27 to 84 years. 87.1% were unaware that regular exercise is

part of lifestyle modification while 60% are unaware of the need for

moderation of alcohol intake. More than 80% are unaware of the roles of

vegetables, fruits, unsaturated oil and reduction in diary food intake in the

control of BP. Among 88 participants with some knowledge of salt restriction,

68.2% practiced it. 8.6%, 7.5%, 32.3%, 12.9% and 6.5% of those with

knowledge of regular exercise, weight reduction, alcohol moderation, fruit

intake and cigarette smoking respectively. There was a negative correlation

between the level of practice. Study concluded Awareness level and practice

of lifestyle modification in blood pressure control among the studied cohort is

poor. Concerted strategies need to be taken to improve these.25

A cross–sectional study conducted at the Hypertensive clinic of

Murtala Muhammad Specialist Hospital, Kano, and North – Western Nigeria.

Structured pre-tested questionnaire was used for data collection with 104

participants. Questions were on socio-demographic characteristics,

knowledge, perception and practice of various lifestyle-modification

measures. Results show 51 (49%) males and 53 (51%) females. Mean age was

56 ±11.7 years, with a range of 24 to 90 years. 92% were aware that regular

19

exercise is part of lifestyle modification while 81% are aware about salt

restriction. Only 9% and 13% of the participants are aware of the roles of

unsaturated oil and reduction in diary food intake in the control of BP.

Overall, 33(31.7%) of the patients had good knowledge, 40(38.5%) average

knowledge and 31 (30%) poor knowledge. Despite the positive attitude

towards lifestyle measures, only 59(56.7%) had good adherence. Study

concluded level of knowledge and practice of lifestyle modification low.

Concerted strategies are required to increase the awareness, knowledge and

practice of the lifestyle-modification.26

A cross-sectional study among 230 patients with essential hypertension

in the Family Medicine clinic in a tertiary hospital using a structured pretested

questionnaire. Results revealed that (149; 64.8%) were educated on lifestyle

practices by health workers. Abstaining from tobacco products (230; 100%)

and drinking alcohol (230; 100%) were the most used lifestyle practices.

Dietary fruit consumption (93; 40.4%) and engagement in physical activity for

thirty minutes per day (35; 15.2%) were the least used lifestyle practices.

Study concludes alcohol consumption and tobacco products were not

practiced. Dietary fruit consumption and engagement in physical activity were

not popular lifestyle practices. It is recommended that primary care clinicians

inquire about unhealthy lifestyles during clinical consultations as well as

motivate hypertensive patients to adopt and adhere to appropriate lifestyle

modifications.27

A cross-sectional study was conducted among hypertensive patients

above 30 years of age attending O.P.D. at Sir Sunder Lal Hospital, Banaras

Hindu University. A semi- structured questionnaire was used to collect data.

Study results revealed that half (54.7%) of the patients were non-vegetarian

before diagnosis and after diagnosis the proportion of non-vegetarian study

subjects reduced by 14%. Similarly, the reduction in consumption of meat,

eggs, salt, ghee and oil (mustard, sunflower) by hypertensive patients was also

noted. Likewise, smoking and consumption of alcohol was also reduced after

diagnosis of hypertension. However physical activity increased among 30% of

the respondents. Study concludes that Most of the patients changed their

20

lifestyle after diagnosis of hypertension. There were many recommended

lifestyle changes but this study showed that even after diagnosis of

hypertension only few lifestyle changes were adopted.28

A cross-sectional study was conducted in Sikkim Manipal Institute of

Medical Sciences. Attending medicine OPD aged >18 years from Jan 1st 2017

to Jan 15th

, 2017 were selected. Semi structured questionnaire interview was

regarding knowledge of life style interventions. Study results revealed (n =

100), 60 patients had adequate knowledge (>50%) and 40 patients had

inadequate (<50%) knowledge. Significant association between educational

background and knowledge on lifestyle interventions was present. Urban

population was more aware as compared to rural population Blood pressure

was significantly under control in the aware population. Study concluded that

Patients knowledge on lifestyle interventions for the management of blood

pressure is important. The rural population and uneducated people have

inadequate knowledge on lifestyle modifications of hypertension. Structured

teaching programs are needed to improve awareness about the lifestyle

changes.29

c) Literature related to association between pre-test knowledge and practice

scores with selected socio-demographic variables.

An Interventional study conducted with 292 first visit patients with

hypertension. 142 were randomly assigned to a Control group (C) and 150 to

an Intervention group (I). 10 multiple-choice questionnaires were developed to

evaluate the effect of the intervention on lifestyle modification. Patients were

given the questionnaire, had their BP measured and drug therapy registered

before educational intervention and 12 months later. Group I patients

participated in the focus group and in the role play 2 and 4 months,

respectively, after recruitment. Group C patients received the oral

information. Main outcome measure Blood pressure values and lifestyle

modification. Results shows 150 interventional patients, 58 participated in

both focus group and role play, 30 participated only in focus group and the

remaining 62 never participated. After 12 months, BP decreased more

markedly in group I than in group C, with P < 0.001 for both. Significant

21

improvement of lifestyle modification after 12 months of follow-up

concerning some aspects in both groups. Study findings show that a

motivational approach is a powerful tool for achieving better blood pressure

control and is an essential skill 30

A study conducted with (516) patients were interviewed using a semi

structured questionnaire on patients knowledge, side effects, frequency,

medicines and life style modification. Study results revealed 193 (37%) were

males and 323 (63%) were females. 184 (36%) had middle school education.

201 (39%) were aware of side effects of medicines dispensed for the

management of hypertension whereas 490 (95%) knew the frequency of

administering anti-hypertensive medicine. The mean anti-hypertensive

knowledge score obtained was 2.6221 [SD: 1.30816] out of 5. 320 (62%) and

195 (37%) of respondents were aware of lifestyle modification such as

reducing dietary salt intake and avoiding cigarette smoking. Study concluded

Patient‟s knowledge on the administration of medicines and lifestyle practices

was average. There is the need for counseling and monitoring of hypertensive

patients with regard to their therapy (both medicines and lifestyle practices) 31

22

4. METHODOLOGY

Research methodology is a systemic way of organizing reliable data for a

problem. This chapter deals with Research approach, research design , research

setting , population, sample and sampling technique, development and description of

the tool, data collection procedure, pilot study and plan for data analysis.

RESEARCH APPROACH

Quantitative Evaluate Research Approach was used to conduct the proposed study.

RESEARCH DESIGN

Pre experimental one group Pre-test Post-test design research design was adopted.

PRE-TEST EXPERIMENT POST-TEST

O1 X O2

KEYS:

O1- Pre-test assessment of knowledge and practice regarding prevention of stroke.

X- Behavior Change Communication on knowledge and practice regarding prevention

of stroke.

O2- Post-test assessment of knowledge and practice regarding prevention of stroke.

SETTINGS: The study was conducted Medicine OPD‟s, At Tertiary care Hospital

Dharwad.

POPULATION: Hypertensive patients.

METHODS OF DATA COLLECTION

SAMPLE: 40

SAMPLING TECHNIQUE:

Non-probability purposive sampling technique was adapted to select the

samples for this proposed study.

SAMPLE SIZE:

Sample size for this proposed study was 40 hypertensive patients.

23

INCLUSION CRITERIA:

Male patients

Patients who are in the age group of 35-55 years.

Patients who are willing to participate in this study.

Early detected hypertensive patients attending OPD‟s. [who are diagnosed

with in a span of 1 year].

Patients Who can read and write either English or Kannada language.

EXCLUSION CRITERIA:

Patients who had history of stroke.

Patients who have complication (Coronary artery Disease, Renal Disease,

Peripheral vascular Disease).

SELECTION OF DEVELOP OF INSTRUMENT:

SELECTION OF TOOL

Tool is an instrument prepared by the investigator to collect the

information required to answer the questions raised in the study.

DEVELOPMENT OF THE TOOL:

A tool was designed, developed and validated by the investigator after going

through

Review of literature

Preparation of blue print

Discussion and suggestion from subject experts and guide.

DESCRIPTION OF TOOL:

o Section I : Socio-demographic Proforma

o Section II : Structured Knowledge Question

PART I : Pre- Contemplation

PART II : Contemplation

PART III : Preparation

o Section III : Practice questionnaire checklist

24

In present study structured knowledge questionnaires and practice checklist was

prepared by the investigator “Evaluate the effectiveness of behavior change

communication on knowledge and practice regarding prevention of stroke” . The tool

was further classified into following sections:

Section I: Socio-demographic Proforma

It consists of 8 items related to demographic variables of hypertensive patients

who are certified as hypertensive by the physician and on treatment with in 1 year to

the time of data collection.

Section II: Structured Knowledge Question

PART I: Pre- Contemplation

It consisted of 6 questions; these data were used to collect the data

from participants.

PART- II: Contemplation

It consists of 4 questions; these data were used to collect the data from

participants.

PART-III Preparation

Consists of 4 questions; these data were used to collect the data from

participants.

Section III: Knowledge Questionnaire Practice Checklist

It consists of 22 items; these data were used to collect the data from

participants.

SCORING AND INTERPRETATION OF KNOWLEDGE

The tool consisted of 14 items on knowledge, 22 items on practice checklist. Each

right answer carried „1‟ mark and wrong answer carried „0‟ mark. Further

categorization of the level of knowledge was done as following as

25

Inadequate knowledge 0-4

Moderate knowledge 5-9

Adequate knowledge 10-14

SCORING AND INTERPRETATION OF PRACTICE

Knowledge questionnaire practice checklist

Good 15-22

Average 7-14

Poor 0-6

CONTENT VALIDITY:

Content validity of the tool refers to the degree of which an instruments

measures, what is supposed to measure. In order to obtain content validity, prepared

instruments along with problem statement, operational definition and blue print were

submitted to 6 experts from the field of Medical Surgical Nursing department. The

experts gave their valuable suggestions. The necessary change in the tool was made

by incorporating suggestions given by experts according to the feasibility, before

conducting of pilot study.

PILOT STUDY:

Pilot study was conducted in selected Tertiary care hospital Dharwad from

08th

March 2021 to 16th

March 2021. To find out the reliability of the tool and

effectiveness of learning teaching programme in terms of enhancement of knowledge

and practice regarding prevention of stroke so as to decide their stability for the final

study. The investigator used purposive sampling technique to select the samples from

the total population. 10 samples were selected for the study and these 10 samples

were excluded for the main study.

The pre-test was administered by using structured questionnaire followed by

Behavior change communication session. After7 days, the post test was administered

by using the same structured questionnaire for evaluating the effectiveness of

26

Behavior change communication session on knowledge and practice regarding


RELIABILITY:

Reliability of an instrument is the degree of consistency with which it

measures the attribute it is supposed to measure.

Reliability of the tool was assessed by collecting data from 10 hypertensive

patients; attending medicine OPD‟s at Tertiary care hospital Dharwad. Using (Karl

Pearson‟s correlation co-efficient) to find the internal consistency. The reliability co-

efficient of correlation of the knowledge tool was found to be r= 0.90. The reliability

co-efficient of correlation of practice tool was found to be r=0.87. Hence the tool was

found statistically reliable for the study.

Development of behavior change communication teaching program on

knowledge and practice regarding prevention of stroke among early detected

hypertensive patients

The teaching programme was designed, developed and validated based on the

review of the literature, research literature and the objectives stated in the teaching

plan.

The following steps were adopted to develop the behavior change communication

teaching programme.

Preparation of BCC teaching programme

Planning for teaching

Identification and stating of objectives in Behavioral terms

The teaching objectives were identified and written in behavioral terms depending on

the needs of the learner.

Selection of the Content

The content of Behavior change communication in prevention of stroke among

early detected hypertensive patients was selected through literature search and in

27

consultation with the guide and experts. The content was analyzed into sub topics and

they were broken down into elements.

Selection and preparation of appropriate Audio-Visual Aids

Flash cards, charts, banners, were considered appropriate to increase the

impact of teaching.

Determining Teaching and Learning Activities

Teaching and learning activities were determined well in advance and includes the

following:

Creating interest by motivation and reinforcement

Discussion

Planning to Implement the Behavior change communication teaching

programme

The time and date was planned and it was decided to implement the BCC

teaching programme.

Informing the participants

It was planned to inform the patients and was taken consent.

PROCEDURE FOR DATA COLLECTION:

The investigator was obtained permission and ethical clearance from the

Institutional Ethical Committee and from the Medicine OPD‟s Department of

Tertiary Care Hospital Dharwad.

Subjects were selected according to the Selection Criteria and were assured

the Confidentiality of the sample.

Informed written consent was obtained from all the subjects who were

participating in the study.

Subjects were selected by using Non-Probability Purposive sampling

technique.

On Day1, Pretest was done. To know the knowledge and practice regarding


28

On the same Day1 BCC teaching was given with the help of lecture using

flash cards, charts and handouts for teaching subjects regarding prevention of

stroke.

After 7 days Post-test was conducted with the help of pre-test questionnaires

to know the effectiveness.

DATA ANALYSIS PLAN:

Data Analysis was collected by descriptive and inferential statistics.

By organizing the data on a master sheet.

Tabulation of data corresponding to the Socio-demographic variables such as

frequency, percentage, mean, standard deviation.

Paired „t‟ test was used to evaluate the effectiveness of behavior Change

Communication on knowledge and practice regarding prevention of stroke

among early detected hypertensive patients.

Chi-square test was used to find the association between Pre-test knowledge

scores and socio-demographic variables.

The findings were presented in form of graphs and tables.

29

RESEARCH PROCESS

RESEARCH APPROACH

RESEARCH DESIGN

RESEARCH SETTING

RESEARCH POPULATION

SAMPLING TECHNIQUE

SAMPLE SIZE

PRE-TEST

POST-TEST

ANALYSIS

TOOL USED FOR DATA

COLLECTION

Quantitative Evaluate Research

Pre experimental One group Pre-test Post-

test

Early Detected Hypertensive patients.

Medicine OPD‟s, of Tertiary care teaching

Hospital

Non-probability purposive sampling

technique

40

Structured knowledge questionnaires and

practice checklist

To assess the level of knowledge and

practice towards maintenance of positive

health

Pre-test data

Posttest after BCC on maintenance of

positive health

-Comparison of results of pre-test & post-

test. Descriptive & inferential statistics

Paired„t‟ test. Finding and conclusion.

STATISTICAL ANALYSIS

INTERPRETATION OF

DATA & DISCUSSION

BEHAVIOR CHANGE COMMUNICATION

Figure 2

30

5. RESULTS

This chapter deals with a logical presentation of the empirical results after

completing the data analysis. It includes tabulated results, results of hypothesis tests,

graphs and figures.

OBJECTIVES







HYPOTHESIS:

H1: The mean post-test knowledge scores of patients with hypertension

attending OPD's will be significantly higher than the mean pre-test knowledge

scores at 0.05 level of significance.

H2: There will be significant association between pre-test knowledge scores

and selected socio-demographic variables.

H3: The mean post-test practice scores of patients with hypertension attending

OPD's will be significantly higher than the mean pre-test practice scores at

0.05 level of significance.

H4: There will be significant association between pre-test practice scores and

selected social-demographic variables.

Presentation of the data

The data is presented in three sections under the following headings:

SECTION-I: Deals with description of the subjects according to the socio-

demographic characteristics of hypertensive people attending OPD's at tertiary care

hospital.

SECTION-II: Analysis is applied to depict effectiveness of Behavior change

Communication(BCC) on maintenance of positive health.

31

SECTION-III: Deals with analysis to find the association between pre-test knowledge

and practice scores with selected socio-demographic variables.

SECTION-I :

Table 1: Frequency and percentage distribution of patients according to socio-

demographic variables.

Sl.no Demographic variables Frequency(f) (Percentage)%

1 Age groups

35-40yrs 9 22.5%

41-45yrs 9 22.5%

46-50yrs 14 35%

51-55yrs 8 20%

2 Educations

SSLC 15 37.5%

PUC 9 22.5%

Degree 16 40%

3 Occupations

Employee 21 52.5%

Business 6 15%

Skilled worker 13 32.5%

4 Monthly income

Rs. 8000-Rs. 10000 13 32.5%

Rs. 10001-Rs.15000 14 35%

32

Rs.15001-Rs. 20000 7 17.5%

Rs.20001-Rs.25000 6 15%

5 Types of family

Nuclear 28 70%

Joint 12 30%

6 Diet

Vegetarian 20 50%

Mixed 20 50%

7 Any family history

Yes 14 35%

No 26 65%

22%

23%

35%

20%

Figure 3: Pie diagram showing percentage distribution of

patients according to age

35-40yrs

41-45yrs

46-50yrs

51-55yrs

33

Figure 3 : Indicated that majority of the subjects 14 (35%) belonged to the age

group of 46-50 years.

Figure 4 : Maximum subjects 16(40%) have attained Degree.

Figure 5 : Majority of the subjects 21(52.2%) were Employees.

SSLC

15

PUC

9

Degree

16

0

2

4

6

8

10

12

14

16

18

SSLC PUC Degree

Figure 4 : Column diagram showing percentage distributionof

patients according to Educational qualifications.

21

6

13

52.50%

15% 32.50%

Figure 5: Cylindrical diagram showing percentage distribution

of patients according to Occupation

frequency percentage

34

Figure 6 : Maximum 14(35%) monthly income of the subjects was between

Rs. 10001-Rs.15000 per month.

Figure 7: Majority of the subjects 28 (70%) belongs to Nuclear family.

Rs. 8000-Rs.

10000

32.50%

Rs. 10001-

Rs.15000

35.00%

Rs.15001-Rs.

20000

17.50%

Rs.20001-

Rs.25000

15.00%

Figure 6: Pie diagram showing percentage distribution of patients according to Monthly Income

Nuclear

28 (70%)

Joint

12 (30%)

0

5

10

15

20

25

30

Figure7: Column diagram showing percentage distribution of

patients according to Type of family

35

Figure 8: While 20 (50%) were vegetarian, 20(50%) were mixed diet.

Figure 9: Majority of the subjects 26 (65%) were not having any family

history.

Vegetarian

50.00%

Mixed

50.00%

Figure 8: Pie diagram showing percentage ditribution of

patients according to Diet

Vegetarian Mixed

14

35%

26

65%

frequency percentage

Figure 9: Pyramid diagram showing percentage ditribution of

patients according to family history

Yes No

36

SECTION-II

Analysis is applied to depict effectiveness of Behavior change Communication(BCC)

on maintenance of positive health.

Table 2: Mean, Standard deviation and Mean percentage of Pre and Post–test

Knowledge scores of patients on maintenance of positive health

n=40

Mean Median Standard

Mean

% Min.

Max.

deviation score

score

Pre- Test 5.23 4.5 3.47 13.07 2 13

Post-Test 10.7 11 2.43 26.75 5 14

Table 2 : Describes that the mean post-test knowledge scores were(26.75%) and the

mean pre-test scores were(13.07%) mentioning the impact of BCC in the

improvement of the knowledge.

Table 3: Mean, Standard deviation and Mean percentage of pre and posttest practice

scores of the patients on maintenance of positive health.

n=40

Mean Median Standard Min. Max.

Mean

%

deviation score score

Pre- Test 7.38 7.5 2.87 1 5 18.45

Post-Test 13.4 13 2.81 12 18 33.5

Table3 : Shows that the mean post-test practice scores were (33.5%) while the mean

pre-test scores (18.45%), indicating that BCC was effective in changing the practice

of the students in positive direction.

37

Table 4 a. Levels of Knowledge scores

Pre-test Post-test

Frequency (F) Percentage (%) Frequency (F) Percentage (%)

Inadequate 25 62.5 3 7.5

Moderate 10 25 2 5

Adequate 5 12.5 35 87.5

Table 4.a. and Figure 10: Depicted that in the posttest 35 (87.5%) has adequate

knowledge and 2 (5%) had moderate knowledge while in the pre-test 25 (62.5%) had

inadequate knowledge and 10 (25%) had moderate knowledge.

Table 4.b. Levels of Practice scores.

Pre-test Post-test

Frequency

(F)

Percentage

(%)

Frequency

(F)

Percentage

(%)

Poor 20 50 4 10

Average 15 37.5 3 7.5

Good 5 12.5 31 77.5

38

Table 4.b. and Figure 11: Depicted that majority 20 (50%) had poor practice in pre-

test where as in post-test 31 (77.5%) had practice towards maintenance of positive

health.

Table 5.a: Comparison of pretest and posttest knowledge scores by dependent „t‟ test

Mean SD Mean

Diff.

SD Diff. t-value P-value

Pre-test 5.23 3.47

Post-test 10.7 2.43 5.48 3.8 9.1058 <0.001, HS

Table 5.a. shows that, the two tailed „P‟ value is less than 0.0001 by conventional

criteria, this difference is considered to be extremely statistically significant.

Table 5.b. Comparison of pretest and post-test practice scores by dependent„t‟ test

Mean SD Mean

Diff.

SD Diff. t-value P-value

Pre-test 7.38 2.87

Post-test 13.4 2.81 6.03 4.3 8.8626 <0.001, HS

20

50% 4 10%

15

37.50% 3

7.50%

5 12.50%

31

77.50%

Figure 11 : Cyindrical diagram showing the

distributionn of percentage of pre and post test level

of practice scores

Poor

Average

Good

39

Table 5.b. and Figure 13 shows that , the two tailed „P‟ value is less than 0.0001 by

conventional criteria, this difference is considered to be extremely statistically

significant.

SECTION-III

Association between Pre-test Knowledge and Practice with selected Socio

demographic Variables.

Table 8.a: Association between Pre-test Knowledge with selected Socio demographic

Variables.

40

Sl.No Demographic characteristics Chi-

square Df

p-

value

Level of

significant

1 Age groups

35-40yrs

2.212 9 0.53 NS

41-45yrs

46-50yrs

51-55yrs

2 Educations

SSLC

11.963 4 0.003 S PUC

Degree

3 Occupations

Employee

3.533 4 0.171 NS

Business

Skilled worker

4 Monthly income

Rs. 8000-Rs. 10000

3.302 9 0.347 NS

Rs. 10001-Rs.15000

Rs.15001-Rs. 20000

Rs.20001-Rs.25000

5 Types of family

Nuclear

4.977 1 0.026 S Joint

6 Diet

Vegetarian

0.143 1 0.705 NS

Mixed


Yes

9.341 1 0.002 S No

* Significant

41

Data presented in table 8.a. shows that the significant association in the Education,

Type of family and Family History with pre-test knowledge scores at 0.05 level of

significance.

Table 8 .b :Association between pre test level of Practice with demographic

characteristics.

Sl.No Demographic characteristics Chi-

square Df p-value Level of significant

1 Age groups

35-40yrs

3.65 9 0.302 NS 41-45yrs

46-50yrs

51-55yrs

2 Educations

SSLC

2.415 4 0.299 NS PUC

Degree

3 Occupations

Employee

0.433 4 0.805 NS Business

Skilled worker

4 Monthly income

Rs. 8000-Rs. 10000

2.108 9 0.55 NS Rs. 10001-Rs.15000

Rs.15001-Rs. 20000

Rs.20001-Rs.25000

5 Types of family

Nuclear

0.008 1 0.928 NS Joint

6 Diet

Vegetarian 0.173 1 0.677 NS

Mixed

42


Yes

0.154 1 0.695 NS

No

*Not significant

Data presented in table 8.b. shows that their is no significant association with pre-test

practice scores at 0.05 level of significance.

43

6. DISCUSSION

This chapter the findings of the study have been discussed with reference to

the objectives and hypotheses stated in Chapter II along with the findings of the other

study.

MAJOR FINDINGS OF THE STUDY

To achieve the set objectives of the study forty subjects were selected by

applying sampling criteria.

Majority of the subjects 14 (35%) belonged to the age group of 46-50 years.

Maximum subjects 16 (40%) have attained Degree.

Majority of the subjects 21(52.2%) were Employees.

Maximum 14 (35%) monthly income of the subjects was between Rs. 10001-

Rs.15000 per month.

Majority of the subjects 28 (70%) belongs to Nuclear family.

While 20 (50%) were vegetarian, 20 (50%) were mixed diet.

Majority of the subjects 26 (65%) were not having any family history.

The mean post-test knowledge scores were (26.75%) and the mean pre-test scores

were (13.07%) mentioning the impact of BCC in the improvement of the

knowledge.

The mean post-test practice scores were (33.5%) while the mean pre-test scores

(18.45%), indicating that BCC was effective in changing the practice of the

students in positive direction.

The post-test 35 (87.5%) has adequate knowledge and 2 (5%) had moderate

knowledge while in the pre-test 25 (62.5%) had inadequate knowledge and 10

(25%) had moderate knowledge.

Majority20 (50%) had poor practice in pre-test where as in post-test 31 (77.5%)

had practice towards maintenance of positive health.

44

The two tailed „P‟ value is less than 0.0001 by conventional criteria, this difference is

considered to be extremely statistically significant. The two tailed „P‟ value is less

than 0.0001 by conventional criteria, this difference is considered to be extremely

statistically significant.

The significant association in the Education, Type of family and Family History

with pre-test knowledge scores at 0.05 level of significance.

Data presented in table 8.b. shows that there is no significant association with

pre-test practice scores at 0.05 level of significance.

DISCUSSION

The findings of the study are organized under the following headings for the

purpose of discussion.

1. Findings related to socio-demographic variables of the patients.

2. Findings related to effectiveness of Behavior Change Communication (BCC) on

maintenance of positive health.

3. Findings related to association between the existing pre-test knowledge scores of

the patients with selected socio-demographic variables.

4. Findings related to association between the existing pre-test practice scores of the

patients with selected socio-demographic variables.

FINDINGS RELATED TO SOCIO DEMOGRAPHIC DATA OF THE

PATIENTS (TABLE 1)

For the proposed study, a sample size comprising of forty Early detected

Hypertensive patients attending Medicine OPD‟s at Tertiary care hospital Dharwad.

The findings (table 1) of the study suggested that all the (40) subjects were

between the age group of 35-55years of age of whom 15 (37.5%) have completed

SSLC, 16 (40%) degree and 9 (22.5%) have done PUC.

45

Majority of the subjects 21 (52.2%) were Employees, 13 (32.5%) were skilled

workers and 6 (15%) were doing Business. Maximum 14 (35%) monthly income of

the subjects was between Rs.10001-Rs.15000 per month. 13 (32.5%) Rs.8000-Rs.

10000, 7 (17.5%) Rs.15001-Rs. 20000, 6 (15%) Rs.20001- Rs.25000. Types of

family Nuclear 28 (70%), Joint 12 (30%). Diet Vegetarian 20 (50%), Mixed 20

(50%). Any family history Yes 14 (35%), No 26 (65%).

FINDINGS RELATED TO EFFECTIVENESS OF BEHAVIOR CHANGE

COMMUNICATION ON MAINTENANCE OF POSITIVE HEALTH.

In the pre-test out of 40 Hypertensive subjects 25 (62.5%) had inadequate, 10

(25%) had moderate and 5 (12.5%) had adequate level of knowledge. While majority

20 (50%) had poor practice, 15 (37.5%) had average and only 5 (12.5%) had good

level of practice scores in pre-test. Where as in the post-test 35 (87.5%) has adequate

knowledge and 2 (5%) had moderate knowledge and 31 (77.5%) had good practice, 3

(7.5%) had average practice towards maintenance of positive health.

Further the computed „t‟ value on knowledge (9.10) and practice (8.8626) found to

be greater than table values at 0.05 level significance confirms that BCC has made

true difference in enhancing the knowledge and changing the practice of the

Hypertensive patients in the maintenance of positive health . Hence H1 is accepted.

FINDINGS RELATED TO ASSOCIATION BETWEEN THE EXISTING PRE-

TEST KNWOLEDGE AND PRACTICE OF THE HYPERTENSIVE

PATIENTS WITH SELECTED SOCIO DEMOGRAPHIC VARIABLES.

To achieve the objective 3 the collected pre-test data was further subjected to

analysis to find an association with socio-demographic variable. The computed X2

results (X2

cal >X2

Tab) revealed that there was statistical significant association at

0.05 level of significance association in the Education, Type of family and Family

History with pre-test knowledge scores of Hypertensive patients, Hence H2 was

accepted and in rest of the case H2 is rejected.

In case of practice, the calculated X2

results (X2

cal >X2

Tab) revealed that there

was statistical significant association at 0.05 level of significance association. In all

the socio-demographic data H2 was rejected.

46

The above findings proved that students were not aware and lack of knowledge and

practice on maintenance of positive health the investigator reasonably concludes that

enhancement in knowledge and practice towards positive change was occurred only

after BCC session on maintenance of positive health.

47

7. CONCLUSION

This chapter deals with the conclusions drawn and its implications of the study

on the different aspects of nursing, such as nursing practice, nursing administration,

nursing education and nursing research, limitations and recommendations. It clarifies

the limitations of the study and suggests recommendations for further research.

Based on the findings of the study, the following conclusions were drawn.

1. As it assumed, that the pre-test findings of the study revealed that the

knowledge scores of the patients on maintains of positive health were average and

attitude score were not fully favorable.

2. Since the above findings did not correlate with each other giving clear

indications that the health maintenance behavior of the patients is inappropriate and

need for the intervention. Hence after extensive review of literature and the opinion of

the experts and investigator‟s personal experience it was planned to use and find the

effectiveness of behavior change communication (BCC) as a mode of intervention.

3. The findings of the post-test result revealed that there were significant

improvement in the level of knowledge and practice on maintenance of positive

health. Hence it is concluded that the BCC in equipping the appropriate knowledge

and practice as a mode of intervention found to be effective.

4. Further it also revealed that socio-demographic characteristics of the

subjects do not have much interfere in the maintenance of positive health. Thus it is

concluded that the behavior of the individual is dependent on knowledge and practice.

IMPLICATIONS OF THE STUDY

The implications of the study could be discussed under four broad areas, as follows,

Nursing practice

Nursing administration

Nursing education

Nursing research.

48

Nursing practice:

National development depends on individual‟s health. As individuals are

considered to be the change in the society they need to be provided with appropriate

Information Education Communication (IEC) which will further improve their health

seeking behavior. Based on the final results of the study. Clearly indicates that nurses

play vital role in prevention of diseases through counseling. Behavior Change

Communication proved to be effective and appropriate method for delivering health

message to the individual‟s, who attend OPD‟s at tertiary care hospital.

Nursing Administration:

The study emphasized the need for Behavior Change Communication on

maintenance of positive health to improve the health of the patients in their day today

life. The nurse administrators can equip the health personnel in delivering appropriate

health message according to situations, level of understanding of the consumers

through proper planning and implementation.

Nursing education:

Along with the care provider‟s, as leaders and managers of health care team

plays a role of educator and counselor. Hence these advance methods of IEC should

be incorporated in the hospital settings.

Nursing research:

This present study conducted by the investigator can be a source to make the

health education methods refined in order to the people in the community and it can

be used for critique or for comparison.

LIMITATIONS

The study is limited to Hypertensive patients at tertiary care hospital,

1. The broad generalization of the findings of the study cannot be made due to

the small size of sample and investigator was unable to reach their place of residence

limited time.

49

2. The instrument used for the study is designed and developed by the

investigator for the purpose of achieving set of objectives of the study. Hence it is not

a standardized tool.

3. The study did not assess the self-reported practice of patients on

maintenance of positive health.

4. The Behavior Change Communication is long process because it takes

several months to Change Behavior so continues monitoring and assessment are

needed in different phases.

RECOMMENDATIONS

On the basis of the findings the study, following recommendation are made.

A similar study on larger sample for a longer period of time with precise

sampling technique would be more pertinent.

An experimental study can be undertaken with a control group for comparison

of the results to be more precise in the following subjects at the place of their

residence.

An comparative study may be conducted between rural and urban people.

50

8. SUMMARY

This chapter presents a brief summary of the research study. The present study

pre-experimental in nature was undertaken with the purpose to evaluate the

effectiveness of Behavior Change Communication (BCC) on maintenance of positive

health among the Hypertensive patients attending Medicine OPD‟s in tertiary care

hospital at Dharwad.

The study was aimed at accomplishing the following objectives.







The conceptual framework selected for this study was based on an integrative

Model of Behavior Prediction by Fishbein, M. & Yzer, MC.(2003). It is based on

Behavioral beliefs, attitude toward the behavior, normative belief, subjective norm

and perceived behavioral control, with each predictor weighted for its importance in

relation to the behavior and population of interest.

The study assumed that the knowledge influences practice exhibited through

actions. The lack of knowledge of Early detected hypertensive patients in

maintenance of positive health has influenced their practices leading them towards

harmful or ignorance practice and it is also assumed that Behavioral Change

Communication (BCC) will have a significant impact on patients health behavior.

The study was confined to Hypertensive patients attending Medicine OPD‟s in

tertiary care hospital, Dharwad.

The extensive review of literature directed the investigator to prepare the BCC

material on Knowledge questionnaire and knowledge practice questionnaire checklist.

51

A pre-experimental one group pre-test post-test design utilized to achieve the

overall and comprehensive purpose. Samples were collected by using Non-probability

purposive sampling technique.

Content validity of the designed tool and Behavior Change Communication

material was obtained through expert judgment.

The pilot study was conducted at Hypertensive patients attending Medicine

OPD‟s in tertiary care hospital Hypertensive patients attending Medicine OPD‟s in

tertiary care Hospital from 8th

March 2021 to 16th

March 2021to know the feasibility

of the main study and establish reliability of the tool and BCC, keeping in mind the

cultural characteristics and rituals as same as to the final setting of the study. The

reliability of the tool and BCC was established by computing the coefficient ( r ) of

internal consistency for both structured knowledge questionnaire and practice were

r=0.90 and r=0.87 respectively, using split half technique which indicates that the tool

is reliable.

The main study was undertaken from 15th April 2021 to 30th

May 2021 in

Medicine OPD‟s in tertiary care hospital, Dharwad after obtaining a formal

permission from Vice Chancellor and HOD of Medicine Department.

The pre and post test data was collected by using above instrument of the

study. Behavior Change Communication was administered to the students at the end

of pre-test and the investigator kept personal contact with individual patients till the

post-test, providing explanations and demonstration. Clearing doubts I order to bring

changes in their health behavior. The post-test was conducted on the seventh day of

intervention.

The data generated through the pre-test and post-test was tabulated and

analyzed by using descriptive and inferential statistics to achieve the set objectives of

the study.

52

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56

10. ANNEXURES

CONSENT FORM FOR THE PATIENTS

Dear respondent,

I Ms. Kotapuri. Prathyusha 2nd

year Nursing Student of Shri Dharmasthala

Manjunatheswara University Institute of Nursing Sciences Dharwad. In partial

fulfillment of the course requirement, I have to undertake a research project to Shri

Dharmasthala Manjunatheswara University Institute of Nursing Sciences Dharwad.

The title of my project is,

“A STUDY TO EVALUATE THE EFFECTIVENESS OF BEHAVIOR

CHANGE COMMUNICATION ON KNOWLEDGE AND PRACTICE

REGARDING PREVENTION OF STROKE AMONG EARLY DETECTED

HYPERTENSIVE PATIENTS ATTENDING OPD’S AT TERTIARY CARE

HOSPITAL, DHARWAD.”

The purpose of this study is to evaluate the effectiveness of behavior change

communication designed by the investigator on knowledge and practice regarding

prevention of stroke among early detected hypertensive patients attending OPD‟s at

tertiary care hospital, Dharwad, thus to evaluate the knowledge and practice of the

early detected hypertensive patients and to update the knowledge and practice during

the study.

You are requested to participate in this study following are the details of the study.

On Day1, Pretest will be conducted to assess the pre-interventional knowledge

and practice. (per day 5 patients will be taken)

Patient will be given an appointment to attend the teaching and demo on


On the same Day1 BCC teaching will be given with the help of lecture using flash

cards, charts and handouts.

Meanwhile, after the teaching session, the patients can also clear their doubts; if

any, by discussing with the investigator. (For those 5 subjects, taken on the same

day teaching will be given).

• Post-test will be conducted on 7th

day of intervention to find out the effectiveness

of behavior change communication.

57

I assure you that the information given by you will be kept strictly confidential

and used only for the study purpose. If you are willing to participate in this study

please sign the consent form given below.

Place: Yours Sincerely

Date: Ms. Kotapuri. Prathyusha

2nd

year M.Sc Nursing Student.

I HERE BY VOLUNTEER AND CONSENT TO PARTICIPATE IN THIS STUDY,

I HAVE READ THE CONSENT OR IT HAS BEEN READ TO MY OWN

LANGUAGE. THE STUDY HAS BEEN FULLY EXPLAINED TO ME AND I

HAVE BEEN TOLD BY THE INVESTIGATOR TO CONTACT HER

PERSONALLY FOR CLARIFICATION OF THE DOUBTS / QUESTIONS OR

WITHDRAW MY SELF FROM THE STUDY AT ANY TIME.

Participants name

and address

Participants

signature

Researcher name

Researcher

signature

Date

Date

I have been informed of the purpose of the study and I voluntarily give my consent to

participate in the study.

Place: Signature of the respondent

Date: Name:

58

LETTER REQUESTING OPINION AND SUGGESTION FROM

EXPERT FOR VALIDITY OF RESEARCH TOOL

From,

Ms. Kotapuri .Prathyusha

II year M.Sc Nursing

Shri Dharmasthala Manjunatheswara University‟s

Institute of Nursing Sciences, Dharwad-580009

To,

Respected sir/Madam

Subject: Request for expert opinion and suggestion to establish content validity of

the research tool.

I, Ms. Kotapuri . Prathyusha, II year M.Sc Nursing [(Medical Surgical

Nursing)] specialty, [(Critical Care Nursing)] student of Shri Dharmasthala

Manjunatheswara University Institute of Nursing Sciences Dharwad, has selected the

topic titled “A STUDY TO EVALUATE THE EFFECTIVENESS OF

BEHAVIOR CHANGE COMMUNICATION ON KNOWLEDGE AND

PRACTICE REGARDING PREVENTION OF STROKE AMONG EARLY

DETECTED HYPERTENSIVE PATIENTS ATTENDING OPD’S AT

TERTIARY CARE HOSPITAL, DHARWAD”. For the dissertation to be

submitted to Shri Dharmasthala Manjunatheswara University Institute of Nursing

Sciences Dharwad, as a partial fulfillment of Master of Science in Nursing

Programme.

May I request you to go through the items and give your valuable suggestions

and opinions to develop the content validity of the tool. Kindly suggest

modifications, additions, if any, in the remark columns.

59

I also request you to certify regarding your validation in the enclosed format. I

will be grateful to your honorable work. Anticipating a favorable response at the

earliest.

I have enclosed the following for your reference:

Statement of the problem, Objectives of the study, operational definitions and

hypothesis.

Demographic data and Observational checklist to evaluate knowledge and

practice.

Evaluative criteria checklist

Content validity certificate

Lesson plan

Thanking you,

Date: Yours Sincerely,

Place: Sattur, Dharwad [Ms. Kotapuri. Prathyusha]

60

CONTENT VALIDATION CERTIFICATE

This is to certify that the tool describing the Knowledge questionnaires prepared by

Ms. Kotapuri. Prathyusha. II year M.Sc Nursing, Shri Dharmasthala Manjunatheswara

University Institute of Nursing Sciences Dharwad. To be used in her study title “A

Study To Evaluate The Effectiveness Of Behavior Change Communication On

Knowledge And Practice Regarding Prevention Of Stroke Among Early

Detected Hypertensive Patients Attending OPD’s At Tertiary Care Hospital,

Dharwad”.

My comments on following :

Tool :

Adequate of tool measure objectives :

Organization of tool :

Feasibility of tool :

Date: Signature & seal of expert

Place: Designation and address

61

EVALUATION CRITERIA CHECKLIST FOR VALIDATION OF TOOL

INSTRUCTIONS:

Please review the items in the tool and give your suggestions regarding accuracy,

relevance and appropriateness of the context. Kindly please tick mark ( ) in the

appropriate column. If there are any suggestions or comments please mention in the

remark column.

Section-I:

Consists of socio-demographic data, it consists of 8 items for obtaining

information about selected base line data.

Section-II:

Structured knowledge question,

PART-I: PRE- CONTEMPLATION

It consists of 6 questions for evaluating the knowledge on hypertension.

PART-II: CONTEMPLATION

Consists knowledge questions on stroke. It consists of 4 questions on

knowledge of Stroke.

PART-III: PREPARATION

It consists of 4 questions on prevention of stroke.

INTERPRETATION OF COLUMN:

Column 1- Relevant

Column-2 Needs modifications

Column-3 Not relevant

Section-III:

KNOWLEDGE PRACTICE QUESTIONNAIRE- CHECKLIST

Consists of 22 items on knowledge practice

62

SECTION I: SOCIO DEMOGRAPHIC DATA

SL.NO RELEVANT NEEDS

MODIFICATION

NOT

RELEVANT

REMARKS &

SUGGESTIONS

1.

2.

3.

4.

5.

6.

7.

SECTION- II STRUCTURED KNOWLEDGE QUESTION

PART-I Knowledge questions on hypertension

1.

2.

3.

4.

5.

6.

PART-II Knowledge questions on stroke

7.

8.

9.

10.

PART-III Prevention of stroke

11.

12.

13.

14.

63

Section-III:


SL.NO RELEVANT NEEDS

MODIFICATION

NOT

RELEVANT

REMARKS &

SUGGESTIONS

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

64

LETTER SEEKING PERMISSION

65

LETTER SEEKING RESEARCH PERMISSION

66

LIST OF EXPERTS

Mr. Basavant. Dhudum Prof. (Mrs). Suchitra. Rathod

Associate.Prof D.Y. Patil‟s College of Nursing,

Dept.Medical Surgical Nursing, Kasaba Bawada,

Bharati Vidyapeeth College of Nursing, Kolhapur.

Sangli.

Prof. Prasanna. Deshpande Mrs. Preeti. Bhupal

Prof & Principal Prof & HOD Medical Surgical Nursing ,

KLE‟S Institute of Nursing Sciences, KLE‟S Institute of Nursing Sciences,

Anokola. Belagavi.

Prof. (Mr). Samuel Fernandis Dr. Sanjay. M. Peerapur

Pricipal Principal

HOD Dept. Medical Surgical Nursing KLE‟S Institute of Nursing Sciences,

Miraj Medical Center, Miraj. Hubli.

67

SECTION 1

SOCIO DEMOGRAPHIC PROFORMA

1. Age in years [ ]

2. Education [ ]

3. Occupation [ ]

4. Monthly income of the family in rupees [ ]

5. Type of family

a) Nuclear [ ]

b) Joint [ ]

6. Diet

a) Vegetarian [ ]

b) Mixed diet [ ]

7. Any family history of hypertension

a) Yes [ ]

b) No [ ]

68

SECTION -2

STRUCTURE KNOWLEDGE QUESTION

INSTRUCTIONS:

Dear participants

1. Kindly read the following questions and follow the instructions.

2. Select and tick the most appropriate answer from options given

below each question.

3. Please note that it is important to answer to all questions.

4. Correct answer will be scored 1 mark and wrong answer is scored

0 marks.

CODE NO :- DATE :-

PART-I: PRE- CONTEMPLATION

1. Hypertension leads to

a) Cancer [ ]

b) Shock [ ]

c) Stroke [ ]

d) Tuberculosis [ ]

2. Does smoking lead to

a) Kidney Failure [ ]

b) Stroke [ ]

c) Liver Failure [ ]

d) Respiratory Failure [ ]

69

3. What is hypertension commonly called as?

a) Stunt killer [ ]

b) Stealing killer [ ]

c) Secret killer [ ]

d) Silent killer [ ]

4. Which is the important way for Stress management?

a) Proper rest [ ]

b) Healthy diet [ ]

c) Listen to music [ ]

d) All the above [ ]

5. A measure to maintain healthy weight

a) Drink plenty of fluids [ ]

b) Proper rest and sleep [ ]

c) Physical activity [ ]

d) All the above [ ]

6. Regular blood pressure monitoring is done to

a) Detect the early symptoms of complications [ ]

b) Start the medication [ ]

c) Get checked only when you get sick /illness [ ]

d) Get checked every for every 6months [ ]

70

PART-II: CONTEMPLATION

7. What is stroke?

a) Heart attack [ ]

b) Liver failure [ ]

c) Brain attack [ ]

d) Kidney failure [ ]

8. How does stroke happen?

a) Blood clot in the brain [ ]

b) Blood clot in the heart [ ]

c) Blood clot in the kidneys [ ]

d) Blood clot in the lungs [ ]

9. What are the main symptoms of stroke?

a) Headache, nausea and vomiting [ ]

b) Fever, nausea and seizure [ ]

c) Diarrhea, fever and coma [ ]

d) All of the above [ ]

10. How hypertension produce stroke?

a) It strains, weakens and damages the blood vessels [ ]

b) It relaxes the blood vessels [ ]

c) It increases the cholesterol level [ ]

d) It increases the hemoglobin level in the blood [ ]

71

PART-III: PREPARATION

11. The salt intake of hypertensive patients should be

a) Stopped [ ]

b) Limited [ ]

c) Increased [ ]

d) Sodium intake is not related with Hypertension [ ]

12. Which is the diet not suitable for high blood pressure?

a) Fruits [ ]

b) Dairy foods [ ]

c) Mixed diet [ ]

d) Salty foods [ ]

13. How many hours a person must sleep in a day?

a) 4-5 hours [ ]

b) 6-7 hours [ ]

c) 7-8 hours [ ]

d) 9-10 hours [ ]

14. The daily recommended minutes of exercise to maintain normal blood

pressure is

a) 10-20 minutes [ ]

b) 20-30 minutes [ ]

c) 30-40 minutes [ ]

d) 60-70 minutes [ ]

72


Content

Yes No Not

Applicable

1. I take prescribed medications regularly in

time.

2. Taking prescribed medication helps to

maintain normal level of blood pressure

3. I always undergo routine health checkup.

4. A person must drink minimum 8 glasses of

water a day

5. I perform 30 minutes of moderate exercise

daily in a week for (5days).

6. A person has to do exercises 3 to 4 times in

a week.

7. I check my weight regularly.

8. I always take low fatty foods only.

9. Frequent consumption of junk foods affects

in maintaining normal blood pressure.

10. I always follow the food timings regularly.

11. I include fruits and vegetables in my diet.

12. I include 1-2 (0.35grams) table spoon of salt

in my diet.

73

13. Reducing the salt intake helps to control

high blood pressure.

14. I eat a balanced diet.

15. I will limit the alcohol intake.

16. I will quit smoking.

17. I will cut back on coffee.

18. I will do meditation to reduce my stress

level.

19. A person who is diagnosed with high blood

pressure should avoid lifting weight or

heavy objects.

20. A person with stroke needs immediate

hospitalization.

21. Lifestyle modification is the first step in

managing normal blood pressure

22. I will do activities such as walking and

gardening to increase physical activity

levels.

Scoring and Interpretation

The tool consisted of 14 items on knowledge, 22 items on practice checklist. Each

right answer carried „1‟ mark and wrong answer carried „0‟ mark. Further

categorization of the level of knowledge was done as following as

74

Inadequate knowledge 0-4

Moderate knowledge 5-9

Adequate knowledge 10-14

SCORING AND INTERPRETATION OF PRACTICE

Knowledge questionnaire practice checklist

Good 15-22

Average 7-14

Poor 0-6

KEY ANSWERS

SECTION-2 STRUCTURE KNOWLEDGE QUESTION

1-C 8-A

2- B 9-D

3-D 10-A

4-D 11-B

5-D 12-D

6-C 13-C

7-C 14-B

75

LESSON PLAN

Name of the teacher : Miss. KOTAPURI. PRATHYUSHA

Topic : Prevention of Stroke among early detected Hypertensive patients.

Group : Patients attending the OPDs (Medicine OPD)

Place : Tertiary Care Hospital Dharwad.

Method of teaching : Lecture cum discussion

AV Aids : Flash cards, Charts and Banners.

Time : 45 Minutes

GENERAL OBJECTIVES:

At the end of the teaching the patient will be able to gain in depth knowledge and practice regarding prevention of stroke.

SPECIFIC OBJECTIVES:

At the end of teaching patient will be able to :

Explain review of anatomy and physiology of brain and heart.

Definition of hypertension

Lists the causes of hypertension

Explains the signs and symptoms of high blood pressure

76

Enumerates the complication of hypertension

Definition of stroke

List out the causes of stroke

How hypertension causes hemorrhagic stroke

Enlist the symptoms of stroke

Explain the preventive measures for stroke.

77

SPECIFIC

OBJECTIVES

CONTENT TEACHER’S

ACTIVITY

LEARNER’S

ACTIVITY

A.V AIDS EVALUA

TION

2

minutes

Introduces the topic

INTRODUCTION

Life style diseases are set of diseases usually

related to our changing urban way of life. The

Important factors contributing to these disorders

are two much work, too much stress, round the

clock working hours, bad eating habits, and

sedentary life with little or no exercise. In many

diseases our life style may be an important

causative factor or may aggravate there disease.

One of the important life style related disease is

hypertension.

Introduces the

topic

Listens and

participates in

discussion

78

4minutes Explains the

anatomy and

physiology of brain

and heart

ANATOMY AND PHYSIOLOGY OF

BRAIN AND HEART

BRAIN

The brain, together with the spinal cord,

makes up the Central nervous system (CNS).

This is the „control centre‟ that coordinates

the body‟s function. The human brain is

hugely interconnected but three major

components can be identified: The Cerebrum,

Brainstem, and Cerebellum. This is the

„control centre‟ that co ordinates the body‟s

function.

Explains the

anatomy and

physiology

Listens and

observes the

flash card and

chart

Flash

cards,

charts

What are the parts of the brain?

79

HEART

The heart is a hollow organ that pumps blood

throughout the blood vessel by repeated,

rhythmic contraction. The adult human heart has

mass of between 250 and 350 grams and is

about the size of a fist. It is situated in the left

side of chest cavity. The average human heart,

beating at 72 beats per minute. The main

function of heart is circulation.

80

BLOOD PRESSSURE

Blood pressure is the force of blood pushing up

against the blood vessel walls. The higher the

pressure the harder the heart has to pump and it

increases the work load of heart.

A blood pressure reading appears to be 2

numbers. The first and higher of the two is a

measure of systolic pressure is the peak pressure

in the arteries, which occurs near the end of the

cardiac cycle when the ventricles are

contracting. Diastolic pressure is the minimum

pressure in the arteries, which occurs near the

beginning of the cardiac cycle when the

ventricles are filled with blood.

The blood pressure usually is measured with a

small, portable instrument called a blood

pressure cuff( sphygmomanometer). Unit is the

millimeters of mercury (mm Hg).

Explaining

Listening

Charts,

flash

cards.

81

2minutes Defines the term

hypertension

HYPERTENSION

Hypertension, also referred to as high blood

pressure, is a condition in which arteries have

persistently elevated blood pressure. Every time

the human heart beats, it pumps blood to the

whole body through the arteries.

High blood pressure is called “silent killer”

because it often causes no symptoms for many

years, even decades.

Recommendations of joint national

committee on prevention detection evaluation,

treatment of high blood pressure, the

classification of blood pressure for adults aged

18 years or older as follows.

Defines the

term

hypertension

Listens and

observes the

chart and

flash card

Charts,

flash

cards.

What is hypertension?

82

People with more than two blood pressure

readings of 140/90 or higher, are said to have

high blood pressure. If the pressure remains

high, your doctor will probably begin treatment.

2minutes Lists the causes of

hypertension CAUSES

The exact causes of hypertension are usually

unknown these include:

Obesity or being overweight

Diabetes

Smoking

Sedentary lifestyle

Lack of physical activity

High levels of salt intake

Insufficient calcium, potassium, and

magnesium consumption

Vitamin D deficiency

High levels of alcohol consumption.

Explains the

causes of

hypertension

Listens

observes the

flash cards

Flash cards

List down the causes of hypertension?

83

Stress

Aging

Medicines such as birth control pills

Genetics and a family history of

hypertension

Chronic kidney disease

Adrenal and thyroid problems or tumors

2minutes Lists the symptoms

of high blood

pressure

SYMPTOMS OF HIGH BLOOD

PRESSURE

One of the most dangerous aspects of

hypertension is that may not know that you have

it. The main symptoms are severe headache,

dizziness, blurred vision.

Explains the

symptoms of

hypertension

Listens and

observes

charts

charts List down the symptoms of high blood pressure.

84

3minutes Discusses the

complications of

hypertension

COMPLICATIONS

One of the main complication which occur due

to uncontrolled hypertension is stroke. The main

organs affected by hypertension are heart, eye

and kidney.

Enumerates

the

complications

of

hypertension

Listens and

observes

charts

charts List down the complications.

85

3minutes Defines the term

stroke STROKE

Stroke is the second leading cause of death

worldwide.

A stroke. Or cerebrovascular (CVA) is the

Rapid Loss Of Brain Function Due To

disturbance in the blood supply to the brain.

This can be used due to ischemia (lack of blood

flow ) caused by blockage (thrombosis, arterial

embolism ), or a hemorrhage.

Stroke is a medical emergency and can cause

permanent neurological damage and death. High

blood pressure is the most important modifiable

risk factor of stroke.

The patient may suddenly lose the ability to

speak, there may be memory problems, or one

side of the body can become paralyzed. If a

person has paralysis on right side of body, left

side of brain is affected.

Defines stroke Listens and

observes

charts

chart What is stroke?


incidence INCIDENCE

According to WHO, high blood pressure

contributes more than 12.7 million of stroke

worldwide .Stroke deaths in India reached 9.2%

of total deaths

Explains the

incidence

Listens What’s the incidence rate?

7minutes Lists the types of

hypertension TYPES

The two main types of stroke include ischemic

stroke and hemorrhagic stroke.

Explains the

types of

hypertension

Listens and

observes

cards

Flash cards List the types

86

Ischemic stroke accounts for about 87%

of all strokes and is caused by a blood

clot that blocks or plugs a blood vessels

in the brain.

A hemorrhagic stroke caused by a vessel

that breaks and bleeds into brain

HOW HYPERTENSION CAUSES

STROKE:

ISCHEMIC STROKE HEMORRHAGIC

STROKE

High blood pressure

deposits the

cholesterol in the

walls of the brain

blood vessels.

Blood supply started

High blood pressure

causes weakness of

the blood vessel wall

in the brain.

Blood vessel wall

87

to reduce. Blood cells

trapped over the

cholesterol deposited

area.

Gradually, blood

vessel perimeter

reduces.

stretch and become

balloon shaped.

Continues high blood

pressure rupture the

weakened blood

vessel.

Alteration in the blood supply of brain causes in

metabolism changes within 30 seconds

Metabolism interrupted within 2 min

Brain cells activity reduced and dies within

5min

3minutes Discuss the

symptoms SYMPTOMS

a) Face dropping

b) Arm/leg weakness,

c) Speech difficulty

d) Paralysis or numbness in any part of the

body

e) Nausea and vomiting

f) Difficulty in walking

g) Irregular breathing

h) Loss of consciousness

Discusss the

symptoms

Listens and

observes

charts

charts List down the symptoms?

88


prevention of

stroke

PREVENTION

Many factors help to reduce blood pressure

there by preventing the risk of stroke.

1.DASH-DIET PLAN

a) The DASH eating plan is based on2000

calories a day.

b) The low salt dietary approaches to stop

hypertension on are proven to lower

blood pressure<2g/day Sodium),(5g/day

Salt) in adults. This diet is not only rich

Explains the

prevention of

stroke

Listens and

observes

cards

Flashcards,

charts

List down the prevention?

89

in proteins, nutrients and fiber.

c) Diet rich in proteins are cereals, ground

nuts almonds, skinless chicken, fish ,

leafy vegetables like Spinach, Palak,

cauliflower , fenugreek leaves , raddish

leaves.

d) Drink plenty of water at least 10 glasses.

e) Diet rich in potassium are tomato,

watermelon, banana, and green

vegetables.

f) Diet rich in Calcium are milk and milk

products, leafy vegetables etc.

g) Diet rich in magnesium are nut such as

almonds, legumes, green leafy

vegetables, brown rice, banana.

FOOD GROUP DAILY INTAKE

Whole Grains 6 Ounces (6-8/day)

Vegetables 3-4 half cups(4-

5/day)

Fruits 4 Half cups (4-5/day)

Low fat /Non-fat

milk

2-3 cups

Lean meats,

fish/poultry

3-6Ounces (6/fewer

per day)

Nuts, seeds and dried

beans

3Ounces per week (4-

5/weeks)

Oils 2teaspoons (2-3/day)

90

DRUG :

You should always take blood pressure

medications as prescribed by the

physician.

Never skip a dose/ abruptly stop taking

your blood pressure medications.

Suddenly stopping blood pressure drugs,

can cause a sharp increase in blood

pressure (rebound hypertension).

Daily maintain the timings while taking

medication and report to the physician if

any side effects like Giddiness/Vertigo,

Headache.

2. EXERCISE REGULARLY

People should be indulged in normal physical

activities to get significant healthy benefits.

Exercises will lower blood pressure by an

average of 5-10mmHg.Daily exercising for 20-

30 minutes very good. Some of the regular

exercises which can be done regularly.

AEROBIC EXERCISES:

These are the activities involving large

muscles done for the extended period of time,

that makes the lungs and heart work for harder.

It can be done for weight loss, also will provide

cardiovascular benefits. Examples are walking,

cycling swimming, jogging etc. for 5-

91

7days/week.

3.QUIT SMOKING

Smoking increases blood pressure because

Nicotine is a stimulant and it narrows the lumen

of blood vessels. Smoking raises blood pressure

from 5-10mmHg or more

4.REDUCE STRESS

a) Go for a walk 30-45 minutes/day

92

b) Call a good friend

c) Listen to music

d) Drink cup of coffee

5.REDUCE SALT INTAKE

Obesity can lead to disease such as diabetes

mellitus type2, high blood cholesterol. The body

mass index (BMI) should be 20-25. If BMI is

calculated as wt./ht m2.

The most effective method for weight loss is

reducing the number of calories consumed while

burning the calories through physical activity.

You can achieve this either by cutting back on

your food intake, by increasing physical

activity, or ideally, by doing both.

6.MANAGING HIGH BLOOD PRESSURE

High blood pressure usually has no warning

signs. Therefore, it is important that you have

93

regular blood pressure checks. Regular blood

pressure monitoring is done to detect the early

symptoms of complications.

7.LIMIT THE INTAKE OF ALCOHOL

Alcohol is a targeted culprit in boosting blood

pressure hypertension makes your heart work

harder than the normal, increase the stress on

your heart muscle which, cause irregular

heartbeats high blood pressure can also lead to

putting you at high risk for stroke.

94

8.GET ENOUGH SLEEP

In a recent study, both systolic and diastolic

blood pressure was higher in people who slept

less than 8 hours at night. Sleep helps to

regulate stress hormones and maintains health of

nervous system.

2minutes CONCLUSION

Hypertension can be controlled by the life style

modification. The health should be maintained

by person to avoid ill effects, because

prevention is better than cure.

BIBILOGRAPHY

1. Lewis text book of medical surgical nursing

(13th edn)Elsevier New Delhi, (2013)1466-

1489

2. Brunner and Siddarth medical surgical

nursing (10th edn) LWW

Philadelphia,(2007),1891-1971

95

3. Joyce M. Black medical surgical nursing (7th

edn) Elsevier New Delhi, (2007)

4. Nettina. Ms Lippincott manual of nursing

practice (8th edn) jaypee brother medical

publishers New Delhi,(2006),490-493

5.Susan L Woods cardiac nursing. (5th edn) ,

Lippincott Williams & Wilkins Philadelphia.

(2005)

96

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