“A qusi experimental study to assess the effectiveness of a pamphlet regarding complementary therapies on Diabetes Mellitus among Diabetic patients in selected Urban areas at Mysore

INTRODUCTION

Diabetes Mellitus is a silent disease and is now recognized as one of the fastest growing threat to the public health in most countries of the World. Every fifth person who suffers from diabetes mellitus in the world today is an Indian. Diabetes Mellitus is a metabolic disease characterized by increased level of glucose in the blood resulting in chronic multisystem disease.⁶ Diabetes Mellitus is the most prevalent disease in the World, and its prevalence is rapidly increasing. An epidemic of Diabetes is starting in India and the country is fast gaining the title of Diabetic capital of the World. It is estimated that around 63 million people have diabetes.⁷ The WHO`s health report 2017 quotes that in India, diabetes disease causes approximately 72 million cases and is expected to double by 2025 to 134 million. According to researchers in 2010, the number of people older than 20 years who were newly diagnosed with diabetes increased by about 1.9 million by 2030 the number of cases expected to exceed 30 million.<sup>8</sup> The age-adjusted prevalence of diabetes is increasing among all genders and race groups. The economic cost of diabetes continuous to increase because of increasing health care cost and an ageing population.<sup>9</sup> According to Indian spend, a public interest journalism initiative founded that diabetes became the country`s fastest growing disease burden over 16 years to 2016. India currently represents 49% of the World`s disease burden. The number of people with diabetes has raised from 108 million in 1980 to 422 million in 2014.The global prevalence of diabetes among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. In 2016; an estimated 1.6 million deaths were directly caused by diabetes. WHO estimates that diabetes was the 7th leading cause of death in 2016.⁸ Healthy diets, regular physical activity, maintaining a normal body weight and avoiding tobacco and fix to certain complimentary therapies use are ways to prevent or delay the onset of diabetes and maintains optimal quality of life in diabetic patients. Increase in the drug dependency and failure of the single drug to control diabetes mellitus are paying way for the dawn of new therapies like complementary therapy which proves to be effective in health aspect as well cost effective and relatively risk free therapy.¹⁰

REVIEW OF LITERATURE:

A Study was conducted to assess the Knowledge, attitude, and practice of complementary and alternative medicine among diabetic patients at Babil, Iraq. This study was carried out with objective to estimate the prevalence of CAM use among diabetic patients and to assess knowledge, attitude, and practice of CAM among diabetic patients. A hospital-based cross-sectional study done at diabetic center of Merjan teaching hospital on 200 patients. The study Results was estimated that the prevalence of CAM use among diabetic patients at Babylon province was 48.5%; the most common type of CAM used by diabetic patients was Herbal products (24.7%), while nutritional supplements and spiritual healing together used by (18.6%) of CAM users, herbal products and nutritional supplements together at rate of (14.4%) and (40.2%) use the 3 types of CAM modalities together. The most common type of Herbal products used by diabetic patients were Garlic which used at (16.9%), while Lemon used by (19.1%) of Diabetic patients, Cinnamon (Darcin) (10.2%), Fenugreek (Helba) (8.8%), (7.3%) bitter gum, and (18.3%) were a mixture of herbs, (7.3%) black seed. (62%) of Subjects had good knowledge about CAM, (28%) had fair knowledge and (10%) poor knowledge. (66%) of CAM users had negative attitudes toward CAM and (34%) had positive attitude. The study was Concluded that estimated prevalence of CAM use among diabetic patients, revealed good knowledge of the diabetic patients and negative attitudes of CAM users, and showed five significant associations with score of knowledge and attitudes (age, educational level, residence, family history of DM, and follow-up visits, which was consistent with some studies in other eastern and western countries¹¹.

STATEMENT OF PROBLEM

“A qausi experimental study to assess the effectiveness of a pamphlet regarding complementary therapies on diabetes mellitus among diabetic patients in selected urban areas at Mysore”

OBJECTIVES

1. To compare the pre-test and post-test knowledge and attitude regarding complementary therapies on diabetes mellitus among diabetic patients in control group.

2. To assess the effectiveness of a pamphlet on knowledge and attitude regarding complementary therapies on diabetes mellitus among diabetic patients in experimental group.

3. To compare the post-test knowledge and attitude regarding complementary therapies on diabetes mellitus between the experimental and control group diabetic patients.

4. To find out the association between the pretest knowledge regarding complementary therapies on diabetes mellitus and other selected background factors in experimental and control group.

5. To find out the association between the pre-test attitude regarding complementary therapies on diabetes mellitus and other selected background factors in experimental and control group.

OPERATIONAL DEFINITIONS

1. Effectiveness: It refers to gain in the knowledge and change in attitude after the administration of a Pamphlet on complementary therapies on diabetes mellitus among diabetic patients in selected urban areas at Mysore.

2. Pamphlet: In this study pamphlet refers to a printed sheet of 4 folds, 8.5’’X11’’size with concise, precise and standardized explanation and instructions about the complementary therapies on diabetes mellitus designed by the researcher. It will have information regarding:- diet, yoga, acupressure, herbs

3. Complementary therapies on diabetes mellitus: It refers to a therapy in addition to the treatments prescribed by the doctor for a diabetes mellitus e.g.: diet, yoga, acupressure, herbs.

4. Diabetic Patients: In this study diabetic patients refers to males and females who diagnostic as diabetic as well as on drug dependency like diabetic tablet of selected urban areas at Mysore.

ASSUMPTIONS

• Diabetic patients may not have adequate knowledge regarding complementary therapies on diabetes mellitus.

• Pamphlet may increase the knowledge regarding complementary therapies on diabetes mellitus among Diabetic patients.

DELIMITATIONS

• Available at the time of the study.

• Willing to participate in the study.

• Diabetic patients who are residences in selected urban areas at Mysore.

• Diabetic patients who are on drug dependency like diabetic tablets.

HYPOTHESES:

At 0.05 level of significance

H1: There will be a significant difference between the mean pre-test and post-test knowledge score on complementary therapies on diabetes mellitus among the Diabetic Patients control group.

H2: There will be a significant difference between the mean pre-test and post-test knowledge score on complementary therapies on diabetes mellitus among Diabetic Patients in the experimental group.

H3: There will be a significant difference between the mean pre-test and post-test attitude score on complementary therapies on diabetes mellitus among Diabetic Patients in the control group.

H4: There will be a significant difference between the mean pre-test and post-test attitude score on complementary therapies on diabetes mellitus among the Diabetic Patients in the experimental group.

H5: There will be a significant difference in the mean post-test knowledge regarding complementary therapies on diabetes mellitus between the experimental and control group Diabetic Patients.

H6: There will be a significant difference in the mean post-test attitude regarding complementary therapies on diabetes mellitus between the experimental and control group Diabetic Patients.

H7: There will be significant association between the pre-test knowledge and the selected background factors among the Diabetic Patients in the control group

H8: There will be significant association between the pre-test knowledge and the selected background factors among the Diabetic Patients in the experimental group.

H9: There will be significant association between the pre-test attitude and the selected background factors among the Diabetic Patients in the control group.

H10: There will be significant association between the pre-test attitude and the selected background factors among the Diabetic Patients in the experimental group.

METHODOLOGY:

RESEARCH APPROACH: An evaluative approach was used for this study to test the effectiveness of Pamphlet on knowledge and Attitude.

RESEARCH DESIGN: To evaluate the effect of selected nursing interventions the investigator selected quasi experimental design. Quasi experimental design in this study design which consists of control group, intervention but there is no randomization .The study design is depicted in table.

Keys:

E=Experimental group

C=Control group

X= Administration of Pamphlets regarding Complimentary Therapies

O1 and O2 = pre-test score

O3 and O4 = post-test score

RESEARCH SETTING: The study was conducted in the Paduvaralli, Vontikoppal, Vijayashripura, Vijayanagar 3rd Stage A1, B1, and C1 Blocks of Mysore on the basis of the feasibility in terms of availability of the subjects who were residing in selected areas at Mysore.

POPULATION:

• Target population: The target population refers to the population that the researcher wishes to make generalization on his research. In this study the target population was the Diabetic Patients.

• Accessible population: It refers to the aggregate of cases which is accessible to the researcher for conducting the study. In this research the accessible population was the Diabetic Patients from Paduvaralli, Vontikoppal, Vijayashripura, Vijayanagar 3th Stage A1, B1, and C1 Blocks of Mysore.

SAMPLE AND SAMPLE SIZE: Total 80 Diabetic Patients were selected for the study. From each Areas Diabetic patients were selected. The sample size for the present study was arbitrarily decided to be 40 Diabetic patients from Paduvaralli, Vontikoppal, as experimental and 40 Diabetic patients from Vijayashripura, Vijayanagar 3rd Stage of A1, B1,C1 Blocks as control group.

SAMPLING TECHNIQUE: In this study convenient sampling technique was adopted to select subjects as they fulfilled the inclusion criteria.

PROCEDURE FOR DATA COLLECTION: Formal permission to conduct study was obtained from the concerned authorities. The study was conducted during the month of November 2019 on 80 patients with Diabetes selected using convenient-sampling technique. The investigator explained the purpose of the study and obtained written consent from the participants then the structured knowledge questionnaire and Attitude scale was administered followed by administration of a teaching module and a post-test was conducted after one week.

RESULTS:

SECTION I: Data on Background factors of Diabetic patients 

Section II: Data on Analysis of Pre-test and Post-test Knowledge and Attitude regarding the Complementary therapies on Diabetes Mellitus in Control Group.

The obtained mean value of pre-test knowledge of the control group is 6.35,the SD is 2.01 and the mean value of the post-test knowledge of the group is 6.62,the SD is 1.73 and the “t” value of the group is .594 (p=0.00) .so null hypothesis( H₀₁) is accepted and Research hypothesis H₁ rejected .It is inferred that there is no significant difference between the mean score of pre-test and post-test knowledge regarding the complementary therapies on diabetes mellitus.

The obtained mean value of pre-test attitude of the control group is 41.9,the SD is 4.79 and the mean value of the post-test knowledge of the group is 39.2,the SD is 7.02 and the “t” value of the group is 2.21(p=0.00) .so null hypothesis H₀₂ is rejected and Research Hypothesis H₂ accepted. It is inferred that there is significant difference between the mean score of pre-test and post-test knowledge regarding the complementary therapies on diabetes mellitus.

Section III: Data on effectiveness of Pamphlets for Diabetic patients in Experimental group.

The obtained mean value of pre-test knowledge of the experimental group is 6.45, the SD is 2.04 and the mean value of the post-test knowledge of the group is 14, the SD is 1.53 and the “t” value of the group is 19.4(p=0.00) was highly significant. There for null hypothesis H₀₃ was rejected and Research Hypothesis (H₃ ) accepted. It was inferred that the knowledge was increased after the administration of Pamphlets . So Pamphlets was effective.

The obtained mean value of pre-test attitude of the experimental group is 41.9, the SD is 5.39 and the mean value of the post-test attitude of the group is 59.2, the SD is 12.73 and the “t” value of the group is 20.5(p=0.00) was highly significant. There for null hypothesis (H_O4) was rejected and the Research Hypothesis (H₄ ) accepted. It was inferred that the attitude was increased after the administration of pamphlet. So pamphlet regarding complementary therapies on diabetes mellitus was effective.

Section IV- Data on comparison of both Experimental and Control group.

The obtained mean value of post-test knowledge of experimental group is 6.62, The SD is 1.73 and the mean value of the post-test knowledge of the control group is 14, the SD is 15 and the “t” value of the group is 20.1(p=0.00) was highly significant. There for null hypothesis (H₀₅) was rejected and the Research Hypothesis (H₅ ) accepted. It was inferred that there was a significant increase in knowledge in the experimental group after the administering Pamphlets. So Pamphlet regarding complementary therapies on diabetes mellitus was effective.

COMPARISON OF ATTITUDE AMONG TWO GROUP

The obtained mean value of post-test attitude of experimental group is 39.2, the SD is 70.2 and the mean value of the post-test attitude of the control group is 59.2, the SD is 2.73 and the “t” value of the group is 16.8(p=0.00) was highly significant. There for null hypothesis (H_O6) was rejected and (H₆) was accepted. It was inferred that there was a significant increase in attitude in the experimental group after the administering pamphlet. So Pamphlet regarding complementary therapies on diabetes mellitus was effective.

Table 14: Showing the level of attitude in the experimental & control group post-test

The above table shows majority of the Diabetic patients (24) had good attitude and 16 had very good attitude in post test. Among control group 28 had average attitude 9 and 3 had good and poor attitude respectively. 

Section V: Data on association with the background factors pre-test knowledge among Diabetic patients in experimental and control group

There had no association between the pre-test knowledge in the experimental group and the selected background factors such as age (p=1.42), sex (p=01.93), education (p=2.91), family history (p=2.39), complementary therapy adopted for dm(p=1.72), previous exposure(p=2.83) and usage of complementary therapy for any other complaints(p=1.72).so H₀₇ accepted. It is inferred that there is no significant association between the knowledge and back ground factor in the experimental group. Hence Research hypothesis H₇ rejected.

There had no association between the pre-test attitude in the experimental group and the selected background factors such as age (p=1.03), sex (p=1.13), Education (p=3.50), family History (p=0.173), complementary therapy adopted for DM (p=0.00), previous exposure (p=0.360) and usage of complementary therapy for any other complaints (p=0.00). So H₀₈ accepted.. It is inferred that there is no significant association between the attitude and back ground factors in the experimental group. Hence research hypothesis H₈ rejected. 

There had no association between the pre-test knowledge in the control group and the selected background factors such as age (p=6.96), sex(p=0.668), Education (p=4.03), family history(p=5.20), complementary therapy adopted for dm(p=0.478), previous exposure(p=0.928) and usage of complementary therapy for any other complaints(p=0.902).but association was found in family history. H₉ is accepted in case of family history of DM. It is inferred that there is significant association between the knowledge and back ground factor like family history. H₀₉ accepted in case of back ground factors like age, gender, education, experience, complementary therapy adopted for DM, previous exposure and use age of complimentary therapy for any other diseases.

There had no association between the pre-test attitude the control group and the selected background factors such as age (p=1.75), gender (p=0.803), Education (p=7.68), family history (p=0.430), complementary therapy adopted for DM (p=3.58), previous exposure(p=0.928) and usage of complementary therapy for any other complaints(p=1.35). Hence H_o10 accepted. It is inferred that there is no significant association between the knowledge and back ground factors

Implications

Nursing practice

1) Nurses have the responsibility to explain regarding complementary therapies on diabetes mellitus to the patients.

2) Various complementary therapies can be adopted to treat diabetes mellitus because it is cost effective and can be easily practiced.

3) lnstructional module can be distributed among staff nurses.

Nursing education

1) Nurse educator could use the findings of the study to introduce the topic among nurses.

2) Nursing tutor can use the findings of this study as an example for the improvement of individualized nursing care and demonstrate autonomous nursing.

Nursing research

1) The study will be a valuable reference for future researchers.

2) The findings of the study would help to expand the scientific body of professional knowledge upon which further research can be conducted

3) Exercises maybe taught more scientifically and can be used as specific nursing intervention

4) Other researchers conducting further studies in the same field could utilize the suggestions and recommendations.

Recommendations

1) A similar study can be replicated on a large scale and for longer period for more reliability and effectiveness

2) Another study can be done with larger sample

3) Factorial designs may be adopted with other indigenous intervention

3) Randomization of the groups needs to be done.