1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1

NAME OF THE

CANDIDATE AND

ADDRESS

Mr. BASIL VARGHESE

BGS COLLEGE OF NURSING

KUVEMPUNAGAR,MYSORE

2. NAME OF THE

INSTITUTION

BGS COLLEGE OF NURSING

KUVEMPUNAGAR,MYSORE

3. COURSE OF THE STUDY

SUBJECT

DEGREE IN MASTER OF NURSING

MENTAL HEALTH NURSING

4. DATE OF ADMISSION TO

COURSE

30-6-2011

5.

TITLE OF THE TOPIC

A STUDY TO ASSESS TO EFFECTIVENESS OF SELF

INSTRUCTIONAL MODULE ON KNOWLEDGE ON ALCOHOL AND ITS

PREVENTION AMONG DRIVERS IN SELECTED BUS DEPOT AT MYSORE.

2

6 BRIEF RESUME OF INTENDED STUDY

INTRODUCTION:

If u drink, don’t drive, don’t even putt-

Dean Martin

Alcohol has been one of the most commonly used chemical substances for

intoxication by man since time immemorial. The word ‘alcohol’ probably originated

from the Arabic term “al-kuhul”, meaning ‘the kohl’ (powder for the eyes), which

later came to mean ‘finely divided spirit’ .The discovery of late stone age beer jugs

established the act that intentionally fermented beverage existed at least as early as the

Neolithic period (10,000BC).Alcohol has been used for medicinal, social,religious and

recreational purposes across different cultures.1

The word alcoholism and alcoholic were first used by Dr Magnus Huss a

Swedish physician Egyptian Osiris and roman Bacchus were patrons of high power

related to alcohol. The bible sanctioned the social use of wine but it also records divine

commands to abstain. The utilitarian nature of alcoholism for pleasure and pain

emerged during the twentieth century. The ayurvedic texts describe both the

beneficent uses of alcoholic beverages and the consequences of intoxication and

alcohol related diseases.2

Alcoholism is defined as condition in which loses control over his alcohol

intake and is unable to stop drinking once he begins. According to the international

classification of diseases and health problems (ICD-10), “Alcoholism is cluster of

physiological, behavioural and cognitive phenomena in which the use of alcohol takes

on a much higher priorty”3

In world, several organisations are working to stop drunken driving.Mothers

Against Drunk Driving (MADD) is one of the anti drunk driving organizations with

goals to stop drunk driving, support the victims of drunken driving crimes and prevent

under age driving. MADD has helped pass thousands of anti drunken driving laws and

made the use of designated drivers acceptable amongst mainstream society. A popular

anti-drunk driving youth organization is Students Against Drunk Driving (SADD), this

3

organization is a peer to peer education program that aim to prevent alcohol use and

abuse in the united states.26

In India, the anti drunken driving program is ‘Don’t Drink and Drive’ and it is

recognition to prevent the increased death caused due to drunken driving, SAB miller

India has launched this campaign that goes beyond spreading awareness of responsible

consumption to offer a safe solution.26

Global research in the last three decades on road safety promotion has opened

new ways to develop and implement programmes on a scientific basis consequently,

many developed countries have used research data to give directions for road safety

policies and programmes, undoubtedly and this has resulted in a reduction of deaths

and injuries while building safer road environments across the world. With nearly 700

deaths and 7000 injuries (as per official reports) on Bangalore roads, road safety does

not have any systematic directions. With a new mission and commitments

“SURAKSHA SANCHAR (Safer Travel)” was launched in Bangalore during 1999

with the active participation of Bangalore Agenda Task Rode, National Institute of

Mental Health and Neuro Sciences,Global Road Safety Programme,Non

Governmental Organization and citizens of Bangalore.“Reduction of drinking and

driving” is the first major problem under project.25

Alcohol misuse has been implicated in over 20% of traumatic brain

injuries accounted for 60% of all injuries reporting to emergency rooms. Road crashes

involving drinking and driving are a feature of the road-injury of the road injury

profile in many countries .Apart from the adverse influence of alcohol as a contributor

to road crashes, the presences of alcohol in the body of a road crash victim adversely

affects the diagnosis, management, and treatment of injuries. Reduction of drunken

driving rest on political commitment, penalties for drinking and driving offences,

implementing good practice, strong and well published enforcement campaigns, public

education to change attitudes to drinking and driving, strict and swiftly enforce

penalties for those caught breaking the law.4,25

In drunken driving, the main cause of accidents is that they don’t care about

themselves and others. They have done it many times before and never had a problem,

so they are willing to take a risk. Another cause of drunk driving is the difficulty in

4

knowing your level of impairment after consuming a given quantity of alcohol.

Alcohol slows down a person’s reflex and impairs their reasoning while deluding the

drunken driver into believing they are competent to drive and their motor skills

unaffected. Some of them reasons for drunken drink due to job stress, relaxation,

family disharmony, pleasure, lack of control over alcohol, peer pressure.7

6.1 NEED FOR STUDY:

WHO estimates that there are about 2 billion people worldwide who consume

alcohol and 76.3million with diagnosable alcohol use disorders. Alcohol use causes

1.8millon death (3.2%total) and a loss of 58.3%millon disability leading life25

The alcohol consumption in India has changed a lot, India has got 62.5 million

users, age of initiating consumption has declined from 30 to 19 years. More women

have started using alcohol in some parts of the country. The Per captia consumption

has gone up tremendously 106.7% and 2.7lakh people die due to use and abuse of

alcohol every year. About 80% of alcohol consumption is in form of hard liquor. The

prevalence of alcohol use and drinking patterns also changed ,Alcohol is a state

subject under the 7th schedule and it is Prevailed among 12-20% of the population, the

Regular uses are 6-10%,Hazardous users around 5%.Alarming increase in alcohol

related in alcohol related problems, which include health problems, violence, traffic

accidents, injuries, crimes8

Alcohol is a major risk factor for road traffic injuries as it impairs

judgement and increases the possibility of involvement in other high risk behaviours

(eg, speeding, violating traffic rules etc). It also affects vision and poses difficulties in

identifying risks and dangerous situations in the road environment; imbalances

appropriate coordination for manoeuvring the vehicle; diminishes reflexes and

psychomotor performance and delays reaction time to light and hearing. It is also

accompanied by physiological changes such as increased fragility of bones and greater

vulnerability to severe injury and resulting recovery.9

According to national highway traffic safety administration, drivers under the

influence of alcohol often display certain characteristics when they are on the road,

they are perception skills area affected, they are less likely to observe traffic signs,

5

bikers, pedestrians or cars coming from the opposite side, less control on the reactions

in traffic situations ,the eyes are slower and they remain focused more time on the

same objective, they tend to focus more straightforward and don’t look right or left,

reaction time increases and reflexes diminish, it take more time to respond fast and

adapt to traffic stimuli and also difficulty to drive in straight line, sometimes driving

on the wrong side of the road, poor judgement of distances and speed, driving at a very

slow speed or stopping without cause driving after dark with head lights off, tendency

to be over confident and drivers, pedestrians in danger. The human cost of drunken

driving can lead to terrible accidents such as killing someone else, losing life of driver,

imprisonment, criminal records, living with guilt that you injured or caused an

accident, depression, legal costs, increased insurance costs10

A study was conducted under the title "High spirits take toll on Bangalore

roads" on Bangalore reveals that the its highest number of road accident deaths on

weekends between 6.00 p.m. and 10.00 p.m, due to drunken driving and statistics

shows that . In 1994, there were 91 deaths on Sundays, 89 on Saturdays and an

average of 70-80 on week days also, in a project report conducted under the title

driving under the influence of alcohol road traffic injuries in Bangalore done by

NIMHANS in 12 major hospitals of Bangalore over a period of 30 days city reveals

that nearly 28% of traffic injuries were directly attributable to alcohol.3

The National Highway Traffic Safety Administration (NHTSA) reports that

16,000 people are killed annually due to drunk and drugged driving in India. Among

the one million people killed on roads during 2000, nearly 75% occurred in developing

countries of the world with nearly half of them occurring in Asia’s selective

examination of RTIs in the region indicate that they account for the second or third

leading cause of death in the 5-44years age group. In India nearly 80,000 people were

killed and 272,000 injured according to official figures in 2000.5,6,26

Hence from the above data the investigator feels that the prevalence of

alcoholism and related accidents is very high in Indian and it shows the necessity of

providing information regarding alcoholism and related accidents through self

instructional module and evaluates the effectiveness of self instructional module.

6

6.2 REVIEW OF LITERATURE

A study was conducted to assess the prevalence of alcohol and psychoactive

drugs usage among Norwegian motor vehicle drivers.12, 000 drivers were selected by

using stratified two-stage cluster sampling procedure. Samples of oral fluid were

obtained from 88% of the drivers, of whom 30% were females and 70% males. The

study result show that alcohol were found in oral fluid samples of 4.5% of the

drivers.11

A study was conducted in USA to assess the prevalence of alcohol use

disorders among night time drivers. Data was collected from 4614 drivers by using a

15-item AUD(alcohol use disorders) questionnaire. The study result showed that

73.7% were current drinkers, among those drinkers 14% were classifiable either

dependent drinkers, 10% of the drivers were classified as heavy drinkers.12

A case control study was conducted to examine the relationship between the

combination of alcohol and the benzodiazepines and the risk of committing an unsafe

driver action. Data was collected from drivers aged 20 or older by using Fatality

Analysis Reporting System. The study result showed that the drivers who tested

positive for intermediate and long acting benzodiazepines in combination with alcohol

had significantly greater odds of a UDA (unsafe driver action) compared to those

under the influence of alcohol alone. The study concluded that the combination of

alcohol and benzodiazepines can have detrimental effects on driving beyond those of

alcohol alone 13

A study was conducted in USA to assess the drinking characteristics of

drivers arrested for driving while intoxicated. The data was collected from 1027

drivers at the time of arrest apprehended for Driving While Intoxicated (DWI) or

driving under the influence (DUI) on their alcohol consumption. The study results

showed that 52 % of the arrested DWI offenders were considered problem drinkers, 46

% were repeated offenders and 57 % were classified as hardcore drinking drivers. The

study concluded that compared to highly intoxicated drivers killed in traffic crashes,

the high-BAC(blood alcohol concentration) arrestees were more likely to be problem

drinkers and to report drinking and driving more often.14

7

A study was conducted in USA to assess the effects of binge drinking and

socio-economic status on sober driving behaviour. Data were collected from 62

drivers. The study results showed that binge drinkers-independent of their income

levels-exhibited more speeding exceedances and longer speeding duration than those

of non-binge drinkers with a high income. Individuals characterized as non-binge

drinkers with a low income also exhibited more speeding behaviours.15

A cross-sectional descriptive survey was conducted at La Paz, Bolivia, to

characterize the distribution and characteristics of motor vehicle accidents related to

alcohol consumption. Data was collected from 62 drivers and pedestrians, over 15

years old, who were involved in motor vehicle accidents involving alcohol. The study

results demonstrated that 71% of the victims were men, 32.3% were between 21 and

30 years old, and 25.8% were the drivers. 16

A study was conducted in British Columbia to determine the prevalence of

alcohol and drug use among night time drivers. Data was collected from 1533

drivers .The study result showed that 8.1 % of drivers had been drinking, 15.5 % of

drivers tested for alcohol, drugs, or both positive. The study was concluded that

alcohol use among drivers was most common on weekends and during late-night

hours.17

A population-based study was conducted to assess the prevalence and

correlates of drinking and driving in Hong Kong. The data was collected from 9860

adults. The study result showed that males who drank the prevalence of drinking and

driving was 5.0% among those without problem drinking, 14.8% among binge

drinkers, 37.1% among alcohol abusers and 22.4% among the alcohol dependent. For

females who drank, the corresponding figures were all lower at 1.2%, 6.9%, 12.1%

and 12.5%, respectively.18

A Cross-sectional and time-series cross-sectional study was conducted in

Berkeley, USA to assess the influence of on-premise alcohol-outlet densities and of

drinking-driver densities on rates of alcohol-related motor vehicle crashes. The study

result showed that effects relating on-premise densities to alcohol-related crashes were

moderated by highway traffic flow19

8

A study was conducted in Atlanta, Georgia, USA to assess the prevalence

and risk factors for, driving during or shortly after a specific binge drinking episode.

Data was collected from 14,085 drivers by questionnaire. The study result showed that

was overall, 11.9% of binge drinkers drove during or within 2 hours of their most

recent binge drinking episode.20

A study was conducted in Canada to assess driving after drinking. The data

was collected by survey. The study result showed that 11.6% of licensed drivers in

Canada reported operating a vehicle within an hour of consuming two or more drinks

containing alcohol. Less than 5% of licensed drivers accounted for 86% of the more

than 20 million (estimated) past-year drinking and driving occurrences.21

A study was conducted in Belo Horizonte, Minas Gerais State, Brazil to

assess the prevalence alcohol consumption. The data was collected from 913 drivers

by internationally accepted sobriety checkpoint method. The study result showed that

38.0% of drivers showed some trace of alcohol in their exhaled air, and 19.6% were at

or above the legal limit (0.6 g/l).22

A study was conducted in United States to assess the Patterns of alcohol

consumption and alcohol-impaired driving .Data was collected by using Behavioural

Risk Factor Surveillance System (BRFSS) .The study result showed that, binge/non

heavy drinkers accounted for the largest percentage of AI drivers (49.4%), while

binge/heavy drinkers accounted for the most episodes of AI driving (51.3%). The

adjusted odds of AI driving were 20.1 (95% CI: 16.7, 24.3) for binge/heavy, 8.2 (6.9,

9.7) for binge/non heavy, and 3.9 (2.4, 6.3) for non binge/heavy drinkers,

respectively.23

A study was conducted in Mexican-American to assess the determinants of

driving under the influence of alcohol (DUI).Data was collected by using

questionnaires. The study result showed the four mechanisms that may contribute to

the high rate of DUI behaviour in this population were identified: (1) a subculture of

permissiveness toward drinking and driving for men, (2) heavy drinking, promoted by

machismo and a propensity to measure masculinity with alcohol intake, (3) inadequate

knowledge of DUI statutes and inadequate understanding of the relationships between

BAC, impairment, and crash risk, and (4) for undocumented drivers, lack of

accountability in case of an alcohol-related incident.24

9

A study was conducted in Bangalore to assess the highest number of road

accident deaths. The result showed there were 91 deaths on Sundays, 89 on Saturdays

and an average of 70-80 on week days.3

A project report conducted in Bangalore to assess driving under the influence

of alcohol road traffic injuries. The study result reveals that nearly 28% of traffic

injuries were directly attributable to alcohol3

A study was conducted in Bangalore to assess the alcohol and road traffic

injures. The data was collected from among 3051 patients in hospitals. The study

result showed that 29% of night time and 11% of RTIs crashes linked to alcohol .3

6.3 PROBLEM STATEMENT A study to assess the effectiveness of Self instructional module on knowledge

regarding alcohol abuse and its prevention among drivers in selected bus depot at

Mysore.

6.4 OBJECTIVES OF THE STUDY

1) To assess pre test level of knowledge regarding alcohol abuse and its prevention

among drivers in selected bus depot at Mysore.

2) To assess post test level of knowledge regarding alcohol abuse and its prevention

among drivers in selected bus depot at Mysore

3) To assess the effectiveness of Self instructional module on knowledge regarding

alcohol abuse and its prevention among drivers in selected bus depot at Mysore.

4) To associate the level of knowledge regarding alcohol abuse and its prevention

among drivers with selected demographic variables.

6.5 OPERATIONAL DEFINITIONS

1) Effectiveness

10

Effectiveness is the improvement in the post test knowledge scores of bus

drivers after administration of self instructional module on alcohol abuse and its

prevention which are measured and expressed in terms of gaining knowledge

2) Self instructional module

Self instructional module refers to a self contained unit of instruction

consisting the information and instructions regarding alcohol abuse and its prevention.

3) Knowledge

Knowledge refers to correct response regarding alcohol abuse and its

prevention among bus drivers which are measured by scores obtained according to the

correct response to the items on the structured questionnaire.

4) Alcohol abuse

Alcohol abuse refers to the disorder characterized by excessive consumption

and dependence to alcoholic beverages leading to physical and psychological harm,

impaired social and vocational functioning.

5) Drivers

Karnataka State Road Transport Corporation Bus drivers who are working in

selected bus depot at Mysore driving for long distance.

6) Prevention

Prevention refers to the abstinence from alcohol intake and thereby reducing

road traffic accidents among drivers

6.6 CONCEPTUAL FRAMEWORK:

In this study, Betty Neuman -system model theory will be used as a conceptual frame

work

6.7 HYPOTHESIS:

At the level of point 0.05 level of significance

11

H1; there will be significant difference between mean pre test knowledge

scores and mean post test knowledge scores on alcohol abuse and prevention

among drivers in selected depots at Mysore.

There will be significant association between pre test level of knowledge

regarding alcohol abuse and prevention among drivers with selected

demographic variable.

6.8 ASSUMPTIONS:

The researcher assumes that

Bus drivers may have inadequate knowledge regarding alcohol abuse and its

prevention.

Knowledge may vary according to demographic variable.

Self instructional module may improve knowledge on alcohol abuse and its

prevention

6.9 DELIMITATION:

The study is limited to those who are;

Available at the time of study

Driving long distance route.

7 MATERIALS AND METHODS

7.1 Source of data:

Sources of data collection is from bus drivers

7.1.1 Research design:

Pre experimental (One group pre and post-test design)

12

Group Pre-test Intervention/

treatment

Post- test

KSRTC

Bus drivers O1 X O2

O1- Administration of structured knowledge questionnaire to the bus drivers.

X –Administration of self instructional module.

O2-Administration of structured knowledge questionnaire after 7 days of

administration of self instructional module

7.1.2 Research variables

In this study educative and evaluative approach will be used.

7.1.3 Variables:

Dependent variable - knowledge on alcohol abuse and its prevention among

drivers

Independent variable - self instructional module on alcohol abuse and

prevention

7.1.4 Setting:

Study will be conducted at selected bus depots at Mysore

7.1.5 Population:

In the study population are bus drivers working in Mysore.

13

7.2 METHODS OF DATA COLLECTION

7.2.1 Sampling procedure:

In the study non probability convenient sampling is used

7.2.2 Sampling size:

In the study sample size is convenient sampling

7.2.3 Inclusion criteria:

Bus drivers of selected bus depots, Mysore.

Bus drivers who are willing to participate.

Only male drivers

7.2.4 Exclusion criteria:

Bus drivers not present at the time of study.

City bus drivers

7.2.5 Instruments used:

Tool for data collection:

Tool1-Part A: Proforma for collecting demographic data such as age, education,

family background.

Part B: structured knowledge questionnaire regarding alcohol abuse and

prevention.

7.2.6 Data collection method:

In the study data is collected by self administered structured questionnaires

7.2.7 Plan for data analysis:

14

In this study pre and post test scores of knowledge will be analyzed trough the

following technique.

Descriptive statistics: Mean, standard deviation, range and mean score percentage will

be used to qualify the level of knowledge before and after self instructional module.

Inferential statistics: Paired‘t’ test will be used to examine the effectiveness of self

instructional module by comparing the pre test and post test score.

Chi-square test will be worked out to determine the association of socio-demographic

factors of people with pre test knowledge.

7.3 Does the study require any investigation or interventions to be conducted on

patients or other humans or animals, if so please describe briefly?

Yes, the investigator is giving self instructional module to bus drivers.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, the ethical clearance has been obtained from our college that is BGS College of

nursing, also consent will be obtained from particular subjects.

8. BIBLIOGRAPHY:

1. History of alcohol. Available from:http//whoindia.orgLinkfiles:Mental health

&substances abuse alcohol atals3.pdf.

15

2. Shetty K S.Alcoholism, addiction and deaddiction. Manglore.panja

publishers.1998: 126-32.

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reducing impaired driving in developing countries:transport research

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6. Ray R,Sharma H.K.Drug addiction-an Indian perspective.Madras.

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injury.1986;(3): 183-92.

9. Alcohol in India at a new high.Available from:

http://www.indianalcoholpolicy.org/enl/at a new high.html

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http://everettanalyzers.com/effects-of-drinking-and-driving.html

11) Gjerde H.Prevalence of alcohol and drugs among Norwegian motor vehicle

driver. Norwegian Institute of Public Health.2008 Sep;40(5): 1765- 72.

Available from: http://www.ncbi.nlm.nih.gov/pubmed?term=%3A

%2018760106%20%20

12) Furr-Holden CD, Voas RB, Lacey J, Romano E, Jones K.The prevalence of

alcohol use disorders among night-time weekend drivers. Johns Hopkins

University, USA. Addiction. 2011 Jul;106(7): 1251-60. Available from:

http://www.ncbi.nlm.nih.gov/pubmed?term=21342301%20%20

13) Maxwell HG, Dubois S, Weaver B, Bédard M. The additive effects of alcohol

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driving while intoxicated in two police jurisdictions.Pacific Institute for

Research and Evaluation,USA.2010.Oct;11(5): 443-52.Availablefrom:

http://www.ncbi.nlm.nih.gov/pubmed?term=20872298

15) Zhao G,Wu C,Houston RJ,Creager W.The effects of binge drinking and socio-

economic status on sober driving behavior.Department of Industrial and

Systems Engineering,USA.2010Aug;11(4):342-52avaliable

from:http://www.ncbi.nlm.nih.gov/pubmed?term=20730681

16) Traffic accidents and alcohol consumption in an emergency unit of La

Paz,Bolivia.Avaliable from :http://www.ncbi.nlm.nih.gov/pubmed?term=%3A

%2020694432%20%20

17) Beirness DJ, Beasley EE. A roadside survey of alcohol and drug use among

drivers in British ColumbiaTraffic.2010.Jun;11(3):p 215-21.Avaliablefrom

http://www.ncbi.nlm.nih.gov/pubmed?term=20544564%20

18) Kim JH,Lee S,Chan KW,Lau J,Tsang A,Griffiths SM. A population-based

study on the prevalence and correlates of drinking and driving in Hong

Kong.The School of Public Health, The Chinese University of Hong Kong,

2010 Jul;42(4): 994-1002.Avaliable from:

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%2020441805%20%20%20

19) Gruenewald PJ, Johnson FW. Drinking, driving, and crashing: a traffic-flow

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from: http://www.ncbi.nlm.nih.gov/pubmed?term=20230721

20) Naimi TS, Nelson DE, Brewer RD. Driving after binge drinking. Alcohol

Team, Emerging Investigations and Analytic Methods Branch, Division of

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Prevention and Health Promotion, CDC, Atlanta, Georgia, USA.2009

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term=19765503%20

21) Beirness DJ, Davis CG. Driving after drinking in Canada.Canadian Centre on

Substance Abuse, Ottawa, ON, Canada.Can J Public Health. 2007 Nov-

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pageid=23

9 Signature of the candidate

10 Remarks of the guide Study is recommended since it will help

the bus drivers to acquire knowledge

regarding the consequences of alcohol

abuse and there by reducing the

18

prevalence of accidents due to drunken

drive

11 Name and designation of (in block letters)

11.1 Guide Mr.BALACHANDAR S

ASST PROFESSOR,

BGS COLLEGE OF NURSING,MYSORE

11.2 signature

11.3 co-guide (if any)

11.4 signature

12 12.1 Head of the department Mr.BALACHANDAR S

HEAD OF THE DEPARTMENT

MENTAL HEALTH NURSING

BGS COLLEGE OF NURSING,MYSORE

12.2 signature

13 13.1 Remarks of the chairman and principal

13.2 signature