RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

MR.NOBLE JOSE

I YEAR M.Sc. (NURSING)

CHILD HEALTH NURSING

YEAR 2011-2013

SRI VENKATESHWARA COLLEGE OF NURSING

NO: 98, MARUTHI INDUSTRIAL ESTATE,

PEENYA 2ND STAGE,

BANGALORE - 560 058.

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. NAME OF THE

CANDIDATE AND

ADDRESS

MR. NOBLE JOSE

1st YEAR M.SC. (N)

SRI VENKATESHWARA COLLEGE OF NURSING,

NO:98, MARUTHI INDUSTRIAL ESTATE,

PEENYA 2nd STAGE,

BANGALORE – 560 058

2. NAME OF THE

INSTITUTION

Sri Venkateshwara College of Nursing,

No:98, Maruthi Industrial Estate,

Peenya 2nd stage, Bangalore- 560 058

3 COURSE OF THE STUDY

AND SUBJECT

1st Year M.Sc. Nursing

Child Health Nursing

4. DATE OF ADMISSION TO

THE COURSE

16.06.2011

5 TITLE OF THE TOPIC

“A study to assess the effectiveness of structured

teaching program regarding promotion of healthy

behavior among the mothers of preschool children

in selected community areas in Bangalore.”

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6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

“Half of the costs of illness are wasted on conditions that could be

prevented”. Dr. Joseph Pizzorriu..

Today’s children are tomorrow’s citizens. Prosperity of the nation depends upon the health

of children. Children with sound mind in sound body are essential for the future development of

the country. During the earliest years of growth and development, preschool children need

dependable attachment to parents and caregivers; they need protection, guidance, stimulation,

nurturance, and skills to cope with adversity1.

A preschool child’s development is under control of parents’ and grandparents’ direct

supervision and increasingly in the hands of near strangers such as health care providers and

teachers. In pre-schools, students learn decent human relations through the techniques of

cooperative learning and supervised service. Curiosity and thinking skills are stimulated through

study of the life sciences. Education and health are linked, each nourishing the other2.

The main conditions for fostering healthy behaviour in preschool children are personal

hygiene, physical and mental health, learning activities and proper nutrition. Schools provide

suitable health-promoting environments for improving healthy behaviour among school going

children. Preschools should provide clear examples of health-promoting behaviour, means of

social reinforcement for such behaviour and encouragement of healthful habits. They should

clarify the nature of good nutrition in the classroom and serve nutritious food in the cafeteria.

Curriculum is another aspect which helps in promoting a healthy behaviour in preschool

children. This concept of active, self-generated learning affects all aspects of the curriculum

from teacher training through classroom practice and parent involvement. Life-skills training in

Preschools can provide their students with knowledge and skills to help them make informed,

deliberate decisions. Such information, combined with training in interpersonal skills and

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decision making, can help students to resist pressure from peers or from the media, relieve

distress without dangerous activity, learn how to make friends if they are isolated 3.

The main conditions for promoting healthy behaviour in preschool children are personal

hygiene, physical and mental health, learning activities and proper nutrition. There is no more

crucial period of life than the age up to six years. Preschool healthy behaviour is now being

recognized as clear indicator of difficulties that may persist into later childhood and that may

indicate family dysfunction. Screening is necessary to detect developmental problems in

preschool children. Therefore their positive health behaviour towards every aspects of life is

important to develop a good generation4.

6.1 NEED FOR STUDY

Preschool period is one of rapid change in developmental, social, emotional, cognitive

and linguistic abilities. The child is progressively developing more autonomy 7.Preschool

children with early emergent behavior problems are likely to evince serious behavior problems,

social skill deficits and academic difficulties later in life5.

The improvement of the health of preschool students and the settings in which they learn

also appears to enrich and improve educational outcomes. Recent major reports and studies cite

various forms of evidence which suggests that preschool children learn better if they are healthy.

Common themes run through this literature which indicates learning is faster, more

comprehensive and enjoyed by students if they are healthy. The health promoting preschool

appears to offer an approach which increases the learning capacity of students. The health

promoting school approach also appears to enrich classroom-based learning outcomes, e.g.

knowledge acquisition, decision making. Evidence in the literature indicates that learning goals

and aims expressed in educational 6.

A study was conducted to analyze the effect of mother’s employment on cognitive

outcomes of her children. A panel of children aged 4 to 15 are analyzed to explore the effect of

maternal employment on a child’s mental health outcomes. Using ordinary least squares and

fixed effects estimates, it was found that mothers who spend more time at home have children

with fewer emotional problems, they scored lower behavioural problems. They are also less

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likely to be frequently unhappy or depressed. In addition, children with mothers spending more

time at home are less likely to hurt someone, stealing something, or skip school7.

A descriptive study was conducted on sedentary behaviour in US preschool

children. The main objective of the study was to identify correlates of objectively measured

sedentary behaviour in a diverse sample of preschool children. A total of 331 children from a

wide range of ethnic and socioeconomic backgrounds, were recruited for this study. All potential

correlates except for anthropometric data of children were measured by a parent survey.

Sedentary behaviour measured by accelerometry in preschool children. The result shows

that Girls spent more time in sedentary behaviour than boys. In the gender-specific final model,

for boys, a child's weekday TV/video games and physical activity equipment in the home were

significant correlates of sedentary behaviour .The study concluded that several factors were

identified as correlates of objectively measured sedentary behaviour in

American preschool children. However, there were no common correlates that influenced

sedentary behaviour for both boys and girls8.

A study was conducted on healthy social relationship among preschool children. It

reveals that preschool children should be able to develop the proper social skills to prevent the

emergence of health problems, emotional distress and personality disturbances. Educators must

train children and adults on how to recognize, encourage and enhance characteristics that help

children develop friendships. The study concluded that teachers, parents, older siblings and other

adults should act as role models for preschool children to develop appropriate behaviours of

affection, sensitivity and cooperation.9

From the various literatures, it is clear that there is an emphasis on age-appropriate

knowledge to preschool children which is useful to sustain one’s health and which forms a basis

for lifelong healthy practices. The focus on knowledge has shifted from an instructional approach

to reflect current understandings about how children learn. The documents and their

accompanying guides and manuals, where present, place a strong emphasis on interaction and

participatory learning methods, and on involving pupils in many outside class and community

activities which require different approaches to the teacher-dominated classroom curriculum1o.

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Therefore the researcher found that there is a need to improve the knowledge regarding

healthy behaviours among the mothers of preschool children. In many areas there is a lack of

health education and knowledge among preschool children. There is a need to prepare a

structured teaching programme to educate the mothers of preschool children regarding

promotion of healthy behaviour. Hence, this study was undertaken.

6.2 REVIEW OF LITERATURE

“A literature review is a body of text that aims to review the critical points of current knowledge

including substantive findings as well as theoretical and methodological contributions to a

particular topic”.

A study was conducted on an innovative preschool health education programme. The

aim of the present study was to explore the effects of health education program, related to the

identification of healthy and unhealthy nutritional habits, physical activities and hygiene in

children 4-5 years of age. It reveals that 125 children participated in an education program for a

period of two months. For data collection, a specialized protocol was constructed with pictures in

order to evaluate the preschool children’s knowledge about healthy behaviour before and after

the implementation of the education program. The results of the present study showed that after

the implementation of the program the scores were higher in identifying healthy and unhealthy

nutritional habits and physical activities compared to the scores before the program. In regard to

the place of residence, children from downgraded areas presented higher performance than

children from privileged areas in identifying healthy and unhealthy physical activities and

hygiene. From the results of the present study, it concluded that taking up habits of healthy

nutrition, exercise and hygiene constitutes the main requirement for the preschool child’s healthy

development and a guarantee for a healthy adulthood11.

A descriptive study was conducted on Municipal Intentions to Promote Preschool

Children’s Healthy behaviour. It is clear that preschools are environments where children are

given opportunities to develop emotional, social and intellectual healthy capabilities,

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characteristics that by recent research have been revealed as health protecting. The objectives of

this study were to examine the intentions of 25 Swedish municipalities to develop such

capabilities through activities in preschool and to relate these intentions to municipal socio-

economic conditions. Indicators on municipal intentions to promote preschool children’s

emotional, social and intellectual capabilities were rather frequently utilized by the 25

municipalities in this study. It concluded that promotion of physical activity, parent support, and

children’s influence in preschool were not prioritized. The extent of intended preschool activities

was not determined by municipal wealth, which might be due to a national system for equalizing

municipal resources.12

A study was conducted on the prevalence of emotional and behavioural problems

among 1488 primary school children aged 5 to 11 years in Karachi, Pakistan. It shows that

assessment of preschool children’s mental health was conducted using Strength and Difficulties

Questionnaire (SDQ). The results show that 34.4% parents rated children as falling under the

“abnormal category” on strength and difficulties questionnaire, 35.8% were reported by the

teacher. The study concluded that there is a gender difference in prevalence. Boys had higher

estimates of behaviour / externalizing problems; whereas emotional problems were more

common amongst females. If parents are employed, the prevalence of behaviour problems, were

more in boys as well as girls13.

A study was conducted on preventing anxiety and promoting social and emotional health

in preschool children .The objective of the study was to examine, for the first time, the efficacy

of The Fun FRIENDS program, a school-based, universal preventative intervention program for

preschool children. The program aims to teach children cognitive-behavioural strategies in a

play-based manner to prevent anxiety and to increase social and emotional strength. Participants

were 263 children aged four to six years attending preschool in Brisbane, Australia. Schools

were randomly allocated to an intervention group (IG) or a waiting list control group (WLG).

Parent report data revealed no significant differences between the IG and WLG on anxiety,

behavioural inhibition (BI) and social emotional strength at post-intervention. At 12-month

follow-up, improvements were found on anxiety, BI and social-emotional competence for

children in the IG. The study concluded that teacher reports revealed significant improvements at

post-intervention on BI and social-emotional strength for children who had received the

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program. The implications of these findings are discussed, along with limitations and directions

for future research14.

A preliminary study was conducted on special education services for preschool-age

children. The objective of this study was to gather information about the structure and

organizational components of inclusive services for preschool-age children in California. The

results indicate that the availability of inclusive services and type of service delivery models vary

according to the child's age and disability. Services for preschoolers tend to fall into two

configurations: children with mild disabilities who are frequently fully included and children

with severe disabilities and low-incidence disabilities who are more often partially included or

placed in special day classes only. The services provided most frequently in inclusive programs

are related services and consultation to families, community preschools, and other agencies. The

results concluded that although inclusive services are available in many local education agencies

(LEAs) service delivery models may not be conducive to the implementation of interventions

needed to support optimal social and developmental outcomes for children15.

A study was conducted on effectiveness of the health promoting among primary school

in improving preschool child healthy behaviour. It indicates that school health programs have

been part of schooling for most of this century. This paper examines the development of the

health promotion and identifies its healthy components. It reviews the claims and evidence which

have emerged from the school health research literature which focus on primary schools.

Findings indicate health gains for primary school students are difficult to assess, and will most

likely occur if a well designed programme is implemented which links the curriculum with other

health promoting school actions, contains substantial professional development for teachers and

is underpinned by a theoretical model. The paper concludes by discussing how improvements

can be made in more accurately assessing the effectiveness of the health promoting primary

school in improving healthy behaviour16.

An epidemiological study of child and adolescent psychiatric disorders was conducted in

urban and rural areas of Bangalore, India. The psychiatric morbidity among less than 3 year old

children was 13.8 % with the most common diagnosis being breath holding spells, pica,

behaviour disorder, expressive language disorder and mental retardation. The prevalence rate of

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psychiatric morbidity in the 4-16 year old children was 12%. Enuresis, specific phobia,

hyperkinetic disorders, stuttering and oppositional defiant disorder were the most frequent

diagnosis. Assessment of felt treatment needs indicated that only 37.5% of the families perceived

that their children had any problem17.

An integrative study was conducted on acquisition and socialization of children's health

attitudes and behaviour. It reveals an overview and synthesis of the literature documenting

various influences on the socialization and acquisition of children's health attitudes and

behaviour is the focus of this review. Cognitive-developmental approaches to understanding

preschool children's health attitudes are presented, followed by an exploration of an individual

differences perspective on children's acquisition of health attitudes and behaviour. The influence

of various socialization agents, including families, peers, schools, and the media, on children's

acquisition of health attitudes and behaviour is considered. Implications of these findings for

social policy, future research, and molding of child health attitudes and behaviour are

examined18.

A study was conducted on supporting system and certain behavioural problems in

preschool children in Malappuram district in Kerala. It was conducted on a sample of 100 pre-

school children of the age group of above four years, i.e. UKG students belonging to the

different types of preschools. Comparison of behaviour problems of boys and girls revealed no

significant difference in between the two groups. The study concluded that the children of high-

socio economic status with less behaviour problems whereas the children of low –socio

economic status were found to have the highest extent of behaviour problems.19

A study was conducted on behavior problems among preschool children. The main

objective of the study was to assess mental health among preschool children. It reveals that out

of 200 Preschool children (aged 3-6 years), 44 (22%) had behavior problems. The study

concluded that the prevalence was higher among boys and more common in children from

nuclear families and a lower socio-economic status20.

A study was conducted on physical activity for preschool children. It reveals that

alarming trends in childhood obesity even among preschool children have re focused attention on

the importance of physical activity in this age group. The aim of the study was to identify the

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amount and type of physical activity appropriate for optimal development of preschool children

and the another purpose of this paper is to provide the scientific evidence to support a link

between physical activity and biological and psychosocial development during early childhood

(ages 2 5 years). To do so, we summarize pertinent literature informing the nature of the physical

activity required to promote healthy physical, cognitive, emotional, and social development

during these early years. Special emphasis is also placed on the nature of physical activity that

promotes healthy weight gain during this period of childhood. The paper also discusses the

strongest determinants of physical activity in preschool-age children, including the role of the

child’s environment (e.g.family, child-care and socio-economic status). We provide

recommendations for physical activity based on the best available evidence, and identify future

research needs21.

Statement of the problem

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTERED TEACHING

PROGRAME REGARDING PROMOTION OF HEALTHY BEHAVIOUR AMONG

MOTHERS OF PRESCHOOL CHILDREN IN SELECTED COMMUNITY AREAS IN

BANGALORE”.

6.3 OBJECTIVES OF THE STUDY

• To assess the pre-test knowledge regarding promotion of healthy behaviour among

mothers of preschool children.

• To assess the post-test knowledge regarding promotion of healthy behaviour among

mothers of preschool children in experimental and control group.

• To compare pre-test and post-test knowledge score regarding promotion of healthy

behaviour among mothers of preschool children in experimental and control group.

• To find out the association between post-test knowledge score regarding promotion of

healthy behaviour among mothers of preschool children with that demographic variables.

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6.4 OPERATIONAL DEFINITIONS

1. Assess- Assess refers to process of the critical analysis and valuation and judgment of the

status or quality of preschool children with unhealthy behaviour.

2. Effectiveness- Effectiveness refers to the difference which is expected in the pre and

post-test knowledge score value of the mothers of preschool children in the promotion of

healthy behaviour.

3. Structure Teaching Programme- It refers to a systematically organized teaching

strategy to provide knowledge regarding the importance of healthy behaviour among the

mothers of preschool children.

4. Healthy behaviour-It refers to an action taken by a person to maintain, attain or regain

good health and prevent illness.

5. Preschool children-in this study the preschool children refer to the children in the age

group of 3-6 years

6.5 HYPOTHESIS OF THE STUDY.

H1:- The mean post-test knowledge score of experimental group is significantly higher

than the mean post-test knowledge score of control group.

H2:-The mean post-test knowledge score of experimental group is significantly higher

than the mean pre-test knowledge score of the experimental group.

H3:- There will be significant association between the post test knowledge scores of the

mothers of preschool children with selected demographic variable in experimental group.

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6.5 DELIMITATIONS OF THE STUDY

The study is delimited to,

1. The sample size was 60

2.The data collection period was only 4 weeks.

3. Mothers with preschool children, who are living in selected community areas.

6.6 PILOT STUDY

The study will be conducted with 12 samples, 6 in each experimental and control group. The

purpose to conduct the pilot study is to find out the feasibility for conducting the study and

design on plan of statistical analysis.

6.7 VARIABLE

A quantity that can assume any of a set of values is called variables.

Dependent variable: Knowledge level of mother’s knowledge regarding promotion of healthy

behaviour.

Independent variable: Structured teaching programme regarding promotion of healthy

behaviour among mothers.

7.0 MATERIAL AND METHODS

7.1 SOURCE OF DATA

The data will be collected from the mothers of preschool children living in selected

community areas in Bangalore.

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7.1.1 RESEARCH DESIGN

The quasi experimental design is non equivalent control group. So pre-test and post test which is

presented below groups

Group Pre-test Intervention Post-test

Group 1 Q1 X Q1

Group 2 Q2 - Q2

SYMPOLS USED

Group 1 - Mothers of preschool children in the experimental group.

Group 2 - Mothers of preschool children in the control group.

Q1 - Collection of demographic data and pre-test assessment of knowledge regarding

promotion of healthy behaviour.

Q2 - Post test done with the same pre-test questioners to assess the knowledge regarding

promotion of healthy behaviour. In this study experimental group received structured teaching

programme and control group did not receive any kind of intervention.

7.1.2 RESEARCH APPROACH

In evaluative research approach was selected from this study.

7.1.3 SETTING OF THE STUDY

The study will be conducted in selected community areas in Bangalore.

7.1.4 POPULATION

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In this study the population selected for mothers, who have children aged between 3-6 years.

7.2. METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE)

Permission will be collected from selected authorities’ in a selected community area. Purposive

sampling technique will be use for the study. Purpose of the study will be explained to the

sample and consigned will be obtained. Data will be collected from using structured interview

schedule to evaluate the effectiveness of knowledge regarding promotion of healthy behaviour

among mothers of preschool children.

Data collection instruments consist of the following sections

Section ‘A’: Demographic data. Age, sex, religion, socio economic status etc.

Section ‘B’: Structured interview shedule related to assess the knowledge regarding promotion

of healthy behaviour among the mothers of preschool children.

SCORING INTERPRETATION

Items of knowledge regarding promotion of healthy behaviour among the mothers of preschool

children which consist of 30 questions.

A score of ‘one’ will be given for each correct response and score of ‘zero’ will be given

for each incorrect response.

Adequate knowledge Above 70%

Moderately adequate knowledge 50-70%

Inadequate knowledge Below 50%

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7.2.1 SAMPLING TECHNIQUE

Non-probability convenience sampling technique for purposive sampling.

7.2.2 SAMPLE SIZE

The sample consists of 60 mothers of preschool children living in selected community

areas in Bangalore, 30 mothers in experimental group and 30 mothers in control group

respectively.

SAMPLING CRITERIA

7.2.3 INCLUSION CRITERIA

• Mothers having child between the age group of 3-6 years.

• Mothers, who are available at the time of data collection.

• Mothers, who can understand English and Kannada.

EXCLUSION CRITERIA

• Mothers, who are selected for pilot study.

• Mothers, who are not willing to participate in the study.

7.2.5 TOOL FOR DATA COLLECTION

Structured interview schedule will be used to collect the data from the mothers of

preschool children in selected community areas at Bangalore.

7.2.6 DATA ANALYSIS METHOD

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The data collected will be analyzed by using descriptive and inferential statistics.

• Descriptive statistics: Frequency and Percentage for analysis of demographic data and

mean, mean percentage and standard deviation will be used for assessing the level of

knowledge of the mothers of preschool children.

• Inferential statistics: Chi-square test will be used to find the association between

knowledge and selected demographic variables. And paired t’ test will be used for

assessing the effectiveness of structured teaching program.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO

BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

Yes, since the study design is quasi-experimental in nature, interventions are required.

7.4 ETHICAL CLEARENCE

Yes ethical committee’s report is here with enclosed.

The main study will be conducted after the approval of research committee of the college.

Permission will be obtained from the head of the institution. The purpose and details of the study

will be explained to the study subjects and assurance will be given regarding the confidentiality

of the data given.

8. LIST OF REFERENCES: [VANCOUVER STYLE FOLLOWED]

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1. Rai,S C and Malik.“Healthy Behaviour among preschool children”. Nightingale Nursing

times.1992. dec; 14(4):475-478

2. Marcon, R.A. “Differential effects of three preschool models on

Inner-city 4-year-olds”. Early Childhood Research Quarterly,1992 Volume 7,page 517

—530

3. David P. Weikart, Ph.D. “Promotive and positive health behaviour in children”.

High/Scope Educational Research Foundation.pg 26-28

4. Perera H and Gunatunge C. “Screening for mental health problems in urban preschool

children- a pilot studies”. Sri Lanka Journal of Child Health 2004; 33 (2):39-42.

5. Huaqing C and Ann P. “Behaviour problems of preschool children from low income

families”. Topics in Early Childhood Special Education 2003 Dec; 23(4):188-216

6. L H St Leger.“The opportunities and effectiveness of the health promoting primary

school in improving child health”. Available from http://her.oxfordjournals.org

7. Mukherjee S. “The impact of maternal employment on child’s mental health”: Evidence

from NSLY-Child [online]. 2009 Sep. [updated Sep 2009; cited 2009 Sep 23].

Available from: URL:

http://artsci.wustl.edu/~econgr/gradconference/Papers/Mukherjee_MaternalEmp.pdf

8. Wonwoo Byun and Russel R Pate. “Correlates of objectivity measured sedentary

behaviour in US preschool children”. Pediatrics journal

9. .Elaine M Murphy. “Promoting healthy behavior”(Healthy Bulletin number 2)

10. Pahl and Paula M. “Preventing Anxiety and Promoting Social and Emotional Strength in

Preschool Children”

11. .Triantafilia and Eva Vidali-Laloumi. “An innovative health education programme”,

Research Group of Archimedes Project. Volume 4,issue 2010

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12. Karlin Guldbrandsson and Sven Bremberg. “Municipal Intentions to promote preschool

children’s health”. Available from

http://www.springerlink.com/content/7h83h136v2624260

13. Syed EU and Haidry SE. “Prevalence of emotional and behavioral problems among

primary school children in Karachi, Pakistan multi informant survey”. Indian Journal of

Paediatrics 2009 Jun; 76(6):623-7.

14. Pahl and Paula M. “Preventing Anxiety and Promoting Social and Emotional Strength in

Preschool Children”. A Universal Evaluation of the Fun FRIENDS Program, Volume

3, Number 3, July 2010 , pp. 14-25(12

15. Maurine Ballard and Rosa Elenor . “A preliminary study of inclusive special education

services for preschool children in California”,

16. Topic-How to Promote Healthy Behaviours in Your Children. Available from

http://tips4diet.net/weight-loss-tips/how-to-promote-healthy-behaviors-in-your-

children.htmlby admin on July 1, 2010

17. Girimaji G and Bhola P. “Epidemiological study of child & adolescent psychiatric

disorders in urban & rural areas of Bangalore, India”. Indian Journal of Medical Research

2005 Jul; 122(1):67-79.

18. Barbara J. Tinsley. “Multiple Influences on the Acquisition and Socialization of

Children's Health Attitudes and Behaviou”r: An Integrative Review. Article first

published online: 28 JUN 2008

19. Kuruvilla M. “Supporting systems and certain behaviour problems of preschool children

in Malappuram district” [Internet].2002 [updated Aug 2002; cited 2008 Aug]. Available

from: URL:http://krpcds.org/report/ushap.pdf

20. .Rai S and Malik SC. “Behaviour problems among preschool children”. Indian

Paediatrics 1993 Apr; 30(4):475-478

21. Brian W. Timmons and Karin A. Pfeiff r. Physical activity for preschool children-how

much and how. Available from www.nrcresearchpress.com by 59.90.233.142 on

12/08/11.

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9. Signature of the candidate.

10. Remarks of the guide.

11. Name and designation.

11.1 Guide

11.2 Signature

11.3 Co-guide

11.4 Signature

11.5 Head of the department

11.6 Signature

12. 12.1 Remarks of the chairman and

principal.

12.2 Signature.

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