Download Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1.
NAME OF THE
CANDIDATE AND
ADDRESS
MRS. ANSHY GEORGE,
1ST YEAR, M.SC. NURSING
RATHNA COLLEGE OF NURSING,
B. M. ROAD, HASSAN, KARNATAKA
2.
NAME OF THE
INSTITUTION
RATHNA COLLEGE OF NURSING,
COURSE OF STUDY AND
SUBJECT
MASTER OF SCIENCE IN NURSING,
3.
B. M. ROAD, HASSAN, KARNATAKA
(MEDICAL SURGICAL NURSING)
4.
DATE OF ADMISSION
TO THE COURSE
5.
TITLE OF THE TOPIC
“EFFECTIVENESS OF VIDEO ASSISTED
TEACHING MODULE ON KNOWLEDGE
REGARDING PREVENTIVE MEASURES
OF LUNG CANCER AMONG OLD AGE
PEOPLE IN A SELECTED OLD AGE
HOME
AT
HASSAN
DISTRICT,
KARNATAKA
5.1
STATEMENT OF THE
PROBLEM
“A
STUDY
TO
ASSESS
THE
EFFECTIVENESS OF VIDEO ASSISTED
TEACHING MODULE ON KNOWLEDGE
REGARDING PREVENTIVE MEASURES
OF LUNG CANCER AMONG OLD AGE
PEOPLE IN A SELECTED OLD AGE
HOME
AT
HASSAN
DISTRICT,
KARNATAKA
1
6. BRIEF RESUME OF THE INTENDED STUDY :
6.1 INTRODUCTION :
“You do not heal old age,
You protect it
You promote it
You extend it”.
Sir James sterling Ross ….
Both in developing and developed countries the aging tendency of community
is noticeable. Now a days, the number of people over 65 years is increasing whereas
the birth rate is decreasing. In population of the elderly, the frequency of occurrence
of cancer is the highest. It stands for 61 percentage and 56 percentage for the men and
women respectively. 1Among those patients, the average of cancer appearance is 68 is
men and 67 years in women2.
Lung cancer is one of the commonest malignant neoplasms all over the world.
It is the second leading cause of death has been increasing since 1980 3. It is
predominantly a disease of the elderly 4. At the time of the diagnosis most patients are
older than 65 years and have stage III or IV disease 5. Smoking particularly of
cigarettes is the major cause of lung cancer17. About 90 % of lung cancer cases in men
and 80% in women are attributable to cigarette smoking; and second hand smoke can
be a contributor as well 4.
Additional risk factors of lung cancer may include exposure to random gas and
asbestos fibers, treatment with radiation therapy to the breast or chest, selected
pulmonary diseases like T.B. and COPD, dietary factors etc. Risk also increases in the
elderly because of the age related decline in cellular DNA repair 4. The most
important cause of lung cancer is exposure to tobacco smoke through active or
passive smoking 7. India is the largest producer and consumer of tobacco. The country
has a long history of tobacco use in the form of chewing and smoking. Tobacco
related cancers accounts for nearly 50% of all cancers among men and 25% among
women 8.
Lung cancer is 10 times more common in cigarette smokers than non smokers.
Risk is determined by the pack year history (Number of packs of cigarettes used each
2
day multiplied by the number of years smoked) the age of initiation of smoking, the
depth of inhalation and the tar and nicotine levels is the cigarettes smoked 9. The
length of time a person smokes (as well as rate of smoking) increases the chance of
developing lung cancer. If a person stops smoking, this chance steadily decreases as
damage to the lungs is repaired and contaminant particles are gradually removed. In
addition, there is evidence that lung cancer in never smokers has a better prognosis
than in smokers and that patients who smoke at the time of diagnosis have shorter
survival times than who have quit 6.
Beyond being the most common form of cancer, lung cancer is also often
difficult to treat. Although lung cancer is difficult to treat and cure it is for the most
part preventable. Life style choices can be made which can almost eliminates the risk
for getting the disease 10. Quitting smoking and to eat a healthy diet, featuring plenty
of fresh fruits and vegetables can greatly decrease the risk; Other things people can do
to reduce the risk of lung cancer include ; avoid second hand smoking, making ones
home safer by testing for random and reduce exposure; discussing the need for any
chest X-ray with doctor and avoid the use of unnecessary diagnostic X-ray’s 11
Knowing the facts about lung cancer; will help the old age people to reach the
ultimate, that is prevention is better than a pound of cure’
3
6.2 NEED FOR TH STUDY :
Lung cancer is a major health problem world-wide 7. It is responsible for about
one million deaths per year at present and it will rise to three million per year by the
year 2010 3. The incidence is increasing gradually at a rate of 0.5% per year 6. It
remains the most lethal form of cancer in men and now surpassed breast cancer in
women 2. The overall risk of developing lung cancer during one’s life time is 1 in 13
for men and 1 in 16 for women 12.
There is a great variation in the prevalence of lung cancer in different
geographical areas. Nearly 70% of all the new cases of lung cancer in the world occur
in the developed countries. U.S.A., Canada, Newzeland and Europe have the highest
incidence ( 50 per 10
5
population) followed by China, Ireland, Spain and Australia
with a moderate incidence (35 – 50 per 10 5 population) and low incidence (35 per
10
5
population) countries include Uthah, Latin America, Norway, Sweden and
Iceland 3. The American cancer society estimate that 171,600 new cases will be
diagnosed and 158,900 lung cancer related deaths occurred in 1999 17.
Across the developed world almost 90% of lung cancer deaths are caused by
smoking 6. Between 1980 and 1998 lung cancer mortality rates decreased for persons
younger than 55 years and increased for those older than 65 years, reflecting
generational patterns in smoking prevalence
13
. In people between 65 years and 84
years of age 35% to 38% of men and 21% to 32% of women have reported smoking
and drinking 16.
The National cancer registry programme of the Indian Council of Medical
Research, which collected data form six different parts of the country, both rural and
urban areas. While cancer of the trachea, bronchus and lungs was the most common in
Madras, third in Bangalore, sixth in Bombay and seventh rank in Bhopal 3. In Polland
about 20,000 people including 15,000 of men die of lung cancer every year and in
Japan 45,927 men and 17,307 women dying form lung cancer in the year 2006 15.
P. Notani and L.D. Sanghvi conducted a retrospective study of 520 patients
with lung cancer seen at the Tata memorial hospital between 1963 and 1970. Matched
controls were obtained from those patients who came to the hospital within the same
period and who here diagnosed as not having cancer. An association was found
4
between smoking habit and lung cancer. The relative risk of all types of smokers to
non-smokers is 2 : 45; of bidi smokers 2:64 and cigarette 2 : 23. The researchers
concluded that there is a preponderance of the group of epidermoid Carcinomata
among smokers as against adeno- Carcinomata 17.
A study conducted by Eduardo De Stephani in Uruguay to examine whether
dietary fat and cholesterol modifies lung cancer risk. The case control study was
conducted on 426 men with lung cancer and 419 hospitalized frequency matched
controls. Dietary patterns were assessed using a 64 item food frequency questionnaire,
which allowed the calculation of total energy intake. The result reveals that Aden
carcinoma of the lung was associated strongly with saturated fat intake, whereas small
cell lung cancer was associated with dietary cholesterol 19.
Richard Peto etal conducted a retrospective Proportional mortality study of
one million deaths; on emerging tobacco hazards in China, subjected one million
people who had died during 1986 – 88, whose families could be intervied. The result
showed that the lung cancer rates at ages 35 – 69 years were about three times great in
smokers as in non-smokers. The researchers conclude that the death rate in smokers
and non smoker; 1 in 4 smoker 4 smokers would be killed by tobacco 20.
Cardenas V. M.
conducted a study on ‘Passive smoking and lung cancer in
Chandiagarh, India to asses the relationship between exposure to environmental
tobacco smoke (ETS) and lung cancer in non-smokers. The case control study consist
of 58 non smoking histological confirmed lung cancer patients and 2 controls for each
cases were selected. Multivariate logistic regression analysis was used to asses the
effects of the ETS exposure variable on lung cancer. The result suggests that ETS
exposure may be a strong risk factor for lung cancer in India, and exposure in vehicles
also was detected as a risk factor of lung cancer in non smokers 21.
However ; improvements in the prevention and early detection and treatment
of disease have had noticeable impact on the health of the old age people
16
. It is
assumed that old age people are the role models to the future generation and the
young generation tend to acquire healthy habits easily from their grand parents.
Therefore; the study aims at improving the level of knowledge about the preventive
measures of lung cancer with the purpose of assisting them to adopt a healthy life
style and thus promote and protect their health.
5
As prevention is better than cure; the investigator feels that the is a need for
this study.
6.3 STATEMENT OF THE PROBLEM :
A study to asses the effectiveness of video assisted teaching module on
Knowledge regarding preventive measures of lung cancer among old age people in a
selected old age home at Hassan District, Karnataka.
6.4 OBJECTIVES :
1. To asses the knowledge of old age people as measured by a pre test in relation
to preventive measures of lung cancer.
2. To develop and implement video assisted teaching module on preventive
measures of lung cancer among old age people.
3. To asses the effectiveness of the video assisted teaching module in terms of
knowledge gain as measured by post test.
4. To find out the association between the level of knowledge and selected
demographic variables.
6.5 HYPOTHESIS :
H1 : There will be significant difference in the level of knowledge of old age
people who have received video assisted teaching module on preventive measure of
lung cancer.
H2 : There will be significant association between the level of knowledge of
old age people and the demographic variables.
6.6 ASSUMPTIONS :
The study assumes that
1. The old age people have some previous knowledge regarding preventive
measures of lung cancer gained through mass media, health team workers,
relatives and others.
2. Video assisted teaching module will enhance the knowledge of old age
people regarding preventive measures of lung cancer.
6
6.7 OPERATIONAL DEFINITIONS :
1. Assess : An activity to estimate the outcome of video assisted teaching module
on knowledge regarding preventive measures of lung cancer among old age
people.
2. Effectiveness : It is defined as a significant increase in the level of knowledge
of old age people regarding preventive measures of lung cancer, which is
measure from the response of pre-test, video assisted teaching module and also
post test.
3.
Video assisted teaching module : In this study video assisted teaching module
refers to the systematic, planned teaching with the help of video on preventive
measures of lung cancer for old age people.
4. Knowledge : It is defined as the correct response to knowledge questions as
measured by structured interview schedule and quantified as knowledge score
about preventive measures of lung cancer.
5. Preventive measures of lung cancer : refers to avoidance of risk factors which
causes lung cancer.
6. Old age people : Old age people with the age group of 60 years and above who
are staying in an old age home at Hassan District.
6.8 CRITERIA FOR SAMPLE SELECTIONS :
Inclusion Criteria :
1. Old age people who are staying in an old age home at Hassan District.
2. Old age people who can understand and speak Kannada.
3. Old age people who are willing to participate in the study.
Exclusive Criteria :
1. Old age people who are not willing to participate in the study.
2. Old age people who are not present at the time of study.
6.9 DELIMITATION OF THE STUDY :
1. The study is delimited to the old age people who are staying in an old age
home at Hassan District.
2. The study period is limited to 4 – 6 weeks of duration.
7
3. No attempt was made for follow up intervention after the post test.
4. Sample size is delimited to 50 old age people.
5. The study design is delimited to Quasi experimental study with
randomization and manipulation and without control group.
6.10 CONCEPTUAL FRAME WORK :
Becker’s health belief model was applied in this study.
6.11 REVIEW OF LITERATURE :
A review of literature is important for developing a broad conceptual context,
in to which research problem fit. The review also serves the essential function of
providing the individual researcher, with a perspective on the problem necessary,
for interpreting the result of the study.
Prasad R etal has done a study (2009) on “Comparison between young and old
patients with bronchiogenic carcinoma”. The present study was conducted on 799
consecutive histopathologically proven cases of bronchiogenic carcinoma that
were reffered from different parts of Uttar Pradesh. The mean ages of the subject
in the younger and older patients groups were 36and 58 years respectively.
Among the older patients 590 (81.3%) were smokers and 53 (72.6%) were
younger patients. The result showed that squamous cell carcinoma was more
frequently diagnosed in older patients than a younger patients 22.
Pavlovska I etal (2009) conducted a study on “Tobacco use and the risk of
lung cancer in Macedonia”. The case control study was conducted in 91 patients
with lung cancer and 9 patients without malignant disease. The result of the study
revealed that cigarette smoking is wise spread among men with lung cancer
(68%), while in control group 40.3%. The study supports the statement that
cigarette smoking is by far the most important risk factor of lung cancer. The
researchers concluded that concerted control of smoking appears to be an
important priority of lung cancer prevention 23.
Hosseini M, Karmi S, Naghan PA has done a study (2009) on “Environmental
risk factors for lung cancer in Iran. The case control study consist of 242 patients
with lung cancer and 2 controls for each patients were interviewed using a
8
structured questionnaire on potential risk factors for lung cancer. From the result
of the study it is clear that smoking was the strongest correlate of lung cancer and
occupational exposure were also a independent risk factor for lung cancer 24.
An article published in Top News on (2008) regarding a study conducted by
Piyush Diwan on “Fruits, Veggies lessen lung cancer risk in smoker”, recruited
558 people having lung cancer and 837 people who did not have lung cancer.
After making a thorough analyses of
their dietary history, the researcher
discovered that tobacco smokers can lessen their lung cancer risk by consuming
three servings of fruits and vegetables and drinking green or black tea on a daily
basis 25.
An article published in Times of India (2008) regarding “Broccoli may cut
lung cancer risk” a study conducted by Li Tang. Li and Colleagues conducted a
hospital based, case controlled study with lung cancer cases and controls matched
on smoking status. The study included all commonly consumed cruciferous
vegetables and also raw vs cooked form and the researchers found cruciferous
vegetables may play a more important role in cancer prevention among people
exposed to cigarette smoking 26.
Lam TH etal (2007) conducted a prospective study on “Smoking, Quitting and
mortality in an elderly cohort of 56,000 Hong Kong Chinese aged 65 years or
greater enrolled from 1998-2000. After a mean follow up 4.1 years, 1848 males
and 2035 female deaths occurred among 54,214 subjects. The study shows the
result that quitters had significantly lower risk of death than current smokers from
all causes; lung cancer, stroke etc. The investigators concluded the study that in
old age, smoking continues to be a major cause of death and quitting is beneficial.
Smoking cessation is urgently needed in rapidly aging population in the east 27.
Bae J etal (2007) conducted a study on “Cigarette smoking, alcohol
consumption, tuberculosis and risk of lung cancer” in a Korean cohort. The study
subjects comprised 13,150 male & female aged above 20 years old. Coxproportional hazards models were used to estimate relative risk (RR) and 95%
confidence intervals (CI). The result showed that cigarette smoking was
confirmed as a risk factor of lung cancer; alcohol and T.B. may b associated with
the risk 28.
9
Sankaranarayanan R. Cherian Varghes and Stephen W. Duffy (2006)
conducted a study in Kerala, South India on “Diet and lung cancer in India”. The
case control study consist of 281 male patients with lung cancer and 1281 hospital
visitor controls completed at a 45 item food frequency questionnaire and were
analyzed by multiple logistic regression producing odds ratio estimates of the
relative risk and deviance chi squared test of significance. The researchers
concluded that an increase in the consumption of green and yellow vegetables and
a reduction in the consumption of animal products may help to prevent epithelial
cancers, including lung cancer 29.
Yun YH etal (2005) conducted a prospective cohort studies of lung cancer, on
“relative and absolute risk of cigarette smoking on major histologic types of lung
cancer in Korean men; The study consist of 437, 976 korean men aged 40 or
greater; who were free of cancer and smoking related chronic disease at the time
of enrollment. During 6 years follow up period 1,357 new lung cancer cases were
identified. Based on multivariate adjusted relative risk, the strongest association
with smoking was shown for small cell lung cancer. (RR, 21.7; 95% CI = 8.0 –
58.5) squamous cell carcinoma (RR – 11.7, 95% CI = 7.1 – 19.4) & adeno
carcinoma (RR = 21, CI 9% = 1.6 – 2.7) The researchers concluded that in Korean
men cigarette smoking was an important risk factor for lung cancer 30.
Jianjun Zhang, Elizabeth HM Temme and Hugo Kesteloot (2000) conducted a
study to investigate the relation between fish consumption and lung cancer
mortality at the population level. Sex specific lung cancer mortality data, mostly
around 1993 and fish consumption data for 10 periods 1961 – 1994 in 36 countries
were obtained from WHO & FAO respectively. The result reveals that there is a
significant inverse correlation exist between log fish consumption and lung cancer
mortality rate in 9 out of the 10 time periods. The researches concluded the study
that fish consumption is associated with a reduced risk from lung cancer mortality,
but this possible protective effect is clear cut in men and in countries with high
level of cigarette smoking or animal fat consumption 31.
10
7 MATERIALS AND METHOD OF STUDY
7.1 SOURCE OF DATA COLLECTION :
Data will be collected from the old age people those who are staying in an old age
home at Hassan.
7.2 RESEARCH DESIGN :
Quasi experimental research design was chosen for the study. (Manipulation
& randomization without control group)
Schematic representation of Research Design :
Pre Test
E
01
Post Test
X
02
Key words:
E
–
Experimental group
01
–
Assessment of the old age people’s knowledge regarding preventive
measures of lung cancer before the administration of video assisted
teaching module.
X
–
Video assisted teaching module on preventive measures of lung cancer.
02
-
Assessment of the old age people’s knowledge regarding preventive
measures of lung cancer after the administration of video assisted
teaching module.
7.3 METHOD OF COLLECTING DATA :
Data collection is planned through using a structured interview schedule on
their knowledge regarding preventive measures of lung cancer.
Part A : Demographic variables include age, sex, religion, influence of the
mass media and life style practices.
11
Part B : Structured questionnaire on knowledge regarding preventive measures
of lung cancer.
Part C : Video assisted teaching module on preventive measures of lung
cancer.
7.4 SAMPLING PROCEDURE :
1.
Population : Old age people those who are staying in an old age home at Hassan.
2.
Sample : Old age people those who fulfill the inclusion and exclusion criteria.
3.
Sample Size : Total sample size is 50 old age people.
4.
Sampling Technique : Convenient sampling technique will be used.
5.
Setting : The setting selected for the study is a selected old age home at Hassan
District.
6.
Pilot Study : 10 percent of the population size is planned for the pilot study.
8. VARIABLES :
8.1 Independent Variable : Video assisted teaching module on preventive measures of
lung cancer.
8.2 Dependent Variable : Knowledge towards preventive measures of lung cancer.
9. PLAN FOR DATA ANALYSIS :
It includes descriptive and inferential statistics.
1. Descriptive Statistics : To describe the demographic variables and level of
knowledge number, frequency, percentage, mean and standard deviation.
2. Inferential Statistics : Chi square test will be used to test the association
between the knowledge and demographic variables. The effect of video
assisted teaching module on preventive measures of lung cancer can be tested
by paired ‘t’ test.
12
10. ETHICAL CELARNACE:
1. Informed consent will be obtained from the chosen sample?
Yes
2. Has ethical clearance being obtained from the institution?
Yes
3. Does the study require any intervention to be conducted on old age people ?
Yes
13
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