QUANTITATIVE AND QUALITATIVE ARTICLE ANALYSIS

152 International Journal of Nursing Education, April-June, 2015, Vol.7, No. 2

A Study to Compare the Effectiveness of Video Assisted Teaching vs Self Instructional Module on Quality of Life

among Type 2 Diabetes

Sithara Begum

Ph.D Scholar, Saveetha University, Chennai

ABSTRACT

Diabetes is becoming the epidemic of the 21st century. Type 2 diabetes , which is more prevalent (more than 90% of all diabetes cases) and the main driver of the diabetes epidemic, now affects 5.9% of the world’s adult population with almost 80% of the total in developing countries .In addition to this, the complications and associated with diabetes is also in the higher rate.

Aim: The aim of study is to compare the effectiveness of of video assisted teaching Vs Self instructional module on quality of life among type 2 diabetes.

Methodology: The research approach adopted for the present study is an Quantitative research approach and the design adopted was quasi experimental design. The se�ing for the study was Crescent Hospital, Alathur. Palakkad, Kerala. The sample size of the present study was 50 used simple random sampling technique to select samples.

Finding: The Pre-test mean Score and Standard Deviation of the type2 diabetes regarding video assisted teaching on quality of life was 55.84 & 6.95,which increased in post test 75.76 and 6.54. pre test mean Score and Standard Deviation of the type 2 diabetes regarding Self-instructional module on quality of life was 54.4 and 4.203, which increased in post test 66.68 and 13.524.

Conclusion: The present study results shows that comparatively the video assisted teaching is more effective in promoting Quality of life than Self-instructional module .

Keywords : Self instructional module(SIM) , Video assisted teaching(VAT), Effectiveness, Compare , Quality of life(QOL), Type 2 diabetes.

INTRODUCTION

While there are many diseases, there is, in a sense only one health. - Park

Encyclopedia, defines diabetes is the group of metabolic diseases which a person has high sugar, either body does not produce enough insulin or because the body does not produce enough insulin or because cells do not respond to the insulin that is produce.

Kumar and Clark (2005) Diabetes Mellitus (DM) is a syndrome of Chronic hyperglycaemia due to relative insulin deficiency, resistance or both It affects more than 120 million people world wide and it is estimated that it will affect 220 million by the year

2020. Diabetes is usually irreversible and although patients can have a reasonably normal lifestyle, its late complications result in reduced life expectancy.1

Dr.V. Mohan and Dr. Pradeepa (2009), conducted a Study on Epidemiology of Diabetes in Different Regions of India. Diabetes is fast becoming the epidemic of the 21st century. Type 2 diabetes , which is more prevalent (more than 90% of all diabetes cases), now affects 5.9% of the world’s adult population with almost 80% of the total in developing countries.2

Kumar and Clark (2005), Type II diabetes is relatively common in all population enjoying affluent life style. The four major determinants for development of type II diabetes mellitus are increase in age, obesity, ethnicity and family history.1

DOI Number: 10.5958/0974-9357.2015.00094.X

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The World Health Organization (2012) estimates that nearly 200 million people all over the world suffer from diabetes and this number is likely to be doubled by 2030. In India, there are nearly 50 million diabetics, according to the statistics of the International Diabetes Federation. The people should be made aware and educated about their health and fitness level to reduce the number of patients in India.3

The Management of type 2 diabetes is most difficult part. Lifestyle modifications like dietary modifications, physical activity, some major drugs of diabetes management, insulin therapy, foot care of diabetes and annual screening. To manage Diabetes patients need a well planned teaching in all aspects of diabetic care

NEED FOR THE STUDY

Maria Polikandrioti,Helen Dokoutsidou(2009) conducted a study on the role of exercise and nutrition in type 2 diabetes mellitus management. In their study concluded that the patients with type 2 diabetes should be constantly informed about the crucial role on nutrition and exercise in the management of the disease. Lack of understanding of the beneficial effects of dietary choices and exercise in the regulation of type 2 diabetes, may lead to inappropriate treatment methods.4

Helen Altman Klein(2013) conducted a study on Diabetes Self-Management Education: Miles to Go. Type 2 diabetes, or non-insulin dependent diabetes mellitus (NIDDM), accounts for 90 to 95% of all diagnosed cases of diabetes in adults.

patients experience increased risks of complications including blindness, kidney damage and failure, cardiovascular disease, nerve damage, and lower-limb amputation.5

Grace Lindsay, Kathryn Inverarity ,and Joan R.S.McDowell (2011) conducted a study on Quality of life in people with type 2 diabetes in Relation to Deprivation, Gender ,and age in a new community based model of care. The study confirms the value of measuring HRQL for people with diabetes, living with a chronic long term condition, to identify changes in status as a mechanism for understanding wider health issues and developing individualized strategies to improve care.6

The latest global figures on diabetes, released by the International Diabetes Federation (IDF), has raised a serious alarm for India by saying that nearly 52% of Indians aren't aware that they are suffering from high blood sugar.7

Kerala has a prevalence of diabetes as high as 20% - double the national average of 8%. The prevalence was 17% in urban, 10% in the midland, 7% in the highland, and 4% in the coastal regions .8

These evidence clearly explains the need for effective education in quality of life among type 2 diabetes and it suggests the need for conducting this studyThe researcher came across many diabetes during the time of clinical postings and found that patients lack in self management of type 2 diabetes.Hence the researcher is interested to take up this study to find an effective teaching method in quality of life among type 2 diabetes.

REVIEW OF LITERATURE

Mohan D et al (2003) conducted a study on Awareness and knowledge of diabetes in Chennai – the Chennai Urban Rural Epidemioogy study. It was Concluded that awareness and knowledge regarding diabetes is still grossly inadequate in India. Massive diabetes education programs are urgently needed both in urban and rural India.9

Tang TS, Funnell MM, Oh M.(2012) Lasting Effects of a 2-Year Diabetes Self-Management Support Intervention: Outcomes at 1-Year Follow-Up. It was concluded that participation in an empowerment based diabetes self management support intervention may have a positive and enduring effect on self care behaviours and on metabolic and cardio vascular health.10

Santhosh Thomas .Vaishali R Mohite(2014) a Study was conducted to assess the effectiveness of self instructional module on the knowledge regarding diabetic diet among diabetic patients. They reported that self instructional module was effective in improving knowledge of diabetic patients.11

Pushpalatha K.S (2007) study conducted on video teaching program of Home care management of Diabetes. The researcher concluded that early teaching program to diabetes mellitus promote the knowledge and alleviate the misconception regarding to practice of life style behaviors’. Timely to education

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will reduce the stress and protect from complications. 12

Vaz N.C et al (2011) conducted study on prevalence of diabetes mellitus in a rural population of Goa, India. the study concluded that innovative community outreach programs are required to create awareness and for screening and treatment of diabetes mellitus to curb the growing epidemic of diabetes in the population.13

Farooq Mohyud Din Chaudhary (2010)et al conducted study on Evaluation of Lifestyle Modifications in Diabetic Patients. It was concluded that Diabetes was more common in female and middle age people. Healthier lifestyle modifications were noted more frequently in males, well educated and those on oral plus insulin medication. 14

STATEMENT OF THE PROBLEM

A study to compare the effectiveness of video assisted teaching VS self instructional module on quality of life among type II diabetes in Crescent hospital, Alathur, Palakkad.

OBJECTIVES:

1. To assess the quality of life among type II diabetic patients before and after administration of Video assisted teaching and self instructional module.

2. To compare the quality of life among type II diabetic patients before and after administration of video assisted teaching.

3. To compare the quality of life among type II diabetic patients before and after administration of self instructional module.

4. To compare the quality of life among type 2 diabetes after administration of video assisted teaching and SIM.

5. To associate the quality of life among type II diabetic patients with their selected demographic variables in video assisted teaching group and SIM.

HYPOTHESES

H1: There is a significant difference in quality of life before and after video assisted teaching & self instructional module.

H2: There is a significant association between post test quality of life scores of video assisted teaching with their selected demographic variables.

H3: There is a significant association between post test quality of life scores of self instructional module with their selected demographic variables.

OPERATIONAL DEFINITION

Effectiveness: In this study effectiveness refers to extent to improve the quality of life among type II diabetes by video assisted teaching or self instructional module.

VIDEO ASSISTED TEACHING

In the study it is a pre recorded video assisted teaching of the management of type II diabetes, which will be projected to the patients using a lap top.

SELF INSTRUCTIONAL MODULE

In this study it refers to the educational booklet prepared for type II diabetes regarding their management.

DEPENDENT VARIABLES: QOL among type II diabetes.

INDEPENDENT VARIABLES: Video assisted teaching and self instructional module.

RESEARCH METHODOLOGY

RESEARCH APPROACH: Quantitative research approach -Quasi experimental subtype approach is used.

RESEARCH DESIGN: The The research design selected for this study is quasi experimental design.

SETTING OF THE STUDY: Study was conducted at Crescent hospital with 300 bed multi specialty hospital. This hospital has Medical and Surgical Wards, Which include Diabetic Clinic.

POPULATION: The Population includes patients who are having type II diabetes in Crescent hospital, Alathur, Palakkad.

SAMPLE: The samples in this study includes the in patients and out patients with type II diabetes in Crescent Hospital.

SAMLE SIZE: Sample size consists of 50type II diabetes patients. Selected 25 for video assisted

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teaching group & 25 for self instructional module group.

SAMPLING TECHNIQUE: Simple random sampling technique is used for selecting the sample.

INCLUSION CRITERIA 1. Patients with type II diabetes diagnosed less

than 1 year.

2. Patients known to write and speak Malayalam and English.

EXCLUSION CRITERIA 1. Patients with documented mental illness and

anxiety disorder.

Data Collection Instrument are:

Section A : Biographic Variables

Section B : Physiological Variables

Section C : QOL For Indian Diabetes Patients

RELIABILITY& VALIDITY

The tool was given two medical experts & six nursing experts, one statistician and the demographic data was prepared. The standard Indian diabetic quality of life tool was used. Final approval was sought from the guide.

FINDINGS Table 1: Distribution according to the demographic variables:

S.No Demographic variables SIM VAT Chi-square(table value) P-value

1 Age 35 -45 years 48% 32% 3.125 0.210(NS) 46 -55 years 40% 36% >55 years 12% 32%

2 Sex Male 60% 60% 0 1.000(NS) Female 40% 40%

3 Marital status Married 92% 68% 7.567 .056(NS) Unmarried 0% 12% Widowed 4% 20% Divorce 4% 0%

4 History of illness 1 -3 months 40% 24% 4 -6 months 32% 12% 8.673 .034(S) 7 -9 months 12% 48% 10 -12 months 16% 16%

5 Education

Primary & secondary school 40% 36%

Diploma 16% 28% Degree 28% 16% 1.8 .615(NS) Others 16% 20%

6 Employment status Cooley 12% 24% Private 36% 52% 6.499 .090(NS) Government 44% 12% Others 8% 12%

In the above observation the comparison is significant only under the category History (0.034<0.05) and no other category is significant.

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Table 2: Comparison of pre test & post test of VAT

S. No Item Mean Standard Deviation t Value Level of Significance

1

Blood Glucose Pre test 142.44 15.149

10.375 0 Post Test 124.2 10.575

2

HbA1c Pre test 7.27 0.514

2.004 0.056 Post Test 7.1 0.256

3 Urine Glucose Pre test 0.88 0.4397

4.272 0 Post Test 0.52 0.1

4 SBP Pre test 138 11.902

0.827 0.417 Post Test 135.6 11.576

5 DBP Pre test 92 7.071

0.659 0.516 Post Test 90.4 10.198

6 BMI Pre test 23.56 1.446

2.619 0.015 Post Test 23.16 1.313

7 Waist circumference measurement

Pre test 100.88 8.064 1.732 0.096

Post Test 99.88 7.513

8 Score Pre test 55.84 6.95

-11.195 0 Post Test 75.76 6.54

Observation shows the comparison between pre-test and post-test all the categories are significant. Since the significance level is less than 0.05 in all the categories.

Table 3: Comparison of pre & post test values of SIM Group

S. No. Item Mean Standard Deviation t Value Level of Significance

1 Blood Glucose Pre test 148.16 14.343

8.959 0 Post Test 130.44 6.893

2 HbA1c Pre test 7.12 0.726

-1.693 0.103 Post Test 7.28 0.542

3 Urine Glucose Pre test 1.1 0.40825

4.437 0 Post Test 0.84 0.45

4 SBP Pre test 128.8 13.638

3.098 0.005 Post Test 124.8 9.626

5 DBP Pre test 82.8 5.416

1.445 0.161 Post Test 82 5

6 BMI Pre test 22.36 1.15

3.116 0.005 Post Test 21.88 0.971

7 Waist circumference measurement

Pre test 92.52 3.618 0.885 0.385

Post Test 92.96 3.857

8 Score Pre test 54.4 4.203

-4.746 0 Post Test 66.68 13.524

In the observation given above pre-test and post-test result in all the categories plays a significant role.

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Table 4 : Comparison of post test between two groups

S.NO Physiological Variables SIM VAT t value Level of significance

Mean Std.Deviation Mean std. Deviation

1 Blood Glucose 130.44 6.893 124.2 10.575 2.472 0.017 2 HbA1c 7.28 0.542 7.1 0.256 1.536 0.131 3 Urine Glucose 0.84 0.45 0.52 0.1 3.471 0.001 4 SBP 124.8 9.626 135.6 11.576 3.587 0.001 5 DBP 82 5 90.4 10.198 3.698 0.001 6 BMI 21.88 0.971 23.16 1.313 3.919 0

7 Waist circumference measurement 92.96 3.857 99.88 7.513 4.097 0

From the above observation comparison of post test given above the comparison shows SIM is found to be significant in SBP, DBP, BMI & Waist circumference measurement, whereas there seems to no significance in the other items.

Table 5: Comparison of QOL between two groups

S. No

Item S I M VAT

Chi Square Level of SignificanceGood Average Poor Good Average Poor

S I M VAT S I M VAT

1

History of ILLNESS

1 - 3 Months 0.00% 0% 45.50% 0% 50% 19.00%

4.482a 2.679 0.214 0.444 4 - 6 Months 0% 67% 27.30% 0% 0% 14.30%

7 - 9 Months 0% 33.30% 9.00% 0% 50.00% 47.60%

10 - 12 Months 0% 0% 18.20% 0% 0% 19.00%

2

Sex

0%

Male 33.30% 63.60% 0% 50% 61.90% 1.010b 0.198 0.315 0.656

Female 66.70% 36.40% 0% 50% 38.10%

Marital Status

0%

.296a 2.241 0.862 0.326 3 Married 100.00% 90.90% 0% 100.00% 61.90%

Widowed 0% 4.50% 0% 0% 14.30%

Divorce 0% 4.50% 0% 0% 23.80%

The above table shows history of illness during stipulated period and sex and marital status. The data do not show a great significant variation between SIM and VAT.

CONCLUSION

The study shows that the Pre-test mean Score and Standard Deviation of the type 2 diabetes regarding video assisted teaching on quality of life was 55.84 and 6.95, which increased in post test 75.76 and 6.54. pre test mean Score and Standard Deviation of the

type 2 diabetes regarding Self-instructional module on quality of life was 54.4 and 4.203, which increased in post test 66.68 and 13.524.

RECOMMENDATION

- The comparative study can be done for the newly diagnosed diabetes with chronic diabetes patient

- A similar study can be done in public health center.

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Acknowledgement: I wish to express my gratitude to Prof. Dr.Prasanna Baby, M.sc(N), Ph.D, my guide for her Expert guidance. I am thankful to Dr. Vijaya Ragaven, Director of Research department & Dr. Gobi Asst. Director of Research department in Saveetha University, my family for their Positive interaction.

Conflict of Interest : None

Source of Funding : None

Ethical Clearance: Obtained from Human institutional Ethical Clearance Commi�ee.

REFERENCE 1. Kumar P and Clark (2005), “Clinical

Medicine”6th Edition, Spain, Elsevier Limited. Pg1106

2. Dr. Mohan.V and Pradeepa. R. “Epidemiology of Diabetes In Different Regions of India.Health Administrator’’ Vol:XXII Number 1&2-2009:1- 18Pg.

3. “50 million people in India have diabetes’’ Wed Nov 14 2012, h�://www.indianexpress.co

4. Maria Polikandrioti, Helen Dokoutsidou “The role of exercise and nutrition in type 2 diabetes mellitus management”Health Science Journal 2009,Volume 3, Issue 4, Pp216-221.

5. Helen Altman Klein, Sarah M. Jackson,Kenley Street, James C. Whitacre, and Gary Klein “Diabetes Self-Management Education: Miles to Go,Nursing Research and Practice”Volume 2013, Article ID 581012, 15 pages.h�p:// dx.doi.org/10.1155/2013/581012.

6. Grace Lindsay, Kathryn Inverarity, and Joan R.S.McDowell “ Quality of life in people with type 2 diabetes in Relation to Deprivation, Gender, and age in a new community based model of care” Nursing Reseach and practice, volume 2011, Pp 1– 8.

7. Kounteya Sinha “ 44 lakh Indians don’t know they are diabetic,Puplic Health Foundation of India” TNN | Nov 19, 2012.h�://times of india.indiatimes.com.

8. Kerala – Health Statistics ,Health status and Public health in Kerala 2011, www.indushealthplus.com.

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11. Santhosh Thomas. Vaishali R Mohite “assess the effectiveness of self instructional module on the knowledge regarding diabetic diet among diabetic patients” International Journal of Science and research(IJSR):ISSN(Online): 2319-7064, Volume3, Issue6, June2014. Pp672.

12. Pushpalatha. K.S Video Teaching Program of Home Care Management Of Diabetes’’Nightingale Nursing Times, December 2007, Pp 41 -44.

13. Vaz N.C, Ferreira A.M, Kulkarani M.S, Vaz F.S “Prevalence of diabetes mellitus in a rural population of Goa India”The National Medical Journal of India.Vol,24.No 1,2011.Pp 16 -18.

14. Farooq Mohyud Din Chaudhary ,Sadia Mohyud Din Chaudhary, Khalid Masood, Siddique Khan Qadri “Evaluation of Lifestle Modifications in Diabetic Patients’’ Nishtar Medical Journal. Volume, No 1, January –March 2010.

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