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A STUDY ON THE KNOWLEDGE ATTITUDE AND PRACTICE OF
CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY.
THESIS SUBMITTED IN PARTIAL FULFILLMENT
FOR THE AWARD OF DEGREE OF
DOCTOR OF PHILOSOPHY IN NURSING
By
GRACY V.C
VINAYAKA MISSIONS UNIVERSITY
SALEM, TAMILNADU, INDIA.
2014
VINAYAKA MISSIONS UNIVERSITY
CERTIFICATE BY THE GUIDE
I DR. REBECCA SAMSON professor and Dean of PIMS
Pondicherry, certify that thesis entitled “A study on the Knowledge
Attitude and Practice of Caregivers of Children with Cerebral Palsy”,
submitted for the award of degree of Doctor of Philosophy in Nursing by
GRACY V.C is the record of research work carried out by her during the
period from 2009 to 2014 under my guidance and supervision and that
this work has not formed the basis for the award of any degree or diploma
associate-ship, fellowship, or other titles in this or any other University or
institutions of higher learning.
Place:
Date: Seal and Signature of the Guide
VINAYAKA MISSIONS UNIVERSITY
DECLARATION BY THE GUIDE
This is to certify that the thesis entitled “A study on the
Knowledge Attitude and Practice of Caregivers of Children with
Cerebral Palsy” is an original research work carried out by
Mrs. Gracy V .C who had registered for PhD in the year 2009.
Place:
Date: Seal and Signature of the Guide
VINAYAKA MISSIONS UNIVERSITY
DECLARATION
I GRACY V.C declare that the thesis entitled “A study on
Knowledge Attitude and Practice of Caregivers of Children with
Cerebral Palsy”, submitted by me for the degree of Doctor of Philosophy
in Nursing is the record of research work carried out by me during the
period from 2009 to 2014 under the guidance of DR. REBECCA
SAMSON professor and Dean of PIMS Pondicherry and has not formed
the basis for the award of any degree or diploma, associate-ship,
fellowship, titles in this or any other University or any other institutions of
higher learning.
Place: Signature of the candidate.
Date:
ACKNOWLEDGEMENT
Success is possible only by others help .The research scholar has been
fortunate to receive sufficient help from various sources.
Gratitude can never be expressed in words. First of all I thank God
almighty for his abundant blessing showered on me to complete the study
successfully. There are several hands and heart behind this work.
I am immensely grateful to Dr. A. Shanmugasundaram Chancellor,
Vinayaka Missions University Salem for providing me an opportunity to
pursue my doctoral degree under Vinayaka Missions University.
I would like to take the privilege to thank Dr. V.R Rajendran, Vice
Chancellor and Dr. K. Rajendran, Dean (Research), Vinayaka Missions
University, Salem for permitting me to carry out this study.
I express my respectful gratitude to my research guide
Dr. Rebecca Samson M.Sc. PhD, Professor and Dean of PIMS
Pondicherry, for her inspiring suggestions, guidance, encouragement and
patience for the completion of this study.
I am grateful to Experts who validate the tool and for their valuable
suggestions and recommendations
The investigator expresses heartfelt thank to Mr. Solomon Prabhakar
editor and statistician, Chennai for his help and support given in doing
statistical analysis and English editing.
My sincere gratitude to caregivers of children with cerebral palsy, for
having participated in this study.
I am forever indebted and grateful to my husband Sri. Abraham for his
love, Patience, encouragement and understanding which allow me to
dedicate most of my time on this research work. I thank my little angel
Shreyas, the spark of life who rekindled the dream to succeed in life.
My warm appreciation to all those, who have helped me directly and
indirectly to complete this thesis.
GRACY V. C
LIST OF CONTENT
CHAPTERS CONTENT PAGE NO
I
INTRODUCTION
1-20
II
REVIEW OF LITERATURE
21-35
III
METHODOLOGY
36 - 53
IV
DATA ANALYSIS AND INTERPRETATION
54 -108
V
DISCUSSION
109-123
VI
SUMMARY , CONCLUSION AND
RECOMMENDATIONS
124-135
VII
BIBLIGRAPHY
136
VIII
APPENDIX
LIST OF TABLES
SL.NO TITLE PAGE NO
1 Distribution of care givers according to their Age. 56
2 Distribution of care givers according to their Gender 58
3 Distribution of care givers according to their
Educational status. 59
4 Distribution of care givers according to their marital
status. 60
5 Distribution of care givers according to Type of
family 61
6 Distribution of care givers according to Employment
status 62
7 Distribution of caregivers according to Religion. 63
8 Distribution of caregivers according to Area of
Residence 64
9 Distr. of caregivers according to Type of House 65
10 Distribution of caregivers according to Ownership
Status 66
11 Distribution of caregivers according to income 67
12.a)
Frequency and percentage distribution of level of
knowledge of caregivers in providing care to
children with cerebral palsy with regard to general
information
68
12.b)
Frequency and percentage distribution of level of
Knowledge of caregivers in providing care to
children with cerebral palsy with regard to Signs
and symptoms
69
12.c)
Frequency and percentage distribution of level of
Knowledge of caregivers in providing care to
children with cerebral palsy with regard to Self-care
needs & Self-care support
70
12.d)
Frequency and percentage distribution of level of
knowledge of caregivers in providing care to
children with cerebral palsy with regard to Feeding
& Nutrition
71
12.e)
Frequency and percentage distribution of level of
knowledge of caregivers in providing care to
children with cerebral palsy with regard to Hygiene
& Elimination
72
12.f)
Frequency and percentage distribution of level of
knowledge of caregivers in providing care to
children with cerebral palsy with regard to Exercise
& Prevention of complications
74
13 Mean, standard deviation, skew, and kurtosis on
the level of knowledge in each domain 76
14 Descriptive statistics for knowledge 77
15
Distribution of caregivers according to the level of
knowledge
77
16
Frequency and percentage distribution of level of
attitude of caregivers of children with cerebral palsy
with regard to special education
78
16.a)
Frequency and percentage distribution of level of
attitude of caregivers of children with cerebral palsy
with regard to Parenting & caring.
80
16b.)
Frequency and percentage distribution of level of
attitude of caregivers of children with cerebral palsy
with regard to bowel training and activities
82
16c.)
Frequency and percentage distribution of level of
attitude of caregivers of children with cerebral palsy
with regard to exercise
83
16d.)
Frequency and percentage distribution of level of
attitude of caregivers of children with cerebral palsy
with regard to socialization
84
17 Mean, standard deviation, Skew, Kurtosis on the
level of attitude in each domain 85
18 Descriptive statistics for attitude 86
19 Percentage Distribution of caregivers according to
the level Attitude. 86
20.a)
Frequency and percentage distribution of level of
Practice of caregivers to children with cerebral
palsy with regard to hygiene
87
20.b)
Frequency and percentage distribution of level of
Practice of caregivers to children with cerebral
palsy with regard to Nutrition.
88
20.c)
Frequency and percentage distribution of level of
Practice of caregivers to children with cerebral
palsy with regard to Toileting.
90
20.d)
Frequency and percentage distribution of level of
Practice of caregivers to children with cerebral
palsy with regard to Medications
91
20.e)
Frequency and percentage distribution of level of
Practice of caregivers with regard to self-help and
self-care.
92
21 Descriptive statistics for practice 93
22 Percentage distribution of caregivers according to
the level of Practice. 94
23 Mean, standard deviation, Skew, Kurtosis on the
level of practice in each domain 95
24 Data on Association of Knowledge score and
selected demographic Variables 97
25 Data on association of Attitude with selected
Demographic Variables. 99
26 Data on Association of practice with the
Demographic Variables. 101
27 Descriptive statistics to reveal the effect of
information brochure on the level of knowledge 102
28 Descriptive statistics to confirm the effect of
information brochure on the level of knowledge 103
29 Descriptive statistics to reveal the effect of
information brochure on the level of attitude 104
30 Descriptive statistics to confirm the effect of
information brochure on the level of attitude 105
31 Descriptive statistics to reveal the effect of
information brochure on the level of Practice 106
32 Descriptive statistics to confirm the effect of
information brochure on the level of practice 107
LIST OF FIGURES
SL NO FIGURES PAGE NO
1 Distribution of care givers according to their Age. 57
2 Distribution of care givers according to their
Gender. 58
3 Distribution of care givers according to their
Educational status 59
4 Distribution of care givers according to their marital
status. 60
5 Distribution of care givers according to Type of
family 61
6 Distribution of care givers according to Employment
status 62
7 Distribution of caregivers according to Religion 63
8 Distribution of caregivers according to Area of
Residence 64
9 Distribution of caregivers according to Type of
House 65
10 Distribution of caregivers according to Ownership
Status 66
11 Distribution of caregivers according to their income 67
12 Percentage distribution of caregivers according to
the level of Practice 94
13 Number of Correct Answers Post distribution of
Information Brochure 104
14 Number of Correct Answers Post Distribution of
Information Brochure 106
15 Number of Correct Answers Post Distribution of
Information Brochure 108
LIST OF APPENDICES
APPENDIX CONTENT
1 Permission letters
II Letter requesting to validate the tool
III Acceptance form for tool validation
IV Content validation Certificate
V List of Experts
VI Letter seeking Consent for Participation
VII Instruments -Tool (English and Kannada)
VIII Certificate for English editing
IX Certificate for Kannada editing
X Information brochure (English and Kannada)
ABSTRACT
A Non experimental Descriptive research study on the
Knowledge Attitude and Practice of Caregivers of Children with
Cerebral Palsy was carried out. Data was collected from 400 subjects
by using structured interview - schedule to assess the knowledge,
Lickert scale to assess the attitude and observational check list to
assess the Practice of caregivers of children with Cerebral palsy.
BACKGROUND OF THE STUDY
Cerebral Palsy (C P) is a neurological disorder caused by damage to
the brain cells that occur before, during or after birth. It is characterized by
loss of movements (crawling, and walking) and nerve functions resulting in
problems of use of hands (eating, writing and dressing) and communication.
During the process of delivery or after delivery any head injury and lack of
sufficient oxygen to the brain cells results in cerebral palsy. Jaundice,
premature birth and infections of the mother (e.g. German measles) are also
causing cerebral palsy.
Cerebral Palsy (CP) is a non-progressive disorder characterized
by uncontrolled movement and posture, resulting from damage to the
brain cells that occur before, during, or shortly after birth. It may be
accompanied by speech and hearing defects and visual problems,
mental retardation, seizures, and loss of nerve functions. Children with
CP may have problems in movement (crawling, and walking),use of
hands (eating, writing, and dressing) and communication (Aravind
Taneja).The motor disorders of CP are often accompanied by
disturbance of sensation and perception ,cognition, communication
behavior, epilepsy and other secondary musculoskeletal problems.
Cerebral palsy is the most common cause of chronic childhood
disability, estimated to be between 2 and 2.5 per 1000 live births in
developed countries. According to Indian statistics, about 25 lakhs of
children are affected by cerebral palsy. The occurrence of cerebral
palsy is higher in males than in females. The caregivers, especially
parents of cerebral palsy children are highly desperate. Nobody can
understand the inner feelings of pain. Moreover, their public life stands
limited.
The children who are severely affected need twenty-four hours
care. Others need help and support to meet their self-care needs. The
caregivers (mother or mother substitutes) need to have proper
knowledge regarding meeting the self-care needs of the children
especially in feeding, toileting, dressing, writing, and walking. They
need to develop a positive attitude and skill towards the care of
children with cerebral palsy. Like any other child, children with cerebral
palsy also need care, love, and affection from the caregivers.
Children with cerebral palsy need special care and special
education to reduce their disability. Parenting an exceptional child is
unique in degree and intensity. The birth of an exceptional child adds a
situational crisis, which results from an unanticipated, traumatic event
beyond parent’s control. Parents progress through emotional stages on
finding their child's exceptionality. Caregivers need to have the proper
knowledge, a positive attitude and proper skill to look after these children
STATEMENT OF THE PROBLEM
A Study on the Knowledge, Attitude and Practice of
Caregivers of Children with Cerebral Palsy.
OBJECTIVES
1. To assess the knowledge of caregivers regarding care of the
children with Cerebral Palsy.
2. To find out the attitude of care givers of children with Cerebral
Palsy.
3. To assess the practice of care givers of children with Cerebral
Palsy
4. To find the association of knowledge, attitude and practice with
selected demographic variables.
5. To know the effect of an information brochure among the
caregivers of Children cerebral palsy.
HYPOTHESES
Section A:
Ho: Knowledge of the caregivers is not influenced by any of the
selected demographic variables
H1: Knowledge of the caregivers is influenced by at least one of
the selected demographic variables
Section B:
Ho: Attitude of the caregivers is not influenced by any of the
selected demographic variables
H1: Attitude of the caregivers is influenced by at least one of the
selected demographic variables
Section C:
Ho: Practice of the caregivers is not influenced by any of the
selected demographic variables
H1: Practice of the caregivers is influenced by at least one of the
selected demographic variables
Section D:
Ho: The information brochure does not have any influence on
the knowledge, attitude, and practice of caregivers of
children cerebral palsy.
H1: The information brochure does have some influence on the
Knowledge, attitude, and practice of caregivers of children
Cerebral palsy.
METHODS OF DATA COLLECTION
1. Structured interview - schedule to assess the knowledge of
caregivers of Children with cerebral palsy.
2. Likert scale to assess the attitude of caregivers of Children with
cerebral palsy.
3. Observational check list to assess the Practice of caregivers of
children with Cerebral palsy.
SPSS version 20 for windows is used for Statistical analysis.
Data was summarized using mean and standard deviation for
continuous variables and percentage for categorical variables. X2 test
was used to test for association between selected demographic
variables and knowledge, attitude, and practice (prior to distribution of
the information brochure).
The level of significance used was P<0.05.
The plan for data analysis was to:
a) Describe the socio-demographic variables of caregivers by
frequency and percentage distribution.
b) Frequency and percentage distribution, arithmetic mean, and
standard deviation were used to analyze the level of knowledge,
attitude, and practice.
c) Chi-square test was used to determine if the selected socio
demographic variables influenced the level of knowledge
attitude, and practice (prior to distribution of the information
brochure).
d) Pearson Correlation, T-Test, and F-Test were used to establish
the effectiveness of the brochure.
THE FINDINGS ARE AS FOLLOWS
Section A. Socio demographic variables
Majority, 169 (42.3%) of the caregivers belong to the age group
of 36-45 years
Majority 362 (90.5%) of the caregivers were females.
Majority, 304 (76.0%) of the caregivers attended school up to
SSLC.
Majority 400 (100%) of the caregivers were married
Majority 254 (63.5%) of the caregivers belong to nuclear family.
Only 27 (6.8%) of the caregivers were salaried.
Majority 204 (51.0 %) of caregivers belong to Muslim.
200 (50.0%) of the caregivers belong to rural and 200 (50.0%)
belong to urban areas.
Majority 350 (87.5 %) of the caregivers reside in concrete
houses.
168 (42.0%) of the caregivers resides in rented House.
196 (49.0%) of the caregivers are between Rs.5001/- to
Rs.10000/-.
Section B. was to assess the knowledge of caregivers regarding care
of the children with Cerebral Palsy
The finding reveals that 20 (5%) of the caregivers had good (>65 %)
knowledge, 229 (57.3%) of the caregivers had average (51% -65%)
knowledge, and 37.8% (151) of the caregivers had poor (≤50%)
knowledge.
The mean, standard deviation, skew, and kurtosis on the level of
knowledge in six domains reveals that the mean score in the domains of
‘General information regarding cerebral palsy’ was 3.2 with standard
deviation of 0.6. The mean score in the aspects of ‘Signs and symptoms of
cerebral palsy’ was 1.4 with standard deviation of 0.6. The mean score in
the aspects of ‘Self-care needs and support’ was1.4 with standard
deviation of 0.6. The mean score in the aspects of ‘Feeding and nutrition’
was 0.01 with standard deviation of 0.3. The mean score in the aspects of
‘Hygiene and elimination’ was 3.7 with standard deviation of 1.0. The
mean score in the aspects of ‘Exercise and prevention’5.5 with standard
deviation of 1.3.
The Percentage distribution of level of knowledge of caregivers
reveals that 5% of the caregivers had good knowledge, with a mean score
of 70.33 and standard deviation of 2.62. 57.5% of the caregivers had
average knowledge, with a mean score of 56.96 and standard deviation
of 3.3. 37.5% of the caregivers had poor knowledge with a mean score of
46.42 and standard deviation of 4.48.
Section C. was to find out the attitude of caregivers of children with
Cerebral Palsy
The finding reveals the percentage distribution of level of attitude of
caregivers of children with cerebral palsy. The Mean, standard deviation,
Skew, Kurtosis on the level of attitude in each domain reveals that the
mean score on Special education was 16.15 with standard deviation 0.61.
The mean score on Parenting & caring was 15.20 with standard deviation
1.03. With regard to Bowel training and activities the mean score
was10.99 with a standard deviation of 0.05. The mean score on Exercise
was 5.95 with a standard deviation of 0.50. The mean score on
Socialization was13.51 with standard deviation of 1.08.
The findings revealed that the level of attitude, in general, is within
the acceptable range. However, for the purpose of the study, we set a very
high benchmark (75%) to consider the attitude level to be considered as
‘favorable’. Accordingly, it was noted that NONE of the caregivers had
favorable attitude (at the predefined level of 75%) prior to the intervention;
ALL of the caregivers had unfavorable attitude (at the predefined level of
75%).
Section. D was to assess the practice of caregivers of children with
Cerebral Palsy.
It reveals that 80 (20%) of the caregivers had good Level of
Practice. 54 (13.5%) of the Caregivers had Average Level of Practice, 266
(66.5%) of caregivers had Poor Level of Practice.
The findings reveal the frequency and percentage distribution of
level of Practice of caregivers to children with cerebral palsy. Mean,
standard deviation, Skew, and Kurtosis on the level of attitude in each
domain. It reveals that the mean score on Special education was 16.15
with standard deviation 0.61.The mean score on Parenting & caring was
15.20 with standard deviation 1.03. With regard to Bowel training and
activities, the mean score was 10.99 with a standard deviation of 0.05. The
mean score on Exercise was 5.95 with a standard deviation of 0.50. The
mean score on Socialization was13.51 with standard deviation of 1.08.
Section. E was to find the association of knowledge, attitude, and
practice with selected demographic variables.
Association of knowledge with selected demographic variables
reveals that the probability of obtaining Chi-square value by chance is
>0.05 (p > 0.05). Therefore, the null hypothesis is accepted, and it is thus
concluded that there is no association between knowledge and selected
demographic variables.
Association of Attitude with selected demographic variables reveals
that age alone seems to have influenced the level of attitude. The p-value
is 0.03, and thus we reject the null hypothesis, which states that there is
no association between the selected demographic variables and level of
attitude. Instead, we accept the alternative hypothesis and conclude that
there is an association between attitude and age group.
Association of practice with the Demographic Variables shows that
age alone seems to have influenced the level of practice. The p-value is
0.009, and thus we reject the null hypothesis, which states that there is no
association between the selected demographic variables and level of
practice. Instead, we accept the alternative hypothesis and conclude that
there is an association between practice and age group.
Section. F was to know the effect of an information brochure on the
caregivers of children cerebral palsy.
The findings reveals that the level of knowledge increased positively
and shifted to the higher end (right) and thus skewed to the right. In
addition, the score became more clustered at the positive end with slight
reduction in the variance. This clearly gives the primary evidence that the
information brochure had a high impact on the level of knowledge.
The correlation, confirmed by Pearson value, indicates that the rise
in knowledge level is uniform and substantial across the sample. The T-
Test value is almost zero, indicating that the increase in score cannot be
due to chance or some other factor. The considerably low F-Test p-value
indicates that the variance in the sample after the intervention is
significantly different from that of one prior to the intervention.
The level of attitude increased positively and shifted to the higher
end (right) and thus skewed to the right. In addition, the score became
more clustered at the positive end with slight reduction in the variance.
This clearly gives the primary evidence that the information brochure had a
considerable impact on the level of attitude.
The correlation, confirmed by Pearson value, indicates that the rise
in attitude level is uniform and considerable across the sample. The T-Test
value is almost zero, indicating that the increase in score cannot be due to
chance or some other factor. The low F-Test p-value indicates that the
variance in the sample after the intervention is significantly different from
that of one prior to the intervention. Compared to the effect on knowledge,
we can say that the effect of the intervention in terms of attitude is slightly
low.
The level of practice increased positively and shifted to the higher
end (right) and thus skewed to the right. In addition, the score became
more clustered at the positive end with slight reduction in the variance.
This clearly gives the primary evidence that the information brochure had a
high impact on the level of practice.
The correlation, confirmed by Pearson value, indicates that the rise
in knowledge level is uniform and substantial across the sample. The T-
Test value is almost zero, indicating that the increase in score cannot be
due to chance or some other factor. F-Test p-value of zero indicates that
the variance in the sample after the intervention is expressively different
from that of one prior to the intervention.
INFERENCE
The present study was conducted on the Knowledge Attitude and
Practice of caregivers of children with cerebral palsy. The following
conclusions were drawn from the study.
1. Only 5% of the caregivers had good knowledge, 57.3% of the
caregivers had average knowledge and. 37.8% of the caregivers
had poor knowledge regarding giving care to the children with
cerebral palsy.
2. It revealed that None of the caregivers had a favourable attitude (as
per the set standards) prior to the intervention.
3. After the intervention, it revealed that at least 15% of the caregivers
of cerebral palsy crossed the threshold to reach the set level of
favourable attitude (at the set standard of 75% and above); yet, 85
% of the caregivers of cerebral palsy had unfavourable attitude (at
the set standard of 75%).
4. Only 20% of the caregivers had good level of practice. 13.5% of the
caregivers had average level of practice and majority 66.5% of
caregivers had poor level of Practice.
5. There was no association between knowledge and demographic
variables of caregivers of children with cerebral palsy at (p>0.05)
6. There is an association between attitude and age, and practice age
at (p>0.01).
7. The information brochure had very positive effect on the level of
knowledge, attitude, and practice. In each case, the probability of
observing such a huge change by chance is ZERO.
8. The impact of information brochure eliminated the effect of age or
any other demographic variable observed in the pre-intervention
setup.
RECOMMENDATIONS
It is recommended that this study can be replicated.
A comparative study can be conducted regarding the knowledge,
attitude, and practice between urban and rural caregivers of children
with cerebral palsy.
A study can be conducted to evaluate the usefulness of an
information brochure among the caregivers of children cerebral
palsy.
IMPLICATIONS FOR NURSING EDUCATION, NURSING PRACTICE,
AND NURSING RESEARCH
Information brochure will help the caregivers to improve their
practice by having right knowledge and develop favourable attitude.
Every centre or home for the disabled should have Information
brochure
Role of the caregivers in giving care to children with cerebral palsy
must be included in nursing curriculum.
Parents of children with cerebral palsy need support from
professionals. Nurses have a vital role in providing support for these
families.
CONCLUSION
The entire research proved that a small change in the level of
knowledge in caregiver of children with CP would have an effect on the
attitude to some extent and, on the practices to a great extent.
INTRODUCTION
CHAPTER - I
1
CHAPTER - 1
INTRODUCTION
BACKGROUND OF THE STUDY
“All parents hope to have normal and happy children they can be
proud of. It is natural that parents are greatly distressed when they
learn that their child is handicapped”.
The birth of a baby is the most joyful moment for both parents
and the Family. If the baby is found to be born with any kind of
developmental disabilities, then the whole situation changes. Physical
or mental disability reduces the performance of everyday function or
makes one to seek the aid of another person or a device. Disability is a
substantial handicap, with onset before the age of 18 years. It includes
mental retardation, autism, cerebral palsy, epilepsy, or other
neuropathies (Medina 2008). An estimate states that 15 percent of the
child population is born with developmental disabilities. According to a
recent US Censes, about 4 million American children have a disability.
Cerebral palsy is the most common cause of chronic childhood
disability, estimated to be between 2 and 2.5 per 1000 live births in
developed countries. According to Indian statistics, about 25 lakhs of
children are affected by cerebral palsy. The occurrence of cerebral
palsy is higher in males than in females. The caregivers, especially
parents of cerebral palsy children are highly desperate. Nobody can
2
understand the inner feelings of pain. Moreover, their public life stands
limited.
Cerebral Palsy (CP) is a non-progressive disorder characterised
by uncontrolled movement and posture, resulting from damage to the
brain cells that occur before, during, or shortly after birth. It may be
accompanied by speech and hearing defects and visual problems,
mental retardation, seizures, and loss of nerve functions. Children with
CP may have problems in movement (crawling, and walking),use of
hands (eating, writing, and dressing) and communication (Aravind
Taneja).The motor disorders of CP are often accompanied by
disturbance of sensation and perception ,cognition, communication
behaviour, epilepsy and other secondary musculoskeletal problems.
Cerebral Palsy has secondary associated conditions. No two
children are affected in the same way. Cerebral Palsy is one of the
major developmental disability found in varying degrees and the
affected person becomes dependent on the caregivers until death.
The children who are severely affected need twenty-four hours
care. Others need help and support to meet their self-care needs. The
caregivers (mother or mother substitutes) need to have proper
knowledge regarding meeting the self-care needs of the children
especially in feeding, toileting, dressing, writing, and walking. They
need to develop a positive attitude and skill towards the care of children
3
with cerebral palsy. Like any other child, children with cerebral palsy
also need care, love, and affection from the caregivers.
Children with cerebral palsy need special care and special
education to reduce their disability. Parenting an exceptional child is
unique in degree and intensity. Children with cerebral palsy need love,
care, guidance, and protection from parents. According to Neeru
Sharma (2004), the birth of an exceptional child adds a situational
crisis, which results from an unanticipated, traumatic event beyond
parent‟s control. Parents progress through emotional stages on finding
their child's exceptionality vis. disbelief, guilt, shame, denial and a
feeling of Helplessness (Mc Dowell, 1976).
INCIDENCE AND PREVALENCE
In the industrialised world, the incidence of cerebral palsy is
about two per 1000 live births. The incidence is higher in males than in
females; the Surveillance of Cerebral Palsy in Europe (SCPE) reports
an M: F ratio of 1.33:1, the incidence rates converge towards the
average rate of 2:1000.
In the United States, approximately 10,000 infants and
babies are diagnosed with CP each year, and 1200 –1500 diagnosed at
preschool age. The incidence of CP increases with premature or very
low-weight babies regardless of the quality of care.
4
Prevalence of cerebral palsy is best calculated around the
school entry age of about six years; in U.S., it is estimated to be 2.4 out
of 1000 children.
AETIOLOGY
Cerebral palsy occurs due to multiple factors. It may be due to
malformation of the brain. Other factors are prenatal hypoxia,
intraventricular haemorrhages, Kernictres, birth trauma, acid base
imbalance, and intrauterine infections. Low birth weight and congenital
malformations are considered as important aetiological factors. APGAR
scores have been also used as a factor to predict whether an individual
will develop cerebral palsy or not.
PATHOLOGY
In mild cerebral palsy, the brain appears normal, but may be
underweight and has sub cortical white matter and spares nerve fibres.
In severe cerebral palsy, there may be various pathological lesions like
atrophy of the basal ganglia, leukomalacia, Porencephaly, Microcephaly
cerebellar lesions, and vascular occlusions.
CAUSES OF CEREBRAL PALSY
o Insufficient oxygen to the brain may damage the brain cells of the
child
o Maternal infections such as rubella , cytomegalovirus, or
toxoplasmosis in the first 4-5 months of the pregnancy
5
o Metabolic disorders in the mother such as diabetes, heart
problem, severe asthma and thyroid disorders
o Use of certain drugs during antenatal period without doctor‟s
consultation
o Trauma to the fetal head during labour or delivery, cerebral
haemorrhage, and use of forceps
o Prematurity and other complications at birth such as difficulty in
breathing or very low birth weight
o In most cases, the cause is some abnormality around the time of
conception.
POSSIBLE SIGNS OF CEREBRAL PALSY
1. Physical signs
It includes poor head control after 3 months of age, stiff or rigid
arms or legs, pushing away or arching back, floppy or limp body
posture. Baby may not sit up without support by 8 months, uses only
one side of the body or only arms to crawl, clenched hands after 3
months of birth. Persistence of primitive reflexes such as morrow and
atonic neck past 6 months, Hand preference demonstrated before 18
months, Leg scissoring, seizure and sensory impairment (hearing,
vision).
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2. Behavioural signs
Extreme irritability or crying, feeding difficulties after 6 months of
age. Persistent tongue thrusting, little interest in surroundings, and
excessive sleeping.
COMMON SIGNS AND SYMPTOMS
Sucking difficulty with the breast or bottle
Absence of normal muscle tone and slow development of
milestones
Abnormal body postures
Uncontrolled body movements and poor coordination
Mental retardation and speech problems.
Unusual muscle tone, reflexes, or motor development and
coordination
Deformities in Joints and bones and contractures
The classical symptoms are spasms, other involuntary
movements (e.g. facial gestures), unsteady gait, problems with
the balance, and decreased muscle mass
Scissor walking and toe walking
Secondary conditions can include seizures, epilepsy, apraxia,
dysarthria or other communication disorders, eating problems,
sensory impairments
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Mental retardation, learning disabilities, and/or behavioural
disorders
Babies born with severe CP often have irregular posture; their
bodies may be either very floppy or very stiff
CLASSIFICATION ACCORDING TO SEVERITY
1. Mild (20%) cerebral palsy: Mild cerebral palsy children are
ambulatory and their only fine movements are impaired.
2. Moderate cerebral palsy (50%) These children achieve
ambulation by self-help. There is impaired gross motor, fine
motor, and speech development.
3. Severe cerebral palsy (80%) These children are with multiple
defects and unable to perform usual activities of daily living.
CLASSIFICATION (GENERAL)
1. Spastic (Pyramidal)
This is the most common type of cerebral palsy. It may affect a
single limb, one side of the body (spastic hemiplegic), legs (spastic
diplegia), or both arms and legs (spastic quadriplegia). There may be
partial (paresis) or full loss of movement (paralysis), abnormalities of
sensation and defects of hearing and vision. Epileptic fits, speech
impediments, mental retardation are other associated problems.
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2. Athetoid or Dyskinetic
In Athetoid or dyskinetic type of cerebral palsy, the damage
occurs to the extra pyramidal motor system and the basal ganglia
.Children with Athetoid CP have difficulty in holding themselves in an
upright, steady position for sitting or walking; they often show
involuntary movements. For some children with Athetoid CP, it just
takes a lot of concentration to get their hand to a certain spot (like
scratching their nose or reaching for a cup). Because of their mixed
tone and difficulty in keeping a position, they may be unable to hold on
to objects (such as a toothbrush or pencil). In newborn infants, elevated
bilirubin levels in the blood, if left untreated, can lead to brain damage.
This may also lead to Athetoid cerebral palsy.
3. Ataxic cerebral palsy (ICD-10 G80.4) type
In ataxic cerebral palsy, the damage goes to the cerebellum.
Ataxic cerebral palsy is not common. Motor skills such as writing,
typing, or using scissors might be affected, as well as balance,
especially while walking. It is often the case that individuals who have
difficulty with visual and/or auditory processing.
4. Hypotonic
People with hypotonic CP appear limp and can move only a little
or cannot move at all.
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5. Mixed cerebral palsy
This occurs when two or more types are mixed together in the
same person. Early diagnosis is essential so that the child can be given
help in the early years of development. The following tests such as the
MRI, CT scan, blood, and urine tests help to diagnose.
Topographic pattern of limb involvement in children with cerebral
palsy
1) Monoplegia: In monoplegia ,one limb is involved
2) Paraplegia: Both legs are affected
3) Diaplegia: Both legs or arms are affected.
Occasionally minimal arm involvement also may be there.
4) Hemiplegic: Both arms or legs are affected. The arm typically
more severely involved than the leg.
5) Double hemiplegic: Both sides of the body display hemiplegic
characteristics.
6) Triplegia: Three extremities are involved, the legs are slightly
worse than arms.
TREATMENT
There is no specific cure for cerebral palsy, but the goal of
treatment is to enable the child self-sufficient. This can be achieved by
physiotherapy, orthopaedic correction, and use of braces, splints, and
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casting. Adaptive equipment such as scooters, bicycles, tricycles and,
wheel chairs also can be utilized.
For occupational therapy, utensils for functional use (eating,
writing) and computers are also worth. Speech and language therapy
contribute to improving oral and motor skills. Appropriate visual help
such as spectacles, hearing aids, medications, and special schooling, is
very useful.
Unique education must include early intervention programmes,
specialized learning programmes, and support services in school, and
socialization to promote self-concept developments. The child can be
directed to a normal school if his physical disabilities or mental
development allow. Medications may include drugs to reduce muscle
tension or control seizures.
Surgical intervention includes orthopaedic (e.g., tendon transfers,
muscle strengthening, and correction of spinal deformities), Neurologic
(e.g., neuroectomies) and selective dorsal rhisotomy; Medication
therapy to treat spasticity, pain and to treat secondary conditions such
as seizure disorder, constipation urinary tract infection, and decubitus
ulcer. Treat for acute child childhood illness.
Behavior therapy by neuromuscular electrical stimulation. Above
all, the parents need to understand and cope with the problem that their
child has, in order to help him in the best possible way. They can join a
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support group ( Spastic society), where they can learn more about the
problem by experts in the field, they can meet parents having children
with similar problems, discuss problems, and share experiences
common to both thereby working towards better management of the
child at home. Care coordination of specialized services and community
resources in collaboration with the child‟s family.
PREVENTION OF CEREBRAL PALSY:
Prevention of cerebral palsy by preventing maternal infection,
good maternal care, and from postnatal damage reduces the
prevalence. Early diagnosis, prompt adequate treatment plans can
reduce the residual neurological and psychosocial, emotional
handicaps for the child and his family.
NEED FOR THE STUDY
Every parent dreams of having a healthy baby. When a child is
born with some disabilities parents panic and they need to adjust to the
new situation and learn to take care of the baby. The goal of care giving
is to make their children reach their maximum potential. There are
many areas of care to be addressed: meeting the hygienic needs,
nutritional needs, bathing, toileting, playing with the child, and in doing
physical therapy to prevent contractures. Many a time, lack of
knowledge and negative attitude of the caregivers may lead to faulty
practices and may not show any progress in life of children with
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cerebral palsy. The families (caregivers) may not have sufficient
knowledge regarding the disease condition and the care to provide.
According to Indian Medical Statistics:-
Indian statistics revealed that in India about 25-lakh children are
affected by cerebral palsy.
Lack of knowledge and negative attitude may lead to faulty
practices and the care will be affected negatively. The investigator
noticed that most of the children with cerebral palsy are neglected, not
exposed to the public, some are put in to the dark room of the house
,sometimes locked in a cage and not given care properly, and leading a
vegetative life. The parents are desperate specially mothers. Their inner
feeling of pain nobody can understand and their public life is limited.
The investigator noticed that a mother was forcefully putting a
steel spoon in to the mouth of a child (8 years) and pressing the tongue
with the spoon to feed him. This child was not able to bring his hand up
1 Incidence of cerebral
palsy 2 to 2.5 per 1,000 births
2 Incidence rate one in 34,000 or 8000 people in U S A
3 Incidence
extrapolations
8,000 per year, 666 per month 153
per week, 21 per day, 0 per hour, 0
per minute, 0 per second
13
to his mouth to feed himself, he was struggling to control his movement
and posture, and was not able to speak, neither to stand nor to sit. This
incident made the investigator to conduct a study regarding the
knowledge, attitude, and practice of caregivers of children with cerebral
palsy.
STATEMENT OF THE PROBLEM
A Study on the Knowledge, Attitude and Practice of Caregivers
of Children with Cerebral Palsy
OBJECTIVES
1) To assess the knowledge of caregivers regarding care of the
children with Cerebral Palsy
2) To find out the attitude of caregivers of children with Cerebral
Palsy
3) To assess the practice of caregivers of children with Cerebral
Palsy
4) To find the association of knowledge, attitude, and practice
with selected demographic variables.
5) To know the effect of an information brochure on the
caregivers of children cerebral palsy.
14
HYPOTHESES
SECTION A:
Ho: Knowledge of the caregivers is not influenced by any of the
selected demographic variables
H1: Knowledge of the caregivers is influenced by at least one of
the selected demographic variables
SECTION B:
Ho: Attitude of the caregivers is not influenced by any of the
selected demographic variables
H1: Attitude of the caregivers is influenced by at least one of the
selected demographic variables
SECTION C:
Ho: Practice of the caregivers is not influenced by any of the
selected demographic variables
H1: Practice of the caregivers is influenced by at least one of the
selected demographic variables
SECTION D:
Ho: The information brochure does not have any influence on the
knowledge, attitude, and practice of caregivers of children
cerebral palsy.
15
H1: The information brochure does have some influence on the
knowledge, attitude, and practice of caregivers of children
cerebral palsy.
OPERATIONAL DEFINITIONS
1) Cerebral palsy
Cerebral palsy refers to the disability due to non-progressive
damage to the motor areas of the brain and causes self-care deficits of
varying degrees in meeting the activities of daily living because of
spastic, involuntary movements of the body.
2) Children
Children include infants, toddler, preschool, school age, and
adolescents between the age group of 6 months to 18 years.
3) Caregivers
Caregivers refer to Mother/mother substitutes who are involved in
providing care to children with cerebral palsy.
4) Knowledge
Knowledge refers to the level of understanding of caregivers in
meeting the physical and emotional needs of children with cerebral
palsy, expressed during interviews.
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5) Attitude
In this study attitude refers to the feelings, values, and beliefs of
the caregivers on giving care to children with cerebral palsy on long-
term basis.
6) Practice
Practice refers to the activities that are carried out by the
caregivers in meeting the physical and emotional needs of children with
cerebral palsy such as hygiene, nutrition, toileting, medication, self-
care, and exercise, prevention of complications, love and affection.
ASSUMPTIONS
1. The inadequate knowledge of caregivers may affect in meeting
the needs of the children with cerebral palsy promptly.
2. The long term care of children may affect the attitude and
practice of caregivers.
DELIMITATIONS
1. This study is confined to Mysore District.
2. It is limited to caregivers of children with cerebral palsy.
3. Caregivers who are willing to participate in the study
4. Care givers who are available during the period of study.
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THEORETICAL FRAMEWORK OF THE STUDY
Theoretical framework of this study is based on Imogene M. kings
(1990) goal attainment theory. King has interrelated the concepts of
perception, action, reaction, interaction and transaction into a theory of
goal attainment.
PERCEPTION
Perception is each persons understanding of reality. The
individuals come together and perceive each other about the reality.
In this study, the researcher and the caregivers of children with
cerebral palsy come together. Each makes judgment to increase the
knowledge attitude and practice.
ACTION
Action is defined as a sequence of behaviours involving mental
and physical action. At first mental action to recognise the present
conditions; then physical action to start activities related to those
conditions; and later, mental action combined with physical action
seeking to achieve goals.
In this study, the researcher administered tools to assess the
Knowledge, Attitude, and Practice of caregivers, which includes
structured questionnaire, Likert Scale to assess the attitude, checklist
for practice. The aspects of structured interview schedule includes 30
questions regarding general information ,signs and symptoms, self-care
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needs and support, feeding and nutrition, hygiene and elimination,
Exercise and prevention. Four-point Likert Scale includes 24
statements (12 positive and 12 negative) used to assess the attitude.
Checklist includes 26 statements to assess the practice of caregivers of
children with cerebral palsy.
REACTION
Reaction is the sequence of behaviours described in action. In
this study response of the caregivers to the interview questions are the
reactions. Caregivers give consent and readiness to be assessed on
Knowledge, Attitude, and Practice.
INTERACTION
King defines interactions as the observable behaviours of two or
more individuals in mutual presence.
In this study, Interaction involves self-introduction, getting
consent in participating the study, administration of the tool to the
caregivers and collection of data. The caregivers actively participated in
the study and responded to interview schedule, attitude scale and to the
checklist.
Transaction
Transaction is a process of interactions in which human beings
communicate with the environment to achieve goals that are valued;
transactions are goal-directed human behaviours.
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In this study, transaction involves distribution of information
brochure with a goal to improve knowledge, attitude, and practice of
caregivers and their understanding of the same. Information brochure
improves the knowledge attitude and practice of caregivers.
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APPLICATION OF KINGS GOAL ATTAINEMENT THEORY
REACTION:
1.Consent and
readiness to be
assessed on KAP
of caregivers
to children with
cp.
2. Responses of
the caregivers on
assessment of
knowledge
,attitude and
practice.
INTERACTION
1. Administer
information
brochure
to the caregivers
and their
understanding
of the same.
2.Reassessment
on K A P
TRANSACTION
Improvement of
knowledge ,
Attitude and
Practice
of caregivers to
children with
cerebral palsy.
ACTION :
Administer Tool
to assess the KAP of
caregivers
1. Structured
questionnaire to
assess the
knowledge of
caregivers
2. Likert scale to
assess the
attitude of
caregivers
3. Check list for
practice on
caregivers of
children with cp
PERCEPTION –
investigator :
Decreased level of
knowledge, attitude
and practice of
caregivers of children
with cerebral palsy.
JUDGMENT:
To increase level of
knowledge, attitude and
practice of caregivers of
children with cerebral
palsy
REVIEW OF
LITERATURE
CHAPTER – II
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CHAPTER – II
REVIEW OF LITERATURE
Literature was reviewed relevant to the study variable on
Knowledge, Attitude, and Practice of caregivers of children with C P.
Resaej M et al (2014) conducted a study (N =77) on knowledge
of Iranian occupational therapists in handling children with cerebral
palsy and the application of their knowledge into practice. A
questionnaire with two scales of a self-report and a knowledge-based
test was used to collect the data. Data analysis was done by descriptive
statistics and Spearman correlation. Of 77 participants, 64.9%
participants reported their knowledge of handling children with cerebral
palsy at moderate, 14.3% at low, and 6.5% at very low level. The result
of the test showed that 57.1% participants had knowledge at moderate
and 16.9% at low level. The results suggest that the participants need
further training to increase their knowledge in toileting and bathing.
Burkhard A (2013) conducted a study on caring for adolescents
with severe cerebral palsy for 11 mothers using semi-structured
interviews and analysed using Van Manners approach. Results
revealed four interrelated essential themes related to managing an
unexpected life, balancing caregiver demands, assuming advocacy
roles, and facing uncertain future. Findings suggest the need for
22
improved supports and services to optimise family care giving during
this transitional period of family life.
Bunning K et al (2013) conducted a descriptive study on
investigation of practices to support the complex communication needs
of children with hearing impairment and CP in rural district of Kenya. A
convenient sampling technique was used for six practitioner child dyads
assigned to partner types. (a) Three children with hearing impairment
and their teachers (b) Three children with cerebral palsy and their
occupational therapists. The study concluded that the assignment of
speech and language therapy duties to teachers and occupational
therapists has resulted in suboptimal practice for children with complex
communication needs.
Gannotti M (2013) conducted a study regarding the caregiver
practices of children with physical disability, for 450 subjects each from
with and without physical disability in U.S. Caregiver-practices were
measured using consensus analysis. Results showed that, more
negative caregiver practices are associated with families of children
with lower socio-emotional skills and behaviours. It is recommended
that health professionals working with children with physical disability
should target developing socio-emotional skills to support positive child-
parent interactions and promote positive out-come.
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Olajide A Olawale et al (2013) conducted a cross – sectional
descriptive survey in the physiotherapy department of a tertiary
hospital, Africa, for 52 parents of children with cerebral palsy regarding
psychological stress on the families and strategies adopted to cope with
the stress. Descriptive statistics were used to show the responses. The
study concluded that families caring for the children with CP generally
have a positive attitude towards their children. It also suggested that
there is a need to educate the public on the causes of CP and
treatment options available to families.
Huang YP et al (2012) conducted a study (n=15) on being
concerned: care giving for Taiwanese mothers of a child with cerebral
palsy. Data collection method used was in depth interviews and
Journaling method, for mothers who were primary caregivers for
children aged between 0-18 years with cerebral palsy. This study
concluded that Taiwanese mothers face the strain of managing barriers
to care giving contexts in which their children are not supported or
acknowledged as being important contributors to family and society at
large. This study highlights how family can be important to care giving
mothers in traditional Chinese family life.
Eduardo Chaves Crus et al (2011) conducted a study on
caregiver‟s attitude towards Augmentative and Alternative
Communication (AACS) for young children with cerebral palsy in
24
Portugal. The study has been recommended that for children who are
severely impaired in their development of communicative abilities, it
was assumed that caregivers attitude towards AACS would be driven
by children‟s degree of cognitive and linguistic Impairments. In order to
verify that, 40 dyads of children with CP and their primary caregivers
(mothers) participated in this study evaluated the children‟s degree of
cognitive and linguistic impairments using Battelle‟s questionnaire, and
the caregiver‟s attitude AACS by means of a Likert Scale containing 15
items. Results showed that the caregivers most negative attitudes
towards the use of AACS were found among those caring for children
with most severe impairments.
Hwang M et al (2011) conducted a Cross-sectional study (N=100)
on Measuring care and comfort in children with cerebral palsy.
Primary caregivers of children with CP whose Gross Motor Function
Classification System (GMFCS) levels were III-V, were selected. The
Care Q was administered to primary caregivers of children with CP.
Internal consistency of the Care Q and its three domains (Personal
Care, Positioning/Transfers, and Comfort) were evaluated with the
Cronbach α. Construct validity of the Care Q was evaluated by its
correlation with the Paediatric Functional Independence Measure (Wee
FIM). Associations between Care Q scores and child and caregiver
characteristics were assessed. Results showed that no caregiver
characteristics were associated with Care Q scores.
25
Morgan F and Tan BK (2011) conducted a qualitative study on
rehabilitation of children with cerebral palsy in rural Cambodia,
regarding parental perception of family-centred practices. This study
examined the perceptions of 24 parents living in rural Cambodia
regarding family-centred rehabilitation practices. Semi structured
individual and small group interviews are used as tools and convenient
sampling technique is used. Result showed that almost all parents
valued family-centred practices in rehabilitation of children with cerebral
palsy.
Tseng MH et al (2011) conducted a study on the determinants of
daily function in children with cerebral palsy. The aim of the study was
to identify determinants of daily function in a population-based sample
of children with cerebral palsy, considering the function, disability, and
health. Here, 216 children and their caregivers participated in the study.
Result showed that knowledge of daily function helps the caregivers to
plan and intervene to improve the capacity and performance in daily
function for children with cerebral palsy.
Guyard A et al (2010) conducted a Study on impact on parents of
cerebral Palsy in children. Here, 40 subjects were selected. The study
confirmed that parents of cerebral Palsy have greater risk of
experiencing a sense of burden than the parents normally developing
children. The study showed that the knowledge of parents were
26
insufficient. It was concluded that more research is needed for
identifying families with a risk of maladaptation and suggesting
solutions to decrease negative impact.
Santos MT et al (2010) conducted (n=65) a cross-sectional study
on Caries prevalence in patients with cerebral palsy and the burden of
caring for them to investigate the correlation between caries prevalence
in individuals with cerebral palsy (CPG) and the burden on their
caregivers (CGCP) compared to nondisabled individuals (CG) and
their caregivers.
In this cross -sectional assessment, 65 subjects with cerebral
palsy were evaluated for their caries prevalence. The CGCP answered
the Caregiver Burden Scale (CBS) questionnaire. Using the same
methodology, 58 CG were evaluated. The CGCP had statistically
significant higher scores on general strain, isolation, disappointment
and environment. The CPG had significantly higher values using the
Decayed, Missed, and Filled (DMF) index than the CG. Values for the
CBS domains in general strain and disappointment and DMF index
were found to have a statistically significant correlation. This study
concluded that taking care of an individual with CP is a potential source
of continual burden for caregivers.
Brinkey et al (2009) conducted a study (n= 107) to determine the
level of knowledge about wheelchair transportation safety practices
27
among wheelchair users (WCUs) and caregivers, therapists,
physicians, and other professionals (CTPs) using convenience sample
. Two 10-question surveys were administered to 107 WCUs.
Results indicated that most WCUs (67%) and about half of the
CTPs had not received education about best transportation practices.
Sixty-seven percent of WCUs and 46% of CTPs felt lack
of knowledge in use of best transportation practices.
This study concluded that there is a poor level
of knowledge about wheelchair transportation safety practices among
WCUs, caregivers, and professionals who prescribe wheelchairs.
This knowledge deficit leads to a lack of standardised transport and a
potential compromise of safety.
Esdaile S A (2009) conducted a qualitative study (n=7) on valuing
difference: care giving by mothers of children with disabilities. Mothers
who are caregivers of children with disabilities seek to have
their children accepted and valued by others in society. In this paper,
qualitative research data from interviews with seven mothers
of children with disabilities were reanalysed using Bourdieu's theory
of practice and van Manen's phenomenological methodology.
The results showed that these mothers, who
were caregivers of children with disabilities, valued their children
despite ongoing challenges, and wanted others to do likewise. This
28
study supports the importance of valuing difference in terms of the
insights and understanding gained from those with disabilities and
their caregivers.
Maria Ingrid (2009) conducted a cross – sectional study
regarding parental adaptation in families of young children with CP for
51 parents in Germany. Assessed their personal reactions to diagnosis
interview, and assumed their personal reaction to these children
diagnosis. Relationships between these reactions were investigated
using univariate and multivariate logistic regression analysis. Results
showed that majority (77%) of the parents of children with CP have
come to terms with this diagnosis.
Rigby P J et al (2009) conducted (N=30), a Baseline-intervention-
baseline study on the effect of adaptive seating devices on the activity
performance of children with cerebral palsy to evaluate the short-term
impact of 2 adaptive seating devices on the activity performance and
satisfaction with performance of children with cerebral palsy (CP), as
observed by their parents.
Parents and their children mean age of 4 years 6 months, with
Gross Motor Function Classification System levels III and IV CP
participated. Two special-purpose seating devices, one for sitting
support on the floor or on a chair, another for postural control on a
toilet. Changes in activity performance and satisfaction were measured
29
through parent ratings on the Canadian Occupational Performance
Measure. Interviewed parents biweekly using the Home Activity Log to
describe and explain their child's activity performance during the three
study phases. Parents identified 139 activity performance issues (4.6 a
child): 58.3% in self-care, 34.5% in play, and 7.2% in socialisation and
quiet recreation. Paired t tests used to demonstrate significantly
improved performance and satisfaction with self-care and play activities
when the children used the adaptive seating devices during the 6-week
intervention phase.
Parents reported that their young children with CP were more
able engage in self-care and play activities when using specific
adaptive seating devices in their home.
Parks J et al (2008) conducted a cross sectional study on
psychological problems in children with cerebral palsy. A cross
sectional Multi-centre survey on 818 children with cerebral palsy aged
8-12 was selected from eight European regions. Multi-level,
multivariable logistic regression analysis was done. The study
concluded that a significant proportion of children with cerebral palsy
have psychological symptoms or social impairments that need
specialist services and care must be taken by the caregivers to assess
and manage children with cerebral palsy.
30
Morrow A.M et al (2008) conducted a qualitative cross sectional
study on comparison of parents and health professionals‟ perceptions
of quality of life in quadriplegic Cerebral Palsy in Australia on 24
parents. Semi-structured focus group interview conducted with parents.
Result showed that the health professionals did not consider the full
range of issues important to families. The difference in priorities for
treatment outcomes negatively affected the parent and health
professional relationship. Study highlighted the parent‟s expert role in
assessing the child‟s emotional and social wellbeing.
Verral T.C et al (2008) conducted a study on nutrition knowledge,
attitude, and belief of caregivers of cerebral palsy children. A
questionnaire was administered to cerebral palsy caregivers (n=52,)
and to a comparison group of non-cerebral palsy caregivers (n=35).
Result showed that non - CP caregivers scored higher nutrition
knowledge (p<0.001), had a more positive attitude about the
importance of nutrition (p<0.05), and had a more positive beliefs about
the relationship between nutrition and health p<0.05).
Aran A et al (2007) conducted a study on parenting style impacts
on quality of life in children with cerebral palsy. Study involved 39
children with cerebral palsy. Their siblings and their parents participated
in this study using questionnaire .Results showed that in children with
cerebral palsy parenting style positively correlated with questionnaire
31
scores. The study concluded that parenting style is a significant factor
on quality of life in children with cerebral palsy.
Sahar etal (2007) conducted a study to examine family
caregiver‟s knowledge skill and attitude in caring for older people
following the implementation of a family caregiver - training programme
(FCTP). Findings indicated significant increase in knowledge skills and
attitudes in the intervention group compared to those of the control
group. Hence, the FCTP demonstrated a positive effect on family
caregiver‟s capabilities and attitudes in caring. In this study, attitudes of
the family caregivers are the major areas of study.
Sen Esine et al (2007) conducted a study to determine the
difficulties experienced by the families with disabled children regarding
social life, working life, and family relationship, in one public and two
private rehabilitation centres by using a questionnaire. Findings of the
study revealed that the caregivers‟ social life, working life, and family
relationship were affected and they had financial problems.
Murphy N.A et al (2006) conducted a study (n=40) on the
caregivers of children with disabilities. This study explores caregiver
perspectives of the health implications of long-term informal care giving
for children with disabilities. Results showed that 41 percent of the
caregivers reported that their health had worsened over the past year,
32
and attributed these changes to a lack of time, Lack of control and
decreased psychosocial energy.
It is concluded that caregivers of children with disabilities
describe negative Physical, emotional and functional health
consequences of long term, informal care giving.
Masasa T et al (2005) conducted a study on Knowledge of,
beliefs about and attitudes to disability: implications for health
professionals in South Africa. Sixty primary caregivers were interviewed
by using a knowledge, attitude, and belief (KAB) survey in a structured
interview format. Probability and non-probability (systematic and
purposive) sampling were used. Results showed all caregivers had only
a rather rudimentary knowledge of the causes of disability, but held
positive attitudes towards people with disabilities. There appears to be
a need for improved disability awareness amongst the caregivers, in
schools and amongst transport service providers.
Raina P et al (2005) conducted a cohort study on the health and
wellbeing of caregivers of children with cerebral palsy, with data from
caregivers of children with cerebral palsy. The design allowed the
examination on the direct and indirect relationship between child health,
behaviour and functional status and caregiver characteristics (n=468).
Data on demographic variables and caregivers physical and
33
psychological health were assessed using standardised, self-completed
parent questionnaires as well as face-to-face home interview.
Results showed that most important predictors of caregiver‟s
wellbeing were child behaviour, care giving demands and family
function. Higher levels of behaviour problems were associated with
lower levels of both psychological and physical health of caregivers.
It is concluded that with psychological and physical health of
caregivers are strongly influenced by child behaviour and care giving
demands.
Brehant et al (2004) conducted a study (n = 468) at Canada on
the health of primary caregivers of children with CP, using self-
completed questionnaires and face-to-face interview. Results showed
that the caregivers of children with CP had lower incomes than the
general population, and they were expressing more stress.
Gabriela E (2004) conducted a study (n=110) at Nigeria on
knowledge, attitude, and expectations of mothers of children with
neurological disorders attending the paediatric neurology clinic, using
semi - structured questionnaire on mothers aged between 21 to 65
years. Majority of the mothers lack knowledge about the possible
cause, diagnosis, and outcome of their children‟s neurological disorder.
Pennington L et al (2004) conducted a study on speech and
Language therapy to improve the communication skills of children with
34
Cerebral Palsy. The study determined the effectiveness of speech and
Language therapy that focuses on their child or their communication
partners, and to find if individual types of SLT intervention are more
effective than others, in terms of changing the interaction patterns. It is
concluded that from evidence of the positive effect of SLT for children
with CP has not been demonstrated by this study. Further research is
needed to describe this client group, and its possible client subgroups,
and methods of treatment used in SLT and rigor in research practice
needs to be extended to enable firm associations between therapy and
communication.
King Gillian et al (1999) Conducted a study on family-centred
caregiving and wellbeing of parents of children with disabilities: Linking
process with outcome (n=164).This study examined the strength of the
relationship between parents of family-centred professionally provided
care giving and their emotional wellbeing using structural equation
modelling. Results showed that more family centred care giving was a
significant predictor of parent‟s wellbeing. It is concluded that services
are most beneficial when they are delivered in a family-centred manner
and when they address parent-identified issues such as the availability
of social support, family functioning, and child behaviour problems.
Amosun SL et al, (1995) conducted a comparative study on
rehabilitation of handicapped children (n=40) using general health
35
questionnaire. The caregivers of handicapped children had a
significantly higher mean score (6.8), which was above the threshold
score of four. This suggests that the task of caring the disabled children
may have stressful impact on the caregivers, which may contribute to
psychiatric morbidity.
Donovan T.J et al (1989) conducted a study on Health literature
of parents of children with cerebral Palsy at Melbourne .The study
examined the use of and need for written educational material by
parents of children with cerebral Palsy aged between 5 and 63 months.
After initial counselling, the majority felt that they needed written
information. The parents of 31 children attempted find a suitable books
or pamphlets. A significant association found between reading material
which parents found satisfactory and their knowledge about the basic
features of cerebral palsy.
METHODOLOGY
CHAPTER - III
36
CHAPTER III
RESEARCH METHODOLOGY
Research methodology refers to the steps, procedures, and
strategies for obtaining, organising, and analysing data in research
investigations. It addresses the development, validation, and evaluation
of research tools or techniques. It is away to systematically solve the
research problem. It is science of studying how research is done
scientifically. Methodology is a significant part of the research under
which the researcher is able to project a blue print of the research
undertaken.
This chapter describes the research methodology adopted to
assess the knowledge, attitude, and practice of caregivers of children
with cerebral palsy at Mysore.
Research methodology of this study includes the following:
Research design
Setting of the study
Population
Sample
Criteria for selection of samples
o Inclusion criteria
o Exclusion criteria
Variables under study
37
Sample size
Sampling technique
Development and description of the tools
Validity of the tool
Reliability of the tool
Reliability
Pilot study
Procedure for data collection
Plan for data analysis
SETTINGS OF THE STUDY
It is essential for the researcher to consider the setting in which
the study is conducted. The study is conducted in Mysore district.
Mysore is populated with more than 1000 CP children residing from
various parts of the country to get treatment from institutions such as All
India Institute of speech and hearing, JSS Hospital and other voluntary
organisations. Majority are staying in Gangothri layout. For the present
study, 400 samples were selected from Gangothri layout Mysore using
systematic random sampling method.
RESEARCH DESIGN
Research design is the researchers overall plan for obtaining
answers to all questions for testing the hypothesis (Polit.F).It spells out
the basic strategies that the researcher adopts to develop information
that is accurate and interpretable. It is the blueprint for study
38
implementation, that maxims and control over factors that could
interfere with the validity of the findings (Polit and Hungler, 1999).
Selection of the design is based on the purpose of the study. Research
design chosen by the researcher to assess the knowledge attitude and
practice of caregivers of children with cerebral palsy was Non
Experimental Descriptive study.
Non-experimental studies are the second broad class of
descriptive research. The purpose of descriptive studies are to
observe, describe, and document aspects of a situation, as it naturally
occurs, and sometimes to serve as a starting point for hypothesis
generation or theory development (Polit & Beck 1978).
The investigator conducted descriptive study to assess the
knowledge attitude and practice (dependent variable) of caregivers of
children with cerebral palsy. An information brochure (Independent
variable) is administered to the caregivers to find out the effect of
information brochure on knowledge, attitude, and practice of caregivers
of children cerebral palsy. The researcher recorded the information that
was present in a population, without manipulating the variables.
Research design could interfere in the blue print of the study for
implementation that maximises and control over factors that could
interfere with the validity of the findings (Polits and Hungler, 1999)
39
In view of the problem under the study and the objectives of the
study, the research design selected for this study was Non-
experimental descriptive design.
40
Fig-1.Schematic Representation of research study Design
Population:
All caregivers of children with cerebral
palsy
Sampling Technique:
Systematic random sampling method
Sample: Caregivers of children with
cerebral palsy (N=400) who fulfill the
inclusion criteria
Data analysis:
Descriptive and inferential statistics
Impact of the Information
Brochure on
Knowledge, Attitude, and
Pracice
Structured interview schedule to
assess the knowledge
Observational check list
to assess the practice
Likert Scale to assess the
attitude
41
POPULATION
Polit (2008) referred population as the entire set of individuals or
subjects having common characteristics sometimes referred to as
universe. Population may be of two types, accessible population, and
target population.
The population selected for this study was all caregivers of
children with cerebral palsy.
ACCESSIBLE POPULATION
Accessible population refers to the aggregate of cases that
conform to the designated criteria and that are assessable as subjects
for the study.
In this study, the accessible population was caregivers of children
with cerebral palsy in Mysore district. The investigator selected two
institutions (All India institute of speech and hearing and JSS Hospital
physiotherapy unit) where children with cerebral palsy are attending for
speech therapy and physiotherapy with their caregivers.
TARGET POPULATION
Target population is the aggregate of cases about which the
researcher would like to generalise.
In this research, the target population was the caregivers of
children with cerebral palsy who are staying in Gangothri layout for
easy access to speech therapy and physiotherapy, at Mysore.
42
SAMPLE
Polit (2008), state that the sample consists of the subset of the
population selected to participate in the research study.
To fulfil the objectives of the study the researcher selected the
caregivers of children with cerebral palsy of Mysore based on the
inclusive and exclusive criteria.
INCLUSION CRITERIA
The criteria that specify population characteristics are referred to
as inclusion criteria. Inclusive criteria of the present study were,
1. Caregivers of who are directly involved in the care of children
with cerebral palsy.
2. Caregivers who are willing to participate in the study.
3. Caregivers of who are present at the time of study.
EXCLUSION CRITERIA
Exclusive criteria of the present study were,
1. Caregivers who are not involved in the direct care of the
children with cerebral palsy.
2. Caregivers who were not staying in Mysore district.
3. Caregivers who refused to participate in the study
43
VARIABLES
According to Sunder Rao (2008), variables are the items or
characteristics on which observations are made. The variables
discussed in the present study are
Knowledge
Attitude
Practice
Age
Gender
Education status
Marital status
Type of family
Employment status
Religion
Area of residence
Type of house
Ownership status
Income
SAMPLE SIZE
Polit (2008), Sample size is the number of study subjects
selected from the population. The main purpose of the researcher is to
obtain a sample large enough to show statistical significance, also to be
44
expedient and economical at the same time. The sample size is
determined based on the study variables being studied, the statistical
significance required, and availability of the sample and feasibility of
conducting the study.
The sample size for the present study was 400. Factors like
nature of the study, availability of the sample, time, money, and material
were considered while deciding the sample size.
SAMPLING TECHNIQUE
Sampling is an important step in research process. It is the
process of selecting the representative units or subset of a population
of the study in a research. Present study adopted Systematic-sampling
method. Systematic Sampling involves the selection of sample
members such that every kth (e.g., every tenth) person or element from
a list (sampling frame) is chosen. In the present study the desired
sample size was established at four hundred (N=400). The estimated
size of the population was thousand (1000).By dividing N by n the
sampling interval width (k) was established. The sampling interval is the
standard distance between elements chosen for the sample. The
formula used for the study was k = 800 / 400 = 2. In other words, every
second person (every even number) in the list was chosen. The first
person was selected randomly, using a table of random numbers. The
caregivers of children with cerebral palsy corresponding to numbers 4,
6, 8, and so forth were sampled to reach a sample size of 400.
45
DEVELOPMENT AND DESCRIPTION OF RESEARCH TOOL
The tool is a written device that a researcher uses to collect the
data. Treece and Treece (1986) states that, instrument selected in the
research must be the vehicle that obtain the best data for drawing
conclusions to the study. In this study, the researcher developed the
tool after an extensive and careful review of literature, internet search,
and discussion with experts in order to select the most suitable and
appropriate assessment tool for data collection. The tool was developed
in English and the same was used for data collection process.
The tool consists of four sections.
SECTION: I
Performa for Socio demographic data such as age,
gender, education status, marital status, type of family, employment
status, religion, area of residence, type of house ownership status, and
income.
SECTION: II
Structured questionnaire for assessing the knowledge of
caregivers of children with cerebral palsy. Multiple-choice questions of
30 items were categorised under the following six domains.
General information regarding cerebral palsy
Signs and symptoms of cerebral palsy
Self-care needs and support of children with cerebral palsy
46
Feeding and nutrition
Hygiene and elimination
Exercise and prevention.
Scoring and interpretation
One mark is given for the correct answer and zero mark is given
for the incorrect answer.
SECTION: III
To measure the level of attitude, four point Likert Scale was used.
A Likert Scale is an ordered scale from which respondents choose one
option that best aligns with their view. It is often used to measure
respondent‟s attitudes by asking the extent to which they agree or
disagree with a particular question or statement. A typical scale might
be “strongly disagree, disagree, neutral, agree, and strongly agree”
.Likert scaling is a bipolar scaling method, measuring either positive or
negative response to a statement. Sometimes an even – point scale is
used, where the middle option “Neither agree nor disagree “is not
available. This is sometimes called a “forced choice” method since the
neutral option is removed.
In this study, the researcher used a four point Likert Scale and
removed the neutral option. Among the 24 items, 12 items were positive
and 12 items were belonging to negative attitude. Responses were
scored between negative and positive items.
47
The level of attitude was classified as follows.
Scoring key was given for each item with SA (strongly agree) = 4
Mark, A (agree) = 3 Mark, D (disagree) = 2 Mark, SD (strongly
disagree) = 1 Mark, for all positive questions and vice-versa for all
negative questions.
SECTION IV:
To measure the practice of caregivers, observational checklist is
used. Checklists are useful when observing specific unambiguous
behaviours. The checklist usually has a rating scale that asks the
observer to indicate the presence or absence of a behaviour and
sequence of events.
In this study Observational Check list has 26 items to assess the
practice of caregivers regarding meeting the self-care needs of children
with C P. On observation, the investigator marked the presence or
absence of events.
Scoring and interpretation
One mark is given for the presence of the trait and zero mark is
given for the absence.
Attitude score Classification
>= 75% Favourable Attitude
< 75% Unfavourable Attitude
48
VALIDITY OF THE TOOL
According to Polit (2008), validity refers to the degree to which
an instrument measures what is supposed to measure. Twelve experts
comprising experts in the field of Community Health Nursing and Child
Health Nursing valued the present tool. Child Health Nursing Expert
and one statistician were requested to judge the tool for its clarity,
relatedness, sequences meaningfulness, and content. Modifications
were made as per the suggestions given by the experts and in
consultation with the guide. Corrections were made as follows:
The investigator framed questionnaire initially with 35 Knowledge
questionnaires, 30 attitude questions, and 30 questions on
observational checklist for assessing practice. With experts opinion
Questions were reframed as 30, 24, and 26 respectively.
The tool was administered and checked for its feasibility and
appropriateness. The subjects chosen were similar in characteristics to
those of population under study. The tool prepared by the researcher
was administered to 30 caregivers (mother / mother substitutes) who
were directly involved in the care of children with cerebral palsy .It was
found that the items were clear and understandable to the subjects.
49
RELIABILITY
Polit (2008) reliability refers to the accuracy and consistency of
information obtained in a study. The three main attributes of a reliability
scale are stability, homogeneity, and equivalence. The stability of an
instrument refers to the extent to which similar results are obtained on
two separate occasions. The homogeneity of the instrument means that
all the items in a tool measure the same concepts or characteristics. An
instrument issued to exhibit equivalent or parallel instrument or
procedure is used.
In the present study the reliability of the study was established by
test – re test method .The tool was administered on 1st and 3rd day.
The tool was administered to 30 caregivers who were directly involved
in care giving. Correlation coefficient „r‟ was 0.75, which showed highly
positive correlation of the tool. Hence, the tool was considered highly
reliable for preceding the main study.
VALIDITY OF THE INFORMATION BROCHURE
The initial draft of the information brochure was given to the guide
to validate. The information brochure was modified and finalised in
consultation with the guide.
PILOT STUDY
Burns &Grove (2007) states that a pilot study is a smaller version
of a proposed study conducted to develop and refine the methodology,
50
such as the treatment, instruments, or data collection process to be
used in a large study.
Pilot study was conducted prior to the actual full-scale study after
obtaining administrative approval from the authorities concerned and in
consultation with the guide and statistician. The researcher selected 30
caregivers as samples who registered their children with cerebral Palsy
at Sneha kirana Spastic Society of Mysore. Pilot study was conducted
in the month of November 2012 .Consent was taken from the samples
before conducting the study and their confidentiality was assured.
ETHICAL ISSUES
The following ethical factors were considered during the period of
the study.
1. The study was approved by the Doctoral Advisory Committee of
Vinayaka Missions University Salem.
2. Formal permission was obtained from the research guide,
Professor Dr. Rebecca Samson, Dean, College of Nursing
Pondicherry Institute of Medical Sciences, Pondicherry.
3. Formal permission was obtained from the Director All India
Institute of Speech and Hearing and Medical Superintendent of
JSS Hospital, Mysore to get the name list of children with
cerebral palsy that registered their names in those institutions to
get treatment .
51
4. The content Validity of the tool was obtained with the
concurrence of all the experts and the guide.
5. Informed consent from each respondent was taken before
participation in the study. Questionnaires were assigned with an
identification number.
Thus, the ethical issues were ensured in the study.
DATA COLLECTION PROCEDURE:
Burns & Grove (2007) states, data collection are the identification
of subjects and the precise systematic gathering of information relevant
to the research purpose or the specific objectives, questions or
hypotheses of a study. The formal permission was obtained from the
research guide who is a professor and Dean of the college of nursing,
Pondicherry institute of Medical sciences before data collection.
Four hundred samples that fulfilled the inclusive criteria were
selected by systematic random sampling technique. On selection of
each study subject, a brief self-introduction was given, followed by
detailed explanation regarding the purpose of the study. The informed
consent was obtained in written form and confidentiality of the subjects
was assured.
Mysore is populated with more than 1000 CP children residing
from various parts of the country to get treatment from institutions like
All India Institute of speech and hearing, JSS Hospital and other
52
voluntary organisations. The names and address of the children with
C P was collected from the institutions and the list of the caregivers
(sampling frame) was made. Every even number was chosen for the
study. Visited the caregivers (mothers or mother substitutes) of children
with cerebral palsy at their houses with prepared questionnaire. Each of
the study subjects were asked to sit comfortably, and collected the
information on demographic data, and the knowledge with structured
questionnaire. Likert Scale was used to collect data regarding the
attitude. Information regarding Practice was collected with observational
checklist. Data collection was done from December 2012 to June 2013.
STATISTICAL TECHNIQUE EMPLOYED
Polit (2008): to answer the research questions and to test the
hypothesis, researchers need to process, and analyse their data in an
orderly coherent fashion, Quantitative information is analysed through
statistical procedures. In this study, the researcher collected data from
the subjects, entered in M.S Excel sheet, and analysed by using both
descriptive and inferential statistical methods. Statistical analysis was
done by statistical package for social sciences (SPSS) version 20 for
windows. Data was summarised using mean and standard deviation for
continuous variables and percentage for categorical variables. X2 test
was used to test for association between selected demographic
variables and knowledge, attitude, and practice (prior to distribution of
the information brochure).
53
The level of significance used was P<0.05.
The plan for data analysis was to:
a) Describe the socio-demographic variables of caregivers by
frequency and percentage distribution.
b) Frequency and percentage distribution, arithmetic mean,
and standard deviation were used to analyse the level of
knowledge, attitude, and practice.
c) Chi-square test was used to determine if the selected socio
demographic variables influenced the level of knowledge
attitude, and practice (prior to distribution of the information
brochure).
d) Pearson Correlation, T-Test, and F-Test were used to
establish the effectiveness of the brochure.
Research Approach: Research Approach selected was
Evaluative approach.
DATA ANALYSIS AND
INTERPRETATION
CHAPTER - IV
54
CHAPTER - IV
DATA ANALYSIS AND INTERPRETATION
Data analysis is a systematic organisation and synthesis of
research and testing of hypothesis using those data. Statistics is an
estimate of a parameter, calculated from sample data. Statistical
procedures enable the researcher to reduce, summarise, organise,
evaluate, interpret, and communicate numerical information. Without
the aid of statistics, the quantitative data collected in a research project
would be little more than a chaotic mass of numbers.
The data after collection, lying in a haphazard mass are of no use
unless they are properly sorted, presented, compared, analysed and
interpreted. They mean something more than figures, give a dimension
to the problem, and even suggest the solution. For such a study of
figures, one has to apply certain mathematical techniques such as
mean, standard deviation, and presentation of life table. Biostatistics is
applied in nursing as they deal with human beings.
Data collection was done for 400 samples to assess the level of
knowledge, attitude, and practice of caregivers of children with cerebral
palsy. The collected data were grouped and analysed as per the
objectives of the study using descriptive and inferential statistics.
Descriptive statistics were used to describe and synthesise data.
Inferential statistics were used to make effective inferences.
55
ORGANISATION OF THE DATA
The data was tabulated and analysed according to the objectives
and hypothesis of the study. Analysis of the data was done after
conferring the entire data to master coding sheet. It was done through
an integrated system of computer programme known as statistical
package for social sciences (SPSS) version 20. The analysed data are
presented under the following sections.
Section A:
Analysis of socio demographic variables of caregivers of children
with cerebral palsy
Section B:
Assessment of level of knowledge of caregivers regarding the
care of children with cerebral palsy
Section C:
Assessment of level of attitude of caregivers using Likertscale
Section D:
Assessment of the level of practice of caregivers of children with
Cerebral Palsy
Section E:
Association of knowledge, attitude, and practice with selected
demographic variables
56
Section F:
Effect of an information brochure on the caregivers of children
cerebral palsy
PRESENTATION OF DATA
SECTION A:
Analysis of socio demographic variables of caregivers of children
with cerebral palsy.
Table-1.Distribution of caregivers according to their Age;
N=400.
Sl. No Variable Frequency Percentage
1 15-25yrs 46 11.5
2 26-35 yrs 160 40.0
3 36-45 yrs 169 42.3
4 46-55 yrs 25 6.2
Total 400 100
57
Fig-1: Distribution of caregivers according to their Age
Table -1 and Fig-1 show the distribution of caregivers with regard
to their Age. It reveals that majority, 42.3% of the caregivers belong to
the age group of 36-45 years, 40.0 % belong to the age group of 26-35
years, 11.5% belong to the age group of 15-25 years, and 6.2 % belong
to the age group of 46-55 years.
0
50
100
150
200
250
15-25yrs 26-35yrs 36-45yrs 46-55yrs
46
160 169
25
11.5
40 42.3
6.2
Percentage
Frequency
58
Table – 2. Distribution of caregivers according to their Gender;
N=400.
Sl. No Variable Frequency Percentage
1 Male 38 9.5
2 Female 362 90.5
Total 400 100
Fig-2: Distribution of caregivers according to their Gender
Table – 2 and Fig- 2 exhibited data on distribution of caregivers
based on their Gender. It revealed that majority, 90.5% of the
caregivers were females and 9.5% of them were males.
38
362
9.5
90.5
0
50
100
150
200
250
300
350
400
450
500
Male Female
Percentage
Frequency
59
Table-3.Distribution of caregivers according to their educational
status; N=400.
Fig-3: Distribution of caregivers according to their educational status
0
50
100
150
200
250
300
350
400
No
Fo
rma
l E
du
cati
on
Sch
oo
l dro
po
ut
Sch
oo
l u
pto
SS
LC
PU
C/H
igh
er
De
gre
e a
nd
ab
ove
261
304
66
3
6.5
0.3
76
16.5
0.7
Percentage
Frequency
Sl. No Variable Frequency Percentage
1 No formal education 26 6.5
2 School dropout 1 .3
3 School up to S S L C 304 76.0
4 P U C / Higher secondary 66 16.5
5 Degree and above 3 0.7
Total 400 100
60
Table – 3 and Fig- 3 revealed that majority, 76 % of the
caregivers attended school up to SSLC, and 16.5 % of the caregivers
studied P U C/ Higher secondary. 0.7 % had degree and above
qualification, 6.5 % had no formal education and 0.3 were school
dropout.
Table 4. Dist. of caregivers according to their marital status;
N=400.
Fig- 4. Dist. of caregivers according to their marital status
Table – 4 and Fig- 4 depicts that 100% of the caregivers were
married.
400
0
Frequency , Percentage
Married
Sl.No Variable Frequency Percentage
1 Married 400 100
2 Unmarried 00 00
Total 400 100
61
Table – 5.Distribution of caregivers according to Type of family;
N=400.
Fig-5: Distribution of caregivers according to Type of family
Table –5 and Fig- 5 revealed that according to the type of family,
63.5% of the caregivers belong to Nuclear family, and 36.5% belong to
Joint family.
0
50
100
150
200
250
300
NuclearJoint
254
146
63.5
36.5
Frequency
Percentage
Sl. No Variable Frequency Percentage
1 Nuclear 254 63.5
2 Joint 146 36.5
Total 400 100
62
Table – 6.Distribution of caregivers according to Employment
status; N=400.
Fig-6: Distribution of caregivers according to Employment status
Table – 6 and Fig- 6 depicted distribution of caregivers
employment status, they highlighted that majority, 74.0 % of caregivers
belong to other category, 19.2 % were self-employed and 6.8 % were
salaried.
0
100
200
300
Self employedSalaried
Others
77
27
296
19.36.8
74Frequency
Percentage
Sl.No Variable Frequency Percentage
1 Self employed 77 19.3
2 Salaried 27 6.8
3 Others 296 74.0
Total 400 100
63
Table – 7. Distribution of caregivers according to Religion.
N=400.
Fig-7: Distribution of caregivers according to Religion.
Table – 7and Fig- 7 depicted distribution of caregivers religion,
51.0 % belong to Muslim, 45.3% belong to Hindu and 3.8% belong to
Christian.
0
50
100
150
200
250
300
Hindu Muslim Christian
181204
15
45.2
51
3.8
Percentage
Frequency
Sl.No Variable Frequency Percentage
1 Hindu 181 45.2
2 Muslim 204 51.0
3 Christian 15 3.8
Total 400 100
64
Table – 8.Dist. of caregivers according to Area of Residence.
N=400.
Fig- 8: Distribution of caregivers according to Area of Residence
Table –8 and Fig- 8 depicted caregivers according to Area of
Residence .It is evident that 50.0% of the caregivers belong to rural and
50.0% belong to urban areas.
200200
Frequency
Rural
Urban
Sl.No Variable Frequency Percentage
1 Rural 200 50.0
2 Urban 200 50.0
Total 400 100
65
Table – 9. Dist. of caregivers according to Type of House;
N=400.
Fig- 9: Distribution of caregivers according to Type of House
Table – 9 and Fig -9 depicted caregivers according to the type of
house they reside. On analysis of type of house majority, 87.5 % of the
caregivers reside in concrete house and 12.5% reside in mud house.
0
50
100
150
200
250
300
350
Mud
house
Concrete
house
50
350
12.5
87.5
Frequency
Percentage
Sl.No Variable Frequency Percentage
1 Mud House 50 12.5
2 Concrete House 350 87.5
Total 400 100
66
Table –10 Dist. of caregivers according to Ownership Status.
N=400.
Fig- 10: Distribution of caregivers according to Ownership Status
Table –10 and Fig- 10 depicted caregivers according to their
Ownership Status. Concerning Ownership Status, 42.0% of the
caregivers reside in rented House, 37.2 % in leased house and 20.8 %
reside in their own house.
0
50
100
150
200
250
Own House Rented On Lease
83
163 149
20.8
42
37.2
Percentage
Frequency
Sl.No Variable Frequency Percentage
1 Own House 83 20.8
2 Rented 168 42.0
3 On lease 149 37.2
Total 400 100
67
Table – 11. Distribution of caregivers according to income;
N=400.
Fig- 11: Distribution of caregivers according to their income
Table –11and Fig- 11 depicted caregivers according to their
income. With regard to income, 49.0% of the caregivers are between
Rs.5001/- to Rs.10000/-, and 28.2 % of the caregivers are Rs.10001/-
and above, and 22.8% are below and equal to Rs.5000/- income.
0
50
100
150
200
Below and equal to
Rs.5000/- Rs.5001/-to Rs
10000/- Rs.10001/-and
above
91
196
11322.8 49
28.2
Frequency
Percentage
Sl.No Variable Frequency Percentage
1 Below and equal to Rs. 5000/- 91 22.8
2 Rs. 5001/- to Rs. 10000/- 196 49.0
3 Rs. 10001/- and above 113 28.2
Total 400 100
68
SECTION B:
Assessment of level of knowledge of caregivers regarding
the care of children with cerebral palsy.
Table.12.a) Frequency and percentage distribution of level of
knowledge of caregivers in providing care to children with cerebral
palsy with regard to General information. N = 400.
Sl.
No Knowledge questions
Correct Answer Incorrect Answer
n % n %
1 Which of the following are
the causes of Cerebral
palsy in children
293 73.3 107 26.8
2 Which of the following
disease causes Spasm &
difficulty in coordination
358 89.5 42 10.5
3 When did you notice that
your child is suffering from
Cerebral palsy
354 88.5 46 11.5
4 How long children with CP
(Cerebral palsy) will be
dependent on caregiver
272 68.0 128 32.0
Table -12.a) reveals the percentage distribution of the level of
knowledge among the caregivers of children with cerebral palsy with
regard to General information. It is evident from the above table that
69
majority, 73.3% of the caregivers answered, brain injury is the cause of
cerebral palsy in children. Majority, 89.5 % of the caregivers answered
that cerebral palsy causes Spasm & difficulty in coordination. 88.5 % of
the caregivers answered that while observing the movement, noticed
that the child is suffering from Cerebral palsy. 68.0 % of the caregivers
answered that children with CP (Cerebral palsy) will be dependent on
caregivers up to lifetime.
Table12.b) Frequency and percentage distribution of level of
knowledge of caregivers in providing care to children with cerebral
palsy with regard to Signs and symptoms; N = 400
Table –12.b) reveals the percentage distribution of the level of
knowledge among the caregivers of children with cerebral palsy with
regard to Signs and symptoms. It is evident from the above table that
only 43.8% of the caregivers answered that early sucking difficulty with
breast or bottle is the early sign of CP during infancy. Majority, 90.0 %
Sl. No Knowledge questions Correct Answer Incorrect Answer
n % n %
1 What is the early sign
of C P during infancy 175 43.8 225 56.3
2 Which of the following
is a sign of C P 360 90.0 40 10
70
of the caregivers of children with cerebral palsy answered that
purposeless body movements is a sign of cerebral palsy.
Table-12.c) Frequency and percentage distribution of level of
knowledge of caregivers in providing care to children with cerebral
palsy with regard to Self-care needs &Self-care support. N = 400.
Sl.
No Knowledge questions
Correct Answer Incorrect Answer
n % n %
1 Self-care needs of
children with C.P include:
385 96.3 15 3.8
2 How do you maintain
safety for your special
child
24 6.0 376 94
3 How do you promote self-
care activities for your
child
51 12.8 349 87.3
4 How do you promote
locomotion for your child
104 26.0 296 74.0
Table-12.c) reveals the percentage distribution of the level of
knowledge among the caregivers of children with cerebral palsy with
regard to self-care needs &self-care support. Majority, 96.3% of the
caregivers replied that self-care needs of children include bathing, toilet
training; dressing and feeding. Only 6.0% of the caregivers answered
71
that to maintain safety for the special child teach him to obey the rules
and regulations. 12.8 % of the caregivers answered that to promote
self-care activities, boost the child‟s ability in self-care activities. 26.0 %
of the caregivers answered that to promote locomotion, supportive aids
are necessary.
Table -12.d) Frequency and percentage distribution of level
of knowledge of caregivers in providing care to children with
cerebral palsy with regard to Feeding & Nutrition. N = 400
Table-12.d) reveals the percentage distribution of the level of
knowledge among the caregivers of children with cerebral palsy with
regard to feeding & nutrition. Majority, 92.5 % of the caregivers replied
that feeding problems in children with CP can identified by poor lip and
tongue control. Only 1.8 % of the caregivers answered that maintaining
the adequate nutrition of the child by recognising the caloric needs.
Sl. No Knowledge questions
Correct Answer
Incorrect Answer
n % n %
1 How do you identify feeding problems in children with C.P
370 92.5 30 7.5
2 How do you maintain adequate nutrition
7 1.8 393 98.3
72
Table12.e) Frequency and percentage distribution of level of
knowledge of caregivers in providing care to children with cerebral
palsy with regard to Hygiene & Elimination; N = 400.
Sl.
No
Knowledge questions
Correct Answer Incorrect Answer
n % n %
1 How do you maintain
cleanliness of the body of your
child
380 95.0 20 5.0
2 What type of bath is
appropriate for children with
CP
350 87.5 50 12.5
3 How do you maintain oral
hygiene
14 3.5 386 96.5
4 How do you prevent Dental
carries
23 5.8 377 94.3
5 Which of the following
complication can arise if the
perineum is not Cleaned
properly
36 9.0 364 91.0
6 What is the best time for toilet
training for your child
350 87.5 50 12.5
7 Children with Cerebral Palsy
frequently suffer from
constipation due to:
96 24.0 304 76.0
8 How can you prevent
constipation
215 53.8 185 46.3
73
Table 12.e) reveals the percentage distribution of the level of
knowledge among the caregivers of children with cerebral palsy with
regard to Hygiene & Elimination. Majority, 95.0 % of the caregivers
replied that daily bath in hot water is necessary to maintain cleanliness
of the body of the child. 87.5% of the caregivers answered that hot
water bath is appropriate for the child with cerebral palsy. Only 3.5 % of
the caregivers replied that rinsing the mouth after each feed help to
maintain oral hygiene. 5.8 % of the caregivers replied that brushing the
teeth twice daily prevent dental carries. Only 9.0% of the caregivers
answered that redness and rashes are the two complications that can
arise if the perineum is not cleaned properly. Majority, 87.5 % of the
caregivers answered that the best time for toilet training is between the
ages of 18 - 48 months. 24.0 % of the caregivers answered that the
children with cerebral palsy frequently suffer from constipation due to
insufficient fibre and liquid in their diet. 53.8 % of the caregivers
answered that constipation can be prevented by encouraging regular
bowel habits.
74
Table12.f) Frequency and percentage distribution of level of
knowledge of caregivers in providing care to children with cerebral
palsy with regard to Exercise & Prevention of complications.
N = 400.
Sl. No Knowledge questions
Correct Answer
Incorrect Answer
n % n %
1 Your child may require equipmentto help with:
346 86.5 54 13.5
2 Which of the following activity needs equipment to exercise your child
344 86.0 56 14.0
3 How do you help your child in walking
319 79.8 81 20.3
4 Some disabilities in children with C P can be prevented by
154 38.5 246 61.5
5 How can you prevent Contractures
267 66.8 133 33.3
6 How do you help your child with C P to be independent
201 50.3 199 49.8
7 A child with C P can acquire social skills by:
10 2.5 390 97.5
8 How can a physiotherapist be helpful
166 41.5 234 58.5
9 What are the Problems encountered by the parents of children with C P
205 51.3 195 48.8
10 What are the facilities provided by Govt. of India to rehabilitate the children with C P
193 48.3 207 51.8
75
Table -12.f) reveals the percentage distribution of the level of
knowledge among the caregivers of children with cerebral palsy with
regard to Exercise & Prevention of complications. Majority, 86.5 % of
the caregivers replied that a child with cerebral palsy require equipment
to help with walking/ mobility and talking / communication. 86.0 % of the
caregivers replied that walking is an activity, which needs equipment to
exercise the child. 79.8% of the caregivers answered that a walker
helps the child in walking. 38.5% of the caregivers replied that some
disabilities in children with cerebral palsy could be prevented by taking
extra care during delivery. 66.8 % of the caregivers replied that
contractures could be prevented by movement through all ranges of
motion. 50.3 % of the caregivers answered that special schooling help
the child to be independent. Only 2.5 % of the caregivers answered that
a child with CP can acquire social skills by giving directions to get
home. 41.5 % of the caregivers answered that a physiotherapist helps
the parents to become skilful in assisting their child. 51.3 % of the
caregivers replied that the problems encountered by the parents of
children with cerebral palsy are shock, anger, and financial problems.
48.3 % of the caregivers replied that the facilities provided by the
government of India to rehabilitate the children with cerebral palsy are
concession for travelling, education, and employment opportunities.
76
Table -13. Mean, standard deviation, skew, and kurtosis on the
level of knowledge in each domain.
Sl. No Domains Mean S. D Skew Kurtosis
1 General information
regarding cerebral palsy
3.22 0.94 2.42 28.67
2 Signs and symptoms of
cerebral palsy
1.34 0.57 -0.14 -0.69
3 Self-care needs and
support
1.41 0.62 0.80 0.18
4 Feeding and nutrition 0.02 0.13 7.39 52.83
5 Hygiene and elimination 3.67 0.98 0.14 -0.12
6 Exercise and prevention 5.52 1.33 -0.02 -0.03
Table -13. depicts the mean, standard deviation, skew, and
kurtosis on the level of knowledge in six domains. It reveals that the
mean score in the domains of „General information regarding cerebral
palsy‟ was 3.2 with standard deviation of 0.6. The mean score in the
aspects of „Signs and symptoms of cerebral palsy‟ was 1.4 with
standard deviation of 0.6.The mean score in the aspects of „Self-care
needs and support‟ was1.4 with standard deviation of 0.6.The mean
score in the aspects of Feeding and nutrition‟ was 0.01 with standard
deviation of 0.3. The mean score in the aspects of Hygiene and
elimination was 3.7 with standard deviation of 1.0. The mean score in
the aspects of „Exercise and prevention‟ was 5.5 with standard
deviation of 1.3.
77
Table-14.Descriptive statistics for knowledge
Variable Knowledge
Mean SD Skew Kurtosis
Knowledge 16.1025 2.231466 0.119608 1.821952
Table – 14. describes the mean Knowledge score of caregivers
were 16.1 with standard deviation 2.23.
Table –15 Distribution of caregivers according to the level of
knowledge
Sl. No Level of Knowledge n % Mean SD
1 Good (>65 %) 20 5% 70.33 2.62
2 Average (51 % -65%) 230 57.5% 56.96 3.39
3 Poor (≤50%) 150 37.5% 46.42 4.48
Table- 15 depicts the Percentage distribution of level of
knowledge of caregivers. It reveals that 5% of the caregivers had good
knowledge, with a mean score of 70.33 and standard deviation of 2.62;
57.5% of the caregivers had average knowledge, with a mean score of
56.96 and standard deviation of 3.39; 37.5% of the caregivers had poor
knowledge with a mean score of 46.42 and standard deviation of 4.48.
78
SECTION C:
Assessment of level of attitude of caregivers of children with
cerebral palsy using Likert Scale.
Table-16: Frequency and percentage distribution of level of
attitude of caregivers of children with cerebral palsy with regard to
special education; N = 400.
Sl. No
Attitude statement
Responses
Strongly agree
Agree Disagree Strongly disagree
n % n % n % n %
1 If a baby is born
with any disability
it is a curse for
the family
- - - - 17 4.3 383 95.8
2 Physically
challenged
children needs
special education
362 90.5 38 9.5 - - - -
3 Physically
challenged
children need not
be sent for
special education
- - - - 372 93.2 28 7.0
4 Special education
will not prevent
disability
- - 322 80.5 78 19.5 - -
5 Special education
reduces the
disability
13 3.3 387 97.0 - - - -
79
Table -16: reveals the percentage distribution of level of attitude
of caregivers of children with cerebral palsy with regard to special
education. It is evident from the above table that majority, 95.8% of the
caregivers strongly disagreed that, if a baby is born with any disability it
is a curse for the family. Only 9.5 % of the caregivers agreed that,
physically challenged children needs special education. 93.2 % of the
caregivers feel that physically challenged children need not be sent for
special education. Majority, 80.5 % of the caregivers agreed that
special education would not prevent disability. Majority, 97.0 % of the
caregivers think that special education reduces the disability.
80
Table -16.a) Frequency and percentage distribution of level of
attitude of caregivers of children with cerebral palsy with regard to
Parenting & caring. N = 400
Sl. No
Attitude statement
Responses
Strongly agree
Agree Disagree Strongly disagree
N % N % N % N %
1 Parenting a special
child gives more
satisfaction
- - 389 97.4 11 2.8 - -
2 Caring a child with
CP is troublesome.
- - 6 1.5 394 98.5 - -
3 A child with CP
becomes lifelong
dependent on
caregivers.
- - 393 98.3 7 1.8 - -
4 One day my child will
be able to walk like
other normal children
- - 277 69.4 123 30.8 - -
5 Like other children
exceptional child
needs love, care and
protection from
parents
258 64.5 142 35.6 - - - -
6 Children with CP
needs hugging and
holding just like other
children
41 10.3 359 90.0 - - - -
7 Both parents must be
involved in caring
- - 351 87.8 49 12.3 - -
8 Both parents need
not be involved in
caring a child with CP
- - 48 12.0 352 88.0 - -
81
Table- 16. a) reveals the percentage distribution of level of
attitude of caregivers of children with cerebral palsy with regard to
Parenting & caring. It is evident from the above table that 97.4 % of
the caregivers agreed that parenting a special child gives more
satisfaction. Only 1.5 % of the caregivers feel that caring a child with
CP is troublesome. Majority 98.3% of the caregivers think that a child
with CP becomes lifelong dependent on caregivers. 69.4% of the
caregivers agreed that one day their child would be able to walk like
other normal children. 64.5% of the caregivers strongly agreed that like
other children exceptional child needs love, care, and protection from
parents. 10.3 % of the caregivers strongly agreed that children with CP
needs hugging and holding just like other children. 87.8 % of the
caregivers agreed that both parents must be involved in caring a child
with cp. Only 12.0% of the caregivers feel that both parents need not
involve in caring for a child with cp.
82
Table- 16.b) Frequency and percentage distribution of level of
attitude of caregivers of children with cerebral palsy with regard to
bowel training and activities; N= 400
Table-16.b) reveals the percentage distribution of level of attitude of
caregivers of children with cerebral palsy with regard to bowel training
and activities. 91.7% of the caregivers disagreed that bowel training can
be challenging for children with cp. 92.0 % of the caregivers disagreed
that bowel training is easy for children with cp. Majority, 93.5 % of the
caregivers disagreed that children with CP are often relatively inactive.
6.5 % of the caregivers disagreed that children with CP are very active.
Sl.No Attitude statement
Responses
Strongly agree
Agree Disagree Strongly disagree
n % n % n % n %
1 Bowel training can be
challenging for
children with CP
- - 34 8.5 366 91.5 - -
2 Bowel training is easy
for children with CP - - 368 92.0 32 8.0 - -
3 Children with CP are
often relatively
inactive.
- - - - 373 93.25 27 6.75
4 Children with CP are
very active - - 374 93.5 26 6.5 - -
83
Table -16.c) Frequency and percentage distribution of level of
attitude of caregivers of children with cerebral palsy with regard to
exercise. N = 400
Table -16.c) reveals the percentage distribution of level of attitude
of caregivers of children with cerebral palsy with regard to exercise.
83.5 % of the caregivers agreed that regular exercise is important to
prevent contractures in children with CP. 86.5 % of the caregivers
disagreed that without exercise children with CP are able to lead a
normal life.
Sl. No Attitude
statement
Responses
Strongly agree
Agree Disagree Strongly disagree
n % n % n % n %
1 Regular exercise
helps to prevent
contractures in
children with CP
- - 334 83.5 66 16.5 - -
2 Without exercise,
children with CP
are able to lead a
normal life
- - 346 86.5 54 13.5 - -
84
Table – 16.d) Frequency and percentage distribution of level of
attitude of caregivers of children with cerebral palsy with regard to
socialization. N = 400
Table -16.d) reveals the percentage distribution of level of attitude
of caregivers of children with cerebral palsy with regard to Socialisation.
84.0 % of the caregivers agreed that a child with CP must be
encouraged to mingle with other people. Majority, 92.0 % of the
caregivers agree that a child with CP needs to pick up social skills. 84.0
Sl.No
Attitude statement
Responses
Strongly agree
Agree Disagree Strongly disagree
n % n % n % n %
1 A child with CP must be encouraged to mingle with other people
- - 335 84.0 65 16.3 - -
2 A child with CP needs to pick up social skills
- - 368 92.0 32 8.0 - -
3 Children with CP need not mingle with other people
- - 65 16.3 335 84.0 - -
4 A child with CP need not pick up social skills
- - 31 7.75 369 92.25 - -
5 Socialisation is not necessary for children with CP
- - 64 16.0 336 84.0 - -
85
% of the caregivers disagreed that children with CP need not mingle
with other people. Majority, 92.25% of the caregivers disagreed that
child with CP need not pick up social skills. 84.0% of the caregivers
disagreed that socialisation is not necessary for children with cp.
Table -17: Mean, standard deviation, Skew, Kurtosis on the level of
attitude in each domain.
Sl.No Domains Mean S.D Skew Kurtosis
1 Special education 16.15 0.61 0.48 0.89
2 Parenting & caring 15.20 1.03 -0.90 0.61
3 Bowel training and
activities
10.99 0.05 -20 400
4 Exercise 5.95 0.50 -0.10 1.01
5 Socialisation 13.51 1.08 -1.82 1.42
Table -17: Mean, standard deviation, Skew, and Kurtosis on the
level of attitude in each domain. It reveals that the mean score on
Special education was 16.15 with standard deviation 0.61.The mean
score on Parenting & caring was 15.20 with standard deviation 1.03.
With regard to Bowel training and activities, the mean score was 10.99
with a standard deviation of 0.05.The mean score on Exercise was 5.95
with a standard deviation of 0.50. The mean score on Socialisation
was13.51 with standard deviation of 1.08.
86
Table-18: Descriptive statistics for attitude
Variable Attitude
Mean SD Skew Kurtosis
Overall 61.81 1.71 -0.47 -0.33
Table-18: Describes that the overall mean score was 61.81 with a
SD of 1.71. The scores were slightly skewed to the right with nil
peakedness.
Table- 19: Percentage Distribution of caregivers according to the
level Attitude.
Sl. No Level of Attitude Frequency Percentage
1 >= 75% (Favourable Attitude) 00 00
2 < 75% (Unfavourable Attitude) 400 100
Table -19) describes the distribution of caregivers according to
the level of attitude. It reveals that NONE of the caregivers had
favourable attitude (at the predefined level of 75%) prior to the
intervention; ALL of the caregivers had unfavourable attitude (at the
predefined level of 75%).
87
SECTION D:
Assessment of the level of practice of caregivers of children with
Cerebral Palsy.
Table-20.a) Frequency and percentage distribution of level of
Practice of caregivers to children with cerebral palsy with regard
to hygiene. N = 400
Table -20.a) depicts the frequency and percentage distribution of
level of Practice of caregivers to children with cerebral palsy. It reveals
that 100% of the caregivers answered yes for the traits, washing the
face every day morning and brushing the teeth every day. 62.3 % of the
Sl. No Traits Yes No
n % n %
1 Washing the face every day
morning 400 100 - -
2 Brushing the teeth everyday 400 100 - -
3 Bathing the child with hot
water 249 62.3 151 37.8
4 Keeping the skin dry and
clean 206 51.5 194 48.5
5 Applying cream on the body
after bath 400 100 - -
6 Cutting the nails every week 140 35.0 260 65.0
88
caregivers answered yes for bathing the child in hot water. 51.5 % of
the caregivers answered yes for keeping the skin dry and clean. 100 %
of the caregivers answered yes for applying cream on the body after
bath. 65.0 % of the caregivers answered yes for cutting the nails every
week.
Table - 20.b) Frequency and percentage distribution of level of
Practice of caregivers to children with cerebral palsy with regard
to Nutrition. N = 400
Table- 20. b) depicts the frequency and percentage distribution of
level of Practice of caregivers to children with cerebral palsy with regard
to Nutrition. It reveals that 37.8 % of the caregivers answered yes for
Sl.
No Traits
Yes No
n % n %
1 Feeding the child with porridges 151 37.8 248 62.0
2 Providing small and frequent feed 8 2.0 392 98.0
3 Allowing longer time for meal 400 100 - -
4 Providing sufficient water at meal time 392 98.0 8 2.0
5 Giving calcium rich food to prevent
dental carries 3 0.8 397 99.3
6 Rinsing the mouth after each feed 9 2.3 391 97.8
7 Providing High roughage diet daily 243 60.8 157 39.3
89
feeding the child with porridges. Only 2.0 % of the caregivers answered
yes for providing small and frequent feed. 100 % of the caregivers
answered yes for allowing longer time for meal. 98.0 % of the
caregivers answered yes for providing sufficient water at mealtime.
Only 0.8 % of the caregivers answered yes for giving calcium rich food
to prevent dental carries. Only 2.3 % of the caregivers answered yes for
rinsing the mouth after each feed. 60.8 % of the caregivers answered
yes for providing High roughage diet daily.
90
Table- 20.c) Frequency and percentage distribution of level of
Practice of caregivers to children with cerebral palsy with regard
to Toileting. N = 400
Table - 20. c) depicts the frequency and percentage distribution
of level of Practice of caregivers to children with cerebral palsy with
regard to Toileting.53.8 % of the caregivers answered yes for making
the child to sit on the toilet stool every day at the same time. 50.0 % of
the caregivers answered yes for praising the child for sitting in the toilet
as you wished.100percentage of the caregivers answered yes for
providing perennial care.
Sl.
No Traits
Yes No
n % n %
1 Making the child to sit on the
toilet stool every day at the same
time
215 53.8 185 46.3
2 Praising the child for sitting in
the toilet as you wished 200 50.0 200 50.0
3 Providing perennial care 400 100
4 Administering medications to
regularise bowel habits 269 67.3 131 32.8
91
Table -20.d) Frequency and percentage distribution of level of
Practice of caregivers to children with cerebral palsy with regard
to Medications. N= 400
Table - 20. d) depicts the frequency and percentage distribution
of level of Practice of caregivers to children with cerebral palsy with
regard to Medications. 44.3% of the caregivers answered yes for taking
the child for regular medical check-up. 67.3 % of the caregivers
answered yes for administering medications to regularise bowel habits.
Only 1.0 % of the caregivers answered yes Putting side rails to maintain
safety. 100 % of the caregivers answered yes for teaching the child to
obey rules and regulations.
Sl.
No Traits
Yes No
n % n %
1 Taking the child for regular
medical check up 177 44.3 223 55.8
2 Administering medications to
regularise bowel habits 269 67.3 131 32.8
3 Putting side rails to maintain
safety 4 1.0 396 99.0
4 Teaching the child to obey
rules and regulations 400 100 - -
92
Table -20.e) Frequency and percentage distribution of level of
Practice of caregivers with regard to self-help and self-care.
N = 400
Table - 20 e) depicts the frequency and percentage distribution of
level of Practice of caregivers to children with cerebral palsy with regard
to self-help and self-care. 35.0 % of the caregivers answered yes for
cutting the nails every week. Majority, 88.0 % of the caregivers
answered yes for providing walker to walk with. 54.5 % of the
caregivers answered yes for using chair with chest strap while sitting.
Only 7.8 % of the caregivers answered yes for developing skill in self-
Sl.
No Traits
Yes No
n % n %
1 Providing walker to walk with 352 88.0 48 12.0
2 Using chair with chest strap
while sitting
218 54.5 182 45.5
3 Developing skill in self-care
activities
31 7.8 369 92.3
4 Encouraging the child for self-
care activities
67 16.8 333 83.3
5 Modifying the utensils and cloths
for self help
157 39.3 243 60.8
6 Using supportive aids for
locomotion
233 58.3 167 41.8
93
care activities. Only 16.8 % of the caregivers answered yes for
encouraging the child for self-care activities. 39.3 % of the caregivers
answered yes for modifying the utensils and cloths for self-help. 58.3 %
of the caregivers answered yes for using supportive aids for locomotion.
Table - 21. Descriptive statistics for practice
Variable Practice
Mean SD Skew Kurtosis
Practice 12.31 3.8 0.01 -0.69
Table - 21 describes that the mean percentage of practice of
caregivers is 12.31 and standard deviation is 3.8. The responses for
practice questionnaire are almost symmetrical with almost equal right
and wrong answers.
94
Table - 22. Percentage distribution of caregivers according to the
level of Practice.
Sl. No Level of Practice Frequency Percentage
1 Good (>65 %) 80 20
2 Average (51 % -65%) 54 13.5
3 Poor (≤50%) 266 66.5
Fig -12: Percentage distribution of caregivers according to the
level of Practice
Table -22 and figure. 12 depicts that the Percentage distribution
of caregivers according to the level of Practice. It reveals that 20% of
the caregivers had good Level of Practice. 13.5% of the Caregivers had
Average Level of Practice, 66.5% of caregivers had Poor Level of
Practice
0
50
100
150
200
250
300
Good (>65 %) Average (51 % -
65%)
Poor ≤50%
Frequency
Percentage
95
Table -23: Mean, standard deviation, Skew, Kurtosis on the level of
practice in each domain.
Sl.
No
Domains Mean S.D Skew Kurtosis
1 Hygiene 3.51 0.89 -0.072 -0.65
2 Nutrition 3.51 0.77 -0.02 0.03
3 Toileting 2.62 1.07 -0.01 -1.27
4 Medication 1.24 0.6 -0.84 -0.4
5 Self-help and self-care 1.77 1.28 0.23 -0.58
Table -23: depicts the mean, standard deviation, skew, and
kurtosis on the level of practice in each domain. The mean score of
domain Hygiene is 3.51 and standard deviation is 0.89 .The mean
score of domain Nutrition is 3.51 and standard deviation is 0.77. The
mean score of domain Toileting is 2.62 and standard deviation is 1.07.
The mean score of domain Medication is 1.24 and standard deviation is
0.6. The mean score of domain Self-help and self-care is 1.77 and
standard deviation is 1.28.
96
Section E:
Demographic variables (Association Analysis)
The following section analyses the data to see if the selected
demographic variables influenced the level of knowledge, attitude, or
practice (prior to distribution of the information brochure). Chi-square
values were calculated for each variable and the p-value for the statistic
was calculated. Each values is marked with labels such as NS (Not
Significant) and SS (Statistically Significant), correspondingly, when p-
value is greater or lesser than 0.05. The association analysis was
conducted on pre-intervention data only.
97
Knowledge Vs Demographics
Table -24: Data on Association of Knowledge score and
selected demographic Variables.
Sl.No Demographic
Variables
Level of Knowledge
X2
value P
value
>65% 51-65% (Average
Knowledge)
50% or less (Poor
knowledge) (Good
Knowledge)
n % n % n %
1
Age
15-25 yrs 1 5 22 9.6 23 15.2
4.625 0.328 (NS)
26-35 yrs 7 35 92 40.2 61 40.4
36-45 yrs 12 60 115 50.2 67 44.4
Gender
Male 1 5 2 9.6 15 9.9 0.507
0.776 (NS) Female 19 95 207 90.4 136 90.1
3
Religion
Hindu 6 30 110 48 65 43
3.998 0.406 (NS)
Muslim 13 65 109 47.6 82 54.3
Christian 1 5 10 4.4 4 2.6
4
Type of family
Nuclear 12 60 143 62.4 99 65.6 0.493
0.782 (NS) Joint 8 40 86 37.6 52 34.4
5
Area of Residence
Rural 11 55 116 50.7 76 50.3 0.156
0.925 (NS) Urban 9 45 113 49.3 75 49.7
6
Educational status
No formal education/
School dropout 1 5 15 6.6 11 7.3
0.561 0.967 (NS) School up to
S S L C 16 80 176 76.9 112 74.2
P U C/ Above 3 15 38 16.6 28 18.5
7
Employment status
Self employed 4 20 46 20.1 27 17.9.
2.158 0.707 (NS) Salaried 2 10 12 5.2 13 8.6
Others 14 70 171 74.7 111 73.5
8
Income
Below and equal to
Rs.5000/- 5 25 57 24.9 29 19.2
2.223 0.695 (NS)
Rs.5001/- to Rs.10000/-
9 45 112 45 75 49.7
Rs.10001/- and above
6 30 60 26.2 47 31.1
98
Conclusion:
For each of the above demographic variable, the probability of
obtaining Chi-square value by chance is >0.05 (p > 0.05). Therefore,
the null hypothesis is accepted, and it is thus concluded that there is no
association between knowledge and selected demographic variables.
99
Attitude Vs Demographics
Table – 25: Data on association of Attitude with selected
Demographic Variables.
Sl.No Demographic
Variables
Level of Attitude
X2 P value
>=75%
(Favourable
Attitude)
<75%
(Unfavourable
Attitude)
N % N %
1
Age
15-25 yrs 2 3.6 44 12.8
6.985 0.03
(SS) 26-35 yrs 30 53.6 130 37.8
>35 yrs 24 42.9 170 49.4
2
Gender
Male 5 8.9 33 9.6 0.025
0.875
(NS) Female 51 91.1 311 90.4
3
Religion
Hindu 7 3.9 108 59.7
3.498 0.174
(NS) Muslim 13 6.4 137 67.2
Christian 0 0 11 73.3
Type of family
4 Nuclear 34 60.7 220 64 0.218
0.641
(NS) Joint 22 39.3 124 36
5
Area of Residence
Rural 28 50 175 50.9 0.015
0.904
(NS) Urban 28 50 169 49.1
6
Educational status
No formal
education/School
dropout
4 7.1 23 6.7
0.073 0.964
(NS) School up to S S L C 43 76.8 261 75.9
P U C/Above 9 16.1 60 17.4
7
Employment status
Self employed 12 21.4 65 18.9
0.234 0.89
(NS) Salaried 4 7.1 23 6.7
Others 40 71.4 256 74.4
8
Income
≤ 5000/- 11 19.6 80 23.3
0.392 0.822
(NS) Rs.5001/- to Rs.10000/- 28 50 168 48.8
Rs.10001/- and above 17 30.4 96 27.9
100
Conclusion:
From the above table, age alone seems to have influenced the
level of attitude. The p-value is 0.03, and thus we reject the null
hypothesis, which states that there is no association between the
selected demographic variables and level of attitude. Instead, we
accept the alternative hypothesis and conclude that there is an
association between attitude and age group.
101
Practice Vs Demographics
Table - 26: Data on Association of practice with the Demographic
Variables.
Sl.N
o
Demographic
Variables
Level of practice
X2
P
value Good Average Poor
n % n % n %
1
Age group
15-25 yrs 6 7.5 4 7.4 36 13.5
13.644 0.009
(SS) 26-35 yrs 40 50 30 55.6 90 33.8
>35 yrs 34 42.5 20 37 140 52.6
2
Gender
Male 9 11.2 3 5.6 26 9.8 1.285
0.526
(NS) Female 71 88.8 51 94.4 240 90.2
3
Religion
Hindu 41 51.2 28 51.9 112 42.1
5.509 0.239
(NS) Muslim 35 43.8 26 48.1 143 53.8
Christian 4 5 0 0 11 4.1
Type of family
4 Nuclear 51 63.8 30 55.6 173 65 1.744
0.418
(NS) Joint 29 36.2 24 44.4 93 35
5
Area of Residence
Rural 40 50 27 50 136 51.1 0.045
0.978
(NS) Urban 40 50 27 50 130 48.9
Educational status
No formal education/
School dropout 7 8.8 5 9.3 15 5.6
1.602 0.808
(NS) School up to SSLC 60 75 40 74.1. 204 76.7
PUC or above 13 16.2 9 16.7 47 17.7
7
Employment status
Self employed 14 17.5 7 13 56 21.1
5.31 0.257
(NS) Salaried 2 2.5 4 7.4 21 7.9
Others 64 80 43 79.6 189 71.1
8
Income
≤ 5000/- 22 27.5 9 16.7 60 22.6
3.069 0.546
(NS) Rs.5001/- to 10000/- 40 50 28 51.9 128 48.1
Rs.10001/- and above 18 22.5 17 31.5 78 29.3
102
Conclusion:
From the above table, age alone seems to have influenced the
level of practice. The p-value is 0.009, and thus we reject the null
hypothesis, which states that there is no association between the
selected demographic variables and level of practice. Instead, we
accept the alternative hypothesis and conclude that there is an
association between practice and age group.
SECTION E:
This section compares and evaluates knowledge, attitude,
and practice of caregivers of children with CP before and after the
intervention.
Knowledge
Table - 27. Descriptive statistics to reveal the effect of information
brochure on the level of knowledge
Knowledge Descriptive statistics
Mean Median Mode Var SD
Pre
Intervention 16.10 16 16 4.98 2.23
Post
Intervention 24.98 25 26 4.38 2.09
As seen in the above table, the level of knowledge increased
positively and shifted to the higher end (right) and thus skewed to the
right. In addition, the score became more clustered at the positive end
103
with slight reduction in the variance. This clearly gives the primary
evidence that the information brochure had a high impact on the level of
knowledge.
It is worth noting the fact that the skew has eliminated
observations in the lower end and thus made a comparison with the
Chi-square test, post intervention, impossible (because of zero values).
Table 28: Descriptive statistics to confirm the effect of information
brochure on the level of knowledge
Descriptive statistics
Knowledge Correlation Pearson T-Test F-Test
0.97 0.97 0 0.20
The correlation, confirmed by Pearson value, indicates that the
rise in knowledge level is uniform and substantial across the sample.
The T-Test value is almost zero, indicating that the increase in score
cannot be due to chance or some other factor. The considerably low F-
Test p-value indicates that the variance in the sample after the
intervention is significantly different from that of one prior to the
intervention.
The figure below represents the rise in the level of knowledge for
each question, by number of caregivers who answered correctly.
104
Fig.13: Number of Correct Answers Post Distribution of
Information Brochure
Attitude
Table - 29: Descriptive statistics to reveal the effect of
information brochure on the level of attitude
Attitude Descriptive statistics
Mean Median Mode Var SD
Pre
Intervention 63.98 64.58 64.58 2.49 1.58
Post
Intervention 72.60 72.92 73.96 4.68 2.16
As seen in the above table, the level of attitude increased
positively and shifted to the higher end (right) and thus skewed to the
right. In addition, the score became more clustered at the positive end
1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930
Pre Intervention 2 3 3 2 1 3 3 3 6 1 3 1 3 3 2 4 5 3 1 2 3 3 3 1 2 2 3 1 2 2
Post Intervention 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 3 3 3 3 3 3 3 3 3 3
0
50
100
150
200
250
300
350
400
450
105
with slight reduction in the variance. This clearly gives the primary
evidence that the information brochure had a considerable impact on
the level of attitude.
It is worth noting the fact that the skew has eliminated
observations in the lower end and thus made a comparison with the
Chi-square test, post intervention, impossible (because of zero values).
Table - 30: Descriptive statistics to confirm the effect of
information brochure on the level of attitude
Descriptive statistics
Attitude Correlation Pearson T-Test F-Test
0.96 0.96 0 0.42
The correlation, confirmed by Pearson value, indicates that the
rise in attitude level is uniform and considerable across the sample. The
T-Test value is almost zero, indicating that the increase in score cannot
be due to chance or some other factor. The low F-Test p-value
indicates that the variance in the sample after the intervention is
significantly different from that of one prior to the intervention.
Compared to the effect on knowledge, we can say that the effect
of the intervention in terms of attitude is slightly low.
106
The figure below represents the rise in the level of attitude for
each question, by number of caregivers who answered correctly.
Fig 14: Number of Correct Answers Post Distribution of
Information Brochure
Practice
Table 31: Descriptive statistics to reveal the effect of
information brochure on the level of Practice
Practice Descriptive statistics
Mean Median Mode Var SD
Pre
Intervention 12.31 12 12 14.24 3.77
Post
Intervention 21.08 21 21 6.94 2.63
As seen in the above table, the level of practice increased
positively and shifted to the higher end (right) and thus skewed to the
right. In addition, the score became more clustered at the positive end
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Pre Intervention 1 1 1 8 1 1 1 8 1 1 1 1 1 1 8 1 1 1 1 1 1 1 8 1
Post Intervention 1 1 1 8 1 1 1 7 1 1 1 8 1 1 1 1 1 1 1 1 1 1 8 1
0
500
1000
1500
2000
107
with slight reduction in the variance. This clearly gives the primary
evidence that the information brochure had a high impact on the level of
practice.
It is worth noting the fact that the skew has eliminated
observations in the lower end and thus made a comparison with the
Chi-square test, post intervention, impossible (because of zero values).
Table - 32: Descriptive statistics to confirm the effect of
information brochure on the level of practice
Descriptive statistics
Knowledge Correlation Pearson T-Test F-Test
0.73 0.73 0 0
The correlation, confirmed by Pearson value, indicates that the
rise in knowledge level is uniform and substantial across the sample.
The T-Test value is almost zero, indicating that the increase in score
cannot be due to chance or some other factor. The F-Test p-value of
zero indicates that the variance in the sample after the intervention is
expressively different from that of one prior to the intervention.
108
The figure below represents the rise in the level of practice for
each question, by number of caregivers who answered correctly.
Fig 15: Number of Correct Answers Post Distribution of
Information Brochure
The entire research proved that a small change in the level of
knowledge in caregiver of children with CP would have an effect on the
attitude to some extent and, on the practices to a great extent.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
Pre Intervention 4 3 2 2 0 1 8 4 3 3 9 2 2 2 4 1 2 1 4 0 3 2 3 6 1 2
Post Intervention 4 4 3 3 3 3 2 4 3 2 3 3 2 2 4 3 3 3 3 3 3 2 3 2 2 2
0
100
200
300
400
500
DISCUSSION
CHAPTER - V
109
CHAPTER - V
DISCUSSION
This chapter deals with the detailed discussion on the findings of
the study interpreted from the statistical analysis. The findings are
discussed in relation to the objectives of the study and hypotheses. The
problem stated is “A study to assess the Knowledge Attitude and
Practice of Caregivers of children with Cerebral Palsy”. This study was
conducted among the caregivers who were giving care to children with
cerebral Palsy.
The researcher collected the information with regard to socio
demographic data of the study subjects as part of the study. The socio
demographic characteristics were analysed using frequency and
percentage. There are 11 tables to describe them .The total number of
the subjects included in the study was 400.
Description of socio demographic characteristics of study
subjects:
The section A, deals with the socio demographic variables of
caregivers of children with cerebral palsy. Distribution of caregivers
according to their age group revealed that majority, 169 (42.3%) of the
caregivers belong to the age group of 36-45 years and 362 (90.5%) of
the caregivers were females.
110
Distribution of caregivers according to their educational status
revealed that majority, 304 (76.0%) of the caregivers attended school
up to SSLC. 400 (100%) of the caregivers were married and 254
(63.5%) of the caregivers belong to nuclear family.
Considering the caregivers employment status, it revealed that
only 27 (6.8%) of the caregivers were salaried. Majority 204 (51.0 %) of
caregivers belong to Muslim. It was evident that 200 (50.0%) of the
caregivers belong to rural and 200 (50.0%) belong to urban areas. On
analysis of type of house majority, 350 (87.5 %) of the caregivers reside
in concrete houses. Concerning ownership status 168 (42.0%) of the
caregivers resides in rented House. With regard to income, 196 (49.0%)
of the caregivers are between Rs.5001/- to Rs.10000/-.
The first objective is to assess the knowledge of caregivers
regarding care of the children with Cerebral Palsy:
The finding reveals that 20 (5%) of the caregivers had good (>65
%) knowledge, 229 (57.3%) of the caregivers had average (51% -65%)
knowledge, and 37.8% (151) of the caregivers had poor (≤50%)
knowledge.
With regard to the domain general information on cerebral palsy
the findings reveals that majority, 293 (73.3%) of the caregivers
answered, brain injury is the cause of cerebral palsy in children.
Majority, 358 (89.5 %) of the caregivers answered that cerebral palsy
111
causes Spasm & difficulty in coordination. 354 (88.5 %) of the
caregivers answered that on observing difficulty in movement, noticed
that the child is suffering from C.P. 272 (68.0 %) of the caregivers
answered that children with CP will be dependent on caregivers up to
lifetime.
On observation of the domain signs and symptoms the results
reveals that the only 175 (43.8%) of the caregivers answered that early
sucking difficulty with breast or bottle is the early sign of CP. Majority,
360 (90.0 %) of the caregivers of children with cerebral palsy answered
that purposeless body movements is a sign of cerebral palsy.
On considering the domain self-care needs & self-care support
reveals Majority, 385 (96.3%) of the caregivers replied that self-care
needs of children include bathing, toilet training; dressing and feeding.
Only 24 (6.0%) of the caregivers answered to maintain safety for the
special child, teach him to obey the rules and regulations. 51 (12.8%) of
the caregivers answered to promote self-care activities, boost the
child‟s ability in self-care activities. 104 (26.0 %) of the caregivers
answered to promote locomotion, supportive aids are necessary.
With regard to the domain feeding & nutrition reveals the
percentage distribution of the level of knowledge among the caregivers
of children with cerebral palsy. Majority, 370 (92.5 %) of the caregivers
replied that feeding problems in children with CP can be identified by
poor lip and tongue control. Only 7 (1.8 %) of the caregivers answered
112
that maintaining the adequate nutrition of the child by recognizing the
caloric needs.
On observation of the domain hygiene & elimination reveals that
majority, 380 (95.0%) of the caregivers replied that daily bath in hot
water is necessary to maintain cleanliness of the body of the child. 350
(87.5%) of the caregivers answered that hot water bath is appropriate
for the child with cerebral palsy. Only 14 (3.5 %) of the caregivers
replied that rinsing the mouth after each feed help to maintain oral
hygiene. 23 (5.8%) of the caregivers replied that brushing the teeth
twice daily prevent dental carries. Only 36(9.0%) of the caregivers
answered that redness and rashes are the two complications that can
arise if the perineum is not cleaned properly. Majority, 350 (87.5%) of
the caregivers answered that the best time for toilet training is between
the ages of 18 - 48 months. 96 (24.0%) of the caregivers answered that
the children with cerebral palsy frequently suffer from constipation due
to insufficient fibre and liquid in their diet. 215 (53.8 %) of the caregivers
answered that constipation can be prevented by encouraging regular
bowel habits.
On considering the domain exercise & prevention of
complications reveals that majority, 346 (86.5 %) of the caregivers
replied that a child with cerebral palsy require equipment to help with
walking/ mobility and talking / communication. 344 (86.0%) of the
caregivers replied that walking is an activity which needs equipment to
113
exercise the child. 319 (79.8%) of the caregivers answered that a
walker helps the child in walking. 154 (38.5% )of the caregivers replied
that some disabilities in children with cerebral palsy can be prevented
by taking extra care during delivery. 267 (66.8 %) of the caregivers
replied that contractures can be prevented by movement through all
ranges of motion. 201 (50.3 %)of the caregivers answered that special
schooling help the child to be independent. Only 10 (2.5%) of the
caregivers answered that a child with cp can acquire social skills by
giving directions to get home. 166 (41.5%) of the caregivers answered
that a physiotherapist helps the parents to become skilful in assisting
their child. 205 (51.3%) of the caregivers replied that the problems
encountered by the parents of children with cerebral palsy are shock,
anger, and financial problems. 193 (48.3%) of the caregivers replied
that the facilities provided by the government of India to rehabilitate the
children with cerebral palsy are concession for travelling, education and
employment opportunities.
The mean, standard deviation, skew, and kurtosis on the level of
knowledge in six domains reveals that the mean score in the domains
of „General information regarding cerebral palsy‟ was 3.2 with standard
deviation of 0.6. The mean score in the aspects of „Signs and
symptoms of cerebral palsy‟ was 1.4 with standard deviation of 0.6. The
mean score in the aspects of „Self-care needs and support‟ was1.4 with
standard deviation of 0.6. The mean score in the aspects of „Feeding
114
and nutrition‟ was 0.01 with standard deviation of 0.3. The mean score
in the aspects of „Hygiene and elimination‟ was 3.7 with standard
deviation of 1.0. The mean score in the aspects of „Exercise and
prevention‟5.5 with standard deviation of 1.3.
The Percentage distribution of level of knowledge of caregivers
reveals that 5% of the caregivers had good knowledge, with a mean
score of 70.33 and standard deviation of 2.62. 57.5% of the caregivers
had average knowledge, with a mean score of 56.96 and standard
deviation of 3.3. 37.5% of the caregivers had poor knowledge with a
mean score of 46.42 and standard deviation of 4.48.
The findings are consistent with the results of the study
conducted by Resaej M etal (2014) (N =77) on assessment of
knowledge of Iranian occupational therapists of
handling children with cerebral palsy and the application of their
knowledge into practice. Data analysis was done by descriptive
statistics and Spearman correlation. Of 77 participants, 64.9%
participants reported their knowledge of handling at moderate, 14.3% at
low, and 6.5% at very low level. The result of the test showed that
57.1% participants had knowledge at moderate and 16.9% at low level.
These results suggest that the participants need further training to
increase their knowledge in toileting and bathing.
115
The second objective was to find out the attitude of caregivers of
children with Cerebral Palsy.
The findings revealed that the level of attitude, in general, is
within the acceptable range. However, for the purpose of the study, we
set a very high benchmark (75%) to consider the attitude level to be
considered as „favourable‟. Accordingly, it was noted that NONE of the
caregivers had favourable attitude (at the predefined level of 75%) prior
to the intervention; ALL of the caregivers had unfavourable attitude (at
the predefined level of 75%).
The findings reveal the percentage distribution of level of attitude
of caregivers of children with cerebral palsy. It is evident from the above
table that majority, 383 (95.8%) of the caregivers strongly disagreed
that, if a baby is born with any disability it is a curse for the family. 372
(93.2 %) of the caregivers think that physically challenged children need
not be sent for special education. Majority, 322 (80.5 %) of the
caregivers agreed that special education will not prevent disability.
Majority, 387 (97.0%) of the caregivers think that special education
reduces the disability. 389 (97.4%) of the caregivers agreed that
parenting a special child gives more satisfaction. Only 6 (1.5 %) of the
caregivers think that caring a child with CP is troublesome. Majority 393
(98.3, %) of the caregivers feel that a child with CP becomes lifelong
dependent on caregivers. 277 (69.4, %) of the caregivers hopes that
one day their child would be able to walk like other normal children. 258
116
( 64.5% ) of the caregivers strongly agreed that like other children
exceptional child needs love, care and protection from parents. 386
(92.0 %) of the caregivers disagreed that bowel training is easy for
children with CP. Majority, 374 (93.5 %) of the caregivers disagreed
that children with CP are often relatively inactive. 334 (83.5 %) of the
caregivers agreed that regular exercise is important to prevent
contractures in children with CP. 346 (86.5 %) of the caregivers
disagreed that without exercise children with CP are able to lead a
normal life. 10.3 % of the caregivers strongly agreed that children with
CP needs hugging and holding just like other children. 87.8 % of the
caregivers agreed that both parents must be involved in caring a child
with CP. 334 (84.0) % of the caregivers agreed that a child with CP
must be encouraged to mingle with other people. Majority, 369 (92. 2
%) of the caregivers agreed that a child with CP need to pick up social
skills. 335 (84.0 %) of the caregivers disagreed that children with CP
need not mingle with other people. 336 (84.0 %) of the caregivers
disagreed that socialization is not necessary for children with CP.
The Mean, standard deviation, Skew, Kurtosis on the level of
attitude in each domain reveals that the mean score on Special
education was 16.15 with standard deviation 0.61. The mean score on
Parenting & caring was 15.20 with standard deviation 1.03. With regard
to Bowel training and activities the mean score was10.99 with a
standard deviation of 0.05. The mean score on Exercise was 5.95 with
117
a standard deviation of 0.50. The mean score on Socialization
was13.51 with standard deviation of 1.08.
The findings are consistent with the results of the study
conducted by Verral T.C etal (2008) examine the nutrition knowledge,
attitude, and belief of caregivers of cerebral palsy children.
Questionnaire was administered to cerebral palsy caregivers (n=52,)
and a comparison group of non-cerebral palsy caregivers (n=35).
Result showed that non-CP caregivers scored higher nutrition
knowledge (p<0.001), had a more positive attitude about the
importance of nutrition (p<0.05), and had more positive beliefs about
the relationship between nutrition and health p<0.05). It is concluded
that Knowledge is lacking about the feeding relationship between
caregivers and children with cerebral palsy (CP).
The findings are consistent with the results of the study
conducted by Masasa T etal (2005) on Knowledge of, beliefs about and
attitudes to disability: implications for health professionals in South
Africa. Sixty primary caregivers were interviewed by using a knowledge,
attitude, and belief (KAB) survey in a structured interview format.
Probability and non-probability (systematic and purposive) sampling
were used. Results showed all caregivers had only a rather rudimentary
knowledge of the causes of disability, but held positive attitudes
towards people with disabilities. There appears to be a need for
118
improved disability awareness amongst the caregivers, in schools and
amongst transport service providers.
The third objective was to assess the practice of caregivers of
children with Cerebral Palsy.
It reveals that 80 (20%) of the caregivers had good Level of
Practice. 54 (13.5%) of the Caregivers had Average Level of Practice,
266 (66.5%) of caregivers had Poor Level of Practice.
The findings reveal the frequency and percentage distribution of
level of Practice of caregivers to children with cerebral palsy. It reveals
that 100% of the caregivers answered yes for the traits, washing the
face every day morning and brushing the teeth every day. 62.3% of the
caregivers answered yes for bathing the child in hot water. 51.5% of the
caregivers answered yes for keeping the skin dry and clean. 100% of
the caregivers answered yes for applying cream on the body after bath.
37.8 % of the caregivers answered yes for feeding the child with
porridges. Only 2.0 % of the caregivers answered yes for providing
small and frequent feed. 100% of the caregivers answered yes for
allowing longer time for meal. 98.0 % of the caregivers answered yes
for providing sufficient water at mealtime. Only 0.8 % of the caregivers
answered yes for giving calcium rich food to prevent dental carries.
Only 2.3 % of the caregivers answered yes for rinsing the mouth after
each feed. 60.8 % of the caregivers answered yes for providing High
roughage diet daily. 53.8 % of the caregivers answered yes for making
119
the child to sit on the toilet stool every day at the same time. 50.0 % of
the caregivers answered yes for praising the child for sitting in the toilet
as you wished. 100% of the caregivers answered yes for providing
perennial care. 44.3% of the caregivers answered yes for taking the
child for regular medical check-up. Majority, 67.3 % of the caregivers
answered yes for administering medications to regularize bowel habits.
35.0 % of the caregivers answered yes for cutting the nails every week.
Only1.0 % of the caregivers answered yes Putting side rails to maintain
safety. 100% of the caregivers answered yes for teaching the child to
obey rules and regulations. Majority, 88.0 % of the caregivers answered
yes for providing walker to walk with. 54.5 % of the caregivers
answered yes for using chair with chest strap while sitting. Only 7.8 %
of the caregivers answered yes for developing skill in self-care
activities. Only 16.8 % of the caregivers answered yes for encouraging
the child for self-care activities. 39.3 % of the caregivers answered yes
for modifying the utensils and cloths for self-help. 58.3 % of the
caregivers answered yes for using supportive aids for locomotion.
The findings are consistent with the results of the study
conducted by Tseng MH etal (2011) on “The determinants of daily
function in children with cerebral palsy. The aim of the study was to
identify determinants of daily function in a population-based sample of
children with cerebral palsy, considering the function, disability, and
health. 216 children and their caregivers participated in the study.
120
Result showed that knowledge of daily function helps the caregivers to
plan and intervene to improve the capacity and performance in daily
function for children with cerebral palsy.
The fourth objective was to find the association of knowledge,
attitude, and practice with selected demographic variables.
Association of knowledge with selected demographic variables
reveals that the probability of obtaining Chi-square value by chance is
>0.05 (p > 0.05). Therefore, the null hypothesis is accepted, and it is
thus concluded that there is no association between knowledge and
selected demographic variables.
Association of Attitude with selected demographic variables
reveals that age alone seems to have influenced the level of attitude.
The p-value is 0.03, and thus we reject the null hypothesis, which states
that there is no association between the selected demographic
variables and level of attitude. Instead, we accept the alternative
hypothesis and conclude that there is an association between attitude
and age group.
Association of practice with the Demographic Variables shows
that age alone seems to have influenced the level of practice. The p-
value is 0.009, and thus we reject the null hypothesis, which states that
there is no association between the selected demographic variables
121
and level of practice. Instead, we accept the alternative hypothesis and
conclude that there is an association between practice and age group.
The fifth objective was to know the effect of an information
brochure on the caregivers of children cerebral palsy.
The findings reveals that the level of knowledge increased
positively and shifted to the higher end (right) and thus skewed to the
right. In addition, the score became more clustered at the positive end
with slight reduction in the variance. This clearly gives the primary
evidence that the information brochure had a high impact on the level of
knowledge.
The correlation, confirmed by Pearson value, indicates that the
rise in knowledge level is uniform and substantial across the sample.
The T-Test value is almost zero, indicating that the increase in score
cannot be due to chance or some other factor. The considerably low
F-Test p-value indicates that the variance in the sample after the
intervention is significantly different from that of one prior to the
intervention.
The level of attitude increased positively and shifted to the higher
end (right) and thus skewed to the right. In addition, the score became
more clustered at the positive end with slight reduction in the variance.
This clearly gives the primary evidence that the information brochure
had a considerable impact on the level of attitude.
122
The correlation, confirmed by Pearson value, indicates that the
rise in attitude level is uniform and considerable across the sample. The
T-Test value is almost zero, indicating that the increase in score cannot
be due to chance or some other factor. The low F-Test p-value
indicates that the variance in the sample after the intervention is
significantly different from that of one prior to the intervention.
Compared to the effect on knowledge, we can say that the effect of the
intervention in terms of attitude is slightly low.
The level of practice increased positively and shifted to the higher
end (right) and thus skewed to the right. In addition, the score became
more clustered at the positive end with slight reduction in the variance.
This clearly gives the primary evidence that the information brochure
had a high impact on the level of practice.
The correlation, confirmed by Pearson value, indicates that the
rise in knowledge level is uniform and substantial across the sample.
The T-Test value is almost zero, indicating that the increase in score
cannot be due to chance or some other factor.
The F-Test p-value of zero indicates that the variance in the
sample after the intervention is expressively different from that of one
prior to the intervention.
123
The entire research proved that a small change in the level of
knowledge in caregivers of children with CP would have an effect on the
attitude to some extent and, on the practices to a great extent.
SUMMARY,
CONCLUSION AND
RECOMMENDATIONS
CHAPTER - VI
124
CHAPTER VI
SUMMARY, CONCLUSIONS, IMPLICATIONS
RECOMMENDATIONS AND LIMITATIONS
This chapter deals with the summary, conclusions, implications,
recommendations, and limitations.
SUMMARY
Cerebral Palsy (C P) is a neurological disorder caused by
damage to the brain cells that occurred before, during or shortly after
birth. It is characterized by loss of movements and nerve functions
resulting in problems of use of hands and communication. Children with
cerebral palsy are struggling to lead a normal life. They are facing
problem with self-care activities. In order to meet their self-care needs,
caregivers are necessary.
Like any other children, C P children also need love and affection
from the caregivers. The goal of cerebral palsy parenting and care
giving is to help children reach their maximum potential. The
investigator has come across with children with cerebral palsy who are
neglected, not exposed to the public; some are put in to the dark room
of the house, sometimes locked in a cage and not given care properly,
and leading a vegetative life.
125
The investigator noticed that a mother was forcefully putting a
steel spoon in to the mouth of a child (8 years) and pressing the tongue
with the spoon to feed him. This child was not able to bring his hand up
to his mouth to feed himself, he was struggling to control his movement
and posture, and was not able to speak, neither to stand nor to sit. This
incident made the investigator to conduct a study on the knowledge,
attitude, and practice of caregivers of children with cerebral palsy.
. Caregivers need to have the proper knowledge, a positive
attitude, and proper skill to look after these children. Many a time, lack
of knowledge and negative attitude may lead to faulty practices and the
care will be affected negatively.
The objectives of the study were:
1. To assess the knowledge of caregivers regarding care of the
children with Cerebral Palsy.
2. To find out the attitude of care givers of children with Cerebral
Palsy
3. To assess the practice of care givers of children with Cerebral
Palsy
4. To find the association of knowledge, attitude and practice with
selected demographic variables
5. To know the effect of an information brochure among the
caregivers of children cerebral palsy.
126
The hypotheses of the study were:
SECTION A:
Ho: Knowledge of the caregivers is not influenced by any of the
selected demographic variables
H1: Knowledge of the caregivers is influenced by at least one of
the selected demographic variables
SECTION B:
Ho: Knowledge of the caregivers is not influenced by any of the
selected demographic variables
H1: Knowledge of the caregivers is influenced by at least one of
the selected demographic variables
SECTION C:
Ho: Attitude of the caregivers is not influenced by any of the
selected demographic variables
H1: Attitude of the caregivers is influenced by at least one of the
selected demographic variables
SECTION D:
Ho: Practice of the caregivers is not influenced by any of the
selected demographic variables
H1: Practice of the caregivers is influenced by at least one of the
selected demographic variables
127
SECTION E:
Ho: The information brochure does not have any influence on the
knowledge, attitude, and practice of caregivers of children
cerebral palsy.
H1: The information brochure does have some influence on the
knowledge, attitude, and practice of caregivers of children
cerebral palsy.
The assumptions of the study were:
1. The inadequate knowledge of caregivers may affect the care of
children in meeting the needs promptly.
2. The long term care of children may affect the attitude of
caregivers.
The delimitations of the study were:
1. This study is confined to Mysore District.
2. It is limited to caregivers of children with cerebral palsy.
3. Caregivers who are willing to participate in the study
4. Care givers who are available during the period of study
Review of the related literature was done on the following
dimensions:
1. Studies and literature related to general information regarding
the children with cerebral palsy
128
2. Studies and literature related to knowledge of caregivers of
children with cerebral palsy.
3. Studies and literature related to attitude of caregivers of
children with cerebral palsy.
4. Studies and literature related to practice attitude of caregivers
of children with cerebral palsy.
The conceptual framework of the study was based on Imogene
M. King‟s Goal attainment theory. King has interrelated the concepts of
interaction, perception, action, reaction, transaction into a theory of goal
attainment. It gives comprehensive framework for achieving the
objectives of the study. This framework clearly depicts what exactly the
caregivers do and they develop knowledge, attitude, and practice of
caregivers of children with cerebral palsy.
Non - Experimental Descriptive design was adopted for the study.
The investigator was interested to study the knowledge, attitude, and
practice of caregivers of children with cerebral palsy. Therefore, the
investigator has selected this design for her study. The researcher has
recorded the information that was present in the population without
manipulating the variables. Population comprises of all caregivers of
children with cerebral palsy
Sample was Caregivers (N=400) of children with cerebral palsy
who fulfils the inclusion criteria. Sampling Technique used was
Systematic random sampling method
129
Structured interview schedule was used to assess the Knowledge
of caregivers of children with CP. Likert scale was used to assess the
attitude of caregivers of children with CP. Observational checklist was
used to assess the practice of caregivers of children with CP.
The findings are as follows:
Section –A .Socio demographic variables of caregivers of
children with cerebral palsy.
Majority, 42.3% of the caregivers belong to the age group of 36-45
years.
The higher percentage 90.5% of the caregivers was females.
Majority, 76 % of the caregivers attended school up to SSLC.
100% of the care givers were married
Majority 63.5% of the care givers were belonging to nuclear family
Only 6.8% of the caregivers were salaried.
Majority 51.0 % of caregivers belong to Muslim.
It was evident that 50.0% of the caregivers belong to rural and
50.0% belong to urban areas.
Majority, 87.5 % of the caregivers were residing in concrete houses.
Concerning ownership status 42.0% of the caregivers reside in
rented House.
With regard to income, 49.0% of the caregivers are between
Rs.5001/- to Rs.10000/-. And it shows that majority of the
caregivers were belonging to low income group.
130
Section – B.
Data was analysed using descriptive and inferential statistics.
The findings shows that , the percentage distribution of level of
knowledge of caregivers reveals that 20 (5%) of the caregivers had
good (>65 %) knowledge, with a mean score of 70.33 and standard
deviation of 2.62. 229 (57.3%) of the caregivers had average (51% -
65%) knowledge, with a mean score of 56.96 and standard deviation
of 3.3. 151 (37.5% ) of the caregivers had poor (≤50%) knowledge with
a mean score of 46.42 and standard deviation of 4.48.
After the intervention the level of knowledge increased positively
and shifted to the higher end (right) and thus skewed to the right. In
addition, the score became more clustered at the positive end with
slight reduction in the variance. This clearly gives the primary evidence
that the information brochure had a high impact on the level of
knowledge.
The distribution of caregivers according to the level of attitude the
findings reveal that NONE of the caregivers had favourable attitude (at
the set level of 75%) prior to the intervention; ALL of the caregivers had
unfavourable attitude (at the set level of 75%). After the intervention,
the level of attitude increased positively and shifted to the higher end
(right) and thus skewed to the right. In addition, the score became more
clustered at the positive end with slight reduction in the variance. This
131
clearly gives the primary evidence that the information brochure had a
considerable impact on the level of attitude.
The distribution of caregivers according to the level of practice
reveals that 20% of the caregivers had good level of practice. 13.5% of
the caregivers had average level of practice, 66.5% of caregivers had
poor level of practice. After the intervention the level of practice
increased positively and shifted to the higher end (right) and thus
skewed to the right. In addition, the score became more clustered at the
positive end with slight reduction in the variance. This clearly gives the
primary evidence that the information brochure had a high impact on
the level of practice. Age alone seems to have influenced the level of
practice. The p-value is 0.009, and thus we reject the null hypothesis,
which states that there is no association between the selected
demographic variables and level of practice. Instead, we accept the
alternative hypothesis and conclude that there is an association
between practice and age group
INFERENCE
The present study was conducted on the Knowledge Attitude and
Practice of caregivers of children with cerebral palsy. The following
conclusions were drawn from the study.
1. Only 5% of the caregivers had good knowledge, 57.3% of the
caregivers had average knowledge and. 37.8% of the caregivers
132
had poor knowledge regarding giving care to the children with
cerebral palsy.
2. It revealed that None of the caregivers had a favourable attitude
(as per the set standards) prior to the intervention.
3. After the intervention, it revealed that at least 15% of the
caregivers of cerebral palsy crossed the threshold to reach the set
level of favourable attitude (at the set standard of 75% and above);
yet, 85 % of the caregivers of cerebral palsy had unfavourable
attitude (at the set standard of 75%).
4. Only 20% of the caregivers had good level of practice. 13.5% of
the caregivers had average level of practice and majority 66.5% of
caregivers had poor level of Practice.
5. There was no association between knowledge and demographic
variables of caregivers of children with cerebral palsy at (p>0.05)
6. There is an association between attitude and age, and practice age
at (p>0.01).
7. The information brochure had very positive effect on the level of
knowledge, attitude, and practice. In each case, the probability of
observing such a huge change by chance is ZERO.
8. The impact of information brochure eliminated the effect of age or
any other demographic variable observed in the pre-intervention
setup.
133
IMPLICATIONS
The following implications are derived from the study by the
investigator, which is important in the field of nursing education, nursing
practice and nursing administration.
IMPLICATION FOR NURSING EDUCATION.
• Role of the caregivers in giving care to children with cerebral
palsy must be included in the nursing curriculum.
IMPLICATION FOR NURSING ADMINISTRATION
• The finding of the study implies that there is a need to plan,
arrange, and conduct, in-service education programs for the staff
nurses regarding the care of children with cerebral palsy.
• Caregivers‟ knowledge, attitude and practice can be improved
by distributing information brochure.
IMPLICATION FOR NURSING PRACTICE
• Nurses play a major role in rendering care to children with
cerebral palsy in the hospital and in the community. It is the
responsibility of nurses to educate the caregivers to improve their
knowledge attitude and practice.
• Distribute information brochure through hospitals and during
home visits to help the caregivers to improve their practice by having
the right knowledge and develop a favorable attitude.
134
• Provide information brochure to home for the disabled.
• Parents of children with cerebral palsy need support from
nursing professionals.
• Nurses are the vital force for providing care for these families.
IMPLICATION FOR NURSING RESEARCH
• More studies are needed to be conducted regarding the
knowledge, attitude, and practice of children with cerebral palsy in
different settings.
• Disseminate the findings through Internet services, web portals
and journals.
RECOMMENDATIONS
• It is recommended that this study can be replicated.
• A comparative study can be conducted regarding the
Knowledge, attitude, and practice between urban and rural
caregivers of children with cerebral palsy.
• A study can be conducted to assess the usefulness of an
information brochure among the caregivers of children with cerebral
palsy.
LIMITATIONS
• This study was limited to Mysore district.
• It was limited to care givers of children with cerebral palsy.
135
CONCLUSION
o The study was carried out on the Knowledge, attitude, and practice
of the caregivers of children cerebral palsy.
o There is an association between attitude and age group, Practice
and age group
o Information brochure had a high impact on the level Knowledge,
attitude, and practice of the caregivers of children with cerebral
palsy.
o The information brochure provides significant information to the
caregivers that would influence the Knowledge, attitude, and
practice. Thus, the present study would help all the caregivers‟ of
children cerebral palsy.
o The entire research proved that a small change in the level of
knowledge in caregiver of children with CP would have an effect on
the attitude to some extent and, on the practices to a great extent.
BIBLIOGRAPHY
136
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birth weight infants on recent secular trends in the
prevalence of Cerebral palsy. Pediatrics, 9 (6), 1094.
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functional outcome measures for children with cerebral
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601-608.
29 Parks, et al. (2008) Psychological problems in children with
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of child psycho psychiatry, 49 (4) 405-13.
30 Verrall T C, et al, (2000) Children with cerebral palsy:
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APPENDIX
i
APPENDIX – 1
ii
iii
APPENDIX - 2
Letter seeking opinion and suggestions of the experts for
establishing content validity of the research tool.
From,
To,
Respected Sir / Madam,
Sub: Opinion and suggestion for validity of the tool - Reg.
I am a registered candidate for PhD at Vinayaka Mission’s
University, Salem, Tamilnadu. I am working on the thesis titled “A Study
on the Knowledge and Attitude and Practice of caregivers of
children with cerebral palsy”.
Objectives
1. To assess the knowledge of caregivers regarding care of the children
with Cerebral Palsy.
2. To find out the attitude of care givers of children with Cerebral Palsy
3. To assess the practice of care givers of children with Cerebral Palsy
4. To find the association of knowledge, attitude and practice with
selected demographic variables
5. To know the effect of an information brochure among the caregivers
of children cerebral palsy.
I humbly request you for the perusal of the tool and give your
expert opinion and valuable suggestions in relation to the objective of
the study. It will be kind of you to return the same to the undersigned at
the earliest by ……….
Thanking you,
Date: Yours sincerely,
Encl: Tools and Content Validity Certificate Gracy V.C
iv
APPENDIX - 3
ACCEPTANCE FORM FOR TOOL VALIDATION
Name………………………………………………………….
Designation………………………………………………….
Name of the institution…………………………………….
Statement of acceptance/ Non acceptance to validate the tool
I give acceptance/ Non acceptance to validate the tool.
Topic: “A Study on the Knowledge, Attitude and Practice of
Caregivers of Children with Cerebral Palsy”.
Date:
Place: Signature
v
APPENDIX - 4
CONTENT VALIDATION CERTIFICATE
I, hereby certify that I have validated the tool of Mrs.GracyVC PhD
candidate of Vinayaka Missions University Salem who is undertaken the
following study
Topic: “A Study on the Knowledge, Attitude and Practice of
Caregivers of Children with Cerebral Palsy”.
:
Date: Signature of the Expert
Place: Designation and Address
vi
APPENDIX – 5
LIST OF EXPERTS
1. Dr. Mangala gowri , PhD ( N )
15 8 , Baba llum ,
Samaj Nagar,Sembakkam,
Chennai -73.
2. Dr. Tamilmani, PhD (N)
Principal
Annai J.K.K Sampoorani Ammal College of Nursing,
Ethirmedu, Komarapalayam-638183
3. Dr. Chellarani Vijaykumar, PhD (N )
No.123, Annai Teresa, 2nd street,
Sathuvachari Phase 3,
Vellore 632 009, Tamilnadu.
4. Dr. Jolly Jose ,PhD ( N )
Principal,
Government College of Nursing,
Near Govt. T.D. Medical College,
Vandanam, Alappuzha, Kerala.
5. Dr. Punitha V. Ezhilarasu, PhD ( N )
Professor & Head
CNE & Research Dept
College of Nursing CMC,
Vellore- 632004. TN
vii
6. Dr. Assuma Beevi T M ,PhD ( N )
Principal,
MIMS College of Nursing,
Vadakkedath Paramba, PO-Vazhayur,
Dist -Malapuram-673633, Kerala.
7. Dr. Judie, PhD (N)
Principal
MMM College of Nursing
131, Sakthi nagar, Nalamboor post
Mogappair west, Chennai-95
8. Dr. Revathy PhD (N )
Principal,
College of Nursing,
JIPMER, Puducherry-605006.
9. Dr. Sharadha Ramesh, PhD (N)
Principal
Saveetha college of Nursing
Chennai
10. Dr. Jeyaseelan M. Devadason, PhD (N),
Dean
Annai J.K.K Sampoorani Ammal College of Nursing,
Ethirmedu, Komarapalayam-638183
viii
APPENDIX - 6
Letter seeking consent for participation to the study
Dear Participant,
I Mrs. Gracy VC PhD scholar of Vinayaka Missions University,
intend to do a study on the “Knowledge Attitude and practice of care
givers of children with cerebral palsy”.
Therefore I request you to co-operate and participate in the
study without any hesitation. I assure you that the information given
by you will be kept confidential and use only for this purpose. Your
participation will help me to complete my study and contribute to the
field of health.
Thanking You, Yours Sincerely
Place: (Gracy V.C)
Date:
ix
APPENDIX - 7
ASSESSMENT TOOL ON KNOWLEDGE, ATTITUDE AND PRACTICE BY
CAREGIVERS TO CHILDREN WITH CEREBRAL PALSY (C.P)
Section – I
Interview Schedule
Instruction
Dear respondent,
This interview schedule requires your response with regard to your personal
characteristics. Kindly listen carefully and tell the most appropriate answers freely. All
information given by you will be kept in confidence.
Socio Demographic Data Code no:
1. Age
15 -25 years
26 -35 years
36 -45 years
46 -55 years
55 years and above
2. Gender
Male
Female
x
3. Educational status
No formal education
School dropout
School up to S S L C
P U C/ Higher secondary
Degree above
4. Marital status
Single
Married
Divorced
Widowed
5. Type of Family
Nuclear Family
Joint family
Extended Family
6. Employment Status
Coolie/Daily Wages
Self employed
Salaried
Business
Others specify
xi
7. Religion
Hindu
Muslim
Christian
Any other
8. Area of Residence
Rural
Urban
9. Type of House
Mud House
Tent
Concrete House
Apartment
10. Ownership Status
Own
Rented
On lease
11. Income (Rs/ Month)
Below and equal to Rs.5000/-
Rs.5001/- to Rs.10000/-
Rs.10001/- and above
xii
SECTION-B
I. Structured interview - schedule to assess the knowledge of caregivers of
Children with cerebral palsy.
II. Likert scale to assess the attitude of caregivers of Children with cerebral
palsy.
III. Observational check list to assess the Practice of caregivers of children
with Cerebral palsy.
I. Structured interview schedule to assess the knowledge of Caregivers of
children with cerebral palsy.
Structured interview schedule has been subdivided into 6 heads
General information
o Signs and symptoms
o Self care needs & support
o Feeding & Nutrition
o Hygiene & Elimination
o Exercise & Prevention
General information
1. Which of the following are the causes of Cerebral palsy in children?
a) Inherited from parents
b) Brain injury
c) Accident
d) Malnutrition
xiii
2. Which of the following disease causes Spasm & difficulty in coordination?
a) Cerebral palsy
b) Meningitis
c) Chicken pox
d) Mental retardation
3. When did you notice that your child is suffering from Cerebral palsy?
a) While bathing the baby
b) While observing the movement
c) While helping him to stand
d) Making him to sit on the potty
4. How long children with CP (Cerebral palsy) will be dependent on caregivers?
a) Up to Toddler period
b) Up to Teenage
c) Up to Adulthood
d) Up to Lifetime
Signs and symptoms
5. What is the early sign of CP during infancy?
a) Early sucking difficulty with breast or bottle
b) Intake of more food
c) Intake of less food
d) Continuous diarrhea
xiv
6. Which of the following is a sign of CP?
a) Purposeless body movements
b) Redness all over the body
c) Swelling on the leg
Self care needs &Self care support
7. Self care needs of children with C.P include:
a) Toilet training
b) Bathing
c) Play
d) Bathing, Toilet training, dressing and feeding
8. How do you maintain safety for your special child?
a) Keep him at home
b) Teaching the child to obey the rules and regulations
c) Leave him freely
d) Keep him with restraints
9. How do you promote self care activities for your child?
a) Doing everything for your child
b) Not allowing him to eat his food by himself
c) Boosting the child’s ability in self care activities
d) Allow the child to bath by leaving him alone
xv
10. How do you promote locomotion for your child?
a) Encouraging the child to sit
b) Providing incentives to get up
c) Having supportive aides to encourage locomotion
d) Encouraging the child to crawl
Feeding & Nutrition
11. How do you identify feeding problems in children with C.P?
a) Vomiting frequently
b) Poor lip and tongue control
c) Intake of less amount of food
d) Frequent Urination
12. How do you maintain adequate nutrition?
a) Recognizing the caloric needs
b) Feeding whenever the child cries
c) Including more water in his diet
d) Allowing him to sit in the toilet
Hygiene &Elimination
13. How do you maintain cleanliness of the body of your child?
a) Daily bath in hot water
b) Cold bath
c) Applying cream on the body
d) Applying powder on the body
xvi
14. What type of bath is appropriate for children with cp?
a) Oil bath
b) Cold water bath
c) Hot water bath
d) Sun bath
15. How do you maintain oral hygiene?
a) Washing the face
b) Rinsing the mouth after each feed
c) Brushing the teeth once daily
d) Brushing the teeth twice daily
16. How do you prevent Dental carries?
a) Brushing the teeth twice daily
b) Cleaning the tongue
c) Brushing the teeth once daily
d) Cleaning the face
17. Which of the following complication can arise if the perineum is not
Cleaned properly?
a) Fever
b) Itching
c) Redness & rashes
d) Diarrhea
xvii
18. What is the best time for toilet training for your child?
a) Between the age of 18-48 months
b) Between the age of 18-40 months
c) Between the age of 16-48 months
d) Between the age of 16-40 months
19. Children with Cerebral Palsy frequently suffer from constipation due to
a) Over feeding
b) Vomiting
c) Drinking Cold Water
d) Insufficient fiber and liquid in their diet
20. How can you prevent Constipation?
a) Giving bland diet
b) Providing cold fluids
c) Encouraging regular bowel habits
d) Providing balanced diet
Exercise& Prevention of complications
21. Your child may require equipment to help with:
a) Walking/Mobility
b) Talking/ Communication
c) Eating, Bathing and toileting
d) Walking/Mobility ,Talking/ Communication
xviii
22. Which of the following activity needs equipment to exercise your child?
a) Walking
b) Talking
c) Bathing
d) Sleeping
23. How do you help your child in walking?
a) Provide a walker to walk with
b) Provide a chair
c) Leave him in the courtyard
d) Instruct him to walk
24. Some disabilities in children with C.P can be prevented by
a) Healthy diet
b) Home safety
c) Home delivery
d) Taking extra care during delivery
25. How can you prevent Contractures?
a) Movement through all ranges of motion
b) Injections
c) Consulting the Doctor
d) Medications
xix
26. How do you help your child with C.P to be independent?
a) By providing healthy food
b) Advise him to walk
c) Playing with him
d) Special schooling
27. A child with C.P can acquire social skills by:
a) Keeping him at home
b) Bathing
c) Toileting
d) Giving directions to get home
28. How can a physiotherapist be helpful?
a) Writing on the board
b) Helping the parents to become skillful in assisting their child.
c) Playing with the child
d) Feeding the child
29. What are the Problems encountered by the parents of children with
C.P?
a) Mental
b) Social
c) Shock, anger, and financial problems
xx
30. What are the facilities provided by Govt. of India to rehabilitate the children
with C.P?
a) Concession for traveling, education & Employment opportunities
b) Free treatment
c) Insurance
d) Free food
SCORING KEY:
One mark for correct answer and zero mark for incorrect answer.
xxi
2. FOUR POINT LICKERT SCALE TO ASSESS, THE ATTITUDE OF
CAREGIVERS TO CHILDREN WITH CEREBRAL PALSY
Sl
No
Direction
of scoring
Item
Responses
1
- If a baby is born with any disability it is a
curse for the family
S A A D SD
2 + Physically challenged children needs special
education
3 - Physically challenged children need not sent
for special education
4 - Special education will not prevent disability
5 + Special education reduces the disability
6 + Parenting a special child gives more
satisfaction
7 - Caring a child with CP is troublesome
8 - A child with CP becomes lifelong dependent
on care givers
9 + One day my child will be able to walk like
other normal children
10
+
Like other children exceptional child needs
love care and protection from parents
11 - Bowel training can be challenging for
children with C.P
12 - Bowel training is easy for children with C.P
13 - Children with C.P are often relatively
inactive
14
+
Children with C.P are very active
xxii
15 + Regular exercise helps to prevent
contractures in children with C.P
16 - Without exercise children with C.P are able
to lead a normal life
17 + Children with C.P needs hugging and
holding just like other children
18 + Both parents must be involved in caring a
child with CP
19 - Both parents need not be involved in caring
a child with CP
20 + A child with CP must be encouraged to
mingle with other people
21 + A child with CP need to pick up social skills
22 - Children with CP need not mingle with
other people
23 + A child with CP need not pick up social
skills
24 _ Socialization is not necessary for children
with CP
Total Score
SCORING KEY
S A (STRONGLY AGREE) = 4, A (AGREE) = 3,
D (DISAGREE) = 2, S A (STRONGLY DISAGREE) =1
xxiii
3. Observational check list to assess the Practice by caregivers to
children with cerebral palsy
SL.No Traits Yes No
1 Washing the face every day morning
2 Brushing the teeth every day
3 Bathing the child in hot water
4 Keeping the skin dry and clean
5 Applying cream on the body after bath
6 Feeding the child with porridges
7 Providing small and frequent feed
8 Allowing longer time for meal
9 Providing sufficient water at mealtime
10 Giving calcium rich food to prevent dental
carries
11 Rinsing the mouth after each feed
12 Providing high roughage diet daily
13 Making the child to sit on the toilet stool
everyday at the same time
14 Praising the child for sitting in the toilet as you
wished
15 Providing perineal care
16 Taking the child for regular medical check up
17 Administering medications to regularize bowel
habit
xxiv
18 Cutting the nails every week
19 Putting side rails to maintain safety
20 Teaching the child to obey rules and regulations
21 Providing walker to walk with
22 Using chair with chest strap while sitting
23 Developing skills in self care activities
24 Encouraging the child for self care activities
25 Modifying the utensils and cloths for self help
26 Using supportive aids for locomotion
SCORING KEY: One mark for “yes” and zero mark for “No”.
xxv
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