A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO

ASSISTED PROGRAMME ON KNOWLEDGE AND ATTITUDE

REGARDING PREVENTION OF RESPIRATORY PROBLEMS AMONG

COTTON MILL WORKERS IN SELECTED COTTON MILLS,

MADURAI- 2011.

A DISSERTATION SUBMITTED TO

THE TAMILNADU DR. M.G.R.MEDICAL UNIVERSITY, CHENNAI.

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR THE DEGREE OF

MASTER OF SCIENCE IN NURSING

APRIL - 2012

ACKNOWLEDGEMENT

“I can do all things through christ who strenghtens me”

Philipians 4:13

I praise and thank God almighty for his blessing and abundant grace that

enriched me throughout the study.

It is my pleasure to express my heartfelt gratitude and sincere thanks to

Dr.Mrs.C. Jothi Sophia M.Sc., (N), Ph.D., Principal , CSI Jeyaraj Annapackiam

College of Nursing, for her expert guidance, encouragement and motivation and

valuable suggestion not only in the study but also throughout the academic career

which helped to lay down a strong foundation for this study.

I would like to express my sincere gratitude to Prof.Mrs. Merlin Jeyapal,

M.Sc (N), Ph.D, Vice Principal, for constant support to this study.

I wish to express my deepest sense of gratitude to my esteemed guide Prof.

Mrs. G. Jaya Thanga Selvi, M.Sc(N), Ph.D, Head of the Department, Medical

Surgical Nursing, C.S.I. Jeyaraj Annapackiam College of Nursing, for her guidance,

support, encouragement and patience corrections, keen interest in the conception,

planning, and execution of the present study which has continuously motivated me for

the successful completion of this dissertation.

I extend my sincere thanks to Panel of experts for their valuable suggestions

to conduct this study.

I express my sincere thanks to Mrs. Anbu Roselin, M.Sc (N) RN.RM,

Mrs.Jeya Jothi M.Sc (N) RN.RM, and MS.Sobia Gnana Mary M.Sc (N) RN.RM,

Lecturers of CSI Jeyaraj Annapackiam college of Nursing for their individual

guidance and valuable suggestions to conduct this study.

I extend my sincere thanks to the Panel of judges in the dissertation

committee for their valuable suggestion throughout this study.

I extend my special thanks to the Managing directors who have permitted

this study to conduct in their esteemed companies and made it successful one.

I would like to express my grateful thanks to Mr. Mani, M.Sc., M.Phil,

Statistician for this excellent advice and support in analyzing and interpreting the

data.

I am also grateful to Mrs. Angelin Mannova, Librarian, CSI Jeyaraj

Annapackiam College of Nursing, for the help in availing the library facility.

I extend my sincere thanks to my classmates “THE GLITTERING

GLADIOLUS”, for their co-operation, prayers and help throughout this study.

I extend my sincere thanks to my beloved family members for their prayers,

support and encouragement throughout this Master programme.

ABSTRACT

Introduction

Respiratory problems associated with exposure to cotton dust have been

studied by many researchers and studies have proved the long term consequences for

disability and mortality of former cotton textile workers.

Statement of the problem

“A study to evaluate the effectiveness of Video Assisted Programme on

knowledge and attitude regarding prevention of respiratory problems among cotton

mill workers in selected Cotton Mills, Madurai.”

Objectives

1. To assess the existing level of knowledge and attitude on prevention of

respiratory problems among selected cotton mill workers, Madurai.

2. To assess the post test level of knowledge, attitude and practice on

prevention of respiratory problems among selected cotton mill workers,

Madurai.

3. To find out the difference between pretest and post –test level of knowledge

and attitude on prevention of respiratory problems among selected cotton

mill workers, Madurai.

4. To find out the association between post tests level of knowledge and

attitude on prevention of respiratory problems among selected cotton mill

workers with the selected demographic variables.

Review of literature

A Review of literature of the study was prepared relevant to the study related

to respiratory problems of cotton mill workers, knowledge and attitude respiratory

problems of cotton mill workers.

Conceptual Framework

The conceptual framework was based on Nola J. Pender, Health promotion

model. Areas of focus were Individual characteristics and experiences, Behavior-

specific cognitions and affect and Behavioral outcomes.

Methodology

Research design

In this chapter the investigator discusses the chosen research approach and the

rationale. An experimental approach was used to assess the Effectiveness of video

assisted programme. Pre experimental design was adopted with one group pre test and

post test design.

Setting of the study

The setting of the study is selected cotton mills, Madurai.

Sample size

The sample size for the study is 60 .Samples for this study were selected

through non probability - purposive sampling.

Results

Results shows that majority of workers had adequate knowledge (66%) and

favourable attitude (75%) on respiratory problems. The obtained paired‘t’ value for

pre and posttest regarding knowledge and attitude regarding prevention of respiratory

problems among cotton mill workers were 7.353 and 11.409, which was highly

significant.

Conclusion

The investigator hopes that the video teaching program could increase the

knowledge and attitude among cotton mill workers.

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CHAPTER-I

INTRODUCTION

“Safety is like a lock - But you are the key.

Be alert, be aware, and be alive.

Know safety - No problem, No safety - Know problem.”

An "environment" is the whole of surrounding things. Surroundings are

defined by a central entity. Generally, environment refers to the biological, physical

and social things on the earth or in inhabitable space outside the earth's atmosphere.

Every human being spends their 1/3rd of the time daily in his working area. And while

thinking about the working area, how healthy it is? Is it safety to the employees?

Actually the healthy and safety environment is the right of the workers. Higher the

healthy environment maintained higher the productivity.

Occupational diseases reflect health hazards brought on by exposure within

the work environment. Due to lack of education, unaware of hazards of their

occupations, general backwardness in the sanitation, poor nutrition and climatic

proneness of this geographic region to epidemics aggravate their health hazards from

work environment (Wang et al., 2003).

In 1956, an epidemiological study in the cotton industry in the UK

documented the occurrence of respiratory problems like byssinosis (Schilling, 1956)

Worldwide, India is the second largest producer of textile goods, which account for

20% of the national industrial output. Twenty million workers are employed in 1175

cotton mills across the country, representing a major occupational group (Datt and

Sundaram, 1998).

Exposure to cotton dust has long been associated with adverse respiratory

effects and diminished lung function, which is most evident as byssinosis, a chest

tightness experienced by workers on the first day back after a weekend or vacation

break (Schilling, 1956; Roach and Schilling, 1960 and Berry et al., 1973). Most

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studies indicate that adverse respiratory effects are more closely associated with

cotton fiber dust (Castellan et al., 1984, 1987; Kennedy et al., 1987).

The reported rates vary from 3% in the UK versus 30–50% in countries like

Indonesia, Sudanand India [3–9]. In our country, the prevalence of byssinosis in the

cotton industry has been found to be as high as 46.0% in the studies done since

1966.Respiratory problems have been reported from most countries with a textile

industry. A high prevalence (63% in men and 48% in women) in cardroom workers of

Lancashire cotton mills processing coarse cotton.

Among cardroom workers, El Batawi reported a prevalence of 27% in Egypt

and Belin et al a prevalence of25-60% in Sweden.23 Prevalences of 21% and 88%

were reported by Valic and Zuskin for Yugoslavia,45 11% by Tuypens for Belgium,6

and 11%, 26%, and 38 4% by Bouhuys et al7 and Merchant et al8 for the United

States. In a recent report from the United Kingdom, only 23 new cases of byssinosis

were reported in 2101 cases of occupational respiratory diseases in 1989. In the

United States strict hygiene standards were enforced in 1978, and these have also

reduced the incidence of this disease.

In developing countries, however, byssinosis is still found in a high

percentage of textile workers, as the following summary indicates: India Three recent

studies in different places suggest a high prevalence of byssinosis. The first study was

carried out at Ahmedabad by Parikh et all' in three textile mills processing a medium

variety of cotton where 929 workers from the spinning department were examined.

The results showed a mean prevalence of 30% in blowrooms and 38% in cardrooms.

The cotton dust concentrations (dust after removal of fly) measured by cone samplers

were 6-8 times higher than the permissible concentrations recommended by the

British Occupational Hygiene Society.

This higher prevalence of byssinosis compared with earlier Indian studies

showed that if correct methods are not used in epidemiological surveys, the

investigators are likely to report a low prevalence of the disease. The second study

carried out by Gupta and Gupta in Delhi in a mill processing a coarse variety of cotton

found the following prevalences: blowroom 37%, cardroom 47%, spinning 17%,

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weaving 22%, and finishing 7%. The study used only questionnaires to detect cases

and neither pulmonary function tests nor dust measurements were included.

The third study was carried out in Kishangarh, Rajasthan, in a mill processing

coarse and synthetic yarn. Among 616 workers examined the prevalence of byssinosis

found was blow room 28%, card room 30%, draw frame 26%, ring frame 20%, and

winding 25%. The higher prevalence rates reported in sections other than in

blowrooms and cardrooms in the second and third study could have been due to the

coarse variety of cotton or the closeness of these sections to cardrooms.

In India, only a limited number studies have been conducted to highlight

occupational hazards in cotton mills. Tirupur being a textile city in Coimbatore

district have 18 ginning factories employing 1,50,00 labours.

There are about 17 cotton mills around Madurai. There are numerous textile

and chemical industries operating in the area, including Thiagarajar Mills (one of the

largest manufacturer and exporter of 100% Indian cotton yarn), Kasim Textile Mills,

Sundaram Textiles, Weaves India, and Vaigai Group.

Working in textile industry hours together, months and years together creates

many health problems earning bread on one side and also neglecting the risk factors

during work can cause many diseases and disabilities. We can prevent those

occupational diseases if we adapt certain precautions and preventive measures.

Byssinosis

(Due to exposure of cotton dust) it is respiratory disease. The most commonly

affected system in the body due to exposure of cotton dust is respiratory problem. It is

also commonly known as brown lung disease; Byssinosis is an occupational disease

caused by inhalation of cotton dust in textile industry. Different name for Byssinosis

are “brown lung disease”, “cotton workers lung,” & “Mill fever, “cotton bract

disease”.

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Riskfactors of byssinosis

Byssinosis most commonly affect textile workers who work in a

manufacturing process where cotton, flax: hemp, yarn, thread, fabric and rope making

activities are performed.

Signs and symptoms of byssinosis

Byssinosis symptoms may appear as quickly as a couple of hours after

exposure and diminish when leaving the manufacturing environment. However, after

long periods of exposure, symptoms may last for days or even weeks after leaving the

manufacturing environment. Long term exposure to cotton, flax hemp or jute

fibers/dust may cause permanent scarring of lungs and airways, leading to debilitating

lung disease Persons with byssinosis generally experience the following symptoms

throughout the work week.

- Wheezing

- Tightness of chest

- Coughing

- Symptoms of byssinosis are more severe during humid weather

People who smoke suffer the most severe impairment from byssinosis. The

combination of dust/ fiber and smoke both aggravate the lungs and airway.

Diagnosis of byssinosis

Chest x-ray and pulmonary function test can be used to diagnosis byssinosis.

PFTs will show a decrease in lung capacity as the day progresses and the exposure

continued.

Treatment of Byssinosis

There is cure of byssinosis it is treated immediately.

Prevention of byssinosis

It can be prevented by using exhaust hoods and face mask, improving ventilation

during manufacturing activities and using wetting producer which help to control the

level of dust caused by the textile.

• Pre- employment screening – To detect hyper reactivity and sensitivity to

textile dust.

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• Smoking cessation is important as it worsen the condition.

• Transfer of person from work place for few days also reduces the risk of

relapse.

• Maintain highly ventilated, good lighting and hygienic environment

• Intake of balanced diet

• Avoid smoking and tobacco chewing

• Adequate rest and sleep

Awareness is very important because awareness regarding occupational health

contributes lot in prevention of disease in workers, healthy worker and healthy work

environment increase the productivity of work as were as contribute progress in

national development.

SIGNIFICANCE AND NEED FOR THE STUDY

In recent days the number of industries on the increase. In India there are

approximately 60 million workers over the age of 16, are involved in various kind of

industrial works. Textile industries are the oldest occupation in India, thousands of

workers are involved in textile manufacturing. A review of textile industry quotes that

it is the largest manufacturing sector in India, accounting for around 20% of India’s

industrial output and 37% of total exports.

Textile manufacturing goes under several process of knitting; winding;

spinning ; dying; etc. Exposure to these processes for years together are causing major

health problems among textile workers. As it is mentioned earlier that healthy

workers and healthy work environment helps to increase the production. The health

impact of work is an important aspect of most clients for whom the community health

nurses provides care. At least one third of average adult life is spent at work;

therefore, the workplace has a significant potential influences on individuals health

and is a primary site for the delivery of preventive health care.

Occupation is the one in which person not only earn his daily bread but also

spent one third of average adult life. These industries have also contributed in

increasing the occupational hazards among workers. The protections of health of

working population in these are primary concern of occupational nurse.

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According to recent estimate, the cost of work related heat loss and associated

productivity loss may amount to several percent of the total gross national product of

country. In India there are about 1.07 million workers are engaged in the manufacture

of cotton textile. 20 million workers are involved in textile industry, in which

byssinosis, hypertension, noise induced hearing loss, dermatitis and risk of cancer due

to various chemicals and dyes are common occupational diseases found among

weavers. A study done by NGO, in 1995 byssinotic condition was first recorded in

Indian history of 150 years. Maximum number of byssinosis cases reported in the

cotton textile industry as it is one of the largest industries in the world.

If well educated, motivated, reinforced supervised and guided properly, then

will became asset to the organization, society and the nation by the large. So far our

knowledge is concerned, however very less studies conducted in India to find out

occupational health problems of cotton mill workers.

Training and education to these workers is an essential component of

occupational health. It is extremely important to make people aware and concerned

about work place. Hence responsibility of community health nurse lies in imparting

knowledge related to specific measure in preventing occupational hazards.

Community health nurse plays an important role in preventing and controlling

occupational hazards. She functions independently and carries responsibility for better

health of workers.

During the community posting, the investigator found many clients visiting

Community health centre with respiratory problems. The investigator was curious to

know the reason and found that it is because of the exposure to cotton dust mainly

who are working in cotton mill. Hence, the investigator decided to give awareness to

prevent the respiratory problem among cotton mill workers.

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STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of video assisted programme on

knowledge and attitude regarding prevention of respiratory problems among cotton

mill workers in selected Cotton Mills at Madurai.

OBJECTIVES

1. To assess the existing level of knowledge and attitude on prevention of

respiratory problems among selected cotton mill workers at Madurai.

2. To assess the post test level of knowledge and attitude on prevention of

respiratory problems among selected cotton mill workers at Madurai.

3. To find out the difference between pretest and post –test level of knowledge

and attitude on prevention of respiratory problems among selected cotton mill

workers at Madurai

4. To find out the association between post tests level of knowledge and attitude

on prevention of respiratory problems among selected cotton mill workers

with the selected demographic variables.

NULL HYPOTHESIS

HO1: There will not be a significant difference in the knowledge and attitude

on prevention of respiratory problems among selected cotton mill workers after

video assisted programme.

HO2: There will not be a significant association between post test level of

knowledge and attitude on prevention of respiratory problems and selected

demographic variables.

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OPERATIONAL DEFINITIONS

Effectiveness

In this study it refers that the outcome of video Assisted Programme as

evaluated by the help of significant mean difference between pretest and post test

scores on knowledge and attitude regarding prevention of respiratory problems among

cotton mill workers.

Video assisted teaching programme

In this study it refers that a well planned structured instruction with the use of

LCD helps to internalize the importance of prevention of respiratory problems among

cotton mill workers.

The aspects included were, definition of respiratory problem, route of

transmission, symptoms, preventive measures and to minimize the chance of

incidences of respiratory problems among cotton mill workers.

Knowledge

In this study it refers that the level of understanding on prevention of

respiratory problems by the cotton mill workers as expressed through written response

as measured by structured knowledge questionnaires.

Attitude

In this study it refers that the way of thinking, beliefs and feelings regarding

prevention of respiratory problems as expressed in the form of statements as measured

by 3 point Likert scale.

Prevention of respiratory problem

In this study it refers that the measures like teaching on stopping the

occurrence of respiratory problem by improving the practice of protective measures

for those who are in the risk to develop respiratory problems like byssinosis, allergic

rhinitis, chronic bronchitis and bronchial asthma due to the exposure of cotton dust.

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Cotton mill workers

In this study it refers that the employees who work in a cotton mills under the

risk to develop respiratory problems.

ASSUMPTIONS

The knowledge and attitude on prevention of respiratory problems among

cotton mill workers are lacking. Cotton mill workers may have some knowledge and

attitude on prevention of respiratory problems. Nurses have their role in prevention of

occupational hazards.Video assisted programme will help to enhance the knowledge

and attitude of cotton mill workers in the prevention of respiratory problems.

DELIMITATIONS

Study is limited to,

- Workers those who are exposed to cotton dust and are at risk of developing

respiratory problems.

- The data collection took place for only six weeks; therefore it has limitations

in terms of evaluating the attitude

- Data collection done by interview and structured questionnaire

PROJECTED OUTCOME

The findings of the study would help to

- identify the respiratory problem

- create awareness to cotton mill workers

- develop a teaching module

- identify the effectiveness of video assisting programme

It improves the knowledge and attitude on prevention of respiratory problems

among cotton mill workers.

It would be useful contribution for improving the practice of protective measures

during the working period.

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CHAPTER – II

REVIEW OF LITERATURE

In this study, the review of literature has been presented as per the available

research studies and relevant literature from with the strength of the study was drawn

as follows:

Studies related to respiratory problems of cotton mill workers

Studies related to knowledge on respiratory problems among cotton

mill workers

Studies related to attitude respiratory problems of cotton mill workers

STUDIES RELATED TO RESPIRATORY PROBLEMS OF COTTON MILL

WORKERS

Ajeet jaiswal (2011) done a study on the occupational health function among

female textile workers mainly in the reduction of respiratory function. It is aimed to

find the factors associated with the deterioration of respiratory function among female

textile workers. The sample consisted of 243 men above the age of 20 years who had

worked for at least 3 months years in a textile factory and 235 female non textile

workers of same area were studied. All the respondents were interviewed by a

pretested questionnaire to gather information regarding the chest symptoms, certain

personal characteristics and occupational history. Statistical analyses like Chi-square

and odds ratio was done to determine the significant difference between female textile

workers and female non textile workers. Univariate analysis of the factors for

symptomatic byssinosis showed that dusty worksites, heavy smoking and duration of

service years were significant. Logistic regression analysis showed that working in the

scouring (odds ratio 11.0), spinning (odds ratio 4.7) and weaving sections (odds ratio

2.6), heavy smoking (odds ratio 12.4) and more than 10 years of service to discourage

smoking among textile workers need to be strengthened to minimize the risk of

developing byssinosis.

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Joseph mberikunashe1, et all (2006) studied on the Prevalence and risk factors

for obstructive respiratory conditions among textile industry workers in Zimbabwe,

Workers in the cotton processing industries risk developing obstructive respiratory

conditions due to prolonged exposure to cotton dust. They conducted a cross sectional

analytic study. Workers were randomly sampled and data was collected using

interviewer-administered questionnaires. Respiratory function was assessed using

spirometry and chest auscultation. A walk through survey was conducted and a

checklist was used to capture hazards and control measures in the work place. A total

of 194 workers participated. The prevalence of severe respiratory obstruction was

27.8%. It was 50.0% among the blowers, 35.3% in waste recovery, 32.5% in carders,

15.0% in spinners and 7.5% among weavers. The mean years of exposure between the

affected and the nonaffected were significantly different (T =2.20; p< 0.05). Working

in the blowing department was significantly associated with developing respiratory

obstruction (OR=3.53; 95% CI= 1.61- 7.79) but working in the weaving department

was significantly protective (OR 0.16; CI 0.04- 0.59).Working in a department for

less than 10 years was protective (OR =0.94; 95% CI= 0.48- 1.85), but not significant.

Obstructive respiratory conditions are common among textile workers, with those in

blowing and waste recovery sections being the most affected. They recommended

worker rotation every six months, regular spirometric screening employment of a

medical officer.

R-s koskela, et all (2005) conducted a study on Respiratory disease and

cardiovascular morbidity .Work related dust exposure is a risk factor for acute and

chronic respiratory irritation and inflammation. The study comprised 6022 dust

exposed (granite, foundry, cotton mill, iron foundry, metal product, and electrical)

workers hired in 1940–76 and followed until the end of 1992. National mortality and

morbidity registers and questionnaires were used. The statistical methods were

person-year analysis and Cox regression. Co-morbidity from cardiovascular and

respiratory diseases ranged from 17% to 35%. In at least 60% of the co-morbidity

cases a respiratory disease preceded a cardiovascular disease. Chronic bronchitis,

pneumonia, and upper respiratory tract infections predicted IHD in granite workers

(rate ratio (RR)�=�1.9; 95% CI 1.38 to 2.72), foundry workers (2.1; 1.48 to 2.93),

and iron foundry workers (1.7; 1.16 to 2.35). Dust exposure was not a significant

12

 

predictor of IHD or other CVD in any group. Dust exposure was related to respiratory

morbidity. Thus, some respiratory diseases appeared to act as intermediate variables

in the association of dust exposure with IHD. Dust exposure had only a small direct

effect on IHD and other CVD. IHD morbidity was associated with preceding

respiratory morbidity. A chronic infectious respiratory tract disease appeared to play

an independent role in the development of IHD.

X-r wang, et all (2003), motivated to determine chronic effects of long term

exposure to cotton dust and endotoxin on incidence of respiratory symptoms and the

effect of cessation of exposure. Respiratory health in 429 Chinese cotton textile

workers (study group) and 449 silk textile workers (control group) was followed

prospectively from 1981 to 1996. Byssinosis, chest tightness, and non-specific

respiratory symptoms were assessed by means of identical standardised

questionnaires at four time points. Exposures to cotton dust and endotoxin were

estimated using area samples collected at each survey. Incidence and persistence of

symptoms were examined in relation to cumulative exposure and exposure cessation

using generalised estimating equations (GEE). Among cotton workers, the

cumulative incidence of byssinosis and chest tightness was 24% and 23%,

respectively, and was significantly more common in smokers than in non-smokers. A

high proportion of symptoms were found to be intermittent, rather than persistent.

Multivariate analysis indicated a trend for higher cumulative exposure to endotoxin in

relation to a higher risk for byssinosis. Chronic exposure to cotton dust is related to

both work specific and non-specific respiratory symptoms. Byssinosis is more

strongly associated with exposure to endotoxin than to dust. Cessation of exposure

may improve the respiratory health of cotton textile workers; the improvement

appears to increase with time since last exposure.

Maunder lR (2003), conducted a study with one hundred and sixty-nine and

175 cotton textile workers were enrolled in the first (1991) and second (1996) surveys

to investigate the prevalence of byssinosis. The synergistic effect of smoking on

cotton dust exposure was also evaluated although the difference in second study

(38.9%) was not statistically significant; smoke had significantly higher frequency

than non smokers in both surveys. The frequency of respiratory symptoms and the

prevalence of severe byssinosis in the second survey were (14.9%and 12.6%)

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respectively. The reduction of symptoms was due to remodeling of this old cotton

mill. The prevalence’s higher than in non- smokers only found in first survey, but not

found in the second survey. These results indicate that smoking potentate’s

byssinosis. The second study reveals high prevalence of byssinosis still smoking was

found to show an additive effect on cotton dust exposure.

Thoreia Mohamed Mahmoud et all (2001) done a study of occupational health

hazards among spinning factory workers.. The aims of the work are study the

occupational health hazards among the workers in Assiut Spinning Factory and to

assess the different protective measures used during working day to prevent the

different hazards.The total number of the studied sample was 550 workers out of 650

who worked in the productive and repair sectors. A questionnaire was constructed

include two parts, one to assess the industrial hazards and their preventive measures

and the second one included the information from the health record of the worker in

Health Insurance included pre-placement examination and periodic medical

examination. The data collection took about 6 months (from July to the end of

December 2001). Study revealed that the vast majority of workers (96.9%) were

males. About two thirds (65.8%) of workers have experience of work for 20-30 years

(mean was 20.5+5.3). 67.3% of the Workers were mentioned that the mask is

available and only 41.6% from them using it during work. 99.5% of workers

mentioned about the availability of the emergency equipments. Moreover 99.3% of

workers mentioned that there are no health education programs. The workers in the

blending and picking department, carding and spinning department and combing and

twisting department suffer from cough (68.3%, 60.2% and 73.7% respectively), chest

pain (68.3%, 57.6%, and 64.9% respectively), and dyspnea (70.7%, 68.1% and 71.9%

respectively). The difference from other departments was statistically significant. Ear

disease and ear secretion were common symptoms among more than half of the

workers in the above mentioned departments in addition to winding and doubling

departments and the differences from other departments were statistically significant

(P<0.05). Only 63.8% of workers were performed periodic medical examination. It

was found that 13.4%, 11.1% and 2.3% were suffering from chronic bronchitis,

chronic bronchitis with emphysema and bronchial asthma respectively. 13.4% of

workers have sensory deafness while 9.9% have sensory conductive deafness. The

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study recommend with improving of worker’s health through: Periodic medical

examination should be performed to all workers in the factory. Periodic inspection of

working environment by industrial hygienist through regularmeasurement of noise

level, illumination, ventilation and cotton dust concentration. Training and health

education programs should be provided to all workers from the start of work.

Emphasizing the correct use of personal protective measures. If possible, the factory

should look into the possibility of replacing the old machines with new ones, which is

less noisy.

STUDIES RELATED TO KNOWLEDGE ON RESPIRATORY PROBLEMS

AMONG COTTON MILL WORKERS

MS. A.Arockia Mary 2010 Done a Non experimental descriptive correlational

study to assess the Knowledge and Attitude regarding Occupational Hazards among

cotton mill workers in a selected textile industry, Bangalore. Sample size was 60.The

objectives are to assess the knowledge regarding Occupational Hazards among cotton

mill workers to assess the attitude regarding Occupational Hazards among cotton mill

workers, to correlate between the knowledge and attitude regarding Occupational

Hazards among cotton mill workers, to associate the knowledge and attitude

Occupational Hazards among cotton mill workers. The study will be conducted at the

selected textile industry; Bangalore. Correlation coefficient will be to analyze

correlation between the knowledge and attitude. Chi-square test will be used to

analyze association. The researcher further recommended that same study can be

conducted in a large scale.

Mr. Basavaraj S. July 2010“A Quasi experimental study to evaluate the

effectiveness of structured teaching programme regarding knowledge on respiratory

problems (bagassosis) and its prevention among the workers of gyanba sugars and

developers limited, doddabathi, the main objective is to assess the effectiveness of

structured teaching programme on prevention of respiratory tract problems

(Bagassosis) through post test knowledge. The total study sample consists of 80

workers. Simple random sampling technique and lottery method was used. The data

was analysed by using appropriate statistical methods.

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A quasi-experimental experimental study conducted in 2007 by Jessica S Kale

in Belgaum, Karnataka, with an objective to assess the knowledge and practice of

preventing occupational health hazards among textile weavers with a sample size of

55 through implementing planned teaching program. Result showed that 11% (6) had

good knowledge during pre test, has improved to 100% (55) during post test. The

researcher further recommended that same study can be conducted in a different

setting.

R. Altina S.et all (2000) done a 15 year follow up observation of the

prevalence of byssinosis is decreasing in industrialized countries and persists at high

levels in developing countries, this prevalence is remaining constant in Turkey. In

order to determine the effects of past cotton dust exposure on the respiratory tract, a

total of 223 persons working in a cotton mill were included in this study. A

questionnaire was used to inquire about respiratory symptoms. Participants underwent

several spirometric measurements, which were performed on the 1st, 3rd and 5th day

of the working week. Cotton dust measurements were performed in different divisions

of the factory. The most common respiratory symptom was chest tightness (20.3%).

The prevalence of byssinosis was 14.2% in cotton- processing workers. Among these

cases, 28.6% had symptoms on the 1st day of the week, and 71.4% had symptoms on

all days of the week. An acute effect was seen in 53.6% of the workers with

byssinosis. Mean respirable dust levels were between 0.095 and 0.413 mg/ m3. In

spite of technological improvements, respirable dust concentrations are still above the

permissible limits, and thus the risk of byssinosis remains. Workers in the cotton

industry where obsolete technology is used and standardized protection measures are

not applied should be followed for byssinosis.

Mentesinot Woldeyohannes, et all (1991) studied to investigate the prevalence

of respiratory problems, in particular byssinosis, and to explore factors associated

with their occurrence among a group of 595 randomly selected workers representing

40-5% of those exposed to dusty operations in a typical Ethiopian cotton textile mill.

A standard questionnaire on respiration was administered and pre and post shift

forced vital capacity (FVC) and forced expiratory volume in one second (FEVI) were

determined for each worker; workers found to have byssinosis and other respiratory

diseases were compared with workers having no respiratory diseases in terms of the

16

 

level and duration of exposure to cotton dust and other variables. Multiple area air

samples from different sections were analysed for elutriated cotton dust

concentrations (086-3 52 mg/im3). The prevalence of byssinosis was 43-2% among

blowers and 37-5% in carders in comparison with four to 24% among workers in

other sections. Prevalence of chronic bronchitis ranged from 17-6 to 47 7% and

bronchial asthma from 8'5 to 20'5% across all sections. Significant across shift

decrements in FEV, and FVC were seen in those workers with respiratory tract

diseases compared with those workers without such diseases. A significant dose

response relation for pulmonary function and respiratory illnesses was also found by

regression analysis. Department of Community Health, Faculty of Medicine, Addis

Ababa University, Ministry of Health, Addis Ababa, People's Democratic Preventive

measures are proposed. Further research including a nationwide survey of textile mills

is suggested. This is the first epidemiological study of the textile industry in Ethiopia.

R-S Koskela et all (1990) conducted a study regarding The mortality and

disability of cotton mill workers in five Finnish cotton mills. The population under

study comprised all 1065 women exposed to raw cotton dust who had been hired

between 1950 and 1971. The minimum exposure period was five years. For the study

on disability, the cohort was followed up until the end of 1981. The follow up period

for the mortality analysis was from 1950 to 1985. At the end of 1981 the observed

number of prevalent disability pensions for respiratory disease was 15, whereas 3 9

were expected (p < 0 01) on the basis of the national figures for women. There were

46 musculoskeletal diseases (27-7 expected p < 0-01), of which 24 were osteoarthritis

(14-5 expected) and 13 rheumatoid arthritis (6-6 expected). The incidence rates of

disability pensions were calculated for the period 1969-81. Comparison of incidence

rates between cotton mill workers and the Finnish female population showed

excessive rates for both respiratory diseases (p < 0 001) and musculoskeletal diseases

(p < 0-01), with an excess of new cases of rheumatoid arthritis (p < 0-05). By the end

of 1985 the number of person-years was 31 678 and the number of deaths 95. The

standardized mortality ratios for the total period of follow up (1950-85) showed no

excess for respiratory diseases. Mortality from cardiovascular diseases was also lower

than expected. The observed number of tumours was 33, the corresponding expected

number 32-0. Thirteen tumours were in the digestive organs (6-6 expected, p < 0-05)

17

 

and three were lung cancers (19 expected). Five workers had died from renal disease;

the expected number was 1-5 (p < 0-05).

STUDIES RELATED TO ATTITUDE RESPIRATORY PROBLEMS OF

COTTON MILL WORKERS

A 25-Year Follow-up Study on Long-term Effects of Work Cessation on

Respiratory Health of Textile Workers was conducted by Jing Shiet all,(2009)1Civil

and Environment Engineering School, University of Science and Technology,

Beijing, Rationale: The degree to which chronic respiratory health effects caused by

exposures to cotton dust and endotoxin is reversible after cessation of textile work is

unknown. Objectives: To investigate changes in lung function and respiratory

symptoms after cessation of textile work and to determine whether past exposure to

cotton dust and endotoxin or smoking history modify the associations. Methods: We

performed a prospective cohort study consisting of 447 cotton textile workers exposed

to cotton dust and 472 unexposed silk textile workers, with a 25-year follow-up.

Spirometry testing and respiratory questionnaires were conducted at 5-year intervals.

Generalized estimated equations were used to model the average 5-year change in

FEV1 and odds ratios of respiratory symptom prevalence. Measurements and Main

Results: Years since cessation of textile work was positively associated with 11.3

ml/yr and 5.6 ml/yr gains in 5-year FEV1 change for cotton and silk workers,

respectively. Among male cotton workers, smokers gained more FEV1 per year after

cessation of exposure than did nonsmokers, and the risk of symptoms of chronic

bronchitis and byssinosis was larger for smoking than for nonsmoking male cotton

workers. Conclusions: Cessation of textile work was significantly associated with

improvement in lung function and respiratory symptoms. The positive effect of work

cessation was greater for cotton workers than for silk workers. For cotton workers, the

improvement in lung function loss after cessation of textile work was greater among

smokers, but no differences were observed for silk workers.

18

 

Mr.Sateesh Satawaji (2007 ) done a Study To Assess The Knowledge And

Practice On Prevention Of Respiratory Problems Among The Workers Of Cotton

Industry In Selected Area At Bijapur, Karnataka After the study, the investigator finds

the level of knowledge and practices regarding the prevention of respiratory problems

among the workers at cotton industry. Based on the findings the investigator

developed the teaching model to the workers of selected cotton industry.

Yih-Ming SU1, et all (2003) done a study on Additive Effect of Smoking and

Cotton Dust Exposure on Respiratory Symptoms and Pulmonary Function of Cotton

Textile February 13, One hundred and sixty-nine and 175 cotton textile workers

(CTWs) were enrolled in the first (1991) and second (1996) surveys to investigate the

prevalence of byssinosis. The synergistic effect of smoking on cotton dust exposure

was also evaluated. Although the difference in prevalence of abnormal pulmonary

function between the first (38.5%) and second study (38.9%) was not statistically

significant, smokers had significantly higher frequency than nonsmokers in both

surveys. A significant trend existed between the cotton dust levels and the frequency

of abnormal lung function. The significant trend was also noted in both smokers and

nonsmokers. The frequency of respiratory symptoms and the prevalence of severe

byssinosis in the second survey (14.9% and 12.6%, respectively) were significantly

lower than that in the first survey (39.7% and 21.9%, respectively). The reduction of

symptoms was due to remodeling of this old cotton mill. The prevalences of

respiratory symptoms and byssinosis in smokers being significantly higher than in

nonsmokers only found in the first survey, but not found in the second survey. These

results indicate that smoking potentiates the effect of cotton dust exposure on

respiratory symptoms and byssinosis. The second study reveals high prevalence of

byssinosis still existed in Taiwanese cotton mill, although the prevalence was

declining. Smoking was found to show an additive effect on cotton dust exposure.

Anti-smoking campaign, occupational health program to reduce the dust exposure,

and periodical medical examination are measures to prevent from byssinosis.

A survey done by Vasantha Kandaswamy (2003) on occupational hazard in

textile industries reveals that most of the workers and family members at Coimbatore

(Tamilnadu) India, suffer from either asthma, allergy, TB or from frequent attacks of

cold. Only few or negligible people suffered from cancer. Another strange ailment

19

 

were nose block, throat infection, which were also a frequent problem faced by them,

future it is also found that the number of weavers who suffered from skin problem

was less than the number of weavers who faced with respiratory problems, thus the

major occupational health hazards faced by weavers was respiratory problem.

An epidemiological survey B. Lammers, 1963 of 414 English and 980 Dutch

male cotton workers was undertaken to determine the prevalence of byssinosis and

respiratory symptoms, and to compare the ventilatory capacities in the two

populations, with particular reference to the influence of air pollution. The English

workers were employed in six mills in Lancashire and the Dutch workers in three

mills in Almelo spinning similar grades of cotton. The methods used included a

questionnaire on respiratory symptoms and illnesses, the collection and examination

of sputum and the measurement of the forced expiratory volume over 0 75 sec. The

crude rates for byssinosis were similar, 13-5 % and 17% respectively in the English

and Dutch card and blow rooms, and 1-5 % and 1 6% respectively in the spinning

rooms. The English workers had significantly higher prevalence of persistent cough

and persistent phlegm and significantly lower indirect maximum breathing capacities.

Nearly twice as many English produced specimens, and the mean volume of sputum

was greater for the English workers. The prevalence of bronchitis, defined as

persistent phlegm and at least one chest illness during the past three years, causing

absence from work, was higher in the English than in the Dutch workers in both types

of work room, but not significantly so after standardizing for differences in age. Since

there are important differences in the social security systems of the two countries,

which may encourage more absence from illness among the Dutch, a comparison of

bronchitis thus defined is likely to be invalid. The higher prevalence of respiratory

symptoms and lower ventilator capacities in the English are unlikely to be due to

observer error. They are discussed in relation to smoking habits, exposure to cotton

dust, and air pollution. The most likely explanation of the unfavourable picture

presented by the English workers is the much higher level of air pollution in

Lancashire.

20

 

Richards. F. Schilling (1964) done epidemiological studies of chronic

respiratory disease among cotton operatives. Compared with chronic diseases like

cancer, coronary heart disease, and rheumatism, it is a very small public health

problem. Nevertheless, it illustrates in microcosm the difficulties of finding the extent

and causes of a chronic disease in a community. It is easy to misinterpret the etiology

and misjudge the importance of a disease using traditional methods of analyzing

mortality and morbidity data and investigating patients in hospital. Instead, a

relatively new type of epidemiology is required-one that studies groups of people and

the environmental and personal factors that together may cause a disease and

influence its course. Clinical epidemiology demands a different approach from

hospital medicine since the unit of study is the group or family rather than the

individual patient, and clinical skills have to be used rather differently. In hospitals

most patients have unequivocal evidence of disease, and diagnosis seldom depends on

a single examination. In field surveys, subjects are often examined only once and

many are found to be normal or to have only early manifestations of disease. This

necessitates more precise definition of the indices of disease than is usually required

in Byssinosis among cotton operative’s schilling hospital practice, as well as

standardization of the techniques of measurement. In the investigation of chronic

respiratory disease, clinical epidemiologists have devoted considerable efforts to the

standardization of questionnaires on chest symptoms, lung function tests, and

radiological films.

L. Belin et all From the Departments of Allergology and Clinical Physiology,

Sahlgrenska (1964) studied The prevalence of byssinosis and chronic respiratory

symptoms in 117 workers in four Swedish cotton mills. Changes of forced expiratory

volume in 0-75 sec. (F.E.V.0.75) duringa Monday and a Wednesday were assessed in

64 male workers in four cardrooms in these mills.Dust sampling was performed with

weighed millipore filters.Prevalences of byssinosis as judged from the workers'

histories were 68 %, 55 %, 44 %, and 25 %in the four mills; the lowest prevalence of

25 % was found in a mill spinning both high grade cotton yarn and rayon. Among 67

workers in the mills having a byssinosis prevalence of 68 % and 55 %, 60% were

non-smokers, 70% had chronic cough, and 27% had chronic dyspnoea. The

F.E.V.0.75decreased on Monday in workers who gave a history of Monday dyspnoea,

21

 

and to a lesser degree, but still significantly, in those who did not. In spite of marked

differences in fine dust (i.e., dust smaller than 2 mm. diameter) concentrationsin the

four cardrooms, no significant relations between dust content, byssinosis prevalence,

andF.E.V.0.75 changes on Monday could be demonstrated. The prevention and

treatment of byssinosis is discussed. Workers at risk should receive a periodical

medical examination including at least a spirographical pulmonary function test

atintervals of one year or less.

I. Dingwall-Fordyce and J. G. O'sullivan from the Department of Occupational

Health, University of Manchester done a study to determine whether byssinosis

occurred among workers in the waste cotton industry. It was undertaken in 1950 at the

instigation of the Minister of National Insurance. Twenty-two mills, representative of

the industry, were surveyed. All the men in these mills, who were over 35 years of

age and with at least 11 years' exposure to cotton dust, were seen. The investigations

included a work history, a clinical examination, an assessment of effort dyspnoea, and

a chest radiograph. There were I40 men who had never been exposed to any dust

hazard other than waste cotton. In this group were found seven (5%) men with

disabling byssinosis and 35 (25%) men with lesser degrees of the same disease. There

were also I5 (11%) men with bronchitis or emphysema without byssinosis. Thus it

was established that byssinosis did occur in the waste cotton industry. Insurance

cover, under the National Insurance (Industrial Injuries) Act, I946, was subsequently

extended to workers in the waste cotton industry. The survey provided no evidence

that either the type of waste cotton processed or an admixture of raw cotton played a

significant part in the aetiology or incidence of the disease.

K.Priya et all conducted a Cross-sectional study study on respiratory problems

in cotton mill workersThey found Cotton industry workers sometimes face a chronic

debilitating disease known as Byssinossis. Health status of workers of Vijaya mohini

Mills Trivandrum City was assessed in this context.the objectives are to assess the

level of awareness about the health hazards in cotton industry among cotton mill

workers and to find the prevalence of respiration diseases among them.Seventy

workers on the evening shift of Vijayamohini mill were included in the study. Semi

structured Questionnaire was used to collect the data. Data analysis was done using

22

 

proportions.All of the workers were aware that they belonged to a high risk group

related to respiratory illness. They knew tact Cotton dust causes pulmonary

diseases.None of them were satisfied with the existing safety practices.47% of

workers are not using mask either due to inadequacy or due to discomfort it

creates.Only one third of the workers were getting information from sources other

than their colleagues.40% of the workers had respiratory problem.Among them 70%

were with more than forty years experience.47% of the smokers are affected and 30%

of the non smokers are affected.Periodic medical examination were absent at the

setting.

26

CHAPTER-III

METHODOLOGY

RESEARCH METHODOLOGY

In this chapter the investigator discusses the chosen research approach and the

rationale. A detailed account of study preparatory and planning phase was discussed

as well as how the research was conducted and how data was analyzed. Steps to

address rigour, ethical considerations and management issues such as time scale and

financial implications are also discussed.

RESEARCH APPROACH

An experimental approach was used to assess the Effectiveness of video

assisted programme

RESEARCH DESIGN

Pre experimental design was adopted with one group pre test and post test

design.

SETTING OF THE STUDY

The setting of the study is selected cotton mills, Madurai. They are private

limited industries. Total strength of the mills are 30, 20, 20 respectively. They have

separate departments for each processing. Totally 4 departments namely, blow room,

carding, spinning and cone winding. There were many workers having more than

three years experience. The investigator chose setting due to availability of samples,

co-operation of authorities, and feasibility in terms of time, money and material and

language convenience.

VARIABLES

Dependent Variable: knowledge and attitude.

Independent Variable: video assisted programme.

27

POPULATION

The target population: All the cotton mill workers working in cotton mill at

Madurai

Accessible population: Cotton mill workers those who are exposed to cotton

dust in selected cotton mills at Madurai.

SAMPLE

Workers those who are employed in the selected cotton mills exposed to

cotton dust during the study and fulfil the inclusion criteria were selected as a sample.

SAMPLE SIZE

The sample size for the study is 60 cotton mill workers in selected cotton mills

,Madurai.

SAMPLING TECHNIQUE

Samples for this study were selected through non probability - purposive

sampling. These samples are those that use whatever subjects are available rather than

following a specific subject selection process. In the present study purposive sampling

technique used to select the cotton mill workers, samples were selected based on

sampling criteria.

CRITERIA FOR SAMPLE SELECTION

Inclusion criteria

Workers who are,

between 21 to 60 years of age.

able to read Tamil.

both gender

available during the data collection time.

willing to participate in this study.

Exclusion criteria

Workers who are

not exposed to cotton dust in the mill.

28

DESCRIPTION OF THE INSTRUMENT

The instrument was developed by the investigator with the guidance of

experts. The tool consist of three parts.The structured questionnaire was prepared to

assess the knowledge and attitude on respiratory problems

Part I- base line data

Part II- knowledge on respiratory problem and its prevention

Part III- attitude on respiratory problems

Part I

It consists of 10 baseline data such as age, sex, and educational status, duration

of work, habit of exercise, and personal habits of person.

Part II

It consists of structured knowledge questionnaire with 20 multiple choice

questions. Each question has 4 responses with one right answer on knowledge among

adult patients regarding respiratory problems on the basis of introduction, causes,

symptoms, prevention.

Part III

It consists of ten positive statements and ten negative statements to assess the

attitude among cotton mill workers. The scale used in this study is 3 Point Likert

scale. The options included were agree, uncertain and disagree.

SCORING PROCEDURE

Part II

The multiple choice questions have four responses each with one right answer,

which is allotted a score of one and every wrong answer was given a score of zero.

The total attainable score of knowledge questionnaire was 20. The total score was

converted into percentage and the resulting score was ranged as follows:

15-20 - Adequate knowledge

8-14 - Moderately adequate knowledge

Below7 - Inadequate knowledge

29

Part III

It consists of 3 Point Likert scale of ten statements to assess the attitude on

respiratory problems. The options included were agree, uncertain, and disagree. The

maximum score for measuring the attitude was 60. A score of one was given for

disagree, score of two was given for uncertain, score of three was given for agree for

each positive statements. A score of one was given for agree, score of two was given

for uncertain, score of three was given for disagree for each negative statements.

Attitude score was interpreted as follows:

41-60 - Favourable attitude

20-40 - Unfavourable attitude

VALIDITY AND RELIABILITY OF THE TOOL

The content validity of an instrument is essentially based on the adequate

coverage of the subject matter. In the present study 12 experts including 1 pulmonary

physician, 10 nursing experts and one community health nursing professor, validated

the entire section of the tool. The experts were requested to check the relevance of the

items in the tools. Based on the recommendations, few items were modified. The tool

was first drafted in English, Tamil translation was done and drafted by Tamil experts

and checked for language validity.

The reliability of an instrument is the degree of consistence with which it

measures the attribute it is supposed to be measuring over a period of Time. The

reliability of interview schedule was established by using split half method. The

second test was conducted 7 days after the first test to the same group of workers.

Then the scores obtained were correlated. Reliability was computed using Karl

Pearson’s correlation co-efficient and it was found to be 0.96 for knowledge and 0.96

for attitude,which was highly, positively correlated. The tool was found to be reliable.

DATA COLLECTION PROCEDURE

The data was collected among workers who are working in selected cotton

mill workers, Madurai. Written permission was sought and obtained from the

authorities concerned. The period of data collection was 6 weeks. 60 workers were

selected as per above mentioned criteria with prior informed verbal consent to

participate in the study. Initially good rapport was maintained with the adult patients

and the purpose of the study was explained to them. Workers were made comfortable

30

and privacy was provided. Data was collected through the structured questionnaire to

assess the knowledge and attitude among cotton mill workers. Video teaching

regarding the respiratory problems and its prevention was given on the first day. It

was followed by the post test after 7 days. Same procedure was followed for the other

two cotton mills also.

DATA COLLECTION SCHEDULE

Week Cotton mill Pretest and video

teaching Post test

1 1 1st day 8th day

2 2 1st day 8th day

3 3 1st day 8th day

PILOT STUDY

The pilot study was conducted among 6 workers in cotton mill in Tanakkankulam,

Madurai after obtaining formal permission from authorities before the main study to

achieve the following puposes.

- To understand and handle the difficulties that may be encountered in the actual

study.

- To become familiar with the use of the study tool

- To find out the feasibility and application of the tool

- To find out the sensitivity of the tool.

Structured questionnaire which consists of 20 questions was used to assess the risk

factors and 20 questions was used for data collection to assess the existing knowledge

and Likert 3 Point attitude scale to assess the attitude among Cotton mill workers.

This time taken to complete the tool was found to be satisfactory in terms of

simplicity and clarity. Based on the time taken for collecting the data, arbitrary

decision was taken to keep the sample size to 60.

31

PROTECTION OF HUMAN RIGHTS

The proposed study was conducted after the approval of dissertation

committee of the college. Permission was obtained from the concern persons in each

cotton mill. Each individual client was informed about the purpose of the study and

confidentiality was promised and ensured. Informed consent was obtained from each

individual. The patient had the freedom to leave the study at his/ her wish without

assigning any reason. Thus the ethical issues were ensured in this study.

32

 

CHAPTER – IV ANALYSIS AND INTERPRETATION

This chapter deals with the description of the sample analysis and

interpretation of the data collected among cotton mill workers to interpret the

knowledge and attitude on prevention of respiratory problem. The data collected were

tabulated, analyzed and presented based on the objectives.

The findings were organized and presented in the following sections:

1. Distribution of cotton mill workers based on the demographic variables.

2. Distribution of pre test and post test Level of Knowledge among cotton

mill workers on respiratory problems.

3. Distribution of pre test and post Level of Attitude among cotton mill

workers on respiratory problems.

4. Difference of pre test, post test level of knowledge and attitude.

5. Association of knowledge with the selected demographic variables on

prevention of respiratory problems among cotton mill workers

6. Association of attitude with the selected demographic variables on

prevention of respiratory problems among cotton mill workers

33

 

TABLE 1.a

DISTRIBUTION OF COTTON MILL WORKERS BASED ON THE

DEMOGRAPHIC VARIABLES N=60

S.No Demographic Variables Frequency Percentage

1 Age in years

21-30 15 25

31-40 16 27

41-50 20 33

51-60 9 15

2 Sex

Male 24 40

Female 36 60

3 Educational status

Educated 18 30

Uneducated 42 70

4 Occupation (in year)

1-10 years 25 42

11-20 years 26 43

>20 years 9 15

5 Overtime work

Some times 16 26

Regularly 27 45

Often 10 17

Never 7 12

Table 1.a reveals that among 60 cotton mill workers majority 20 (33%) of

workers were between 41-50 years. Regarding Sex, majority 36 (60%) is Females.

With regard to educational status, majority 42(70%) were uneducated. In connection

with occupational experience majority 26 (43%) were 11-20years experience. With

regard to Overtime work majority 27(45%) are regularly doing the overtime.

34

 

TABLE 1.b

DISTRIBUTION OF COTTON MILL WORKERS BASED ON THE

DEMOGRAPHIC VARIABLES

N=60

S.No Demographic Variables Frequency Percentage

6 Place of work

Blow room 12 20

Carding 19 32

Drawing 9 15

Spinning 9 15

Cone winding 11 18

7 Exercise

Walking/Running 14 23

Yoga 3 5

Any other 14 23

Not at all 29 49

8 Habits

Smoking 9 15

Consuming alcohol 14 23

Tobacco chewing 15 25

Any other 12 20

None of the above 10 17

Table 1.b reveals that among 60 cotton mill workers majority 19(32%) are

working in carding department. In connection to habits Majority 15(25%) are having

tobacco chewing habits.

35

 

TABLE 1.c

DISTRIBUTION OF COTTON MILL WORKERS BASED ON THE

DEMOGRAPHIC VARIABLES

N=60

S.No Demographic Variables Frequency Percentage

9 Disease

Allergic disorders 7 12

Pulmonary tuberculosis 19 32

Bronchial asthma 19 32

Other respiratory problems 7 12

None of the above 8 13

10 Symptoms

Persistent cough 11 18

Fever 22 37

Loss of weight 7 12

Chest tightness 8 13

Shortness of breath 7 12

None of the above 5 8

Table 1.c reveals that among 60 cotton mill workers majority majority 19

(32%) are suffering from pulmonary tuberculosis and bronchial asthma. Regarding

Symptoms majority 22(37%) are having fever.

36

 

FIGURE 2

DISTRIBUTION OF PRE TEST AND POST TEST LEVEL OF KNOWLEDGE

AMONG COTTON MILL WORKERS ON RESPIRATORY PROBLEMS

The above figure reveals that pre test knowledge majority 40(66%) had

inadequate knowledge. The post test knowledge revealed majority36 (60%) had

adequate knowledge and 16(27%) had moderately adequate knowledge. It is inferred

that there is a significant difference between pre and post – test level of knowledge of

respiratory problems among cotton mill workers.

37

 

FIGURE 3

DISTRIBUTION OF PRE TEST AND POST LEVEL OF ATTITUDE AMONG

COTTON MILL WORKERS ON RESPIRATORY PROBLEMS

The above figure reveals that pre test attitude for all 56(93%) had

unfavourable attitude .The post test attitude revealed 45(75%) had favourable attitude.

It is inferred that there is a significant difference between pre and post – test level of

attitude of respiratory problems among cotton mill workers.

38

 

TABLE 2

DIFFERENCE OF PRETEST; POST TEST LEVEL OF KNOWLEDGE

AND ATTITUDE

Max Pre test scores Post test scores

‘t’ value Area score Mean SD

Mean

% Mean SD

Mean

%

Knowledge 20 10.52 3.61 53 15.45 3.96 77 7.353***

Attitude 60 29 7.06 48 46.95 10.97 78 11.409***

(p<0.001 highly significant)

The above table reveals the obtained knowledge of pre-test and post test. The

pretest mean score was 10.52 with a standard deviation of 3.93; post-test mean score

was 15.45 with a standard deviation of 3.96 and the paried‘t’ score on knowledge was

7.353 (p<0.001) was highly significant and the obtained attitude pretest mean score

was 29 with a standard deviation of 7.06 .The mean difference of post test was 46.95

with a standard deviation of 10 and the obtained paired‘t’ score was 11.409 (p<0.001)

was highly significant. It is inferred that there is a significant difference between pre

and post –test level of knowledge and attitude on respiratory problems among cotton

mill workers. Therefore video teaching programme brings improvement in their

knowledge and attitude among cotton mill workers. Thereby the research hypothesis

was accepted.

39

 

TABLE 3.a

ASSOCIATION OF KNOWLEDGE WITH THE SELECTED

DEMOGRAPHIC VARIABLES

N = 60

Demographic variable In-

adequate moderate Adequate

χ2

value

p-

value

Age

21-30yrs

1

3

11

31-40 yrs 2 4 10

41-50 yrs 4 6 10 2.53# 0.87

51-60yrs 1 3 5

Overtime

work

Some times

3 4 9

Regularly 2 6 19

Often 2 3 5 3.38# 0.76

Never 1 3 3

Occupational

experience in

years

1-10 yrs

4 5 16

11-20 yrs 3 8 15 1.08# 0.9

>20 yrs 1 3 5

# Not significant at 0.05% level.

Table 3.a presents the association between post test level of knowledge with

demographic variables among cotton mill workers. Regarding age, the χ2 was

2.53(p<0.05) which was not significant. Regarding Occupational experience, the χ2

was 1.079(p<0.05) which was also not significant. Regarding overtime work the χ2

was 3.378 (p<0.05) which was not significant.

40

 

TABLE 3.b

ASSOCIATION OF KNOWLEDGE WITH THE SELECTED

DEMOGRAPHIC VARIABLES

N=60

Demographic variable In-

adequate Moderate Adequate χ2 value

p-

value

Place

of

work

Blow room

2

4

6

Carding 2 9 8

Drawing 1 1 7

Spinning 0 2 7 12.578# 0.127

Cone winding 3 0 8

Habits

Smoking

1

3

5

Consuming

alcohol

3 5 6

Tobacco Chewing 1 3 11 6.815# 0.557

Any other 3 3 6

None of the

above

0 2 8

# Not significant at 0.05% level.

Table 3.b presents the association between post test levels of knowledge with

demographic variables among cotton mill workers. Regarding Place of work, the χ2

was 12.578 (p<0.05) which was not significant. Regarding habits the χ2 was 3.13

(p<0.05) which was not significant.

41

 

TABLE 4.a

ASSOCIATION OF ATTITUDE WITH THE SELECTED DEMOGRAPHIC

VARIABLES

N = 60

Demographic variable Un

favourable

attitude

Favourable

attitude Chi

square

value

p-

value

Age

21-30

4

11

31-40 3 13

41-50 6 14 0.659# 0.883

51-60 2 7

Occupational

experience in

years

1-10 9 16

11-20 4 22 2.93# 0.23

>20 2 7

Place of work

Below room 4 8

Carding 4 15

Drawing 3 6 2.756# 0.6

Spinning 3 6

Cone

winding

1 10

# Not significant at 0.05% level.

Table 4.a presents the association between post test levels of attitude with

demographic variables among cotton mill workers. Regarding age, the χ2 was

0.659(p<0.05) which was not significant. Regarding Occupational experience, the χ2

was 2.93(p<0.05) which was also not significant. Regarding Place of work, the χ2 was

2.756 (p<0.05) which was not significant.

42

 

TABLE 4.b

ASSOCIATION OF ATTITUDE WITH THE SELECTED DEMOGRAPHIC

VARIABLES N = 60

Demographic

variable 

Un

favourable

attitude

Favourable

attitude χ2

P value

Overtime work 

• Some times 4 12

• Regularly 7 20

• Often 4 6 3.456# 0.315

• Never 0 7

• Not at all 2 4

• Smoking 2 7

Habits

• Consuming

alcohol 3 11

• Tobacco

Chewing 6 9 3.13# 0.536

• Any other 3 9

• None of the

above 1 9

 

# Not significant at 0.05% level.

Table 4.b presents the association between post test levels of attitude with

demographic variables among cotton mill workers.Regarding overtime work the χ2

was 3.456 (p<0.05) which was not significant. Regarding habits the χ2 was 6.815

(p<0.05) which was not significant.

43

 

CHAPTER- V DISCUSSION

The study was conducted to evaluate the effectiveness of video assisted

programme on knowledge and attitude regarding prevention of respiratory problems

among cotton mill workers in selected cotton mills, Madurai. This chapter deals with

the discussion and interpretation of the findings to assess the Knowledge and Attitude

on respiratory problems among cotton mill workers.

This study was conducted by pre experimental design. Subjects were selected

by purposive sampling method. The sample size was 60.

A questionnaire and checklist was used to find out the knowledge and

attitude among cotton mill workers regarding respiratory problems. The response

were analysed through preexperimental measures (mean, frequency, percentage,

standard deviation) and inferential statistics (chi-square,‘t’ test).

The discussion was based on the objectives specified in this study.

The first objective of this study was to assess the existing level of knowledge and

attitude on prevention of respiratory problems among selected cotton mill

workers.

Pretest knowledge revealed 40 (66%) had inadequate knowledge and10

(15%) had moderately adequate knowledge. And the pretest attitude for all56 (93%)

had unfavourable attitude. The pretest knowledge (mean=10.52, SD=3.62). The

pretest attitude (Mean=29, SD= 7.06). These findings were consistent with the study

done by K.Priya et all found the existing knowledge of using safety practices of the

sample were not satisfactory. They identified that before teaching the knowledge and

attitude among cotton mill workers are lacking. Thus teaching programme will

improve their knowledge and brings changes in their attitude.

44

 

The second objective of this study was to assess the post test level of knowledge,

attitude and practice on prevention of respiratory problems among selected

cotton mill workers.

The post test knowledge revealed 36(60%) had adequate knowledge and

16 (27%) had moderately adequate knowledge, the post test attitude revealed 45(75%)

had favourable attitude. The post test knowledge (Mean= 15.45, SD= 3.96) the post

test attitude (Mean=46.95, SD=10.97).

The finding of this study is consistent with Thoreia Mohamed et all(2001)

conducted a study on effectiveness of among cotton mill workers to improve their

knowledge and skills. They proved that Periodic inspection, training and health

education improve the knowledge regarding respiratory problems. Main objective of

the study is teaching and guidance in order to gain the better outcomes.

The third objective of this study was to find out the difference between pretest

and post –test level of knowledge and attitude on prevention of respiratory

problems among selected cotton mill workers.

The obtained post test mean value of knowledge 15.45 was higher than the

pretest value 10.52. The mean difference between pretest and post test was 24 and the

obtained paired‘t’ test value was 7.353( p<0.001) was highly significant. The obtained

post test attitude mean value 46.95 was higher than the pretest attitude mean value 29.

The mean difference between pretest and post test attitude was 30. and obtained

paired ‘t’ test value was 11.409(p<0.001) highly significant These findings reveal that

the video teaching programme was effective and the cotton mill workers gained

adequate knowledge and attitude. Thereby research hypothesis was accepted.

The findings suggested that suggested that knowledge and attitude level was

enhanced after video teaching programme.

The findings of the study is consistent with Sateesh Satawaji(2007) conducted

a study on effectiveness of teaching programme on prevention of respiratory problems

among cotton mill workers. They found that the effectiveness of educational

programme tested by inferential statistics using the paired‘t’ test. A significance

difference was found between pre and post tests knowledge score.

45

 

The fourth objective of this study was to find out the association between post

test level of knowledge and attitude on prevention of respiratory problems

among selected cotton mill workers with the selected demographic variables.

The findings of the study concluded that there is no association between level

of knowledge and attitude with selected demographic variables.

The finding of the study is consistent with Jessica S Kale (2007) conducted

study on effectiveness of structured teaching programme on respiratory problems

among cotton mill workers. She identified that there was no significant association

between level of knowledge and attitude with selected demographic variables. The

investigator feels that inspite of all the variables the video teaching programme will

improve the knowledge and attitude of cotton mill workers on respiratory problems.

LIMITATIONS

1. Study is limited in assessing the knowledge on respiratory problems by

questionnaire.

2. Study is limited to the cotton mill workers who are working in selected

cotton mills, Madurai.

46

 

CHAPTER-VI SUMMARY AND RECOMMENDATIONS

This chapter deals with the summary and conclusion drawn. It focuses on the

implications and gives recommendations for nursing practices, nursing research,

nursing administration and nursing education.

Summary of the study

The focus of the study to evaluate the effectiveness of video teaching program

on knowledge and attitude of cotton mill workers on respiratory problems. A review

of literature helped the investigator to develop the conceptual framework,

questionnaire, likert scale and methodology. The review was done with the help of

various literatures. The conceptual frame work adopted for this study was derived

from Nola pender’s Health promotion model.

Research design adopted for the study was pre experimental design. A

questionnaire was developed and used for collecting data about knowledge and

attitude of cotton mill workers on respiratory problems. The tool was found to be

reliable and feasible. The reliability of the tool was established by test-retest method.

The tool was administered among 6 cotton mill workers at Madurai. After a gap of

one week, a retest was given. Karl parson’s coefficient of correlation was computed

and reliability of the knowledge found to be 0.99% and the reliability for attitude

found to be 0.99%. The tool was found to be reliable. Data gathered were analyzed

and interpreted terms of the study objectives.

The main study was conducted in selected cotton mills, Madurai for a period

of six weeks. Purposive sampling technique was used to collect data from the

respondents of the study. Data were organized and interpreted by using both

descriptive and inferential statistics.

47

 

Main findings of the study

Regarding level of knowledge and attitude in the pre test among cotton mill

workers, 40(66%) had inadequate knowledge and 10(17%) had moderate knowledge

about respiratory problems. Regarding level of attitude 56(93%) had unfavorable

attitude and remaining 4(7%) of the total cotton mill workers had favorable attitude

towards respiratory problems.

Regarding the effectiveness of video teaching program, mean score for post

test knowledge was higher than pretest knowledge. It was 10.52 in pretest and 15.45

in post test. The mean score of attitude in posttest is 24 increased from pretest mean

score 10.52. This shows that there was significant difference between pretest and

posttest knowledge and attitude regarding respiratory problems among cotton mill

workers. This shows that the video teaching program was effective. It was observed

that the video teaching program plays a vital role in improving the knowledge and

attitude of cotton mill workers.

Regarding association between level of knowledge and attitude with selected

demographic variables, there was no significant association between levels of

knowledge and level of attitude with demographic variables like age, sex,

occupational experience, overtime work, place of work and habits etc.

CONCLUSION

The main conclusion of this present study is that education plays fundamental

role in bringing changes in knowledge and attitude of the cotton mill worker. The

investigator hopes that the video teaching program could increase their knowledge

and attitude among cotton mill workers.

48

 

IMPLICATIONS

The findings of the study have several implications in following field. It can

be discussed on four areas namely nursing practice, nursing administration, nursing

education and nursing research.

Implications of nursing practice

• The study findings will help the occupational health nurse to create awareness

to the cotton mill workers regarding the early identification of respiratory

problems with the help of effective audio-visual aids

• The findings emphasize the need for early detection regarding respiratory

problems through the medical professionals to increase the knowledge and

attitude.

• The nurses can help the workers to get periodical medical examination

• Nursing personnel are in the best position to teach protective measure of

workers .

• Rotation of work from more dusty area to the less dusty area must be ensured.

Implications of nursing administration

• The present study will help the nursing administrative authority to recognize

the need for developing appropriate education program on respiratory

problems among cotton mill workers.

• Nursing administration should provide necessary facilities to conduct

awareness program on respiratory problems with nearby cotton mills.

• The administration should allocate budgets for developing educational

materials like pamphlets, posters, slides, cassettes, etc. which contain

information about respiratory problems in cotton mills.

Implications of nursing education

• The study emphasize the need for educating the nursing personnel through in-

service or continuing education program to update their knowledge regarding

respiratory problems in cotton mills to assess, plan and care for occupational

health problems

49

 

• Occupational health can be offered as a selected speciality of community

health nursing in higher studies

Implications of nursing research

• The findings of the study help to expand the scientific body of professional

knowledge upon which further research.

• Based upon this study, in-depth research studies of various factors contributes

for respiratory problems among cotton mill workers can be conducted

• Large scale studies can be conducted in consideration of other contributing

variables.

• This study helps the nurse researcher to develop insight in the development of

other research methods and set information for various workers towards

promotion of healthy life and prevention of diseases.

RECOMMENDATIONS

• A similar study can be undertaken with large number of samples which might

lead to generalization

• A similar study can be conducted in another setting

• A similar study can be undertaken by utilizing other domain like practice

• Experimental study can be conducted on effectiveness of protocols on

prevention of respiratory problems.

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