RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



|RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES |

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|SYNOPSIS ON |

|THE M.SC.(N) DISSERTATION |

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|"A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF SELF-INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING IRON DEFICIENCY |

|ANEMIA AMONG GIRL STUDENTS IN SELECTED PRE-UNIVERSITY COLLEGES, MANGALORE.” |

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|Submitted By: |

|Ms. MARIAMMA ROSHINI P JOY |

|1st year M.Sc. Nursing student, |

|Srinivas Institute of Nursing Sciences, |

|Valachil Padavu, |

|Arkula, |

|Mangalore – 574 143. |

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|Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. |

|ANNEXURE – II |

|PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION |

|1. |NAME OF THE CANDIDATE |MS. MARIAMMA ROSHINI P JOY |

| |AND ADDRESS |1st YEAR M. Sc. (NURSING) |

| |(IN BLOCK LETTERS) |MEDICAL SURGICAL NURSING |

| | |SRINIVAS INSTITUTE OF NURSING SCIENCES, |

| | |VALACHIL PADAVU, |

| | |ARKULA, |

| | |MANGALORE – 574 143. |

|2. |NAME OF THE INSTITUTION |SRINIVAS INSTITUTE OF NURSING SCIENCES, |

| | |VALACHIL PADAVU, |

| | |ARKULA, |

| | |MANGALORE – 574 143. |

|3. |COURSE OF STUDY SUBJECT |M.Sc. NURSING |

| | |MEDICAL SURGICAL NURSING |

|4. |DATE OF ADMISSION TO COURSE |01-06-2011 |

|5. |TITLE OF THE TOPIC. |

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| |"A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF SELF-INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING IRON |

| |DEFICIENCY ANEMIA AMONG GIRL STUDENTS IN SELECTED PRE-UNIVERSITY COLLEGES, MANGALORE.” |

|6. |BRIEF RESUME OF INTENDED WORK |

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|6.1. |Introduction |

| |“It is health that is real wealth and not pieces of gold and silver” |

| |-Mahatma Gandhi |

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| |Blood is a complex fluid in which a variety of cells RBCs (red blood cells or erythrocytes), WBCs (white blood cells or |

| |leukocytes) and platelets (thrombocytes) are suspended in plasma. Blood circulates continuously through the heart and |

| |vascular system.1 Mature RBCs consist primarily of hemoglobin, which contains iron and makes up to 95 % of the cell |

| |mass. Hemoglobin, a complex protein-iron compound composed of heme (an iron compound) and globin (a simple protein), |

| |functions to bind with oxygen and carbon dioxide. The normal values of hemoglobin in men is 13.5-18g/dl and in females |

| |12-16g/ dl.2 |

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| |Iron is obtained from food and dietary supplements. Approximately 1mg of every 10 to 20 mg of ingested iron is absorbed |

| |in the duodenum and upper jejunum. Therefore only 5% to 10% of ingested iron is absorbed. When the stored iron is not |

| |replaced, hemoglobin production is reduced.2 Iron is of great importance in human nutrition. The adult human body |

| |contains between 3-4 g of iron, of which about 60-70 percent is present in the blood (Hb iron) as circulating iron, and |

| |the rest (1 to 1.5g) as stored iron in liver, spleen, bone marrow and kidney. Each gram of hemoglobin contains about |

| |3.34 mg of iron.3 |

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| |Anemia is a clinical condition that results from an insufficient supply of healthy red blood cells to oxygenate the |

| |body’s tissue adequately; results in hypoxia1. It is a deficiency in the number of erythrocytes, the quantity of |

| |hemoglobin and or the volume of packed RBCs. Iron deficiency anemia is a condition due to decreased hemoglobin |

| |synthesis.2 It typically results when the intake of dietary iron is inadequate for hemoglobin synthesis.4 |

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| |Anemia is found in 30% of the world’s population. It is a widespread public health problem with major consequences for |

| |human health as well as social and economic development of the country. Iron deficiency anemia is the most prevalent |

| |nutritional disorder in the world today; especially amongst women in developing countries. It is the most common |

| |micronutrient deficiency which affects more than two billion populations worldwide, leading to anemia in more than 40% |

| |of women of reproductive age in the developing world. Adolescents aged between 13-19 years account for more than one |

| |fifth of the world’s population. Prevalence of anemia among adolescents is more than 25% in developing countries and |

| |7-12% in developed countries. In India this age group forms 21.4 per cent of total population.5 |

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| |Need For The Study |

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| |The word adolescence comes from the Latin word adolescere, which means “to grow” or “to grow maturity”. Adolescence is a|

| |period of transition when the individual changes physically and psychologically from a child into adult. Adolescence in |

| |contrast to puberty is not a single stage but a range of 13 to 19 years and is accomplished by its profound changes in |

| |growth rates, body compositions and marked physiological and endocrinal changes. Adolescent girls are very important |

| |section of our society as they are our potential mothers and future homemakers.6 |

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| |Adolescents are vulnerable to both macro and micronutrient deficiencies. Iron requirements increase due to growth during|

| |adolescence. Adolescent girls are particularly vulnerable group as their requirement of iron as well as its loss from |

| |the body is high which may be due the blood loss during menstruation and poor dietary habits. The average monthly |

| |menstrual blood loss is about 45ml and causes the loss of about 22mg of iron.2 As a result, a peak in the prevalence of |

| |iron deficiency anemia frequently occurs among females during adolescence. Anemia during adolescence limits its growth |

| |and delays the onset of menarche, which in turn may later lead to cephalopelvic disproportion.5 About 75% teenage girls,|

| |do not meet their dietary requirements for iron, compared to only 17% of teenage boys.7 |

| |Very often in India, girls get married and pregnant even before the growth period is over, making anemia double risky. |

| |It can result in adverse pregnancy outcomes and severe anemia which can lead to maternal death, reducing work |

| |productivity and impairing physical capabilities and other adverse outcomes. Care during this period is likely to pay |

| |rich dividends.5 Poor nutritional status and anemia in pregnancy have consequences that extend over generations. In |

| |order to tackle this public health problem, a multi-pronged 12 x 12 initiative has been launched in the country. The |

| |initiative is targeted at all adolescents across the country with the aim for achieving hemoglobin level of 12 gm% by |

| |the age of 12 years by 2012.8 |

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| |In India, this silent emergency is rampant among women belonging to reproductive age group (15-49), children (6-35 |

|6.2. |months) and low socio economic strata of the population. As per district level health survey, prevalence of anemia in |

| |adolescent girls is very high (72.6%) in India, with prevalence of severe anemia among them much higher (21.1%) than |

| |that in preschool children (2.1%). The overall prevalence of anemia in India has increased from 74.2% (1998-99) to 79.2%|

| |(2005-06). Nagaland had the lowest prevalence (44.3%), then Goa (49.3%) & Mizoram (51.7%). Bihar had the highest |

| |prevalence (87.6%) followed closely by Rajasthan (85.1%), and Karnataka (82.7%).3 As per statistical rate in 2006, the |

| |incidence rate of anemia among women aged 15-49 years in India is 55.3% and in Karnataka 51.5%.9 |

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| |A study was conducted on prevalence of anemia among pregnant women and adolescent girls in 16 districts of 11 states of |

| |India in 2006. The objective of the study was to assess the status of anemia among pregnant women and adolescent girls. |

| |A two-stage random sampling method was used to select 30 clusters. Anemia was diagnosed by estimating the hemoglobin |

| |concentration in the blood, using indirect cyanmethemoglobin method. The survey data showed that 84.9% of pregnant women|

| |(n = 6,923) and 90.1% of adolescent girls (n = 4,337) were anemic. The study concluded that any |

| |intervention strategy for this population must address not only the problem of iron deficiency, but also deficiencies of|

| |other micronutrients, such as vitamin B12 and folic acid and other possible causal factors.10 |

| |A quasi experimental study was conducted on effectiveness of planned teaching program on knowledge regarding iron |

| |deficiency anemia among women of reproductive age group, in a selected primary health centre, Bangalore north. The |

| |purpose of the study was to assess the effectiveness of planned teaching program on knowledge regarding iron deficiency |

| |anemia. In this study, 100 samples were selected through multi stage & simple random sampling, from women aged between |

| |15-45 yrs in yelahanka PHC area and the tool used was structured interview schedule. The study concluded that, the |

| |effectiveness of planned teaching program, percentage of pre test mean was 47.79% which increased to 86.52% and the gain|

| |in knowledge was 38.73% after the implementation of teaching.11 |

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| |To prevent iron deficiency anemia, teenage girls and young women need to be aware of the condition and build knowledge |

| |and skills to prevent and treat it. Females attending high school, college and vocational schools are already role |

| |models to their communities and families. By educating them and motivating their behavior change, it is hoped that other|

| |females will also be more inclined to eat iron-rich foods and foods that are iron sources, practice home-based methods |

| |of food fortification and monitor monthly bleeding. So the investigator felt to conduct this study among pre university |

| |girls. |

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| |Review of Literature |

| |A descriptive survey study was conducted on prevalence of anemia among adolescent girls in a selected rural community of|

| |Coimbatore district, Tamil Nadu. The aim of the study was to identify the prevalence of anemia among adolescent girls |

| |through screening for signs of anemia and confirming with hemoglobin estimation. The sample consisted of 93 girls |

| |studying in ninth standard in a selected higher secondary school situated in a rural area, Coimbatore district. After |

| |obtaining consent from the parents, students were screened for signs of anemia by using a check list and hemoglobin |

| |estimation was done through cyanmethglobin method. The result shown that among 93 adolescent girls, 44 (47%) girls were |

| |having anemia.12 |

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| |A pre experimental study was conducted on the effectiveness of structured teaching program on knowledge and attitude of |

| |adolescent girls in prevention of iron and folic acid deficiency anemia at a selected corporation school, Coimbatore. |

| |The objective of the study was to assess the knowledge and attitude of adolescent girls, administer structured teaching |

| |program and re assess the knowledge and attitude. The sample consisted of 60 adolescents selected by stratified random |

| |sampling technique. Major findings of the study revealed that during pre test 90% of them were has inadequate knowledge |

| |and 65% of them have unfavorable attitude towards iron and folic acid deficiency anemia. After the structured teaching |

| |program the knowledge and attitude was improved (73% had adequate knowledge and 79% of them had most favorable |

| |attitude).13 |

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| |A qualitative analysis study was conducted on factors influencing anemia among anemic adolescent girls. The purpose of |

| |the study was to analyze the factors influencing anemia among anemic adolescent girls. Data was collected using |

| |interview method from a sample of 10 adolescent girls who were selected from rural areas of Udupi district, Karnataka |

| |using small non probability purposive sampling method. The result shown that factors responsible for anemia among anemic|

| |adolescent girls were decreased calorie intake, protein intake and iron intake. The study concluded that the knowledge |

| |of causes of anemia among adolescent girls about food containing iron was less.14 |

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| |An interventional study on iron deficiency anemia and change in dietary behavior among adolescent girls was conducted in|

| |Maharashtra. The objective was to study the effect of change in dietary behaviors and iron supplementation for reduction|

| |of iron‐deficiency anemia. The sample consisted of 387 unmarried adolescent girls of which 104 were anemic. The |

| |information was collected with anthropometric measurements and hemoglobin estimation. Socioeconomic status was collected|

| |using standard questionnaires. The anemic girls were administered iron‐folate and calcium tablets on alternate days for |

| |3 months. Results showed there was an increment of 19.55 g/L hemoglobin in the group of girls receiving IFA supplements |

| |whereas hemoglobin decreased slightly in girls in the control group. The study concluded that supplementation of iron |

| |should be started and dietary behaviors should be improved in adolescent girls for the control and prevention of anemia |

| |and iron deficiency anemia in this population.15 |

| |A community based cross sectional study was conducted on iron deficiency anemia among women of reproductive ages in |

| |Ethiopia. The aim of the study was to find out the existence of iron deficiency anemia in Ethiopia. 970 representative |

| |samples were selected systematically from the age group of 15 to 49 years. Hemoglobin was measured from capillary blood |

| |& for serum ferritin; venous blood from antecubital veins. The tool used for diet assessment was simplified food |

| |frequency questionnaire. The result shown that, overall prevalence rate of iron deficiency anemia was 18.0%. Prevalence |

| |of anemia, iron deficiency, and iron deficiency anemia was highest among those 31-49 years old.16 |

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| |A study was conducted on Consumption pattern of green leafy vegetables and impact of nutrition education on hemoglobin |

| |status of rural adolescent girls in Dharwad. A total of 300 school going adolescent girls were selected in the age group|

| |of 13-16 years. Prevalence of anemia was found to be 100%. Specific information on the consumption pattern of green |

| |leafy vegetables indicated that the adequacy of green leafy vegetable was less than ten percent. Nutrition education |

| |intervention resulted in significant increase in the mean knowledge scores. The mean pre test knowledge score was 13.70 |

| |and was increased to 24.43 after intervention. The study concluded that, nutrition education is one of the appropriate, |

| |effective and sustainable approach to combat iron deficiency anemia.17 |

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| |An experimental research study was conducted to assess the effectiveness of nutritional intervention among women with |

| |anemia in a selected village, Thiruvallur district. The objective of the study was to determine the effect of consuming |

| |nutritive balls on hemoglobin level of women with anemia. The sample consisted of 60 anemic women in the age group of |

| |15-45 years were selected by simple random sampling method, in which 30 anemic women in experimental group and 30 anemic|

| |women in control group. The intervention included preparation of nutritive balls by the investigator. The result shown |

| |that in experimental group, pre test Hb is 9.59 gm and post test is 10.18 gm, the gain score is 0.59 gm whereas in |

| |control group, 0.07 gm score is observed, thereby the effect of nutritive balls was proven.18 |

| |Statement of the Problem |

| |“A Quasi experimental study to assess the effectiveness of self-instructional module on knowledge regarding iron |

| |deficiency anemia among girl students in selected pre-university colleges, Mangalore” |

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| |Objectives of the Study |

| |Objectives of the study are to: |

| |Assess the pre test knowledge among experimental and control groups of pre-university girl students regarding iron |

| |deficiency anemia. |

| |Design and administer SIM on iron deficiency anemia to experimental group. |

| |Evaluate the effectiveness of SIM on iron deficiency anemia by comparing the post test knowledge scores of experimental |

| |and control groups. |

| |Compare the pretest & post test knowledge scores of experimental group. |

| |Find out the association between pretest knowledge scores and selected demographic variables. |

|6.3. | |

| |Operational Definitions |

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| |1. Effectiveness: |

| |In this study, effectiveness refers to improvement in the post-test scores of experimental group after administration of|

| |SIM on iron deficiency anemia; which is measured and expressed in terms of knowledge score. |

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| |2. Self instructional module: |

| |It refers to the structured learning material to improve the knowledge on iron deficiency anemia in pre-university |

| |students regarding meaning, etiology, clinical features, immediate and late complications and its management & |

| |prevention. |

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| |3. Knowledge: |

| |Knowledge refers to the correct responses of students to the items in the questionnaire on iron deficiency anemia, which|

| |are measured and expressed in terms of knowledge scores and are categorized as good, average and poor. |

| |4. Iron deficiency anemia: |

| |Iron deficiency anemia is a chronic, hypo chromic, microcytic anemia resulting from an insufficient supply of iron in |

| |the body, leads to reduced hemoglobin concentration in RBCs and the cells are unable to oxygenate the body’s tissue |

| |adequately, resulting in anemia.1 |

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| |5. Girl students: |

| |In this study, it refers to the girls who are studying in 11th & 12th classes from selected pre-university colleges who |

| |meets the inclusion criteria. |

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| |Assumptions |

| |Pre university girl students may not have adequate knowledge on iron deficiency anemia. |

| |A self-instructional module on iron deficiency anemia may improve the knowledge level of pre-university girl students. |

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| |Delimitations |

| |The study will be limited to |

| |60 pre-university girls from selected pre university colleges. |

| |Evaluate the effectiveness of SIM only in gaining knowledge. |

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| |Hypotheses |

| |H1:- There will be a significant difference in the mean post test knowledge scores between experimental and control |

| |groups of pre-university students. |

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| |H2:- There will be significant difference between mean pre test and post test knowledge scores of experimental groups. |

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| |H3:- There will be a significant association between pre test knowledge score on iron deficiency anemia and selected |

| |demographic variables. |

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| |MATERIALS AND METHODS |

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| |Source of Data |

| |Data will be collected from girl students of selected pre University Colleges in Mangalore, who fulfill the inclusion |

| |criteria. |

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| |Research Design |

| |The research design selected for this study is Quasi experimental - Non randomized control group before and after design|

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| |Pre test administration of SIM post test |

| |Experimental group O1 X O2 |

| |Control group O1 -- O2 |

| |(Day 1) (Day 1) (Day 7) |

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| |SCHEMATIC OUTLINE OF RESEARCH DESIGN |

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|6.4 | |

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| |Setting |

| |The study will be conducted in selected pre University Colleges in Mangalore. |

|6.5. | |

| |Population |

| |The population selected for the study will be girls studying in selected pre-university colleges in Mangalore. |

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| |Method of Data Collection |

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| |Sampling Procedure |

| |Sampling procedure will be non-random purposive sampling. |

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| |Sample Size |

| |A sample of 60 pre-university girl students who meet the inclusion criteria. |

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| |Inclusion Criteria for Sampling |

| |Girl students studying in 11th and 12th classes |

| |Within the age limit of 16-20 years |

|6.6. |Available on the day of data collection |

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| |Exclusion Criteria for Sampling |

| |Not willing to participate |

| |Absent on the day of data collection |

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| |Instrument Used |

| |A self administered structured questionnaire is used to assess the knowledge of students on iron deficiency anemia. The |

| |questionnaire is divided into two sections. |

| |Section 1. Demographic data |

| |Section 2. A knowledge questionnaire for assessing the knowledge of pre-university students regarding iron deficiency |

| |anemia. |

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| |Data Collection Method |

| |Data will be collected after obtaining permission from the concerned authorities of the selected schools, Mangalore. The|

| |objectives of the study will be explained to the participants and a formal written consent will be taken from the |

| |subjects. The investigator selects 60 pre-university college girls through non probability purposive sampling from |

| |selected pre university colleges and will be divided into experimental and control group, each group consist of 30 |

| |subjects. The investigator will introduce herself to the participants and then the closed ended knowledge questionnaire |

| |is administered. After 30 minutes, the questionnaire will be collected back and on the same day a well designed self |

| |instructional module on iron deficiency anemia will be distributed only to the experimental group. After 7 days, a post |

| |test will be conducted on both groups by using the same questionnaire. |

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| |Data Analysis Plan |

| |Based on the objectives, data analysis will be done using descriptive and inferential statistics. Findings will be |

| |presented in the form of tables and figures. |

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| |Descriptive statistics |

| |To describe the demographic variables and level of knowledge frequency, percentage, mean and standard deviation will be |

| |used. |

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|6.7. |Inferential statistics |

| |1. The Chi-square test will be used to find the association of pre-test knowledge score with selected demographic |

| |variables. |

| |2. The effectiveness of SIM will be evaluated by using paired and unpaired “t” test. |

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| |Does the study require any investigation or intervention to be conducted on |

| |patient or other human or animals? If it so please describe briefly. |

| |No, this study does not require any investigation or intervention such as injections, medications, surgical |

|6.8. |interventions or any other procedures which produces pain or harm will not be conducted on patients or animals. |

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| |Has ethical clearance will be obtained from your institution in case of 7.6? |

| |Ethical clearance will be obtained from the ethical committee of the college of nursing prior to the conduction of the |

| |study. Administrative permission will be obtained from the concerned authorities of the selected pre university |

| |colleges. Written consent will be obtained from the samples and confidentiality will be maintained. |

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|6.9. | |

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|7. |BIBLIOGRAPHY |

| |Black MJ, Hawks HJ. Medical Surgical Nursing. 7th ed. Missouri: Saunders; 2007. |

|7.1 | |

| |Lewis SL, Heitkemper MM, Dirksen SR. Medical Surgical Nursing. 6th ed. Missouri: Mosby Elsevier publication; 2004. |

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| |Park K. Park’s Textbook of preventive and social medicine. 21st ed. Jabalpur: Bandarsidas Bhanot publishers; 2011. |

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| |Smelter CS, Bare GB. Text book of medical surgical nursing. 10th ed. Philadelphia: Lippincott Williams & Wilkin; 2004. |

|7.1.1 | |

| |Iron Deficiency Anemia Assessment Prevention and Control A Guide for Program Managers. World Health |

| |Organization(online).2001; |

| |Available from: URL:. |

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| |Hurlock BE. Developmental psychology a life span approach. 5th ed. New Delhi: Tata McGraw Hill company; 2006. |

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| |Anemia in Adolescents The Teen Scene. Featured article (online). 2009 January; Available from: URL: |

| |. |

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| |Addressing Iron Deficiency Anemia 12 x 12 Initiative. World health organization (online). 2009 November; Available from:|

| |URL: |

| |. |

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| |Statistics on women in India. National institute of public co-operation and child development (online). New Delhi 2010. |

| |Available from: URL: |

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| |Toteja GS, Singh P, Dhillon BS, Saxena BN, Ahmed FU, et al. Prevalence of anemia among pregnant women and adolescent |

| |girls in 16 districts of India. Food and nutrition bulletin (online). 2006 Dec; 27(4):311-5. Available from: URL: |

| |. |

| |George R. Effectiveness of planned teaching program on knowledge regarding iron deficiency anemia among women of |

| |reproductive age group in a selected primary health centre Bangalore north. Unpublished M Sc nursing dissertation, |

| |submitted to Rajeev Gandhi university, Bangalore; 2001. |

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| |Nirmala T, Sathya P. Prevalence of anemia among adolescent girls. Nightingale Nursing Times 2011 May; 7(2):12-16. |

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| |Kala K, Christopher S, Das S. Effectiveness of structured teaching program on knowledge and attitude of adolescent |

| |girls in prevention of iron and folic acid deficiency anemia at a selected corporation school Coimbatore. Indian Journal|

| |of Holistic Nursing 2010 September; 6(2):17-23. |

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| |Karkada S. Factors influencing anemia among anemic adolescent girls A qualitative analysis. Nightingale nursing times |

| |2010 May; 6(2): 27-30. |

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| |Bhanushali MM, Shirode AR, Joshi YM, Kadam VJ. An intervention on iron deficiency anemia and change in dietary behavior |

| |among adolescent girls. International Journal of Pharmacy and Pharmaceutical Sciences (online). 2011;3(1) Available |

| |from: URL: |

| |. |

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| |Haidar AJ, Pobocik SR. Iron deficiency anemia is not a rare problem among women of reproductive ages in Ethiopia - a |

| |community based cross sectional study. BMC Blood Disorders (online). 2009 September; 9(7) |

| |Available from: URL:. |

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| |Sajjan TJ. Consumption pattern of green leafy vegetables and impact of nutrition education on hemoglobin status of rural|

| |adolescent girls (online). 2008 August; Available from: URL: . |

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| |Mohan RJ, Sujatha T. A study to assess the effectiveness of nutritional intervention among women with anemia in a |

| |selected village Thiruvallur district. Nightingale nursing times 2008 July; 4(4): 9-11. |

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-----------------------

DESIGN

Quasi Experimental Design

INDEPENDENT

Administration of self-instructional module only for experimental group

STUDY SETTING

Selected Pre University Colleges in Mangalore

POPULATION

Pre-University girl students

TOOL

Structured Knowledge questionnaire

Baseline +,.CDVXY[mû - . / 0 9 G v z ‘ ’ ” ž Ÿ § ¨ Ã Ç Ù Ú ê ë óçÜÐÇÐܾ³ªŸ—ŸªŒƒçwnwdwVwƒwvariables and knowledge scores will be analyzed using mean, frequency, percentage and standard deviation

ATTRIBUTES

Age, religion, socio-economic status, marks scored in 10th standard, previous exposure to information, dietary pattern

ANALYSIS

Un paired “t” test to compare the knowledge scores of experimental & control groups

STUDY SAMPLE

30 in control group & 30 in experimental group

VARIABLES

Paired “t” test for significance of difference between the pretest and post test knowledge scores, Chi square test for association between pre test and socio demographic variables

DEPENDENT

Knowledge on iron deficiency anemia

SAMPLING TECHNIQUE

Purposive sampling

FINDING, DISCUSSION AND CONCLUSION

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