DISSERTATION ONA STUDY TO ASSESS THE KNOWLEDGE ON MANGEMENT OF DIABETES MELLCITUS AMONG DIABETIC PATIENTS ADMITTED IN SELECTED

HOSPITALS

IN

FARIDABAD

BYMiss. Arti Memoria

Miss. Tenzin Saldon

Miss. Tiljy.K.K

Miss. Shakarani

Miss. Usha Rani

Miss. Susheela Devi

Miss. Meenakshi

Miss. Renu

Mr. Vinaya ChandranPost Basic BS.c Nursing

Batch 2011- 2013

FLORENCE

SCHOOL AND COLLEGE OF NURSING

DAYALPUR(FARIDABAD)

PANDIT BHAGWAT DAYAL SHARMA

UNIVERSITY OF SCIENCE

ROHTAK

MAY 2013A STUDY TO ASSESS THE KNOWLEDGE ON MANGEMENT OF DIABETES MELLITUSAMONG DIABETIC PATIENT ADMITTED INSELECTED HOSPITAL IN FARIDABAD

Approved by the Dissertation Committee on May 2013Professor in Nursing Research Mr. Sujith.A R.N R.M M.sc (N)

Principal

Florence College of Nursing

Research Guide Miss Sonia John

Wise Principal

Florence College of NursingDayalpur (Faridabad)

Dissertation submitted as a partial Fulfillment of requirement for the degree of Bachelor of Science in Nursing, Pandit Bhagwat Dayal Sharma University

Rohtak

A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE ON MANAGEMENT OF DIABETES MELLITUS AMONG DIABETIC PATIENTS ADMITTED IN SELECTED HOSPITAL IN FARIDABAD WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET

PROJECT REPORT

SUBMITTED AS PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE PCBSC NURSING AFFILIATED TO PANDIT DAYAL SHARMA UNIVERSITY OF HEALTH SCIENCES IN ROHTAK

PANDIT BHAGWAT DAYAL SHARMA UNIVERSITY OF HEALTH SCIENCES IN ROHTAK

DECLARATION BY THE CANDIDATE We hereby declare that this dissertation entitled as A descriptive study to assess the knowledge on management of Diabetes Mellitus among diabetic patients admitted in selected hospital in Faridabad with a view to develop an information Booklet is a bonafide and a genuine research work carried out by us under the guidance of Ms. Sonia John Department of Mental Health Nursing. Certified that this project done by the following Candidates.

Date:

Place :

Signature of the Candidates

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled as A descriptive study to assess the knowledge on management of Diabetes Mellitus among diabetic patients admitted in selected hospital in Faridabad with a view to develop an information Booklet is a bonafide and a genuine research work carried out by Miss.Arti Memoria, Miss.Tenzin Saldon, Miss.Tiljy.K.K, Miss.Shaka Rani, Miss. Usha Rani, Miss.Susheela Devi, Miss. Meenakshi, Miss.Renu, Mr. Vinaya Chandran In partial fulfillment of the requirement for the PCBSE students.

Date:

Place :

Signature of the Guide

Ms. Sonia John

Department of Mental Health

Nursing.

ENDORSEMENT BY THE H.O.D PRINCIPAL/HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled as A descriptive study to assess the knowledge on management of Diabetes Mellitus among diabetic patients admitted in selected hospital in Faridabad with a view to develop an information Booklet is a bonafide research work carried out by Miss.Arti Memoria, Miss.Tenzin Saldon, Miss.Tiljy.K.K, Miss.Shaka Rani, Miss.Usha Rani, Miss. Susheeladevi, Miss. Meenakshi, Miss.Renu, Mr. Vinaya Chandran In partial fulfillment of the requirement for the PCBSE. Under the guidance of Miss. Soniya John Department of Mental Health Nursing, Faridabad College of Nursing, Faridabad.Seal and Signature of the H.O.D Seal and Signature of the Principal Date:

Date:

Place :

Place :

ACKNOWLEDGEMENT

O Give thanks to the Lord for He is good!

For His mercy endures forever - Psalms 107:1Drops of ocean makes an ocean. Although bricks give the structure of house, proper foundation make it strong. The satisfaction and pleasure that accompany the successful completion of any task, would be incomplete with all maintaining the people who have made it possible & whose constant guidance & encouragement reward any effort with successfully

First of all, we extend our sincere in debt to Florence College of Nursing for providing an opportunity to be in the student of this esteemed institution to conduct study.

We would like to convey our heartful gratitude to Sujith Aravindakshan, Principal, Florence and college of nursing for his guidance & suggestion for the study successfully. We express our esteemed thanks to the Vice Principal. Miss Soniya John for the guidance and contribution to support the project work.

We thank to our staff who had been with us & being with us & who had been the source of inspiration throughout this course of study

We extended our thanks to Florence College Library staff who granted special permission and helps us in referring the books & Journals.

We express our heartfelt gratitude and thanks to our parents, friends and Colleagues for their constant support and prayers. RESEARCH ABSTRACT

A descriptive study to assess the knowledge on management of Diabetes Mellitus among diabetic patients admitted in selected hospital in Faridabad with a view to develop an information Booklet.

OBJECTIVES

To assess the existing knowledge level of diabetic patients on management of Diabetes Mellitus. To find association between the knowledge scores with selected demographic variables. To develop an infoamtion Booklet on management of Diabetes MellitusBACKGROUND

Diabetes is a major health problems being faced by modern society of today all over the world and India is predicted to have the most number of people with Diabetes Mellitus by the year 2015. Once one has develop Diabetes, it cannot be cured but fortunately enough can be managed very well and quality of life can be improved under wellness programme involving diet, exercise, and medicine.

METHODS The study was conducted in the month of May 2013 at selected hospital in Faridabad. an administrative approval was obtained from concerned authority in Faridabad.

A descriptive study with a sample size consisting of 40 diabetic patients. Purposive sampling method was used to select the sample respondents. The tool used in collection of demographic data on diabetic patients comprised of 10 items.

Structure self administered knowledge questionnaire consist of 35 statements on management of Diabetes Mellitus. The Diabetes Mellitus management comprised of diet, medication, exercise, foot care and complication. RESULTS The result indicate that majority of the respondents (32.5%) were between 41-50 years of age group. Majority of respondents (70%) were male. Majority of respondents (57.5%) were belong to Hindu religion. Majority of respondents (50%) were belongs to joint family. Majority of respondents (65%) were married. 35% of respondents were educated upto high school. Majority of respondents (35%) are private employee. Majority of the respondents (52.5%) has a history of Diabetic Mellitus. Majority of the respondents (40%) were received information from electronic media. Among the sample 29 (72.5%) had inadequate knowledge, 9 (22.5%) had moderately adequate knowledge and 2 (5%) had adequate knowledge. Demographic variable such as age, sex, religion type of family, marital status, monthly income of the family, source of information were found to be non significant at 0.05 level. Demographic variables such as educational status, occupation, family history of Diabetic Mellitus were found to be significant 0.05 level. Interpretation and conclusion

The study reflects that there is lack of knowledge even in the educated population. So thereby, an information Booklet is developed on management of Diabetes Mellitus to impart knowledge in health promotional behavior regarding management of Diabetes Mellitus.

TABLE OF CONTENTSCHAPTER NO.TITLEPAGE NO.

1INTRODUCTION 1-4

2OBJECTIVES 5-10

3REVIEW OF LITERATURE11-16

4METHODOLOGY17-24

5DATA ANALYSIS 25-54

6DISCUSSION55-57

7CONCLUSION58-60

8SUMMERY61-63

9BIBLIOGRAPHY64-66

10ANNEXURES 67-91

LIST OF TABLESTABLE NO.TITLE OF THE TABLESPAGE NO.

1Classification of Respondents by age group29

2Classification of Respondents by sex 31

3Classification of Respondents by religion33

4Classification of Respondents by type of family35

5Classification of Respondents by marital status37

6Classification of Respondents by educational status39

7Classification of Respondents by occupation41

8Classification of Respondents by monthly income43

9Classification of Respondents by family history of Diabetes Mellitus 45

10Classification of Respondents by source of information47

11Frequency and percentage distribution of Respondents according to pre test knowledge level on management of Diabetes Mellitus 49

12Classification of Respondents on diet, medication, exercise, foot care and complication 51

13.Data on association of knowledge on management of Diabetes Mellitus among diabetic patients with their selected demographic variables. 52-53

LIST OF FIGURES

FIGURE

NO.FIGURESPAGE NO.

1Conceptual frame work of the study 10

2Schematic representation of research design 18

3Classification of Respondents by age group 30

4Classification of Respondents by sex32

5Classification of Respondents by religion 34

6Classification of Respondents by type of family 36

7Classification of Respondents by marital status 38

8Classification of Respondents by educational status 40

9Classification of Respondents by occupation 42

10Classification of Respondents by monthly income of the family 44

11Classification of Respondents by family history of Diabetes Mellitus46

12Classification of Respondents by source of information 48

13.Frequency and percentage distribution of Respondents according to pre test knowledge level on management of Diabetes Mellitus50

LIST OF ANNEXURES

SL NO.TITLEPAGE NO.

1Certificate of content validity 67

2Lists of experts consulted for the content validity of the tool 68

3Structured self administrated knowledge questionnaire tool-English and Hindi version69-90

4Answers and scoring key 91

INTRODUCTIONAnts die in Sugar

- Malawin proverb

The word Diabetes was coined by Aretacus of separated. The word taken from Greek diabainein, and literally means passing through or Siphon, a reference to one of diabetes major symptoms of excessive urine discharge. The word became diabetes from the English adoption of the medieval Latin diabetes. In 1965 Thomas Willis added Mellitus to the name (Greek mel-honey) when he noted that a diabetics urine and blood has a sweet taste. In 1776it was confirmed the sweet taste was because of an excess of sugar in the blood. The ancient Chinese tested for Diabetes by observing whether ants were attracted to a person is urine and called the ailment Sweet urine disease

Diabetes Mellitus is a chronic progressive disease characterized by the bodys inability to metabolize carbohydrates, fats and proteins leading to hyperglycemia (high blood glucose level). The management of Diabetes is one of the most important subjects in clinical practice in Indian context, increasing urbanization, industrialization and changing life style seem to be contributing to increasing prevalence of Diabetes.

Medical management for clients with Diabetes Mellitus includes restoring and maintaining blood glucose levels to as near normal as possible by balancing diet, exercise and the use of oral hypoglycemic agents or insulin in general, when Diabetes Mellitus is successfully managed clients avoid the complication of hypoglycemia and hyperglycemia.

Initial as well as ongoing client education is vital in helping the client manage this chronic condition. Interventions must be individualized to the clients goals, age, life. Style, nutritional needs, malnutrition activity level, occupation, type of Diabetes Mellitus and ability to independently perform the skills required by the management plan.NEED FOR STUDY

Diabetic mellitus is a chronic system disease related to abnormal insulin production, impaired insulin utilization or both. Diabetes Mellitus is a serious health problem throughout the work and its prevalence is increasing rapidly

W.H.O:-

The world health organization (WHO) has estimated that there will be 350 million people with Diabetes is the world by 2012. WHO develop a program for worldwide Diabetes Mellitus is increasing rapidly in China and India and other countries, where the standard of living is increasing in association with their increase in obesity. Diabetes Mellitus increasing not only in the Western world as it has been for many years, but also in Mid Eastern countries for reasons there are unclear.

WORLDWIDE:-

0.6 million males and 0.54 million females with diagnosed Diabetes in enlarged and Wales in 2008, and over half (60 and 53% respectively) where aged 50-74 years. Because the population in ageing the members male and females with diagnosed. Diabetes is projected to use to 0.84 million (37%) and 0.67 million (24%) respectively, in specific prevalence. From 2004-2008 the increases were 24% in 0-24 years old males, 18% in 24-29 years old men, 15% in 50-74 years old men and 14% in men aged 75 years. In female, the increases were 17, 2018 and 12% respectively, if prevalence increase by 10% from 2008-2023, the number of males with the diagnosis is projected to rise by 36% to 0.74 million, given a 20% increase prevalence, the number of female is projected to rise to 1.9 million (78% increase) and 8.7 million (67% increase) respectively in 2013.

The estimated Diabetes prevalence for 2010 in 285 million and is expected to affect 438 million people by 2023.According to International Diabetes Federation (IDF) estimated that in 2010, the five countries with the largest number of people with diabetic are India, China the United States, Russia and Brazil. The IDF also reported that in 2010, the five countries with the highest Diabetes prevalence in the adult population all Norway, the UAE, Saudi Arabia and Bahrain. Low and middle income countries for the greatest burden of Diabetes.

According to ADA and CDC, total ADC 23.8 million (7.8%, CDC 24 (8%). Undiagnosed 5.7 million, Pre Diabetes 57 million, New case per years 1.6 million is previous over 20 years of age. Prevalence under 20 years age-186,000 or 0.22%. This equals about in every 400-600 children with Diabetes Mellitus. Prevalence in person aged 20 years and older 23.5 million (or) 10.7% of all people in this age group. Prevalence in person aged 20 years and older 12.2 million (or) 23.1% of all people in this group. Prevalence in men aged 20 years and older 12 million (or) 11.2% prevalence in women age 20 years and older 11.5 million or 10.2% Non-Hispanic white 14.9 million (or) 19.8% Non-Hispanic blacks 3.7 million or 14% of this group. American Indians and Alaskan natives 14.2%

Adjusted for age over 20 years for patient of the Indian Health service 16.5% (Total), 60% (Alaskan) and 29.3% (Southern) (Arizona) of these population have Diabetes. Adjusting again for age 20 (or) above 6.6% of non-Hispanic whites 7.5% of Asian Americans. 10.4% of Hispanics and 11.8% of non-Hispanic blacks have Diabetes Mellitus.

INDIA:-

Further, evidence for the rise in prevalence of Diabetes case from Chennai as the prevalence. Diabetes has rises to 11.6% in the same Urban area which had a prevalence 8.2% five year in 2008. A study from Guwahati reported a prevalence of 8.2%. A study done in Kerala showed very high prevalence of 16.3% of 15.2% in 2009, the prevalence of undiagnosed Diabetes was 4.3% which was more than double that of diagnosed cases.

A study done in Mumbai, in 2010 reported a prevalence of 4.5% according to WHO criteria, the national urban Diabetes survey was a population based study conducted in sic large cities from different region of India, the prevalence was the highest in Hyderabad (16.6%) followed by Chennai (13.5%), Bangalore (12.4%) Kolkatta (11.7%), New Delhi (11.6%) and Mumbai (9.3%) A recent study from rural Maharastra showed a high prevalence of 4.3%. The prevalence of self reported Diabetes was 5.6& in this study population.

In Karnataka, the Hindu edition of 2008, February 18 reported that over 30 million population in India has Diabetes Mellitus. Every person sustain after 40 years in unfortunately being attributed to old age.

The overall prevalence of type 1 diabetes in Karnal district is 10.20/100,000 population, with a higher prevalence in urban (26.6/100,000) as compared to rural areas (4.27/100,000). Karnal city, with a population of 222017, has a relatively high prevalence of type 1 diabetes (31.9/100,000). The prevalence in men is higher (11.56/100,000) than in women (8.6/100,000).

In the 5 to 16 years age group, the prevalence is 22.22/100,000, while in the 0-5 years age group, prevalence is 3.82/100,000.

Based on the above Review of literature and findings the researcher found that there is a need to educate the Diabetes Mellitus patients regarding management of Diabetes to promote the health and prevent the diabetic complications. OBJECTIVES

STATEMENT OF THE PROBLEM

A descriptive study to assess the knowledge on management of Diabetes Mellitus among diabetic patients admitted in selected hospital in Faridabad with a view to develop an information.

OBJECTIVES To assess the existing knowledge level of diabetic patients regarding management of Diabetes Mellitus. To find an association between the knowledge store with selected demographic variables.

To develop an information Booklet an management of Diabetes Mellitus

OPERATIONAL DEFINITIONS

Assessment :-It refers to knowledge of diabetic patient on management of Diabetes by using structured questionnaire.

Knowledge :-In this study knowledge refers to the level of understanding of patients regarding management of Diabetes Mellitus

Management of

:-It refers to the diet, medication, exercise and foot care Diabetes Mellitus.

Diabetic patients:-Refers to persons whose blood sugar levels higher than normal.

Information Booklet:- Refers to a Booklet of contents prepared by an investigator and validated by experts. It contains information regarding meaning and management of Diabetes Mellitus which will be provided to the subjects for self reading and gaining information.

ASSUMPTION:1. Diabetic patients may have inadequate knowledge on management of Diabetes Mellitus.2. Knowledge may vary with selected demographic variables.

HYPOTHESIS:

H1 There will be a significant association between knowledge scores and selected demographic variables.

DELIMITATION

The study is delimited to 40 sample

Delimited to assessment of knowledge aspect only

Delimited to selected hospital patients only

CONCEPTUAL FRAMEWORK

A conceptual framework is a group of concepts and a set of proportions that spell out the relationship between them.

Conceptual framework deals with abstractions (concepts) that are assembled by virtue of their relevance to a common theme. Conceptual framework play several inter-related roles in the process of science. It serves as a spring board for the generation of researcher hypothesis and can provide and important context for scientific research.

It is the process of mixing from an abstract idea to a concrete proposal. It helps investigator to organize their thinking observation interpretation and goal direction.

The conceptual framework represents a less formal attempt of organizing a phenomena. Conceptual models deals with concepts that are used as building blocks and provide a conceptual perspective regarding inter-related phenomena which are closely structured.

A conceptual frame work is a network of intra-related concepts that provide a structure for organizing and describing the phenomenon of interest research studies are based on a theoretical conceptual framework that facilities to visualizing the problem and places the variable in a logical context.

The present study was aimed at assessing knowledge on management of Diabetes Mellitus among diabetic patients in a selected hospital, Faridabad with a view to prepare an information booklet on management of Diabetes Mellitus. The conceptual frame work for present study is based on modified Penders Health promotion Model (1980s) reframed by S. Saddle River, N.J. Prentile Hall 2002. The model consists of 3 steps. 1. Individual characteristic and experience.

7.

2. Behaviour specific cognition and effect. 3. Behaviour outcome.

IN THE PRESENT STUDY INDIVIDUAL CHARACTERISTICS

Refers to personal, biological, psychological, social, cultural factors and prior related behavior.

BEHAVOUR SPECIFIC COGNITION AND EFFECT:-Refers to motivational significances for acquiring and maintaining health promoting behaviours. These are critical care for intervention because they can be modified through nursing intervention. They include perceived benefit of action, perceived barrier to action actively related effect.

BEHAVOIUR OUTCOME:-

It refers toward attaining positive health outcome for the old age people those who are effected Diabetic Mellitus. The investigator has modified the health promotional model for the present study.

THE INDIVIDUAL CHARACTERISTIC AND EXPERIENCE:- Refers to demographic variables and study variables.

BEHAVOUR SPECIFIC COGNITIVE AND EFFECTS:- Refers to knowledge on management of Diabetic Mellitus among diabetes patients.

8.BEHAVIOUR OUTCOME :- The student investigator assessed the knowledge on management of Diabetic Mellitus among people by using structured questionnaire.

9.

10.REVIEW OF LITERATUREReview of Literature is a key step in research process. A through Literature review focusing on prior research provides a foundation on which to base the knowledge. Hence a survey of literature becomes a vital part in any research separated. It will help to identify what is known and unknown about a problem. It broadens the understanding and gives insight in to the problem under study?1. Studies related to diabetes mellitus.

2. Studies related to knowledge of diabetic patients regarding management of diabetes mellitus.

I. STUDIES RELATED TO DIABETES MELLITUS:-

A study was conducted on life style risk factors and new onset Diabetes Mellitus in adults. The objective of the study was to determine how life style factors assessed in combination, relate to new-onset Diabetes in a broad and relatively unselected population of adults. The sample include low risk life style group were defined by physical activity level above the median, dietary score (higher fiber intake and poly unsaturated to saturated fat ratio, lower trans-felt intake and lower mean glycemic index) in the top 2 quintiles, never smoked or farmer smoker more than 20 years ago or far fewer than 5 pack years; alcohol use; body mass index less than 25 and waist circumference of 88cm for women or 92cm for men. The finding shows that during 34539 person years, 337 new cases of drug treated Diabetes Mellitus occurred (9.8 per 100 person years). After adjustment for age, sex, race, education level, and annual income, each life style factor was independently associated with incident Diabetes over all the rate of incident Diabetes was 35% lower (relative risk, 0.65; 95% confidence interval 0.59, 0.71) for each 1 additional life style factor in the low risk group.

11.A study was conducted on time trends in the prevalence of Diabetes Mellitus (Ten years analysis from India on 19,072 subjects with Diabetes). The objective of the study was to assess the time trends in the prevalence of Diabetes on the following parameters, age, group, sex and individual with freshly diagnosed Diabetes versus known Diabetes the sample include person time can be estimated for each patient when a patient changed from diabetic free to diabetic patient. This can be captured for each patient from the variable onset of first diagnoses as a diabetic patient the result shows that there is an increasing trend in the number of individuals in the young particularly the 18-34 years group. The number of women with Diabetes tended to increase over the 10 years period.

A study was conducted on Diabetes risk factors Diabetes and Diabetes care, across sectional mail study. Self completed survey and retrospective chart review were used the objective of the study was to comprehensively describe Diabetes-related risk factors and quality of care. The sample include ninety seven patients with Diabetes and 495 with other diseases. In the mail study 84 with Diabetes in the self completed survey and 101 diabetic patient chart reviews. The finding showed that most residents without Diabetes had recently had their blood pressure and cholesterol checked 60.4% were trying to control their weight and 73.9% were exercise regularly. Those with Diabetes reported a greater uptake of healthy living messages and had a mean HbAIC of 7.3% total cholesterol of 5.0 mmol L(-1):12.9% had a diastolic blood pressure greater than or equal to 85 mmHg foot checks were infrequent (18%)II. STUDIES RELATED TO KNOWLEDGE OF DIABETIC PATIENTS REGARDING MANAGEMENT OF DIABETES MELLITUS.A study was conducted on glycemic control. The purpose of the study was glycemic control are important components of management to prevent and delay the complications of Diabetes. 46 patients who participated in this study were randomly assigned to either an in person or a teleconference approach the 12.

participants were middle aged adults, both men and women with type I or type II Diabetes. Variables examined including glycemic control as measured by glycated hemoglobin and psychological variable, psychological measures were assessed using validated instruments such as problem areas in diabetic scale, the Diabetes quality of life scale to determine. Whether there were difference in patients quality and satisfaction with life with Diabetes. The findings showed that significant improvement (PL.001) in metabolic control in both groups, as demonstrated by decreases in glycated Hemoglobin level after the programme. However, there were no significance between group difference, suggesting that both approaches are acceptable methods for teaching patients.

A study was conducted on preventing of diabetic foot, ulcer recurrence in high risk patients. Use of temperature monitoring as a self assessment tool in this physician blinded randomized 1.5 month, multi centre trial, 173 subjects with a previous history of diabetic foot ulceration were assigned to standard therapy, structured foot examination or enhanced therapy group. Each group received therapeutic foot wear, diabetic foot education and regular foot care subjects in the enhanced therapy group used an infrared thermometer to measure temperatures on six foot sites each day the temperature difference greater than 4 degrees F (greater than 2.2 degrees c) between left and right corresponding cities triggered patients to contact the study nurse and reduce activity until temperature normalized the findings show that enhanced therapy group had fewer foot ulcers than the standard therapy and structured foot examination groups (enhanced therapy 8.5 Vs standard therapy 29.3%, P=0.0046 and enhanced therapy Vs structured foot examination groups were 4.37 and 4.71 times more likely to develop ulcer than patients in the enhanced therapy group14.

A study was conducted on quality evidence for life style management and glycemic control in adults. A quasi experimental study was used to evaluating life style (diet and or physical activity) modification and life style control date 13.

source included bibliographic data base, manual reference search and contract with study others. The kindly show that search strategy generated 4,572 citations. The majority of citations were not relevant to the study objective in this retrospective study morbidity obese with Diabetes Mellitus treated with a very low carbohydrate diet15. A study was conducted on beliefs and practices among people with Diabetes Mellitus. A structures question knowledge, beliefs and practices regarding Diabetes was administered to 199 persons with Diabetes (92.5%) mean age (SD) was 53 (11) years. Mean deviation of Diabetes (SD) was 8 (7) years in men and 9 (6) years in women men had a significantly better knowledge score that women (P=0.02) there was no significant difference in the beliefs an practices scores. Score were classed as good (60%) in only 13.6% of participants for knowledge, 17.6%. for beliefs and 11.2% for practices, about 38* of the participants had recovered education on diabetes care16.A study was conducted on exercise on Diabetes Mellitus. The patients none of whom were regular exercises, were randomized to on of four groups-aerobic exercise, resistance training combination of both or none. Overall researches saw improvements in blood sugar control in all the patients who worked out compared with controls patients in the aerobic group bad a reduction of 51% in their separate n weight training group had a 38% reduction compared with control. Access all 3 exercise groups date suggested that working out could improve blood pressure/triglyceride and cholesterol levels in the changes among groups. Exercising also led to modest weight loss even though patients were put on diets especially designed to maintain weight and reduction in belly fat17 A study was conducted on exercise on Diabetes Mellitus. It is estimated that No. of people with Diabetes in the world will double in coming years from 171 million in 2000 to 366 million in 2030, cardiovascular disease accounts for 14.

more than 70% total mortality among patients with type 2 Diabetes. The association of physical activity physical fitness, and changes in the life style with the risk of type 2 Diabetes has been assessed by number of prospective studies and clinical trials in the past decade. Several studies have also evaluated the joint associations of physical activity, body mass index and glucose levels with the risk of type 2 Diabetes these studies showed that moderate or high levels of physical activity or physical fitness and changes in the life style can prevent type 2 Diabetes18. A study was conducted on complications of diabetes Mellitus, long term complications due to diabetes continue to be a major problem for patients with this disease. Most common complication were peripheral neuropathy (68%) and problems related to eyes (43%) lower extremity ulcer as a consequences of this disease was also found to a common complication. Thus this study showed that early detection and effective control of Diabetes can be expected to reduce the incident of Diabetes related complications. Furthermore prevention and proper management of foot ulcers will reduce risk of amputation in these patients19. A study was conducted on developed of a Diabetes diet related quality of life style. The objective of the study was to assess the reliability and validity of diabetic diet related quality of the scale. Which is a measure of the influence of diet therapy on patients quality of life. The sample include patient with Diabetes (N-236) who were being treated on an outpatient basis were asked to complete the self administered DDRQOL instrument. The factor validity, convergent and discriminant validity. Internal consistency and reproducibility of the DDRQOL scale were then assessed. The result shows that the following seven subscales were adopted for the DDRQOL `satisfaction with diet burden of diet therapy perceived merits of diet therapy general perception of diet restriction of social function vitality and mental health. As hypothesized the DDRQOL scale was associated C each of the SF-36 subscales, C convergent & discriminate validity being generally exhibited 20. 15.

A study was conducted on exercise prescription. For patients with diabetes and pre-diabetes. Diabetes Mellitus and pre-diabetic conditions such as impaired fasting glucose and impaired glucose-tolerance (Igt) are rapidly increasing in prevalence exercise training often in combination with other life style strategies as beneficial effect on preventing concept of Diabetes and improve glycemic control in those with pre-diabetes in addition exercise training improve cardiovascular risk profile, body composition and cardio-respiratory fitness, all strongly related to better health outcomes based on the evidence it is recommended that patients with Diabetes or pre-diabetes accumulate a minimum of 210 min/week of moderate-intensity exercise or 125 min/week of vigorous-intensity exercise within no more than two consecutive days without training. The finding showed that two or more resistance training section per weeks (2-4 sets of 8-10 repetitions) should be included in the total 210 or 125 min of moderate or vigorous exercise respectively21. 16.METHODOLOGY

Methodology indicates the general patterns for organizing the procedure to gather valid and reliable data for investigations. This chapter deals with the methodology and procedure adopted by the researcher for the conduction of the study. It presents in detail about the research approach, research design, the settling, population, sample and sampling technique, instrument used for data collection, data collection procedure and plan for data analysis.

RESEARCH APPROACH:-

The research approach indicates the procedure for conducting the study. It guides the researcher what to research, whom to analyse and interpret the results in view of the nature of the problem selected for the study and the objectives to be accomplished a descriptive research approach was considered as appropriate for the study.

RESEARCH DESIGN:-

Research design refers to the researchers over the plan for obtaining answers to the research questions and it spells out the strategies that the researcher adopt to develop information that is accurate, and interpretable. The present study assess the knowledge on management of Diabetes Mellitus among diabetic patients. Research design selected for the study was descriptive design. Variables under study :-A variable is a characteristic or quality that various from one person or object to another. A variable is anything that can change or anything that is liable to vary.

17.

DEMOGRAPHIC VARIABLES :

Demographic variables under the study are age, sex, religion, educational status, occupational status, income, type of family, marital status and family history of Diabetes Mellitus. SETTING OF THE STUDY :-The setting is the location where the study is conducted. The current study was conducted in Apoorva Hospital Faridabad.

POPULATION :-A population is a group whose members possess specific attribution that a researcher is interested in studying. The target population of this study is patients with Diabetes Mellitus.

Accessible population of this study is patients with Diabetes Mellitus in Apoorva Hospital Faridabad. SAMPLE : - Sample refers to submit of a population that is selected to participate in a particular study. It is a subset of the population which represents the entire population. The sample size chosen for this study is 40 patients with Diabetes mellitus in Apoorva Hospital Faridabad.SAMPLING TECHNIQUE:-

Sampling defined as the process of selecting a group of people or the elements for the conduction of the study.

Purposive sampling technique was used to select the samples. 19.SAMPLING CRITERIA :-1. Inclusive criteria :

1. The patients who are diagnosed as either type I or type II Diabetes Mellitus

2. Patient age group between 35-55 years

3. Those who are willing to participate in the study.

4. Patients who are available at the period of study

5. Patients who can read and write English & Hindi

6. Patients of both gender.

2. Exclusive Criteria :-

1. The patients who are having complications 2. Patients who received information on management of Diabetes Mellitus.

DEVELOPMENT OF INSTRUMENT:

Structural knowledge questionnaire was selected on the basis of the objectives of the study, as it was considered to be the most appropriate instrument to elicit responses from the subjects.

The instrument is a vehicle that could best obtain data pertinent to the study and at the same time add to the body of general knowledge in the discipline.

The tool was developed based on review of literature, opinion on the subject experts and in discussion with the guide and personal experience in clinical setting.

20.DESCRIPTION OF THE INSTRUMENTS:-The tool is divided into section I and II Section I : demographic data :

Socio demographic data contain 10 items on age, sex, religion, type of family, marital status, educational status, occupational status, income, family history of Diabetes Mellitus and source of information on knowledge regarding management of Diabetes Mellitus.

Section II :-

This section consisted of 35 items regarding management of Diabetes Mellitus. The items were developed as to cover the following groups.

General questions related to management of Diabetes Mellitus.

Diet

Medication

Exercise

Foot care

Complication For each questionnaire four opinion were given and only one correct answer, for each correct answer, the score was 1. If answer was wrong the score was given as o. the highest score was 35.

>27 Score (>75% is adequate knowledge)

18-26 Score (50-75% is adequate knowledge)

>17 Score (>50% is adequate knowledge)

21.TESTING OF THE TOOL

Content Validity

Validity refers to the degree to which an instrument measures what is supposed to measure content validity of the tool and give their valuable suggestions. The suggestions of experts were incorporated in the tool and information Booklet was further modified and finalized with experts opinion with consolation of guide after content validation, tools were given language expert to translate them to Hindi Language. RELIABILITY OF THE TOOL: Reliability is the degree of consistency that the instrument of the procedure demonstrated whatever is measuring, it does so consistently.

The tool was administered to 5 patient with Diabetes Mellitus after getting formal permission from the hospital in order to establish reliability.

PILOT STUDY : Pilot study is the trail run of the methodology planned for the major project, the purpose of the study is two fold, to make improvement in the research projects and to detect problems that must be solved before the major study is attempted.

22.The purpose of pilot study was as follows:- Find out feasibility of conducting the final study. Determine the methods of statistical analysis. A pilot study was conducted on 10 sample in the month of May 2011 at Vardaan Hospital Faridabad. they were selected for the pilot study by purposive sampling technique. Subject for they were selected for the pilot study by purposive sampling technique. Subject for the pilot study possessed the same characteristics as that of samples for main study. After the data collection, the data were analyzed and it was found feasible to conduct main study. DATA COLLECTION PROCEDURE:- A formal permission from medical superintendent from hospital was obtained prior to the starting of the study, the study was conducted in Vardaan hospital, Medical Surgical department. The data collection was done in month of March 2013 and data collected from 35 patients with diabetes mellitus. The objective and nature of the study was explained to the patients. Confidentiality was assured to all the patients to get their co-operation through the process of data collection. A questionnaire was administered which is compressed of two sections. Demographic variables and standardized tool for assessing the knowledge regarding management of Diabetes mellitus among diabetic patients.

PLAN FOR DATA ANALYSIS :- Analysis is the systematic organization and synthesis of research data and testing of research hypothesis using these data. The data obtained was analyzed in terms of the objectives of the study by using descriptive and inferential statistics, the master data sheet was prepared with response given by subjects. The plan for data analysis was follows:

23.SECTION I : DESCRIPTION OF BASE LINE VARIABLES. Section II : Description of Knowledge scores of sample by using frequency, percentage mean and standard Deviation (SD).

Section III : Association between knowledge score and selected base line variables.

CONCLUSION :- This chapter gives a brief description of the methodology adopted for the study which includes the research approach, design, setting, population, sample sampling technique, development and description of tool pilot study, data collection, procedure and plan for data analysis. 24.DATA ANALYSIS

Statistical Analysis is a method of rendering quantities information meaning and intelligently statistical procedure enable the researcher to reduce summarize, evaluate, interpret and communicate numeric information.

This chapter deals analysis and interpretation of data collected from 40 peoples regarding management of Diabetes Mellitus. Keeping in view the objective of descriptive study which was adopted to assess the knowledge regarding management of Diabetes Mellitus among diabetic patients admitted is selected hospital Faridabad.

The data was collected from the respondents before giving information booklet. The collected information was organized, tabulated, analyzed and interpreted using descriptive and inferential statistics. Analysis was done based on the objectives and assumptions of the study.

OBJECTIVE OF THE STUDY :-

1. To asses the existing knowledge level of diabetic patient on management of Diabetes Mellitus.

2. To find an association between the knowledge score with selected demographic variables.

3. To develop an information Booklet on management of Diabetes Mellitus.

25.PRESENTATION OF THE DATA:-

To begin with the data were entering in master data sheet tabulation and stoical processing. The data are analyzing and interpreting using descriptive and inferential statistics. The data were presented on following headings.

Section I : Description of baseline variables.

Section II : Description of knowledge score of sample by using frequency, percentage mean and standard deviation (SD)

Section III : Association between knowledge score and selected baseline variables.

ANALYSIS OF THE DEMOGRAPHICAL VARIABLES:-

Analysis of the demographic characteristic of the respondents such as age, sex, religion, Type of family, marital status, educational status, occupational status, monthly income, family history of Diabetes Mellitus and source of information.

The selection deals with description of socio demographic variables or samples characteristics 40 samples from selected hospital based on the sample criteria. The data on the sample characteristics were analyzing using descriptive statistics and presented in terms of frequency percentage depicted with diagram.

26.SECTION A DEMOGRAPHIC TABLE

Sl NoCharacteristicsCategoryF%

1Age30-40 years

41 50 years

51-60 years

61 & above10

13

12

525

32.5

30

12.5

2SexMale

Female28

12 70

30

3.ReligionHindu

Muslim

Christian

Others23

12

5

0 57.5

30

12.5

0

4.Type of familyNuclear

Joint

Extent18

20

2 45

5

5. Marital StatusMarried

Unmarried

Widow/Widower

Divorce/Separated26

8

4

265

20

10

5

6.Educational StatusPrimary

Secondary

High School

P.U.C

Graduate & above10

12

14

2

225

30

25

5

5

7.OccupationHouse wife

Private employee

Self employee

Retired10

14

13

325

35

32.5

7.5

27.

8. Monthly Income of the familyRs.1000

Rs.1000 2000

Rs.2001-3000

Rs.>30005

10

10

15 12.5

25

25

37.5

9Family history of D.MYes

No.21

1952.5

47.5

10 Source if informationElectronic media

Printed media

Health professional

Family members / relatives / friends6

4

10

10 40

10

25

25

28.DESCRIPTION OF SAMPLES ACCORDING TO THE AGE GROUP

Table I (a)

N=40

Sl NoAge GroupF%

130-40 years1025

241 50 years133.2.5

353-60 years1230

461 & above512.5

Total 40100

Table 1 (1) indicates the majority of subject belongs to 41-51 years that is about 32.5% of subject in this study 29.

30.DESCRIPTION OF SIMPLE ACCORDING TO SEXTable 1 (b)

N=40

Sl NoReligion Frequency Percentage

1Male 2870

2Female 1230

Total 40100

Table 1 (b) indicates distribution of subject according to sex. In the total samples about 70% are male and 30% are female.

31.

32.DESCRIPTION OF SIMPLE ACCORDING TO RELIGIONTable 1 I

N=40

Sl NoReligion Frequency Percentage

1Hindu 2357.5

2Muslim 1230

3Christian 512.5

4Others 00

Total 40100

Table 1 I indicates distribution of subject according to religion. In this study 57.5% of the subject are Hindu, 30% belongs to Muslim and 12.5% of belongs of Christian

33.

34.DESCRIPTION OF SIMPLE ACCORDING TO FAMILYTable 1 (d)

N=40

Sl NoReligion Frequency Percentage

1Nuclear 1845

2Joint 20 50

3Extend 2 5

Total 40100

Table 1 (d) indicates distribution of subject according of family. In this study sample , 30% belongs to Muslim and 12.5% of belongs of Christian

35.

36.DESCRIPTION OF SIMPLE ACCORDING TO MARITAL STATUSTable 1 (e)

N=40

Sl NoType of family Frequency Percentage

1Married 2665%

2Unmarried 2 5%

3Widow/Widower 820%

4Divorce/Separated 410%

Total 40100

Table 1(e) indicates distribution of subject according of Marital Status. In the total subjects 65% are married 20% are unmarried. 10% are widow/widower and 5% are divorce / separated.

37.

38.DESCRIPTION OF SIMPLE ACCORDING TO EDUCATIONAL STATUSTable I (f)

N=40

Sl NoEducational Status Frequency Percentage

1Primary 1025

2Secondary 1230

3High School 1435

4PUC 25

5Graduate & above 25

Total 40100

Table 1 (f) indicates the distribution of subject according to educational Status. In this sample about 25% are primary, 30% secondary, 35% are high school, 5% are PUC and 5% are graduate and above.

39.

40.DESCRIPTION OF SIMPLE ACCORDING TO OCCUPATION STATUSTable I (g)

N=40

Sl NoEducational Status Frequency Percentage

1House wife 102.5

2Primary Employee1442.5

3Self Employee 1332.5

4Retired 37.5

Total 40100

Table 1 (g) indicates the distribution of subject according to occupation. Above 25% of samples are house wives 42.5%, sample are private employee, 32.5% are self employee and 7.5 are retired.

41.

42.

FIG No. 10 Column diagram representing distribution of samples according to monthly income of the family.

44.DISTRIBUTION OF SAMPLE ACCORDING TO FAMILY HISTORY OF

DIABETETS MELLITUS

Table I (i)

Sl.

No.Family History of Diabetes MellitusFrequencyPercentage (%)

1Yes2152.5

2No1947.5

Total40100

Table 1(i) indicates distribution of sample according to family history of Diabetes Mellitus. About 52.5% or samples have family history of Diabetes Mellitus. And 47.5% do have family history of Diabetes Mellitus.

FIG NO. 11 Column diagram representing distribution of subjects according to family history of Diabetes Mellitus.

45.

46.DISTRIBUTION OF SAMPLE ACCORDING TO SOURCE OF

INFORMATION REGARDING DIABETES MELLIITUS

Table I (j)

Sl.

No.Source of informationFrequencyPercentage(%)

1Electronics media1640

2Printed media410

3Health professional 1025

4Family members / relatives/ friends

1025

Total :40100

Table 1(j) indicates distribution of sample according to source of information regarding Diabetes Mellitus. About 40% samples got information from electronic media 10% from printed media 25% from health members relates/friends.

FIG No. 12 Cone diagram representing distribution of subjects according to the source of information.

47.

48.SECTION II

FREQUENCY AND PERCENTAGE DISTRIBUTION OF

RESPONDENTS ACCORDING TO PRE TEST KNOWLEDGE

LEVEL OF MANAGEMENT OF DIABETES MELLITUS

Respondents

Knowledge levelCategoryNumberPercentage(%)

Adequate

Knowledge

>75%25

Moderate Knowledge

51-75%922.9

Inadequate

Knowledge