CHAPTER I

INTRODUCTION

BACK GROUND OF THE STUDY

“Enter in to learn go forth to serve.”

The prevalence of diabetes mellitus is increasing

worldwide.Globally,the prevalence of diabetes in adults

aged 20 years and over was estimated to be 4% in 1995,and

this is projected to rise to 5.5% by 2005.Prevention is

important because diabetes is costly both in human and

monetary matters.At present,diabetes prevention is

centered on preventing the development of diabetes

complications.1

Education and training of patients and their

families are the foundation of good diabetic therapy.

Education of the general public is an integral part of a

prevention-oriented approach to diabetes mellitus.It is

also essential because,at present,diabetes is often not

perceived by the community or the health services as a

public health problem.Accurate and comprehensible

information must be provided for populations with a wide

variety of cultures,ranging from highly sophisticated,

technically attuned societies to those that,at best may

be only semiliterate.A formal process of education

carries enormous advantages to the health and life of the

diabetic patient and consequent social and economic

advantages to society.Medical therapy and expertise of

1
health care workers are most effective in the treatment

of acute episodes of diabetes mellitus such as hypo-

glycemia,hyperglycemia or severe ketoacidosis.The

majority of these episodes could be prevented by proper

education and training of patients.In the daily

management of diabetes,active participation of the

patient appears to be the only efficient solution for

control of the disease and its long term complications.2

Healthy life is the valuable gift of an individual

if a person is healthy enough he is the richest person in

his own world.But there are certain disease condition

which affects the normalcy of many people in our existing

world,such as heart problems neurological problems and

the orthopedic problems,metabolic disorders especially

diabetes mellitus.3

Among which diabetes is the one of the important

health issue in today’s world which may affect the entire

life pattern of an individual. Over the past decade it

has been obvious that the occurrence of type 2 diabetes

mellitus is increasing very rapidly.Even,many people are

unaware of whether they are at increased risk of

developing diabetes in future or actually having

diabetes.It is well known that the late detection of

diabetes ultimately leads to more complications and

increased health cost.4

2
 Therefore with early detection of diabetes or

detection of risk of developing diabetes in future will

help to avoid the complications and thereby sufferings.

Diabetic mellitus is a multisystem disease related to

abnormal insulin production,impaired insulin utilization

or both.Disease stroke adult blindness and non-traumatic

lower limb amputation.People with diabetic mellitus have

at least a twofold risk for development of coronary

artery disease.And more than 65%hasve hypertension.5

Diabetic mellitus is a third major killer in non-

communicable disease in the world. It is chronic lifelong

and debilitation desease.The incidence of diabetic India

ranges between 2-5% in adult population and 1-2% in

general population.6

As diabetic is the chronic lifelong illness,diabetic

patient require regular monitoring and evaluation

throughout their life.Lace of understanding of the

disease and its self care management often dooms

therapies to failure.Patient must attain the knowledge

skill required and develop favorable attitude essential

for diabetic control.Patient education is the vital

element in the management of diabetes.A need for

increased planned education is indicated to augment

awareness of care needs and prevention of complication.7

Various study in India and abroad have revealed

patient’s Lack of knowledge and skills resulting in poor

3
control of their glycemic levels development of diabetic

complication finding of the study suggest the need

planned teaching programme for developing self care

abilities in diabetic mellitus.8

As study was conducted to assess the self learning

package(auto instruction)as the method of patient

education for adult with diabetic and it was observed

that patient had sufficient gain in their knowledge

levels.In another Pune based study conducted by the

diabetic care and research foundation reveals that

diabetic prevented in 14$%of the Pune population.9

Hyperglycemia and resulting from the combination of

insulin action,inadequate insulin secretion and excessive

or inappropriate glucagon secretion.Poorly controlled

type 2 diabetes is associated with an array of micro

vascular,and neuropathic complications.Micro-vascular

complications of diabetes include retinal renal and

possibly neuropathic disease.Microvascular complications

include coronary artery and peripheral nerve. Unlike

patient with type 1dbiabetes mellitus patient with type

2are not absolutely dependent on insulin for life‘This

distinction was the basis for the older terms for types 1

and 2 insulin dependent and non insulin dependent

diabetes.10

However many patient with types 2 diabetes are

ultimately treated with insulin.Because they retain the

4
ability to secrete some endogenous insulin they are

considered to require insulin but not to depend on

insulin.This Nevertheless gives the potential for

confusion due to classification based on treatment rather

than etiology,The older terms have been abandoned another

older term for type 2 diabetes mellitus was adult onset

diabetes.11

Currently because of the epidemic of obesity and

inactivity in children,the 2 diabetes mellitus is

occurring at younger and younger ages.Although type 2

diabetes mellitus typically affects individuals older

than 40 years,it has been diagnosed in Children as young

as 2 years of age who have a family history of

diabetes.In many communities,type 2 diabetes now

outnumbers type 1 among children with newly diagnosed

diabetes.12

NEED OF THE STUDY

India has nearly 50 million diabetic subjects

today,which is briefly contributed by the population.The

scenario is changing rapidly due to socio–economic

transition occurring in the rural area also.Availability

of improved mode of transport and less strenuously as in

the vicinity have resulted in decreased physical

activities.The conditions are more favourable for

expression of diabetes in the population which already

has a racial genetic susceptibility of disease.Recent

5
epidemiological data show that situations are similar

throughout the country.The conversion to diabetes is

enhanced by the low thresholds for the risk factor such

as age, body index and upper body adiposity. Indians have

a genetic phenotype characterised by low body mass

index,but with higher upper body adiposity,high body fat

percentage and high level of insulin resistance with a

high genetic predisposition and the high susceptibility

to the environmental issues.The Indian population faces

a high risk for diabetes and its associated

complications.13

As per international diabetes federation [IDF]

global projections for people with diabetes [between age

group 27-29 yrs old] in 285 million in 2010 and 380

million in 2025 which is 55% increase in diabetes

population.India in 2010 has 50 million people with

diabetes which will increase by 73% in 2025 up to 80.5

million,the total number of people with diabetes is

projected to rise from 171million in 2000 to 366 million

in 2030.The prevalence of diabetes is higher in men than

women,but there are more women with diabetes than men,the

urban population of the developing countries is projected

to double between 2000 and 2030.The estimated number of

people with diabetes in India in 2000 is 31 million which

will increase to 79 million in 2030 therefore a concerted

global initiative is required to address the diabetic

6
epidemic.The number of people with diabetes is increasing

due to the population growth,aging,urbanisation and

increasing prevalence of obesity and physical

inactivity.14

An article analysing data from the 3rd National and

Nutrition Examination Survey (NHANES-III) concluded that

for patients with type-2 diabetes there was little co-

relation between SMBG frequency and glycemic control and

the article was sparked considerable controversy

including questions regarding the validity of the NHAMES-

III study design to properly examine the relationship

between SMBG and glycemic control so the prospective

study design used to be employed to better understand the

role of SMBG in all patients with diabetes.15

Self monitoring blood glucose level is an key

element of home blood glucose monitoring by people with

diabetes mellitus or hypoglycaemia since approximately

1980,a primary goal of the management of type-2 diabetes

mellitus has been achieving closer to normal levels of

glucose in the blood for as much of the time as

possible,guided by HBGM several times a day the benefits

included a reduction in the occurrence rate and severity

of long term complication from hyperglycaemia as well as

reduction in the short term potentially life threatening

complications of hypoglycaemia.16

7
 Patients therefore require a traditional finger

sticks measurements for typically twice per day and are

often advised to use fingersticks measurements to confirm

hypo or hyper glycemia before taking corrective

action.However blood sugar levels when changing rapidly

may read in normal range on a continuous blood glucose

monitoring system while in reality the patients in

already experiencing symptoms of an out of range blood

glucose value and may require treatment patients using

CGM are therefore advised to consider both absolute

volume of the blood glucose level given by the system as

well as any trend in the blood glucose levels.continuous

monitoring allows examination of how the blood glucose

level reacts to insulin exercise,food and other factors.

While technology has limitations studies have

demonstrated that patients with continuous sensors

experience less hyperglycaemia and also reduced their

glycosyleted Hb levels.Here there was significant

improved knowledge was found by researcher in patients.17

Diabetes is the single most important metabolic

which can affect nearly every organ system in the body.It

has been projected that 300 million individuals would be

affected with diabetes by the year 2025.The reason for

this escalation are due to change in lifestyle,People

living longer than before (aging) and low birth weight

could lead to diabetes during adulthood.Diabetes related

8
complications are coronary artery disease,peripheral

vascular disease, Neuropathy, Retinopathy and Nephropathy

people with diabetes are 25 times more likely to develop

blindness 17 times more likely to develop kidney disease,

30-40 times more likely to undergo amputation,2 to 4 more

likely to develop myocardial infarction and twice more

likely to suffer a stroke than non-diabetes lifestyle

modifycations,inclusive of the dietary modification,

regular physical activity and weight reduction or

indicated for prevention of diabete.18

Diabetic is an”Iceberg”disease.Acorrding to recent

estimates,in India prevalence of diabetic mellitus in

adult was around 45% worlwide and this means that over

143 Million persons are now affected.It is projected that

the disease provenance will be 5.4% by the year 2025 with

the global diabetic population reaching 300 million of

this close up to 77% present of global burden of disease

is projected to occur in the developing countries.19

Over 200 million people worldwide.Diabetes costs

Canada an estimated $9 billion annually and the incidence

of diabetes in increasing dramatically.Because of its

chronic nature the financial burden of diabetes

approaches that of all cancers combined. Diabetes

research continues to be under-Funded.20

There are several forms of diabities.Type1

diabetes,also known as juvenile diabetics,occurs when the

9
body’s own immune system destroys the insulin secreting

pancreatic beta-cells.Type 1 diabetes is the most severe

form of the disease and requires multiple daily insulin

injections for survival.Even with excellent glucose

control,patients are at significant risk for developing

debility acting complications.Type2 diabetes, formally

known as adult-onset diabetics,occurs when there are

insufficient insulin producing pancreatic beta-cells for

the body’s needs Type 2diabities is commonly associated

with obesity.There are other forms of diabetes caused by

rare mutations in important genes.In all forms of

diabetics,the exact causes remain unclear.21

Diabetes is clearly one of the most important

medical problems of our time. We in the UBC diabetes

research group are trying to understand the causes of

this disease well enough to design rational therapies to

defeat it.China 98.4,India 65.1 USA 24.4 Brazil 11.9 this

are the countries persons with DM.22

A non-governmental organization (NGO) has designed a

pilot intervention which aims to train local health care

providers and involve NGOs, the local community,students

and youth groups to increase diabetes awareness in the

community.Educational programmes in the Pokhara valley to

sensitize people regarding the different aspects of

diabetes and its prevention and management are required.

The Drug Information Center(DIC)of our hospital runs a

10
Medication Counseling Center (MCC)which provides

counseling to the selected out patients regarding their

disease, medications and lifestyle modifications. In this

center the diabetes patients are also being provided

counseling.The preliminary evaluation of the center

concluded that the MCC can play a definite role in

enhancing patients’understanding about medications and

disease pattern, which in turn may improve patient

compliance.There is a huge scope for this center in

providing counseling to the diabetes patients.Departments

of Internal Medicine,Community Medicine, Hospital and

Clinical Pharmacy,Pharmacology of our institution aim to

have more diabetes screening and awareness programmes in

the future.However,due to logistical and other reasons

only two more diabetes screening and education programmes

were organized in the two years following the data

collection.23

The person with diabetes mellitus has a chronic

lifelong disease,the person must be knowledgeable to

coordinate life style modification in to a daily routine

of work to achieve and maintain normal physiological

blood glucose level.The objective of this study was to

determine the knowledge,attitude and practices of LSM

management of type 2 diabetic patients in Adama Medical

college Hospital.Methodology:Across-sectional study was

conducted to assess knowledge,attitude and practice of

11
type 2 diabetic patients towards LSM management of DM in

Adama Medical College Hospital.Data was cleaned and

analysed by using SPSS version 16.0 and presented

descriptively and analytically.24

Diabetes is chronic illness it requires continuing

medical care and patient self management education to

prevent acute complications and to reduce the risk of

long term complications diabetes care in complex and

requires that many issues, behind glycemic control,be

addressed.Type-2 diabetes mellitus forms more than 95 %

of cases.In the last two decades type-2 diabetic mellitus

is on the rise degree of which varies in different

countries.The world Health organisation (WHO) has

projected that global prevalence of type-2 diabetes

mellitus will be more than double from 135 million in

1995 to 300 million by 2025 today.India has primary

position in the global diabetes epidemiology map as it is

the home for nearly 15 million diabetics, which is the

highest number in the world and disease expected to

increase to 80 million by 2030.The national urban

diabetes survey in India has shown standardised

prevalence of diabetes and impaired glucose tolerance

(IGT) to be 12.5% and 14 %respectively with no gender

difference subjects under 40 years of age and higher

prevalence of IGT than diabetes(12.8 Vs 4.6 P<0.001)so

12
India has gowned the notoriety of being the diabetic

capital of the world.25

PROBLEM STATEMENT

“A study to assess the knowledge and effect of Health

Teaching Program regarding Diabetes Mellitus among

patients relatives attending Diabetes OPD in the selected

hospitals.”

OBJECTIVES

1.To assess the knowledge of diabetes mellitus among the

patient relatives before and after health teaching

programme.

2.To evaluate the effectiveness of diabetes mellitus

among by the patient relatives.

3.To find the association between selected demographic

variable and knowledge regarding diabetes mellitus.

OPERATIONAL DEFINITION
Assess
According to Oxford dictionary,‘Assess’means,to

calculate or estimate the value or quality of someone or

something.26

In this study ‘assess’means,Gathered evaluation of

information regarding knowledge of diabetes mellitus

among relatives of diabetes mellitus patients.

13
Knowledge

According to the oxford dictionary,‘knowledge’

means,the theoretical or practical understanding of a

subject.26

In this study,'Knowledge'means,to the awareness of

patients relatives regarding diabetes mellitus those

are attending diabetes OPD.

Effect

According to Oxford dictionary,‘Effect’means,a

change which is a result or consequence of an action or

other cause.or degree to which something is successful

in producing a desired result.26

In this study,effect is a change in pre-test post-

test knowledge score after health teaching.

Health teaching

According to According to medical dictionary,health

teaching is any combination of learning experiences

designed to help individuals and communities improve

their health,by increasing their knowledge or influencing

their attitudes.27

In this study,health teaching means ideas or

principles regarding diabetes mellitus among patients

relatives attending Diabetes OPD.

14
Diabetes mellitus

According to According to medical dictionary,

‘Diabetes mellitus type 2 is the long-term metabolic

disorder that is a characterized by high blood sugar

insulin resistance and relative lack of insulin.27

In this study,Diabetes mellitus means the process of

receiving and giving systematic instruction on issues

relating to type 2 Diabetes mellitus,including emotional

relations and responsibilities.

Patients relatives
According to medical dictionary,‘patients relatives’

means,recipient’s of health services.27

In this study,‘patients relatives,means,those are

attending diabetes OPD.

VARIABLE
Independent variable

An independent variable is a stimulus or activity

that is manipulated by researcher to create an effect on

the dependent variable.It is also called an intervention

or experimental variable.

The independent variable in this study is Health

Teaching.

Dependent variable

“It is response,behavior or outcome that the

researcher wants to predict or explain changes in the

15
dependent variable are presumed to be caused by the

independent variable”.

The dependent variables in this study are knowledge

of patient relatives.

Attributing Variables

Demographic variables such as age,sex,education,

occupation,Family income in rupees.

HYPOTHESIS

H0-There will not be significant difference in pre-

test and post-test knowledge score after delivering

Health teaching regarding diabetes mellitus among patient

relatives measured at P< 0.05 level of significance.

H1-There will be significant difference in pre-test

and post-test knowledge score after delivering Health

teaching regarding diabetes mellitus among patient

relatives measured at P < 0.05 level of significance.

ASSUMPTIONS

The Study assumes that:

1.The knowledge regarding diabetic mellitus help to

improve care by the relatives and will reduce its

complication.

2.The structured teaching programme will improve the

knowledge of diabetics mellitus.It will serve as guide.

16
 CONCEPTUAL FRAMEWORK

Concept is defined as complex mental formulation of

an object,property or event that is derived from

individual perception and experience.

Conceptual framework is interrelated concept or

abstractions that are assembled together in some

rational scheme by virtue of their relevance to a common

theme.

Concepts are critical to knowledge development in

that they describe structure and provide building blocks

of conceptual framework.A conceptual frame work or a

model is made up of concepts,which are the mental images

of the phenomenon.These concepts are linked together to

express the relationship between them.A model is used to

denote the symbolic representation of the concepts.Kings

process of concept development is one of the synthesis

and reformulation using inductive and deductive

processes,critical thinking,empirical observation as well

as extensive reviews of the nursing and other literature.

Imogene king’s goal attainment theory is based on the

personal and interpersonal system including interaction,

perception,communication,transaction,stress,growth and a

development,time and space.

According to this theory two people meet in some

situation they interact then interpersonal systems are

formed they perceive each other,make judgment about the

17
other take some mental action and react to each one of

these.Since these behaviors cannot be directly observed,

one can only make inference about the same.The next step

in the process is interaction which can be directly

observed.The last step in this model is transudation,

which is dependent upon the achievement of the goal.

The Investigator adopted King’s Goal Attainment

Theory as a basis for conceptual frame work,which is

aimed to develop Health Teaching on diabetes mellitus to

find out these effectiveness and provision of Health

teaching by assessing the patient relatives knowledge

before and after the Health teaching given.

The six major concepts of the phenomenon are

described as follows:

I)Perception:

Refers to Person’s representation of reality.It is

universal,yet highly subjective and unique to each person.It

is not observable but it can be inferred.

Here the investigations perception is needed for-

1.Promoting knowledge of patient relatives related diabetes

mellitus.

2.Promoting patient relatives role in diabetes mellitus to

adolescence.

3.Motivate patient relatives to update the knowledge

regarding diabetes mellitus.

18
II)Judgment:

The Investigator judged(felt the need)to develop Health

teaching regarding diabetes mellitus.

III)Action:

Refers to mental or physical activity to achieve the goal

which the individual perceive.The nurse educator’s action is

to plan for Health teaching regarding diabetes mellitus.

IV)Reaction:

In this study Investigators and patient relatives

reaction are setting mutual goal and plan for assessing

effectiveness of Health teaching.

V)Interaction:

Refers to the verbal and nonverbal behavior of individual

and the environment and between two or more individual.It

involves goal directed perception and communication.

In this study the investigator interacts with the

patient relatives by giving pre-test questionnaires and by

providing Health teaching to them.

VII)Transaction:

It depends upon the attainment of a goal in this stage

the Investigator reassesses the knowledge regarding diabetes

mellitus and assesses effectiveness Health Teaching.

19
 Poor
PERCEPTION Average
Need for health Knowledge
education on diabetes
mellitus. Good

JUDGMENT
Nurse Excellent
Planned teaching about
Educator diabetes mellitus.
Provides better
knowledge MUTUAL GOAL
SETTING REACTION INTERACTION TRANSACTION

ACTION Patient Pretest Planned Post test

Education should provide relatives & conducted to teaching for conducted to
should gain assess patient assess
adequate knowledge relatives increase in
knowledge about diabetes
mellitus knowledge
about
prevention about diabetes
Patient
Relatives ACTION and diabetes mellitus.
Consent & readiness to mellitus
receive health teaching .

JUDGMENT
Learning & update the
knowledge on diabetes
mellitus Not included in study
.

PERCEPTION
Need for education
diabetes mellitus
FEEDBACK

Fig- 1:Conceptual Framework Modified E. King Goal Attainment Theory,Nursing Theory 20

 REVIEW OF LITERATURE

Research is made in order to inform people with new

knowledge or discovery.However it is not expected that

everybody would willingly believe what is being tackled with

the whole research paper. Thus, what one can do to is to make

the research more credible. This will support them with other

work which has spoken about the same topic that one has for

research.28

This is where Literature Review comes in as Review of

Literature is a key step in the research process.

According to Bavanthappa of literature is defined as

broad comprehensive in depth systematic and critical review

of scholarly publication unpublished scholarly print material

audio visual material and personal communication.28

The review of literature provides a basis for future

investigations.It justifies the need for replication throws

light on the feasibility of the study indicates constraints

of data collection and helps to relate findings of one study

to another.29

In order to accomplish the goal of present study an

attempt has been made to review and discuss the literature

which is organized under the following sections:

21
A.Review of literature related to knowledge of health teaching

programe regarding Diabetes Mellitus among patients relatives

attending Diabetes OPD in selected hospitals.

B.Review of literature related to effect of health teaching

programe regarding Diabetes Mellitus among patient’s relatives

attending Diabetes OPD in selected hospitals.

A.Review of literature related to knowledge of health teaching

programe regarding Diabetes Mellitus among patients relatives

attending Diabetes OPD in selected hospitals.

A study was aimed on the types of diabetes mellitus in

patient relatives of diabetic patients.The genetic charac-

teristics of the diabetic types had been assessed by following

up their frequency in patient relatives of some non-selected

diabetic patients,registered at eight different centers of the

country.Out of 1,003 non-diabetic controls only 46 (4.6%) had

52 diabetic relatives,65.4% of type 2(non-insulin-

dependent).Comparatively,out of the 704 patients,172 (24.4%)

had 229 diabetic first degree relatives,72.5 of type 2. Out of

231 type1(insulin-dependent)diabetic patients,2(12.6%) had 34

diabetic relatives,55.9% of type 1.Out of 300 type 2 patients

99(33.0%) had 121 diabetic relatives 84.0%of type2. The other

173 diabetic patients presented an "intermediary" type of the

disease(needing insulin many years after onset). Forty-

four(25.4%)of them had 64 diabetic relatives,67.2% of type

22
2,20.3% of type 1 and 12.5% with the"intermediary" diabetes.The

five times higher frequency of diabetes in patients relatives

versus controls is pointed out.Type 2 diabetic relatives

predominated.The proportion of probands with diabetic relatives

increased from 4.6% in non-diabetics to 12.6% in type 1 to

25.4% in"intermediary"diabetes and to 33.0% in type 2.30

A prospective study was done in north Indian population to see the

prevalence of insulin resistance in first degree relatives of type-2

diabetes mellitus patients. A total of 172 first degree relatives

(FDRs) and 178 controls were included in this study.All the cases and

controls were subjected to various anthropometric measurements

fasting and postprandial glucose estimation,fasting insulin

measurement and fasting lipid profile.Results revealed the prevalence

of Impaired Fasting Glucose (IFG) (cases 37% Vs controls 11.6%),

Impaired Glucose Tolerance (IGT)(cases 34.3% Vs controls 11.2%) and

diabetes (cases 11.05% controls 3.37%) was significantly higher in

patient relatives.31

A study was conducted on the diabetes knowledge in

patients and family care givers in an urban emergency

department the purpose of the study was to described the base

line level of disease specific knowledge in predominantly

Latino patients with diabetes in their family,and to elucidate

characteristics which are associated with increased diabetes

knowledge with 24 item diabetes knowledge questionnaire (DKQ)

was administered to a convenience sample of 291 primarily

23
Latino adults in the emergency department who either had

diabetes or who identified themselves as a care giver for an

immediate family member with disease the patients with diabetes

received higher score on the DKQ than their family care givers

(13.9 Vs 12.3,P < 01).However on multivariate analysis only

years since diagnosis and education reached statistical

significance.Here the significant improved knowledge was

observed.32

The present study was undertaken to explore knowledge,

attitude and practice (KAP) regarding -diabetes mellitus (DM)

among nondiabetic(nonDM) and type 2 diabetes mellitus(T2DM)

patients in Bangladesh.A cross-sectional study was conducted

among 18,697 adults (aged 18 years and above 7796 male and

10,901 female 6780 nonDM and 11,917 T2DM) selected purposively

from the OPD of 19 healthcare centres in and around Dhaka and

in northern parts of Bangladesh.KAP were assessed by a pre-

structured,interviewer administered questionnaire categorized

using predefined scores of poor(<mean-1 SD),average (mean ± 1

SD) and good(>mean + 1 SD).Univariate and bivariate statistical

analysis were done as appropriate.Multivariate linear

regression was done to examine the association between diabetes

related KAP and other covariates.Females showed better attitude

score compared to males.Overall KAP were found to be

significantly higher(p < 0.001)in middle aged (31–50 years)

24
participants in each group.Participants from urban residents,

higher educational background and upper socio-economic class

demonstrated significantly greater score in terms of KAP in

both non DM and T2DM groups(p < 0.001).On linear regression

analysis knowledge scores correlated strongly with education

income residence diabetic state BMI and attitude.33

Study for assess the knowledge and practices regarding

foot care among diabetes patients.Determine the association

between knowledge and practices regarding foot care among

diabetes patients with selected demographic variables and find

the co-relation between knowledge and practice regarding foot

care among diabetes patients.The level of knowledge score of

diabetic patients regarding foot care reveals that majority

29(58%) had average knowledge12(24%) had good knowledge and

9(18%) had poor knowledge.The level of practice score of

diabetic patients regarding foot care reveals that majority

29(58%)had average practice11(22%)had good practice and

10(20%)had poor practice.There was a perfect correlation

between knowledge and practice regarding foot care among

diabetic patients which means there is increase in knowledge

with increase in practice of the patients.34

Diabetes has been traditionally divided into insulin

dependent(IDDM) and non insulin dependent (NIDDM).A third form

LADA(latent autoimmune diabetes in young) having features of

25
both has emerged.DM is a disorder characterized by fasting and

post prandial hyperglycaemia resulting from a deficiency of

insulin secretion and/or resistance to it.The aim of the study

was to assess the practice of diabetic patient towards self

care activities.In this study 500 diabetic patients were

selected by simple random selection technique.The participants

were received structured practice questionnaire with their

formal concerned.Result of research indicates that mean score

(9.44)with S.D of 2.06 of practice towards self care activities

among diabetic patients and this value indicate that the

practice of diabetic patients towards self care activities were

not satisfactory and the result showed that significant

association between practice towards self care activities in

diabetic patients with socio demographic variables such as

gender,age,marital status,type of family,educational status,

dietary habits and duration of diabetes.35

Conducted a study on Diabetes prevalence has been steadily

increasing in Nepal.Information on the knowledge about diabetes

in the community is lacking in western Nepal.The present study

was carried out to assess the respondents knowledge about

diabetes and note the association if any of the knowledge with

demographic characteristics.Individuals attending a diabetes

screening and education programme on 11th January 2003 were

interviewed using a questionnaire and their responses recorded.

26
180 of the 521 individuals attending the programme consented to

be interviewed.67 were diabetics while 66 had a diabetic family

member.The calculated median knowledge score was 5(maximum

possible score.The median score was higher among male

respondents diabetics and respondents with a diabetic family

member.Knowledge about diabetes was low.The results will be

helpful in designing diabetes education awareness programmes.

Further studies with a larger sample size are required.36

Conducted the study on Diabeties mellitus knowledge

attitude practice(KAP)scores of the patients were low.This

suggests the need for educational interventions to improve the

knowledge, attitude and practices of the diabetes patients.

Altogether 182 patients were enrolled in the study.There were

103 (56.59%) males and 79 (43.41%)females.The greatest numbers

of patients were in the age group of 51-60 years. A total of

685 drugs were prescribed to these patients.Antidiabetics were

the commonest class of drugs prescribed accounting for 314

(45.84%) of the total drugs. The overall mean (± SD) scores of

the patients was 7.78 ± 3.8.Knowledge score was 4.90 ± 3.34;

attitude 2.03 ± 0.95 and practice 0.84±0.76 with maximum

possible scores for knowledge attitude and practice patient

being 18,4 and 3 respectively.37

Conducted a study on Diabeties mellitus the knowledge,

attitude and practice(KAP) among 100 patients attending the

27
diabetic clinic at Klinik Kesihatan Seri Manjung from December

2002 until January 2003.A face-to-face interview using a

structured questionnaire was carried out for data collection.

The results revealed that 87% of the respondents were able to

answer 50% or more questions on knowledge correctly,while 98%

of them had 50% or more score for the attitude questions.

Ninety-nine percent of them reported 50% or more score for the

questions on practice.However,only 56% of them practice all 4

of the practices that were asked regular exercise, healthy

diet, monitoring blood glucose level and monitoring body

weight. There was a significant positive correlation between

knowledge and attitude(r=0.536,p<0.01)but there was no

significant correlation found between attitude and practice.

The results indicate that an increase in knowledge will

increase attitude however this is not necessarily the same

between attitude and practice.A better structured educational

programme on diabetes and preventive measures should be

conducted for all especially those with diabetes to improve

their practice towards diabetes.38

Conducted a study on knowledge aptitude and practice of

patients if given proper guidance and education regarding

diabetes care would be able to make significant improvement in

their life-style which is helpful for good glycemic control.

Education to diabetic patients would be more effective if we

28
know the level of knowledge attitude and practices of our

patients.Thus a study was conducted to assess the general

characteristics,knowledge,attitude and practices of type 2

diabetic patients attending the Out-Patient Department (OPD) of

Baqai Institute of Diabetology and Endocrinology(Karachi,

Pakistan).Fifty-seven percent of the patients were overweight

or obese.Only 10.7% had good glycemic control.Sixty seven

percent did not do exercise of any kind.The overall awareness

about the risk of complications was satisfactory but the

misconceptions regarding diet,insulin and diabetes were quite

common.This study highlights the need for better health

information to the patient through large scale awareness

programmes so as to change the attitude of our public regarding

diabetes.39

As diabetes mellitus is one of the most challenging public

health problem in 21st century,it is important to know about

the awareness level of a disease condition in a population,

which plays a vital role in future development,early detection

and prevention of disease.To assess the awareness and knowledge

regarding diabetes mellitus among diabetic and non-diabetic

subjects.A prospective and observational study was done in 100

diabetic and 50 non-diabetic subjects.All in- patients and out-

patients either gender of age 20-80 years were included in the

study.Paediatric patients,pregnant/lactating women were the

29
excluded.After analysing the scores,it was found that among

diabetic patients 46% had poor knowledge,45% had medium

knowledge and 9% had good knowledge regarding Diabetes Mellitus

where as 64% of non-diabetics had poor knowledge, 34% of non-

diabetics had medium knowledge and 2% of non-diabetics had good

knowledge regarding Diabetes Mellitus.Overall,our study

concludes that diabetic patients had more knowledge regarding

diabetes mellitus than non-diabetic subjects.41

Diabetes mellitus is a chronic disease,with which the

patient must live his life.To achieve a state of health and

acceptable level of function,patient with diabetes mellitus

needs to have adequate knowledge and attitude of self-care

activities.They need to clear their doubts related to self care

activities such as diet,exercise,medication,self administration

of insulin,food care and follow-up.To lead an independent

life,the individual diabetes should be a controller of his own

life.11 An increase in population in India has an increased

susceptibility to diabetes mellitus.The prevalence of diabetes

in adults was found to be 2.4% in rural and 4.0- 11.6% in urban

dwellers.High frequencies of impaired glucose tolerance, shown

by those studies,ranging from 3.6-9.1% indicates the potential

for further rise in prevalence of diabetes mellitus in the

coming decades.It is estimated 30 million people in India are

affected by diabetes and India is the country with highest rate

30
of diabetes.The WHO estimated that India would be the home for

57 million diabetes by 2025.12 Self care is a crucial element

in secondary prevention of diabetes. Diabetics had a poor level

of knowledge about the disease and self-care and hence a very

casual attitude towards the disease.This predisposes them to

the risk of development of complications in later life.Health

education is an area which needs to be addressed immediately to

improve patients'knowledge and skills of diabetes self-care

practices so that they can better contribute towards the

management of their disease.24 The investigator during his

clinical experiences identified that the diagnosis of diabetes

created anxiety and doubts among diabetics on how to adjust

with the restrictions imposed on them to control diabetes,also

the investigator identified lack of knowledge in Preventing

complications of diabetes mellitus and to make the patient to

adhere with right self care activities.42

Present study based on Training teachers and education

professionals on diabetes is crucial for full-time monitoring

of diabetic children in schools.The objective of this study was

to assess the knowledge on diabetes in a group of school

teachers in Turkey.Between November 2010 and November 2011,

1054 teachers from three regions of Ankara were given a

questionnaire to assess their knowledge on diabetes.The mean

age of the group(27% males,73% females)was 38.8±8 years.61.7%

31
of the participants were class teachers,23.3% were school

counselors,and the rest were physical education teachers and

administrators.A fair percentage(47.6%) of the participants had

a moderate knowledge level on diabetes and 32.4% expressed a

lower level of knowledge.A large proportion(94%) gave an

accurate definition of diabetes.Of the total group of 1054

teachers,625 were aware that blood glucose level might decrease

in diabetic children during follow-up.Also,75% believed that

diabetic children were eligible for physical education classes.

52.8% of these teachers had no diabetic child in their classes

and teachers with a diabetic patient in their family had better

knowledge of diabetes compared to their counterparts.43

Conducted a study on knowledge aptitude and practice of

patients if given proper guidance and education regarding

diabetes care would be able to make significant improvement in

their life-style which is helpful for good glycemic control.

Education to diabetic patients would be more effective if we

know the level of knowledge, attitude and practices of our

patients.Thus a study was conducted to assess the general

characteristics knowledge,attitude and practices of type 2

diabetic patients attending the Out-Patient Department (OPD) of

Baqai Institute of Diabetology and Endocrinology Fifty-seven

percent of the patients were overweight or obese. Only 10.7%

had good glycemic control.Sixty seven percent did not do

32
exercise of any kind.The overall awareness about the risk of

complications was satisfactory but the misconceptions regarding

diet,insulin and diabetes were quite common.This study

highlights the need for better health information to the

patient through large scale awareness programmes so as to

change the attitude of our public regarding diabetes.44

Present Study based on The prevalence of diabetes in India

is rising.It is also occurring at a younger age.Ulcers on the

foot in patients with diabetes are a common cause of

amputations and are largely preventable.We assessed the

awareness of foot care among patients with diabetes attending a

tertiary care hospital in northern India and whether this

varied with the level of healthcare availed,i.e.primary,

secondary or tertiary.A scored questionnaire was designed based

on foot care practices advised by the American Diabetes

Association as part of the national diabetes education

programme.It was administered to 400 patients and a total foot

care score was calculated and correlated with various

variables. Only 50 of 400 patients (12.5%)had received previous

foot care advice from healthcare professionals,and 193(48.2%)

28(7%)and 179(44.8%)patients were being taken care of by

primary,secondary and tertiary healthcare systems,respect-

ively.Almost one-quarter of patients were uneducated.The mean

foot care score in all three groups was 5 of a maximum of

33
14,which was poor.The awareness of foot care among people with

diabetes is low among those attending all levels of health care

primary,secondary and tertiary.It is necessary to educate

people about foot care,lack of which will lead to a huge

financial and health burden due to preventable complications of

diabetes.45

Diabetes Mellitus is a chronic disorder,which is becoming

rapidly epidemic in India.There are many complications occur

due to uncontrolled diabetes mellitus.The outcome of diabetes

depends mainly on the patient’s self-management like health-

related behavior,which is based on his or her knowledge.

Awareness on diabetes mellitus is still a lacunae among the

Indian population.To determine the knowledge regarding

awareness of diabetes like the risk factors,symptoms,

complications and the management among the males and females in

rural population.It is a cross sectional study conducted at the

tertiary care center in rural Bangalore.A structured

questionnaire was used and 300 adults were assessed on their

knowledge regarding the awareness of diabetes.Out of 300

adults,159 adults (53%) had a history of diabetes.There was no

gender difference observed regarding the awareness,nor the

education played a role.There was significant difference

observed in knowledge of diabetes Mellitus among the diabetics

with respect to renal complications(p < 0.043) and burning feet

34
(p < 0.009).Both the diabetic and non-diabetic groups had very

low awareness regarding diabetes and associated risk factors.

Both Males and females awareness levels were poor. Proper

Diabetic education programme will help in raising public

awareness of the disease.46

Present Study based on knowledge on DM,and their practices

about diabetes need to be improved.This prompted us to evaluate

what happens when old diagnosed patients receive DE.The study

therefore assessed the association between knowledge and

practices in terms of Hemoglobin A1c (HbA1c),body mass index

(BMI),and waist circumference(WC)among 500 diagnosed T2 DM

using a cross-sectional design.An interviewer-administered

questionnaire was used for assessing their knowledge. The mean

knowledge score of the patients was 15.29 ± 3.6.A significant

negative association was found between the knowledge score and

the HbA1c level.Age was positively associated with HbA1c and WC.

Duration of DM was positively and education was negatively

associated with HbA1c.Gender was negatively associated with BMI

while income was positively associated with BMI and WC. All the

associations were significant.The diagnosed T2 DM patients are

deficient of sufficient knowledge;the knowledge score and HbA1c

have a significant negative relationship,not other actions.The

risk factors for the patients outcome include old age female

gender,years of education economic status,and duration of DM.47

35
 A study was conducted on impact of education on diseased

knowledge and glycemic control among diabetic patients in

family practice.The purpose of study was to find out basic

level of disease knowledge and glycemic control.Stating with

130 participants 91 patients with diabetes was used evaluate

knowledge about diabetes and glycemic control was assessed by

HbA1c participants were tested at the beginning of survey

after three months of passive education and additional and

three months of intensive one.Basic test showed good knowledge

about participants(score 8.3out of 15)improved knowledge after

passive education(score9.23)and intensive one(11.19),(P<0.0001)

Generally patients education improved significantly gycemic

control by HbA1c reduction0.45%(P=0.011)without significant

differences between passive and intensive one.Education of

patients improves both disease knowledge and glycemic control

among type-2 diabetic patients.48

B.Review of literature related to effect of health teaching

programe regarding Diabetes Mellitus among patient’s relatives

attending Diabetes OPD in selected hospitals.

Present study based on Awareness of varied aspects of

diabetes mellitus (DM) is essential for the prevention,

management and control of the disease.The aim was to assess the

level of understanding of DM among patients and their

bystanders attending the ophthalmology out-patient department

36
of a Tertiary Care Hospital in North Kerala.Cross-sectional

study based on a questionnaire survey.The cases were selected

by convenient sampling. The questionnaire covered demographic

characteristics general knowledge on DM its causes,management,

and prevention.The study included 40 cases of DM and 50

bystanders.The median age was 49.78 years (range:19-78).About

32%of the bystanders were diabetic. 29 subjects led a sedentary

life.More than one family member was affected among 52.22%.

Despite general awareness only 38.70% knew about the hidden

complications of the disease.The source of information was the

treating physician in 47.11%.Knowledge about visible

complications was better.Awareness about management options and

preventive strategies was poor.Duration of the disease family

history and being an accompanying person had correlation with

the awareness among the group.50

A study was conducted on a randomised controlled trial to

determine the effect on glycemic control of different

strategies of blood glucose monitoring in people with type-2

diabetes design on randomised parallel group trial set in UK

general practises a total of 450 patients with type -2 diabetes

managed with life style or oral glucose lowering medication are

included.The trial has an 80% power at a 5% level of

significance to detect a difference in change in the primary

out come.Secondary outcome measures include health services

37
costs well –being and the medication analysis will explore the

extent to which changes in beliefs about self management of

diabetes between experimental groups leads to changes in our

comes in accordance with the common sense model of illness.The

study is open and has recruited more than half of the sample.

The trial will provide evidence to support focus use of

specific BGSM strategies.51

Present study based on prevalence of diabetes in India is

resulting in an epidemiological transition.The care of the

people with diabetes is traditionally seen as doctor centered,

but the concept of self-care of people with diabetes is a new

domain and is proven beneficial.The aim was to determine the

practice of self-care activities among people with diabetes

attending a tertiary care hospital in Mangalore.Subjects A

facility based cross-sectional study was conducted in

Government the Wenlock Hospital Mangalore during September

October 2012.A total of 290 patients with >1-year duration of

diabetes mellitus(DM) were asked to respond to summary diabetes

self-care activities questionnaire after obtaining the consent

from them.The statistical analysis was performed in terms of

descriptive statistics and association between the variables

was tested using Mann–Whitney U-test.A healthy eating plan on a

daily basis was followed by 45.9%(133/290) of the participants,

daily exercises for 30 min were followed by 43.4%(126/290),and

38
regular blood sugar monitoring was done by 76.6%(222/290).

Regarding the adherence to oral hypoglycemic agents and insulin

daily adherence to medication was seen among 60.5%(155/256) and

66.9%(138/206) were found to be adherent to insulin injections

on a daily basis.Self-care practices were found to be

unsatisfactory in almost all aspects except for blood sugar

monitoring and treatment adherence.52

Present study conducted on Auditory dysfunctions in

diabetes are known but are difficult to identify.Role of

clinical tests and routine audiological tools are still to be

established in early detection of diabetes-related auditory

complication.The study aims to establish a link between

diabetes and auditory dysfunction and assess the role of

clinical examination and audiological investigations as a

sensitive indicator of auditory dysfunctions in diabetics.The

auditory functions of 100 diabetic patients and 100 non-

diabetics were assessed by clinical otological examination

including free-field hearing and pure tone audiometry(PTA)in

this descriptive study.The data for diabetic and non-diabetic

groups and effect of age on auditory functions were analyzed

with suitable statistical tests using SPSS 2.0 software with an

error margin of 10%.The demographical variables were comparable

in both groups.The results showed a decline in free field

hearing, which are furthur adversely affected by duration of

39
diabetes and patient’s age.Overall pure tone thresholds were

not significantly higher in diabetics however the thresholds

were higher in diabetics in older age groups.The hearing loss

appears at an early age in diabetics but gradually becomes

indistinguishable from age-related hearing loss.53

Present study conducted on examine the effects of type 2

diabetes mellitus(DM)on the variables associated with prostatic

growth including serum prostate-specific antigen(PSA),serum

testosterone,and prostate volume,and to correlate these

variables with the duration of diabetes treatment.Our study was

conducted over 3 months recruiting 501 men aged ≥ 55 years;of

whom 207 had type 2 DM.Exclusion criteria were active urinary

tract infection,suspicious rectal examination urologic cancer

end-organ damage,and recent urological manipulations.Serum PSA

and serum testosterone were measured.Prostate volume was

determined by abdominal ultrasonography using an ellipsoid

formula.The mean patient age was 60.21 ± 5.95 years.The mean

PSA testosterone and prostate volume for diabetic respectively

P =0.001,P = 0.001,P = 0.03respectively)mean the of PSA the

density was 0.049 ± 0.043mng/mL/cm3 in diabetics versus 0.080

±0.056 ng/mL/cm3 in non-diabetics(P<0.001).54

Present study conducted Cohort Study on to evaluate the 5-

year effectiveness of a multi-disciplinary Risk Assessment and

Management Programme–Diabetes Mellitus(RAMP-DM) in primary care

40
patients with type 2 diabetes.5-year prospective cohort study

was conducted with 121,584 Chinese primary care patients with

type 2 DM who were recruited between August 2009 and June 2011.

Missing data were dealt with multiple imputations.After

excluding patients with prior diabetes mellitus(DM)-related

complications and one-to-one propensity score matching on all

patient characteristics 26,718 RAMP-DM participants and 26,718

matched usual care patients were followed up for a median time

of 4.5years.The effect of RAMP-DM on nine DM-related

complications and all-cause mortality were evaluated using Cox

regressions.The first incidence for each event was used for all

models.Health service use was analyzed using negative binomial

regressions.Subgroup analyses on different patient character-

ristics were performed.The cumulative incidence of all events

(DM-related complications and all-cause mortality) was 23.2% in

the RAMP-DM group and 43.6% in the usual care group.RAMP-DM led

to significantly greater reductions in cardiovascular dise-

ase(CVD)risk by 56.6% microvascular complications by 11.9%

mortality by 66.1% specialist attendance emergency attendance

by 41.2% and hospitalizations by 58.5% Patients with low

baseline CVD risks benefitted the most from RAMP-DM,which

decreased CVD and mortality risk by 60.4% and 83.6%

respectively.55

41
 World will have 300 million diabetics by 2025. The disease

leads to high levels of morbidity and mortality and has huge

financial impact on individuals and national budgets. Knowledge

of the disease will play a great cost effective role in

prevention and control of the disease.This study was undertaken

with the aim to assess awareness regarding diabetes mellitus

and factors affecting the awareness levels.Patients of a

tertiary care hospital, with diabetes mellitus were included in

the study.Awareness regarding diabetes was judged for

knowledge,self care practices and complications by using a self

administered questionnaire. The scores are analysed against the

variables to determine the factors affecting the scores.The

average scores on all three aspects were observed to be above

60 %.Awareness regarding fasting and post prandial blood sugar,

high fibre diet,foot care and ophthalmic complications was

observed to be high.Moderate awareness was observed regarding

diabetes mellitus being a lifestyle disorder,self monitoring of

sugar and renal cardiac and cerebral complications.Poor

knowledge was observed regarding Hb A1c.Females and unemployed

individuals had significantly lower scores.Self employed,

higher education,family history of diabetes mellitus and long

duration of sickness had positive effect on the scores.Age,

marital status and BMI had no effect on the scores.56

42
 This study was carried out to assess the influence of

pharmacist provided patient counseling on patients' perception

about the disease management and quality of life in type 2

diabetes mellitus patients.The present study was a randomized

prospective controlled study conducted over a period of six

months in two community pharmacies in Calicut,Kerala,India.A

total of seventy(48 male and 22 female)type 2 diabetes mellitus

patients were enrolled and randomized into test and control

groups.Patients in the test group received patient counseling

and patient information leaflets from the pharmacist where as

the control group patients received the counseling and patient

information leaflets only at the end of the study.After the

baseline,two follow-ups were made with sixty days interval

between the follow-ups.During each visit patient's random

capillary blood glucose was measured by using standard

Glucometer.57

Suitably designed and validated knowledge,attitude and

practices questionnaire was administered at baseline and final

follow up for both test and control group patients to assess

the disease management awareness.Audit of diabetes-dependent

quality of life questionnaire was administered to measure the

quality of life in both control and test group patients at each

follow up.At the end of the study,knowledge,attitude and

practices scores found markedly improved in test group

43
patients.Mean capillary blood glucose levels were decreased in

test group(P<0.05) and an improvement in mean quality of life

scores (P<0.05) was observed. Where as a reduction of quality

of life score(P<0.05)and a non-significant increase of

capillary blood glucose levels(P>0.05) was observed in the

control group patients.The correlation between the capillary

blood glucose levels and quality of life scores were also found

to be highly significant in the test group(r=0.955).The results

of the study suggests that pharmacist provided patient

counseling has an impact in improving the perception about

disease,diet and life style changes and in turn on glycemic

control and overall quality of life in diabetic patients.

Pharmacist provided patient counseling might be considered as

an important element in implementing the disease management.58

A study was conducted on the effectiveness of post

education following progression on diabetic.31 elderly patients

with diabetes were randomly assigned to an experimental

subject.In experimental group contacting by telephones within

24-48 hours after discharge from the hospital the calls were

repeated at weakly intervals for 3-4 weeks each phone calls

consisted of assessor the subject self care.Knowledge and

practice in self care activities are behavior.Supplemental

instruction were when individual subject.The control group

didn’t receive a phone call after discharge.Diabetic self care

44
knowledge and self care behavior were assessed in both group

and the result indicated the experimental group had higher

score on knowledge and self care behavior than control group.59

In recent study in Chennai nearly 25% of population

studied were unaware of a condition called diabetes,only 40% of

participant felt that prevalence of diabetes was increasing and

only 22% of population felt that diabetes could be prevented,

through the awareness level increased with education only 4.2%

of postgraduate and professional including doctors know that

diabetes was preventable.The knowledge of risk factor was even

low only 11.9% of study reported obesity and physical inactive

as a risk factor.Even amongst the known diabetes only 40.6% was

aware that diabetes could leads to organ damage and complica-

tions many people 46% with diabetes felt that it was a

temporary phenomenon.60

Diabetes has been traditionally divided into insulin

dependent(IDDM) and non insulin dependent(NIDDM).A third form

LADA(latent autoimmune diabetes in young)having features of

both has emerged.DM is a disorder characterized by fasting and

post prandial hyperglycaemia resulting from a deficiency of

insulin secretion and/resistance to it.The aim of the study was

to assess the practice of diabetic patient towards self care

activities.In this study 500 diabetic patients were selected by

simple random selection technique.The participants were

45
received structured practice questionnaire with their formal

concerned.Result of research indicates that mean score

(9.44)with S.D of 2.06 of practice towards self care activities

among diabetic patients and this value indicate that the

practice of diabetic patients towards self care activities were

not satisfactory and the result showed that significant

association between practice towards self care activities in

diabetic patients.61

Conducted a study on Diabetes prevalence has been steadily

increasing in Nepal.Information on the knowledge about diabetes

in the community is lacking in western Nepal.The present study

was carried out to assess the respondents’knowledge about

diabetes and note the association,if any, of the knowledge with

demographic characteristics.Individuals attending a diabetes

screening and education programme on 11th January 2003 were

interviewed using a questionnaire and their responses

recorded.180 of the 521 individuals attending the programme

consented to be interviewed.67 were diabetics while 66 had a

diabetic family member.The calculated median knowledge score

was 5(maximum possible score.The median score was higher among

male respondents diabetics and respondents with a diabetic

family member.Knowledge about diabetes was low.The results will

be helpful in designing diabetes education and awareness

46
programmes.Further studies with a larger sample size are

required.62

Conducted a study on Diabetes mellitus the knowledge,

attitude and practice(KAP)among 100 patients attending the

diabetic clinic at Klinik Kesihatan Seri Manjung from December

2002 until January 2003.A face-to-face interview using a

structured questionnaire was carried out for data collection.

The results revealed that 87% of the respondents were able to

answer 50% or more questions on knowledge correctly while 98%

of them had 50% or more score for the attitude questions.

Ninety-nine percent of them reported 50% or more score for the

questions on practice.However only 56% of them practice all 4

of the practices that were asked regular exercise healthy diet

monitoring blood glucose level and monitoring body weight.

There was a significant positive correlation between knowledge

and attitude(r=0.536,p<0.01)but there was no significant

correlation found between attitude and practice.The results

indicate that an increase in knowledge will increase attitude

however this is not necessarily the same between attitude and

practice.A better structured educational programme on diabetes

and preventive measures should be conducted for all especially

those with diabetes to improve their practice towards

diabetes.63

47
 CHAPTER - III

RESEARCH METHODOLOGY

The selection of the subjects was based on Purposive

Sampling therefore randomization is required for the study.The

methodology of research indicates the general pattern of

diagnosing the procedure for gathering valid and reliable data

for the purpose of investigation.67

This chapter deals with the methodology adopted for

assessing the level of knowledge of patient relatives for the

adolescent regarding d it include diabetes mellitus research

design, setting of the study,variable,population,sample size,

sampling technique,criteria for sample selection,description of

tool content Validity,reliability,pilot study,method of data

collection and plan for the data analysis.

ETHICAL CONSIDERATION

The research problem and objectivies were approved by the

research committee and follows by procedure mentioned below

1.Due permission for authorities was sought and obtained

2.Consent from participants was taken.

3.Anonymity of the participants was censured.

48
 RESEARCH APPROACH

The research approach described in terms of a number of

characteristics.It is systematic disciplined and controlled

process.64

RESEARCH APPROACH

The research approach refers to the way in which the

investigator plans and constructs in research process.

Quantitative approach is used in this study.This approach was

selected because the aim of this research study was to find out

the effect of Health Teaching in improving the knowledge of

patient relatives regarding diabetes mellitus in hospital OPD.

With this approach it would be possible to describe the

knowledge of patient relatives regarding diabetes mellitus.67

The quantitative research approach would help the

investigator to find out the effect of the intervention that is

‘Health Teaching’on the variable that is knowledge of patient

relative regarding diabetes mellitus for those are attending

diabetes mellitus.

Hence the quantitative research approach was considered

being appropriate to assess the knowledge and effect regarding

Diabetes Mellitus among patients relatives attending Diabetes

OPD in selected hospitals.

49
 RESEARCH DESIGN

Research Design is the backbone or the structure of the

study.The term research design refers to plan or organization

of a scientific investigation.It provides a framework that

supports the study and holds it together.64

The research design helps the researcher in the selection

of subjects for observation;it also determines the type of

analysis to be used to interpret the data.

The term research design pre experimental one group pre-

test and post-test refers to a researcher overall plan for

obtaining answers to the research question or for testing the

research hypothesis.The research design helps the researcher in

the selection of subject’s manipulation experimental variables,

procedures of data collection and the type of statistical

analysis to be used to interpret the data.

Research design chosen for this study is one group pre

test post test pre experimental design.68In the present study a

pre test was administered by means of structured questionnaire

depicted as O1 and then Health Teaching was developed depicted

x.A post test was conducted using the same structured

questionnaire depicted as O2.Quasi experimental one group pre &

post test research design.

50
 It helps to researcher in selection of subject,

manipulation of the experience variable and procedure of data

collection.

In this study research design was selected for this study

was Pre-Experimental Pre-test post test design.

SETTING OF THE STUDY

According to the Oxford dictionary,‘Setting,refers to the

area where the study is conducted.26

Research setting may be natural setting or laboratory

setting depending upon the study topic and the researcher

choice.68

Research setting in this study is the selected hospital

OPD,Rao hospital,in pcmc Pimpri for assessing the knowledge and

effect regarding Diabetes Mellitus among patients relatives

those are attending Diabetes OPD.

To avoid the contamination of sample the reliability and

pilot study was conducted in the selected hospital.

POPULATION

According to the Oxford dictionary,‘A population’ was a

group whose members possess specific attributes that the

researcher is interested in studying.26

Polite and Hunger,‘The requirement of defining the

population for a Research project arises from the need to

51
specify the group to which the result of the study can be

generalized.69

In this study,‘population,consists of all the patients

relatives those are attending diabetes OPD in selected

hospitals.

TARGET POPULATION

Target population is one which represent the entire group

or all the elements that meet the criteria for inclusion of the

study.69

In this study the target population consists of all 100

patients relatives those are attending diabetes OPD in selected

hospitals.

ACCESSIBLE POPULATION

The accessible population is the 100 patients relatives

those are attending diabetes OPD in selected hospitals.

SAMPLE AND SAMPLING TECHNIQUE

According to Mosby medical dictionary,‘sub group of the

population is called a sample.66

In this study,sample is Patient relatives of diabetes

mellitus those are attending diabetes OPD.

Samples are chosen through type of sampling procedures

Purposive Sampling involves use of a random selection process

to select a sample from members or element of population.

52
 In this study,Purposive Sampling technique is used.

SAMPLE SIZE

‘An optimum sample is survey is one which fulfils the

requirements of efficiency,representativeness Reliability and

flexibility.69

Sample consists of 100 patients relatives those are

attending diabetes OPD in selected hospitals.

SAMPLING CRITERIA
Inclusion criteria

1.Relatives who are willing to participate in the study

2.Relaltives of patients with diabetes mellitus those can

understating English, Marathi and Hindi.

Exclusion criteria

1.Patients relative who are not willing to participates in the

study.

2.Patients relative who are cannot able read and write.

METHOD OF DATA COLLECTION

Data was collected by using Structured Knowledge

questionnaire.The investigator introduced herself and obtained

consent from patient relatives in the selected hospital this

participates who were willing to participate.Purpose and

importance of research study has explained before collection of

53
data.The Questionnaire was given to the patient relatives to

assess their knowledge on diabetes mellitus.

The Investigator chose the following technique in this

step wise study.

The technique of Pre test and Post test design was used to

assess the knowledge of patient relatives for the adolescent

regarding diabetes mellitus.

DATA COLLECTION TECHNIQUE AND TOOL

“According to the Oxford dictionary,‘the most important

and crucial aspect of any research is collection of appropriate

information,which would provide necessary data to answer the

questions raised in the study.67

The present study aimed at assessed the knowledge and

effect of health teaching programme regarding Diabetes Mellitus

among patients relatives those are attending Diabetes OPD in

selected hospitals.

Thus,a Structured Knowledge Questionnaire was used to

assess knowledge of patients relatives and assess effect of the

health teaching programme regarding diabetes mellitus among

patients relatives those attending diabetes OPD.

A good deal of information can be gathered by structured

knowledge Questionnaire and Health teaching programme.Based on

54
the objectives of the study the following data collection tools

are selected in order to obtain necessary data.

DEVELOPMENT OF TOOL

Development of tool was based on research study for the

collection of data a knowledge questionnaire was used in

research study.A questionnaire was formulated after reviewing

of literature.

There are 15 questions in knowledge questionnaire.

DESCRIPTION OF TOOLS

Section I- Demographic data

Demographic variables which includes the age, gender,

education,occupation,family income in rupees.

Section II- Structured knowledge questionnaire

There were multiple choice questions to assess the

knowledge of patient relatives regarding diabetes mellitus.

Total 15 items were selected for the Questionnaire.A blue print

was prepared.

Scoring

Score 1 was given to every correct answer.

Score 0 was given to every wrong answer.Based on the

percentage of scores,level of knowledge was graded as follows.

55
The total knowledge score were categorized into-

Grade Score Marks

Poor Below 25 % 0 – 5

Average 26 – 50 % 5 – 9

Good 51 – 75 % 9 – 13

Excellent Above 76 % 13 – 15

HEALTH TEACHING

Health Teaching developed by review of literature and

obtaining expert opinion.The Health teaching consist of

information regarding diabetes mellitus as follows-

1.Introduction,definition of diabetes mellitus

2.Types and causes of diabetes mellitus

3.Clinical feature of diabetes mellitus

4.Treatment of diabetes mellitus

5.Diebetes diet

VALIDITY

Validity refers to getting results that accurately reflect

the concept being measured.A valid measure refers to the degree

to which an instrument measures what it is supposed to be

measuring. In practice,validity can also refer to the success

of the research in retrieving ‘valid’results.69

The content Validity of the tool was established in

consultation with 21guide and seven experts from the field of

56
Community Health Nursing.Suggestions of the experts were

considered and changes were made accordingly.

Data Collection Tool for the research study title‘A Study

to assess knowledge and effect of health teaching programme

regarding Diabetes Mellitus among patients relatives attending

Diabetes OPD in selected hospitals.‘Has been presented before

the ethical committee member and corrections were made as per

the suggestion given by the ethical committee experts.

A Structured Knowledge Questionnaire Schedule for baseline

data of patients relatives and to assess the health teaching

programme regarding Diabetes Mellitus among patients relatives

attending Diabetes OPD in selected hospitals.

Tool was checked by guide after final correction which

content validity of the tool and then it was submitted to 20

experts who included doctors from medical department,obgy and

gynac Department and statistician and were faculty members of

different college of nursing.15 tools were received back from

experts and they suggested for modification of tools.

Data Collection Tool sent for validation tool,on common

agreement a few additions and deletions were made in the tools.

Experts suggested that demographic status in family income in ruppes

should be added,some point that was extended in addiction occupation

should be added,and in education secondary education should be added.

And focus on level of knowledge of patients relatives.

57
 Based on the suggestion,a tool was modified.Few changes were

made according to their suggestions,the considering the

practicability of the tool.

Re-organization of the item of the tools was done finally

and validated tools were ready to ascertain the data from the

sample subjects.

RELIABILITY

After establishing the validity of the tool to be used for

the study,the final tool was made and then the reliability of the

tool was done.

In this study,the reliability of the tool was determined

by administering the questionnaire to five samples.Split half

method was used for reliability.The reliability co-efficient

was calculated.The Questionnaires is said to be reliable if the

co-efficient is more than 0.8.67

Reliability has to do with the quality of measurement. in

its everyday sense,reliability is the consistency or

repeatability of measures.Reliability is the consistency of a

set of measurement or measuring instrument.Reliability does not

imply validity.66

The reliability co-efficient‘r’of the knowledge questi-

onnaire was 0.86,calculated by test-retest method which is more

than 0.8.Hence the questionnaire was found to be reliable.

58
 PILOT STUDY

The pilot study was conducted in Dr.D.Y.Patil Hospital

OPD,Pimpri from 1sep 2017 to 7 sep 2017 the pre test was

administered on the 1st day after seven days,Post test was done.

A sample of 5 patient relatives was selected from the

diabetes hospital OPD.

The Investigator approaches research sample individually

and discussed the objective of study and obtained their consent

for participation in study.

Knowledge of patient relatives regarding diabetes mellitus

was assessed by administering the Questionnaire.Then the same

day Health teaching was given.Knowledge assessment of the

patient relatives after giving Health teaching was done on the

seventh day.

The collected data was coded,tabulated and analyzed by

using descriptive statistics(mean,mean percentage,standard

deviation)and coefficient correlation to find out the

association between the demographic variables and knowledge

score.The data regarding knowledge of patient relatives was

analyzed statistically using‘t’test.It was found to be

significant at 0.05 level.

The pilot study helps the Investigator to visualize some

of the practical problems during the study and gave better

insight in to the technique.

59
 The objective of study and obtained consent for

participation in study.pre-test post-test was done assessed

knowledge and effect of health teaching programme among

patient’s relatives attending Diabetes OPD.

DATA COLLECTION PROCESS

Data was collected by using Structured Knowledge

Questionnaire.For the present study the validated tool was

used.A Structured Knowledge Questionnaires containing 15

multiple choice items was given to the subjects to answer.

The Investigator visited the selected hospital OPD much

before the actual data collection and introduced herself to the

head of department.

Formal administrative approval was sought from the Dean of

Dr.D.Y.Patil college of nursing and head of Obgy and gynac

departments Dr.D.Y.Patil college of nursing,rao hospital Pimpri

Pune was taken.

The data was gathered during three weeks from 10th

September 2016 to 30th September 2017.

60
 PROCESS OF DATA COLLECTION:

The following schedule was followed for data collection:

1.The subjects were explained about the nature and purpose of

study in the language they understand and only after this,

written consent was obtained from them.

2.A written consent was obtained from the participants prior to

their recruitment in the study.

3.They were assured about the confidentiality of the data.

4.The subjects were given Structured Knowledge Questionnaire.

5.It took 30 minutes to fill the pretest.

6.Health Teaching was given to the subjects on the same day

after pretest.

7.Posttest with the same questionnaire was conducted after

seven days after the pretest and distribution of Health

Teaching.

PLAN FOR DATA ANALYSIS

The data analysis was planned to include descriptive and

inferential statistics.The following plan of analysis was

developed with opinion of experts.The analysis was done based

on the objectives and hypothesis to be tested.The demographic

data was be analyzed in terms of descriptive statistics.

The Investigator planned to analyze the data in the

following manner.

61
 Demographic data was analyzed using frequency and

percentage and presented in the form of table and graphs.

Data from the questionnaire before and after Health

teaching administered to be analyzed using frequency,

percentage and ‘t’ test.

Association between knowledge finding and demographic

variables using t test and one way ANOVA.

62
 CHAPTER -IV

ANALYSIS AND INTERPRETATION OF DATA

The analysis is defined as,the categories,ordering,

manipulating and summarizing of data to obtain answers the

research questions.

The purpose of analysis is to reduce the data to

intelligible and interpretable from so that the relation of

research problems can study and test.67

The analysis and interpretation of the collected data is

presented in this chapter to “A study to assess the knowledge and

effect of health teaching program regarding Diabetes Mellitus

among patients relatives attending Diabetes OPD in selected

hospitals”.

The data was analyzed based on the following objectives.

OBJECTIVES OF THE STUDY

1.To To assess the knowledge of sex education among the

Anganwadi workers before and after health teaching.

2.To evaluate the effectiveness of diabetes mellitus among by

the patient relatives.

3.To find the association between selected demographic variable

and knowledge regarding diabetes mellitus.

63
 DATA ANALYSIS AND INTERPRETATION

Analysis is a process of organizing and synthesizing data

in such a way that research questions can be answered and

hypothesis tested”.69

This chapter deals with the analysis and interpretation of

data collected from hundred patient relatives,to assess the

effectiveness of Health teaching on knowledge patient relatives

regarding diabetes mellitus.

The data collected was analyzed on the basis of objectives

of the study in the following way.

Section I

Description of the patient relatives according to their

demographic Variables.

Section II

Assessment of knowledge pre test and post test of patient re-

latives regarding diabetes mellitus.

Section III

Evaluate the effectiveness of Health teaching on diabetes

mellitus.

Section IV

Associate knowledge of patient relatives with demographic

Variables.

64
SECION I

Description of samples(among patients relatives attending

Diabetes OPD)”.according to personal characteristics in terms

of frequency and percentages.

Table1.1:Description of samples according personal characte-

ristics in terms of frequency and percentages.

N=100
Demographic variable Freq Percentage

Age

a)31-41 year 36 36

b)41-50 years 39 39

c)51-60 year 22 22

d)Above 60 year 3 3

Gender
a)Male 57 57

b)Female 43 43

Education

a)Illiterate 29 29

b)Primary 55 55

c)Secondary 10 10

d)Graduation 5 5

e)Post graduation 1 1

65
 N=100
Demographic variable Freq Percentage

Occupation

a)House work 41 41

b)Service 30 30

c)laborer 20 20

d)Retired 9 9

Family income in rupees

a)Ruppes 5000-Rs.15,000 30 30

b)Rupees 15,001-Rs.25,000 40 40

c)Rupees 25,001-Rs.35,000 20 20

d)Above Rs.35,001 10 10

For the classification of age of child exclusive method

was used.
1.In above finding 36(36%)of the 31-41 year,39(39%)of them had

age 41 to 50 years and 22 (22%) of them had age 51-60 years,

3(3%)above 60 year.

2.In the above findings,57(57%)were males and 43(43%)of them

were females.

3.In the above table states that 29(29%)of them were from

illiterates,55(55%)of them had primary education,10(10%)of them

done secondary education,5(5%)of them had post graduation and

1(1%)of them done post graduation.

66
4.41(41%)of the were doing house work,30(30%)of them had

services,20(20%)of them had laborer,9(9%)of them had Retired.

5.30(30)%of them had monthly family income upto Rs.5000 Rs.

15,000,40% of them had monthly family incomeRs.15,001-Rs.25,000

and 20% of them had monthly family income Rs.25,001-Rs.35,000,

10(10%)of them had above Rs.35,001.

SECTION II

Table 2:Analysis of data related to identify the level of Pre

test knowledge regarding Diabetes Mellitus among patient’s

relatives attending Diabetes OPD in selected hospitals”.

N=100

Pretest
Knowledge
Freq %

Poor (score 0-6) 95 95

Average (score 7-13) 5 5

Good (score 14-20) 0 0

95% of the patient relatives had poor knowledge(score0-6)

and 5% of them had average knowledge(score7-13)regarding

diabetes mellitus.

67
 Pretest knowledge of patient relatives regarding diabetes mellitus

5%

Poor (score 0-6)

Average (score 7-13)
95%

Fig-2
Pie Diagram showing pretest knowledge of patient relatives
regarding diabetes mellitus.

Section III
Analysis of data related to effect of on knowledge of

patients relatives regarding Diabetes OPD.

Table 3:Effect health teaching program of on knowledge of

patients relatives regarding Diabetes Mellitus among patients

relatives attending Diabetes OPD in selected hospitals.

N=100
Pretest Posttest
Knowledge
Freq % Freq %

Poor (score 0-6) 95 95 0 0

Average (score 7-13) 5 5 1 1

Good (score 14-20) 0 0 99 99

68
 In pretest,95% of the patient relatives had poor knowl-

edge(score0-6)and 5% of them had average knowledge(score7-13)

regarding diabetes mellitus.

In posttest,99% of the patient relatives had good

knowledge(score14-20) and 1% of them had average knowledge

(score7-13)regarding diabetes mellitus among patient’s

relatives attending Diabetes OPD in selected hospitals.This

indicates that there is remarkable improvement in the knowledge

of patients relatives after health teaching programme.

Pretest and posttest knowledge on health teaching programme

among patient relatives regarding diabetes mellitus
Pretest Posttest

95% 99%

0% 5% 1% 0%

Poor (score Average (score Good (score

0-6) 7-13) 14-20)

Fig-3
Bar Diagram showing pretest and posttest knowledge on health
teaching programme among patient relatives regarding diabetes
mellitus

69
Table 4:Paired t-test for effect of health teaching programme

on knowledge of patient relatives regarding diabetes mellitus

those are attending diabetes OPD.

N=100

Mean SD t Df p-value

Pretest 3.6 1.6 73.7 99 0.000

Posttest 19.2 1.3

Researcher applied paired t-test for comparison of

knowledge scores of pretest and posttest.Average knowledge

score in pretest was 3.6 which increased to 19.2 in posttest.

T-value for this comparison is 73.7 with 99 degrees of

freedom.Corresponding p-value is 0.000.

This indicates that the knowledge of patient relatives

improved significantly after planned health teaching.

70
 Average knowledge score of health teaching programme in pretest
and posttest regarding diabetes mellitus among patient relatives

19.2

3.6

Pretest Posttest

Fig-4

Bar Diagram showing Average knowledge score of health teaching

programme in pretest and posttest regarding diabetes mellitus

among patient relatives

71
Section IV

Analysis of data related to the association of knowledge

health teaching program regarding Diabetes Mellitus among patients

relatives attending Diabetes OPD in selected hospitals with their

demographic variables.

Association of knowledge of health teaching program regarding

Diabetes Mellitus among patients relatives attending Diabetes OPD in

selected hospitals with their demographic variables was assessed

using Fisher’s exact test.The summary of Fisher’s text is

tabulated below:

Table 5:Fisher’s exact test for association of knowledge

of health teaching program regarding Diabetes Mellitus among patients

relatives attending Diabetes OPD in selected hospitals with their

demographic variables.

N=100
Demographic variable Average Poor p-value

31-41 year
4 37
Age
41-50 year 1 34
0.299

51-60 year 2 35

Above60 year 0 24

Male 3 54
Gender 1.000
Female 2 41

72
 N=100

Demographic variable Average Poor p-value

Illiterate 4 25

Primary 1 54
Education
0.171
Secondary 0 10

Graduation 0 5

Post graduation 0 1

House work 1 40

Service 0 29
Occupation 0.491
Labour 1 18

Retired 4 43

Rs.5000-Rs.15000 2 40
Family
Rs.15,001-Rs.15,000 0 27
income in
rupees Rs.25,000 Rs.35,000 3 50 0.320

Above Rs.35,001 2 18

Since p-value corresponding to‘Do you have previous

knowledge of health teaching programme(less than 0.05),

demographic variable‘Do you have previous knowledge of health

teaching programm’was found to be significant.

73
 CHAPTER V

Findings, discussion, summary, conclusion, limitation and

recommendation

This chapter presents a summary and conclusion of the

study,as well as its implication for nursing and health care

services followed by its limitations.This chapter ends with

suggestions and recommendation for future research in this

field.

Major findings of the study

SECTION I

Description of demographic data

Description of samples according to personal characteristics

in terms of frequency and percentages-

In above finding 36(36%)of the 31-41 year,39(39%)of them had

age 41 to 50 years and 22(22%)of them had age 51-60 years,3

(3%)above 60 year.

2.In the above findings,57(57%)were males and 43(43%)of them

were females.

3.In the above table states that 29(29%)of them were from

illiterates,55(55%)of them had primary education,10(10%)of them

done secondary education,5(5%)of them had post graduation and

1(1%)of them done post graduation.

4.41(41%)of the were doing house work,30(30%)of them had

services,20(20%)of them had laborer,9(9%)of them had Retired.

74
5.30(30)%of them had monthly family income upto Rs.5000 Rs.

15,000,40% of them had monthly family incomeRs.15,001-Rs.25,000

and 20% of them had monthly family income Rs.25,001-Rs.35,000,

10(10%)of them had above Rs.35,001.

SECTION II

Table.2:Analysis of data related to identify the level of

knowledge regarding Diabetes Mellitus among patient’s relatives

attending Diabetes OPD in selected hospitals”.

95% of the patient relatives had poor knowledge(score0-6)

and 5% of them had average knowledge(score7-13)regarding

diabetes mellitus.

SECTION III

Analysis of data related to effect of on knowledge of

patients relatives regarding Diabetes OPD.

Effect health teaching program of on knowledge of patients

relatives regarding Diabetes Mellitus among patients relatives

attending Diabetes OPD in selected hospitals.

In pretest,95% of the patient relatives had poor knowl-

edge(score0-6)and 5% of them had average knowledge(score7-13)

regarding diabetes mellitus.

In posttest,99% of the patient relatives had good

knowledge(score14-20) and 1% of them had average knowledge

(score7-13)regarding diabetes mellitus among patient’s

relatives attending Diabetes OPD in selected hospitals.This

75
 indicates that there is remarkable improvement in the knowledge

of patients relatives after health teaching programme.

SECTION IV

Analysis of data related to the association of knowledge

health teaching program regarding Diabetes Mellitus among patients

relatives attending Diabetes OPD in selected hospitals with their

demographic variables.

Association of knowledge of health teaching program regarding

Diabetes Mellitus among patients relatives attending Diabetes OPD in

selected hospitals with their demographic variables was assessed

using Fisher’s exact test.The summary of Fisher’s text is

tabulated below:

Fisher’s exact test for association of knowledge of health

teaching program regarding Diabetes Mellitus among patients relatives

attending Diabetes OPD in selected hospitals with their demographic

variables.

Since p-value corresponding to‘Do you have previous

knowledge of health teaching programme(less than 0.05),

demographic variable‘Do you have previous knowledge of health

teaching programm’was found to be significant.

Discussion

The findings of the study are discussed with reference

to the objectives stated in chapter 1 and with findings of

other studies.

76
 Major findings of the other studies

The findings of this study have been discussed with

reference to the objectives.

Similar study on a study was conducted on effectiveness of

individual planned teaching to the caregivers Astha Nepal,a

non-governmental organization (NGO)has designed a pilot

intervention which aims to train local health care providers

and involve NGOs,the local community, students and youth groups

to increase diabetes awareness in the community. Educational

programmes in the Pokhara valley to sensitize people regarding

the different aspects of diabetes and its prevention and

management are required. The Drug Information Center (DIC) of

our hospital runs a Medication Counseling Center (MCC) which

provides counseling to the selected out patients regarding

their disease,medications and lifestyle modifications. In this

center the diabetes patients are also being provided

counseling.The preliminary evaluation of the center concluded

that the MCC can play a definite role in enhancing patients’

understanding about medications and disease pattern, which in

turn may improve patient compliance. There is a huge scope for

this center in providing counseling to the diabetes patients.

The Departments of Internal Medicine,Community Medicine,

Hospital and Clinical Pharmacy,Pharmacology of our institution

aim to have more diabetes screening and awareness programmes in

77
the future. However, due to logistical and other reasons only

two more diabetes screening and education programmes were

organized in the two years following the data collection.70

The study of assess the knowledge and effect of health teaching

program regarding Diabetes Mellitus among patients relatives

attending Diabetes OPD in selected hospitals.”

During the researcher personal and clinical experience

research found the diabeties mellitus patients have

complications and many problems because of lack of knowledge,

attitude are the contribution of the quality of life in

Diabeties mellitus patient.Hence the researcher identified an

education to the patient relatives is necessary and selected

this topic.

Summary

The main aim of the study was to assess knowledge and

practice regarding home management of chronically ill client

among care givers.

The conceptual frame work used for this study was based

on E King goel attainment thory.Pre-Experimental Pre-test post

test design.Design was adopted for the present study.Study

consisted of 100 samples of pateints relatives.Sample and

Sampling In this study sample is relatives of diabetes mellitus

patients attending diabetes OPD.In this study Purposive

78
sampling technique is used.study Sample size was 100 patient’s

relatives.

The present study aimed at assessed the knowledge and

effect of health teaching programme regarding Diabetes Mellitus

among patients relatives attending Diabetes OPD in selected

hospitals.

Thus,a Structured Knowledge Questionnaire was used to

assess knowledge of patients relatives and assess effect of the

health teaching programme regarding diabetes mellitus among

patients relatives attending diabetes OPD was prepared.

Deals with Structured knowledge Questionnaire Schedule for

Baseline data all the patients relatives attending Diabetes OPD

in selected hospitals was prepared.

suggestion given by the ethical committee experts.A

Structured Knowledge Questionnaire Schedule for baseline data

of patients relatives and to assess the health teaching

programme regarding Diabetes Mellitus among patients relatives

attending Diabetes OPD in selected hospitals.

Tool was checked by guide after final correction which

content validity of the tool and then it was submitted to 20

experts who included doctors from medical department,obgy and

gynac Department and statistician and were faculty members of

different college of nursing.15 tools were received back from

experts and they suggested for modification of tools.

79
 Data Collection Tool sent for validation tool,Re-

organization of the item of the tools was done finally and

validated tools were ready to ascertain the data from the

sample subjects. The final tool was made and then the reliability

of the tool was done.quantitative research approach was considered

being appropriate to assess the knowledge and effect.Research design

chosen for this study is one group pre test post test pre

experimental design.In the present study a pre test was

administered by means of structured questionnaire depicted as O1

and then Health Teaching was developed depicted x.A post test

was conducted using the same structured questionnaire depicted

as O2.Quasi experimental one group pre & post test research

design.In this study research design was selected for this

study was Pre-Experimental Pre-test post test design.

Research setting in this study is the selected hospital OPD,Rao

hospital,in pcmc Pimpri for assessing the knowledge and effect

regarding Diabetes Mellitus among patients relatives those are

attending Diabetes OPD.

In this study,‘Purposive Sampling technique is used.Sample

consists of 100 patients relatives those are attending diabetes

OPD in selected hospitals.Data was collected by using

Structured Knowledge questionnaire.The investigator introduced

herself and obtained consent from patient relatives in the

selected hospital this participates who were willing to

80
participate.Purpose and importance of research study has

explained before collection of data.The Questionnaire was given

to the patient relatives to assess their knowledge on diabetes

mellitus.

The technique of Pre test and Post test design was used to

assess the knowledge of patient relatives for the adolescent

regarding diabetes mellitus.

Structured Knowledge Questionnaire was used to assess

knowledge of patients relatives and assess effect of the health

teaching programme regarding diabetes mellitus among patients

relatives those attending diabetes OPD.The reliability co-

efficient‘r’of the knowledge questi-onnaire was 0.86,calculated

by test-retest method which is more than 0.8.Hence the

questionnaire was found to be reliable.

The data analysis was planned to include descriptive and

inferential statistics.The following plan of analysis was

developed with opinion of experts.The analysis was done based

on the objectives and hypothesis to be tested.The demographic

data was be analyzed in terms of descriptive statistics.

Demographic data was analyzed using frequency and

percentage and presented in the form of table and graphs.

Data from the questionnaire before and after Health

teaching administered to be analyzed using frequency,

percentage and ‘t’ test.

81
 Association between knowledge finding and demographic

variables using t test and one way ANOVA.

Conclusion

The overall experience of conducting this study was

satisfying one,as there was good co-operation from.

Knowledge and effect of health teaching program regarding

Diabetes Mellitus among patients relatives

The study was a new learning experience for the

investigator.The result of the present study shows that the

demographic variables which were found to have significant

association with knowledge and effect of health teaching

program regarding Diabetes Mellitus among patients relatives.

Implications of the study

The present study findings have implication for nursing

research, administration, practice and education.

Nursing Education

Nursing Education should prepare effective and competent

future nurses.Active participation of the students nurses in

conducting educational programmes to provide information

knowledge and effect of health teaching program regarding

Diabetes Mellitus among patients relatives there problems and

home management.The nursing curriculum focuses more on the

preventive aspect,the nurse must therefore, be prepared to

identify the areas of knowledge deficit through the

82
assessment Of learning needs of health teaching program

regarding Diabetes Mellitus among patients relatives

attending Diabetes OPD in selected hospitals.

Health information can be imparted through various

methods like lecture,incidental teaching, and mass media.

Several educational strategies can be used to disseminate

the health information like lecture,demonstration,flip

chart, flash cards, and hand out set, which would make it

interesting and helps to gain adequate knowledge. Nurses

have to involve themselves in the areas of health practices

which help to patients relatives control problems and pain

in chronically ill client.And improve them.

Nursing Practice

In assessing knowledge and practice regarding study to

assess the knowledge and effect of health teaching program

regarding Diabetes Mellitus among patients relatives attending

Diabetes OPD in selected hospitals.”

Nurses need to implement an awareness programs on

chronic illness and provide care and support to knowledge

and effect of health teaching program regarding Diabetes

Mellitus among patients relatives and find out the problems.

83
 Nursing Administration

Nurse administrators are responsible to identify the

nature of the to assess the knowledge and effect of health

teaching program regarding Diabetes Mellitus among patients

relatives attending Diabetes OPD in selected hospitals.

The study assists the nursing administrative

authorities to initiate and carry out study at such selected

OPD.Nurse administrator can also take the initiative in

imparting health information through different effective

methods.They have to support and encourage the nursing

students to participate in health promotion activities and

reduce chronically illness and improve home management among

care givers.

RECOMMENDATION

On the basis of the findings of the study, the

following recommendations are made for the future research.

1.A similar study can be replicated on a larger sample with

different demographic characteristics.

2.A similar study can be replicated with broader content

knowledge and effect of health teaching program regarding

Diabetes Mellitus among patients relatives.

3.A similar study can be done in different setting.

4.Same study can be conducted by using different set of

questionnaires.

84
 APPENDIX ‘A’

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27.Medical Allied Health Dictionary,(2008),‘5thedition,‘Pp’.no-

28.Basavanthappa,Nursing research,(2008)1st edition, New Delhi,

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30.Cheta D,Dumitrescu C,(2012),‘Public health:India's diabetes

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32.Gates,Mechine M.(2011),‘Public health:India's diabetes time

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33.who,(2015),‘World Health Organization:(2015),Global status

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34.Dinesh K Upadhyay, Subish Palaian, P. Ravi Shankar, Pranaya

Mishra,etal.Knowledge,Attitude And Practice About Diabetes

Among Diabetes Patients In Western Nepal,Original Article-

1.2007;

35.Shetty P;(2012),‘Public health:India's diabetes time bomb.

International Weekly Journal of Science,2012; 485

36.Shankar PR.(2010),Subish P,Vijay Bhaskar,Dubey AK,etal.

Knowledge And Perceptions About Diabetes In The Community: A

Survey Among Individuals Attending A Diabetes-Screening

Programme In Pokhara City, Western Nepal,Pharmacology online

.2010;1:148-161.

37.Ranjini Ambigapathy,Subashini Ambigapathy,H M LingA.

Knowledge,Attitude And Practice(Kap) Study Of Diabetes Mellitus

Among Patients Attending Klinik Kesihatan Seri Manjung,NCD

Malaysia.2009;2(2):6.

38.Saurabh RS.(2012),‘Services provided by Drop in Centre,care

givers home care,Vol 2, No1,‘Pp’.445-461

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39.Naeema Badruddin, Abdul Basit, M.Zafar Iqbal Hydrie and

Rubina Hakeem,etal.Knowledge,Attitude And Practices Of Patients

Visiting A Diabetes Care Unit.2002;1(2):99-102.

40.Sweetha T,Smitha T,‘(2012),‘Self care knowledge on diabetes

among diabetic patients in Warangal Region: International

Journal of Life Science and Pharma Research. 2012;2(2).

41.Archibald PG,(2009)IOSR Journal of Nursing and Health

Science (IOSR-JNHS) e-ISSN:2320–1959.p- ISSN: 2320–1940 Volume

4,Issue(May,Jun.2015),PP01-08

42.Padma B Prabhu,(2015),‘Volume : 2 Issue : 2 Page 54-60 Level

of understanding about diabetes mellitus among health seekers

for diabetic related eye care.

43.Kamal Deep Joshi(2017),‘A Study on Effects of Diabetes

Mellitus on Auditory System,1(2): 99-102.

44.Mc.daniel G.et al,http;//www.pubmed.com.jin HM.M.J.clin 2008

sep;88(3);660-6.
45.Corolyn,L Gegor, Helan vermay, Jan M Kriebs;(2005),‘Varneys

text book of midwifery:4th edition,2005,Rajendra K Arya New

Delhi:863,866.

46.Mercer.BM.(2003),‘Preterm premature rupture of the

membranes.Obstetrics and Gynecology 2003;101:178,93.

47.Black JM,Hawks JH.(2009),‘Medical-Surgical Nursing: clinical

management for Positive outcomes.8th ed.Philadelphia:Reed

Elsevier India Pvt Ltd;.

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age of 40.Seminars in Oncology 2009;36(3):237-49

49.Amutha P.Effectiveness of structured teaching program on

breast self examination for early detection of breast cancer.

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50.Farmer A,wade A,(2010),‘Etiology and outcome of low birth

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51.Farmer A,2010 Blackmore CA,Thorp JM(2009),‘Epidemiologic

characteristics of preterm delivery.Etiologic heterogeneity.Am

J Obstetrics and Gynecology ;164:467.

52.WHO(2012),‘Trends in Diabetic Mellitus,1990 to 2010.

2012,World Health Organization,UNICEF,UNFPA and The World Bank

:1-59.

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Care Centre:Indian Journal of Basic and Applied Medical

Research. June 2013: Issue-7.Vol-2: 702-709

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2000.173-184.

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acute care hospitals Wound Repair,vol-16,no-(1),‘Pp’11-8.

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es-related-to-knowledge of caregiver.

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Nursing research January,vol-23,no,9,‘Pp’34,35,36.

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59.Archibald PG.(2007),‘Pain of DM and stress of care giving:

links between patient function and caregiver burden.Journal of

Orthopedic Nurses,vol-26,No(3),’Pp’:155-156.

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outcomes in the elderly hip fracture population,Clinical

Orthopedics and Research,vol-6,no-30,‘Pp’23-24.

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‘Pp’33,34,25,36.

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Kirk,and SchrollKnowledge about Aging—the Way to Action,vol-

7,no-9,‘Pp’9.10,11.

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homecare management,‘Pp’20,23

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limited,‘Pp’34-35.

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Nursing Dictionary,6th edition,‘Pp’no-28.

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2001,page 108-117.

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Publisher limited,‘Pp’44-45.

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about domains of the child development.‘Pp’ 33:237-244.

92
 SECTION II

STRUCTURED QUESTIONNAIRE
ANSWER KEY

NO ANS

1 A

2 A

3 B

4 A

5 B

6 B

7 A

8 D

9 A

10 D

11 A

12 D

13 C

14 C

15 C

93
 APENDIX ‘B’

SR.NO LIST OF EXPERTS

1. Mr.Suresh Ray(CHN)

Asst.Proffesor

BVDU College of Nursing

2. Mrs.Minnimol Louis

Associate Professor

BVDU College of Nursing

3. Mr.Hanumaan Bishnoi

Associate Professor

Sihangad College of Nursing

4. Mr.Vishal Naikre

Asst.Professor

Sihangad College of Nursing

5. Mr.Ramakant Gaikwad

Asst.Professor

Sihangad College of Nursing

6. Mrs.Romila devi

Lecturer

mkss College of Nursing, Pune

7. Dr.Hemant Deshpande

HOD(Dept of Obs and Gyn)

Dr.D.Y.Patil Medical College,Pimpri,Pune 18.

94
SR.NO. LIST OF EXPERTS

8. Mrs.Rupali salvi(CHN)

Asso,Proffesor

Dr.D.Y.Patil College of Nursing

9. Mrs.Sadhna Adhyapak(MED-SURG)

Associate Proffesor

Department of medical surgical

D.y.Patil College of Nursing

10. Mrs.Kavita Kelkar(CHN)

Lecturer

Sinhgad college of nursing

11. Ms.Suchita Yangad(MED-SURG)

Lecturer

D.y.Patil College of Nursing

12. Mrs.martha rout (OBS/GYN NSG)

Lecturer

D.y.Patil College of Nursing

13. Ms.Jaybala Aghamkar (OBS/GYN NSG)

Lecturer

D.y.Patil College of Nursing

14. Dr.Sharma Sir.

Professor

Medicine,Department.D.Y.Patil Medical College

95
SR.NO. LIST OF EXPERTS

15. Dr.Deshpande sir

OBS AND GYNAC,Department

D.Y.Patil Medical College

16. Dr.Patvekar madam

OBS AND GYNAC,Department

D.Y.Patil Medical College

17. Ms.Manisha Gaikwad(MED-SURG)

Lecturer

D.Y Patil College of Nursing

19. Mrs.Vaishali Chirmade(PEAD)

Statistician

96
 APPENDIX ‘C’

Letter requesting permission from ethical committee to conduct

the study
From,

Mrs.ASHWINI CHAVAN

Final year M. Sc.(N)student.

Dr.D.Y.Patil Nursing College

Pimpri Pune-18

The Principal,

Respected madam,

In the partial fulfillment of M.Sc.Nursing degree,I have

to undertake a research project in the clinical specialty area

Obstetric and Gynecologic Nursing.

Topic:“A study to assess the knowledge and effect of health

teaching program regarding Diabetes Mellitus among patients

relatives attending Diabetes OPD in selected hospitals.”

I wish to seek administrative permission from the ethical

committee to conduct the study. May I request you to kindly do

the needful.Herewith I am enclosing a copy of research proposal

and copy of data collection tool.

Thanking you,

Yours sincerely,

(Mrs.Ahwini Chavan)

97
 APPENDIX ‘D’

CONSENT FORM

CODE-: NO.

I-----------hereby give my consent,for my participant in

the study titled “A study to assess the knowledge and effect of

health teaching program regarding Diabetes Mellitus among

patients relatives attending Diabetes OPD in selected

hospitals.”While it is being conducted by Mrs........M.Sc.

Nursing student of Dr.D.Y.Patil College of Nursing;it has been

informed that the information collected will be kept

confidential and will cause no harm to the participant.I am

taking part in this research study without any external

pressure or objection.Thank you.

I have been explained about this study and I am willing to

participate.

Date-: / /

Signature of participant

98
 APPENDIX ‘E’

Structured questionnaire on assess the Knowledge regarding

Diabetes Mellitus among Patients Relatives attending Diabetes

OPD. Code no

DESCRIPTION OF TOOL

PART I

Demographic variables which includes sex, age, education,

weight,height,occupation etc.

PART II

Tool:-Questionnaire

Tool to assess knowledge and practice regarding Diabetes

Mellitus among Patients Relatives attending Diabetes OPD in

selected hospitals.

Instruction

1.Please read each item carefully and express your repose by

placing (√) on appropriate answer.

2.Attempt all question

3.Avoid over writing.

SECTION I

1)Age

a)31-41 year

b)41-50 years

c)51-60 year

d)Above 60 year

99
2)Gender

a)Male

b)Female

3)Education

a)Illiterate

b)Primary

c)Secondary

d)Graduation

e)Post graduation

4)Occupation

a)House work

b)Service

c)Labour

d)Retired

5)Family income in rupees

a)Ruppes 5000-Rs.15,000

b)Rupees 15,001-Rs.25,000

c)Rupees 25,001-Rs.35,000

d)Above Rs.35,001

100
 APPENDIX ‘F’

Section II Code no

Knowledge regarding disease condition

1.What do you understand about diabetes mellitus.

a)Increased sugar level

b)Increased blood pressure

c)Decreased sugar level

d)Decreased blood pressure.

2.What are the signs and symptoms of diabetes mellitus?

a)Polyuria

b)Backache

c)Weakness

d)Weight loss

3.What are the investigations of diabetes mellitus

a)Urine test

b)Blood test

c)Sputum test

d)Stool test

4.The normal sugar level is

a)100 to 150 mg/dl

b)120 to 160 mg/dl

c)180 to 220 mg/dl

d)200 to 120 mg/d

101
5.The type of diabetes mellitus is

a)1

b)2

c)3

d)4

6.What is the primary treatment of type-2 diabetes mellitus

a)Weight loss

b)Insulin

c)Oral medication

d)Surgical treatment

7.The most preferred route of insulin injection is

a)Subcutaneous

b)Intramuscular

c)Intravenous

d)Deep intra muscular

8.Diabetes diet should be

a)Soft

b)Sugar free

c)Liquid diet

d)Semi solid diet

102
9.Diet diabetes patient should take

a)2-3 times a day

b)4-5 times a day

c)Strictly 3 times a day

d)1 time daily

10.The dietary pattern of diabetes patient will be

a)Low caleries diet

b)Exchange of food items

c)All frequent meal

d)All of the above

11.The complication of diabetic mellitus are expect

a)Hypoglycemia

b)Headache

c)Loss of appetite

d)Loss of weight

12.The care taken diabetic patient is to avoid diabetic

complication.
a)Regular Exercise

b)Diet control

c)Take drug on time

d)All of the above

103
13.Diabetic Patient should always have following things while

travelling.

a)Sugar

b)Drugs

c)Identification card

d)Food

14.Which the organ that is less functioning of diabetes

mellitus
a)Stomach

b)Kidney

c)Liver

d)Pancreas

15.Which the more treatment for diabetes mellitus

a)Physiotherapy

b)Doug therapy

c)Insulin therapy

d)Weight reduction therapy

104
 APPENDIX ‘G’

LANGUAGE TRANSLATOR’S LETTER.

This is to certify that I have translated the tool used by

Mrs.Ashwini chavan in her study “A study to assess the

knowledge and effect of health teaching program regarding

Diabetes Mellitus among patients relatives attending Diabetes

OPD in selected hospitals.”from English to Marathi.

I wish her Best wishes.

(Mr.Ladhe P.H.)

Pimpri Pune -18: -

Date: -

105
 APPENDIX ‘H’

EDITOR LETTER

This is to certify that I have edited the study done by

Mrs.Ashvini Chavan Topic “A study to assess the knowledge and

practice regarding first degree relatives of type 2 diabetes

mellitus among patients attending diabetes OPD in selected

hospital”.

I wish her Best wishes for the same.

Pimpri Pune -18:

Date:

106
 अनुमती
संशोधनात भाग घेण्यासाठी अनुमती पत्र.
मी.श्री.सौ.---------- खालील संधोधनात सहभागी होण्यास अनुमती दे त आहे . हे

संशोधन ममममममममम मममममम मममममम ममममम मममममम ममममम

ममममम मममममम मममममममम ममम.मम मममममम,
"ममममम मममममममममम मममममममममममम मममममम
मममममममममममम ममममम ममममम मममममममममम ममम.मम
ममममममममममम म.मम.मम.ममम मममममममम ममममम मममममम मममम
ममम.”
हे संशोधन सौ.ममममममम मममममम डॉ .डड .वाय पाटील नडसिंग कॉलेज,

एम. एस. सी नडसिंगची डवद्यार्थीनी असुनया सं दभाा त डदलेली माडहती गुप्त ठे वण्याची खात्री

डदली आहे .तरि कोणत्याही दबावा खालीन येता मीसं शोधनसास सहभागी होण्यास अनुमती

दे त आहे .

ममममममम

ममममम
मममममममममम मममममममममममम ममम

107
 विभाग – अ

सुचना–कृपया प्रश्न काळजी पुवाक वाचा आडण अचूक उत्तिला √ अशी खुण किा.
ममम मम.
विभाग – अ

सुचना–कृपया प्रश्न काळजी पुवाक वाचा आडण अचूक उत्तिला √ अशी खुण किा.
ममम मम.
ममममम म.
मममममममममम
१.११
म.मम-मम मममम
म. मम-मम मममम
म.मम-मम मममम
म. मम मममम मम
१.११११
म. ममममम
म. मममममम
१.११११११
म.मममममममम
म.मममममममम
म.मममममम
म.मममम
म. मममममम
१.१११११११
म.मममममम ममम
म.ममममम
म.ममममम
म.ममममममम

108
१.ममममममममम ममममममम ममममममम
म.मम.मममम-ममममम मम.
म.मम.मम,ममम-मम.ममममम
म.मम.मम,ममम-मम.मम,ममम
म.ममममम मममम मम

ममम मम.
ममममम म.

ममममम ममममम मममममम ममममम

म.मममममममममममम ममममममम मममम ममममम ममम मम.?

म.मममम ममम मममम
म.ममममममम मममम ममममम
म.ममममममम मममममम ममममम
म.ममममममम मममम ममम मममम

109
१.१११११११११ १११११ १११ ११११११ १११११ ११११.
म.ममममम मममममममम मममम मममम
म.ममममम ममममम
म.मममममममम
म.ममम ममम मममम

म.ममममममममममम मममममममम ममममममम मममम.

म.मममममम मममममम
म.ममममममम
म.ममममममम
म.मममममममम

१.११११११११११ १११११११ ११११११ ११ १११.

म.ममम-ममम मम.मम/मम.ममम.
म.ममम-ममम मम.मम/मम.ममम.
म.ममम-ममम मम.मम/मम.ममम.
म.ममम-ममम मम.मम/मम.ममम.

१.१११११११११ ११११११ ११ १११

म.म
म.म
म.म
म.म

१.१११११११११ १११११११११ ११११११ १११ १११.

म.ममम ममम मममम.
म.मममममममम ममम मममम
म.ममममम ममम
म.मममममममममम ममममम

110
१.११११११११ ११११११११११ १११११११ ११११११११ १११११
११११११११ ११११ ११११.
म.मममममममममम
म.मममममममममम
म.ममममममम
म.ममम मममममममम

१.११११११११ ११११ १११ ११११११.

म.मम
म.मममम मममममम
म.मममम मममम
म.ममममम मम मममम

१.११११११ ११११११११ १११११११ ११११ ११११ ११११ १११११

११११११.
म.मममममममम म-म मममम
म.मममममममम म-म मममम
म.मममममममममम मममममममम ममम मममम.
म.मममममममम मम मममम

111
 PLANNED HEALTH TEACHING

SUBJECT: Medical Surgical Nursing TOPIC: Diabetes Mellitus

GROUP: Patients relatives attending diabetes mellitus PLACE: D.Y.Patil hospital.OPD.

DURATION: 45 minutes TEACHING AIDS: Charts,Flash cards.

METHOD OF TEACHING: Lecture cum Discussion

PREVIOUS KNOWLEDGE OF THE GROUP: The group has some knowledge regarding Diabetes Mellitus .

GENERAL OBJECTIVES:

At the end of planned teaching, the group will have adequate knowledge on Diabetes Mellitus .

SPECIFIC OBJECTIVES: At the end of planned teaching, the group will be able to

1) Define Diabetes Mellitus.

2) List down the causes of Diabetes Mellitus.
3) Explain the clinical features Diabetes Mellitus.
4) Discuss the treatment of Diabetes Mellitus.
5) Explain the diets taken for Diabetes Mellitus.

112
 HEALTH TEACHING PLAN ON DIABETES MELLITUS

SR. TIME SPECIFIC CONTENT TEACHING/LEARNING A.V.AIDS EVALUATION

NO. OBJECTIVES OBJECTIVES
Self introduction I am ashwini chavan Msc.Nursing student from Dr.D.Y.Patil
college of nursing,Pune-18.Today we are going to discuss a
1. 1min.
very important topic that is-diabetes mellitus.
The group will be DEFINITION OF DIABETES MELLITUS
able to understand The group will be
Diabetes mellitus is a group of metabolic disease
2. 2min. meaning of What do you mean by able to understood
Lecture
diabetes mellitus. characterized by hyperglycaemia, resulting from defect in meaning of diabetes
diabetes mellitus
mellitus.
insulin secretion, insulin action, or both.
Cum
The group will be TYPES
able to understand What are the types diabetes The group will be
types of diabetes 1) Type-I Insulin dependent diabetes mellitus able to understood
mellitus Discussion
3. 3min mellitus. 2) Type-II Non insulin dependent diabetes types of diabetes
mellitus.
mellitus.
The group will be CAUSES OF DIABETES MELLITUS
able to list down What are the causes
the causes of 1. Obesity
diabetes mellitus
4. 3min diabetes mellitus. 2. Hereditary Chart

3. Pregnancy (gestational diabetes)

4. Increasing age

113
SR. TIME SPECIFIC CONTENT TEACHING/LEARNING A.V.AIDS EVALUATION
NO. OBJECTIVES OBJECTIVES
5. Infection with a specific virus or bacteria
6. Exposure to food-borne chemical toxins
7. Physical inactivity
8. Certain medicines

CLINICAL FEATURES

The group will be 1. Incresead urination (especially during

3min able to enumerate night) What are the clinical Flash card The group will be
5. the signs and able to understood
symptoms of 2. Increased hunger (especially after eating) features diabetes clinical features of
diabetes mellitus. mellitus diabetes mellitus.
3. Increased thirst (>10glasses a day)
4. Unexplained weight loss
5. Slow to heal wounds
6. Giddiness and weakness
7. Tingling or numbness in hands or feet
8. Blurred vision
9. Frequent skin,bladder or gum infections
10. Irritability
11. Extreme unexplained fatigue

114
SR. TIME SPECIFIC CONTENT TEACHING/LEARNING A.V.AIDS EVALUATION
NO. OBJECTIVES OBJECTIVES
TREATMENT
The group
The goals of diabetes management are to reduce symptoms,
will be able to
6. 7min enumerate the promote well being, and prevent short term complication. What is the treatment Lecture The group will be
signs and able to understood
1.Nutritionl therapy diabetes mellitus
symptoms of treatment of
diabetes 2.Insulin(to decrease blood sugar level) Cum diabetes mellitus.
mellitus.
3.Diabetes drug
Discussion
4.Physical activity
5.Self monitoring blood glucose
6.Foot care
7.Yoga and regular exercises
8.Regular check-up
9.Countinuating of care
10.Wegiht control
11.Patient and family teaching
12.Follow up programme.
7. 6min The group DIET
will be able to The group will be
1.Diabetes patient should not eat much together What is the dietary
understand the able to understood
dietary but should 4-5 times a day. management diabetes Dietary
management management
2.Diet should be consumed at regular interval mellitus
diabetes
mellitus.

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NO. OBJECTIVES OBJECTIVES
3.One should consume low calorie and sugar free
diet
4.Exchange of food items is permitted
5.A diabetes patient should never fast
6.Green leafy vegetables should be included in
the diet.
7.Obese person should take low fat diet.
8.Chocolates,cake,jam and bkery items should be
avoided.
9.Some fruits should be restricted
10.Apple And Tea without sugar is allowed
11.Alcohol should be restricted.
12.Some fruits are allowed but
banana,mango,chiku,and dired fruits should be
restricted.

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SR. TIME SPECIFIC CONTENT TEACHING/LEARNING A.V.AIDS EVALUATION
NO. OBJECTIVES OBJECTIVES
SUMMERY
So,i delt with diabetes mellitus today.In that we saw the
definition,various type of diabetes mellitus,causes and clinical
fetures,treatment and dietary management.

CONCLUSION
The group came to know about the diabetes mellitus and its
types,causes,clinical features, treatment and dietary
management.

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