PRESENTED BYSOJI CHERIAN

DISSERTATION

STATEMENT OF THE PROBLEM

EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE (SIM) ON THE KNOWLEDGE OF CAREGIVERS ON PREVENTION OF SUICIDE AMONG DEPRESSIVE PATIENTS IN SELECTED HOSPITALS AT MANGALORE

OBJECTIVES

To determine the level of knowledge of caregivers on the prevention of suicide among depressive patients as measured by structured knowledge questionnaire.

To evaluate the effectiveness of Self-Instructional Module on the level of knowledge of caregivers on the prevention of suicide among depressive patients in terms of gain in knowledge score.

To find an association of pre-test knowledge score of caregivers on the prevention of suicide among depressive patients with selected demographic variables

HYPOTHESIS

All hypotheses are tested at .05 level of significance

H1:The post-test knowledge score of subjects is significantly higher than their pre-test knowledge scores.

H2 There is a significant association of pre-test knowledge score on the prevention of suicide with selected demographic variables.

ASSUMPTIONS

The study assumes that:Caregivers of depressive patients will have some knowledge regarding suicide.

Depressive patients have a tendency to attempt suicide.

Self-instructional module improves the knowledge of caregivers on the prevention of suicide.

NEED FOR THE STUDY

World Health Organisation predicts that within 20 years, 90% of people will be affected by depression than any other problems. Suicidal risk may increase during periods of rapid changes of depressive state. The people most affected due to the suicidal behaviour of depressive patients are their family members and relatives. Research studies have shown that they have very less knowledge in preventing suicide.

DELIMITATIONS

The study is delimited to caregivers:Attending the selected hospitals along with depressive patients.

Above 18 years of age.

CONCEPTUAL FRAMEWORK

Conceptual framework based on Imogene King’s Goal Attainment Model

(1989).

Figure1: Conceptual fram ework based on Im ogene K ing’s Goal Attainm ent M odel

M utual goal setting

To acquire adequate knowledge regarding

prevention of suicide

CA

RE GIVER

Perception Learning needs of caregivers regarding prevention of suicide

Perception Lack of

knowledge on

prevention of suicide

Investigator Preparation of structured knowledge questionnaire

Preparation of SIM

Caregivers W illingness to participate in the study

REACTIO N

REACTIO N

Determining the pre-test knowledge of caregivers of depressive patients.

Adm inistration of SIM .

Determining the post-test knowledge of caregivers of depressive patients

Participates with good response

IN

TERA

CTION

INTERA

CTION

Transaction

Adequate Gain in

knowledge on prevention of

suicide

Inadequate No gain in

knowledge on prevention of

suicide

IN

VETIGA

TOR

Age,gender,religion, education,relationship with patient

FEED BACK

FEED BACK

Not under study

ACTION

AC

TION

Continued………………

A study was conducted to assess the relationship between depression and suicidal ideation among 1801 adults in a primary care centre at Washington. Depression was measured using Hopkins Symptoms Checklist (HSCL-20). Suicidal ideation was operationalised using one item from HSCL-20. The results revealed that suicidal ideation was highly dependent on changes in depression (5.38, 95% confidence interval 3.93-7.36, df=81, t=10.66, P<0.0001). The study concluded that there was a strong relationship between suicidal ideation and depression.

Continued………………

A cross-sectional study was conducted to find the knowledge and attitude of friends or family members of those bereaved by suicide among 5154 residents of Northern Japan, aged 30-69 years. A structured knowledge questionnaire was used. The results showed that 67.5% of the subjects had inappropriate knowledge and 30.4% of the responses were undetermined and 2.1% were appropriate. The study concluded about the need for having an educational programme to improve the knowledge of family members about suicide.

RESEARCH APPROACH

Evaluative approach

RESEARCH DESIGN

Pre-experimentalone group pre-test - post- test design

Subjects Pre-test

Treatment Post test after 7 days

Caregivers O1 x O2

RESEARCH SETTING

SELECTED HOSPITAL AT MANGALORE

POPULATION

CAREGIVERS OF DEPRESSIVE PATIENTS ADMITTED IN HOSPITALS AT MANGALORE

SAMPLE AND SAMPLING TECHNIQUE

SAMPLE50 Caregivers of depressive patients admitted in selected hospitals at Mangalore comprises the sample.

SAMPLING TECHNIQUEConvenience Sampling Technique

INCLUSION CRITERIA

Caregivers of depressive patients:who are able to understand Kannada or English.

aged between 18 years and 60 years.who are present at the time of the study

EXCLUSION CRITERIA

Those who are not willing to participate in the study.

Those who have a history of psychiatric illness.

DEVELOPMENT OF TOOL

The tool consisted of two parts:Part I: Baseline proforma Part II: Self-administered structured knowledge questionnaire to assess the knowledge of caregivers on prevention of suicide among depressive patients.

DESCRIPTION OF TOOL

Part I: Baseline proformaIt contained 5 items for obtaining information regarding age, gender, religion, educational qualification, relationship with the patient.

CONTINUES………………………………..

Part II: Self-administered structured knowledge questionnaire

This part of the tool consisted of 28 items in 5 areas of prevention of suicide. The areas are:

Definition and causes of suicideEpidemiology and risk factorsMethods and warning signsMyths and factsTreatment and prevention

VALIDITY

Content validity of the tools was obtained by giving the tool to 11 experts.

Part A there was 100% agreement for all the items.

RELIABILITY

The reliability of the instrument was established by administering the tool to 8 subjects, in the selected hospital at Mangalore. Reliability is established by Split-half method using Spearman Brown Prophecy formula. The reliability is 0.82, thus the tool is found to be highly reliable.

PRE-TESTING

Pre-testing of the tool is estimated out of 5 subjects at one of the hospital, Mangalore

PILOT STUDY

Pilot study was conducted in a selected Hospital at Mangalore

The study was found to be feasible; hence no modifications were done in the study methodology.

ANALYSIS

The knowledge of caregivers on the prevention of suicide before and after the administration of SIM would be calculated using range, mean, and mean percentage, median and standard deviation.

Section- IDescription of sample characteristics in frequency and percentages..

CONTINUED..

Most of the caregivers of depressive patients(34%) were in the age group of 30-39 years.

Majority of the caregivers (80%) were females

Most of the caregivers(48%) were Hindus.

Majority of the caregivers(42%) were undergraduates.

Majority of the caregivers(38%) were spouses.

Section II

Pre-test knowledge score of caregivers on the prevention of suicide

CONTINUED..

In the pre-test, majority of the respondents (48%) had average knowledge scores and 46% had poor knowledge scores. None of the respondents possessed good or very good knowledge score on the prevention of suicide.

Section III

Effectiveness of SIM in terms of gain in knowledge score

CONTINUED..

The mean post-test knowledge score is higher (18.78) than the mean pre-test knowledge score (8.40). The difference between the mean post-test and the mean pre-test knowledge score was found to be statistically significant (t49 =17.09) at 0.05 level of significance, which shows that the SIM was effective in increasing the knowledge of caregivers on prevention of suicide.

Section IV:Association between pre-test knowledge score with selected demographic variables

CONTINUED..

The findings of the study revealed that there was a significant association of pretest knowledge score with age ( 2=8.573, P=0.014). However there was no significant association of pre-test knowledge score of subjects with all other variables like gender (2=0.408), religion (2=0.181), educational qualification (2=2.254), and relationship with the patient (2=0.232) at .05 level of significance.

Limitations

Since the sample was limited only to a selected hospital, generalisation of findings is limited.

The study was confined to only 50 caregivers in selected hospital.

Convenience sampling technique was used by the investigator due to scarcity in availability of sample.

No attempt was made to do the follow-up to measure the retention of knowledge among caregivers.

The study did not use a control group. The investigator had no control over the event that took place between pre-test and post-test.

Recommendations

The study can be replicated on a larger sample for generalising the finding.

A descriptive study may be conducted to assess the prevalence of suicidal attempts among depressive patients.

A comparative study may be conducted to find out the effectiveness of planned teaching programme and SIM on the sample topic.

Similar study may be conducted to assess the knowledge of nurses and community health workers about prevention of suicide.

A follow-up study may be taken to determine the long-term effectiveness of the SIM.

CONCLUSION

Suicide becomes a serious threat to public when it is complicated with major mental illness like depression. Caregivers are people who take care of other adults, often parents, spouses or children with special needs. Some may be family members, others are paid. So the caregivers should have adequate knowledge in preventing suicidal acts.