CHAPTER-1

INTRODUCTION

“People will forget what you said, people will forget what you did, but people
will never forget how you made them feel.”

Maya Angelou

BACKGROUND OF THE STUDY

A healthy individual is not only physically healthy, but is also mentally

healthy. The modern concept of health extends beyond the proper functioning of the

body. It includes a sound, efficient mind and controlled emotions. Health is a state of

being sound, or whole, in body, mind or soul. It means that both body and mind are

working efficiently and harmoniously. Man is an integrated mechanism, a

psychosomatic unit (body- mind), whose behaviour is determined by both physical

and mental factors. Mental health which today is recognised is an important aspects

of one’s total health status, is a basic factor that contributes to the maintenance of

physical health as well as social effectiveness.

Mental health is a state of balance between the individual and the surrounding

world, a state of harmony between oneself and others, a co-existence between the

realities of the self and that of other people and the environment. Mental health

includes our emotional, psychological, and social well-being. It affects how we think,

feel, and act. It also helps determine how we handle stress, relate to others, and make

choices.

Mental health is very important for the emotional, social, psychological

development of school children. Mental health is important at every stage of life,

from childhood and adolescence through adulthood. A mentally healthy child will be
able to perform well in academics, adjust with others and shows normal behaviour.

Over the course of our life, if we experience mental health problems, our thinking,

mood, and behaviour could be affected. Mental health problems are common but

help is available. People with mental health problems can get better and many

recover completely. 4

Mental hygiene is the branch of psychiatry that deals with the science and

practice of maintaining and restoring mental health, and of preventing mental

disorder through education, early treatment, and public health measures. Positive

mental health allows people to Realize their full potential, Cope with the stresses of

life, Work productively, Make meaningful contributions to their communities.7

Mental hygiene is a community responsibility not just an individual concern.

WHO had chosen the theme ‘Making Mental Hygiene a Global Priority- scaling up

services through citizen advocacy and action’ during the year 2008, to focus

worldwide attention on the issues related to mental health.2

Children and adolescents form a major proportion of our country. According

to the 2001 census the population of India is 1.028 billion. 46.7% of this population

is below the age of 20 years. The period of adolescence is considered as crucial and

significant period of an individual’s life. Psychologically, adolescence is the age

when the individual becomes integrated into the society of the adults. It is the Stage

when the child no longer feels that he is below the level of his elders but rather an

equal with them, at least in rights. This integration into the adult society has many

aspects, more or less linked with puberty. It also includes intellectual changes. These

intellectual transformations, typical of an adolescent’s thinking, enable him achieve

his integration into the social relationships of the adults. This is the most general

characteristic of this period of development.3

The importance of psychological wellbeing in children and adolescents for

their healthy emotional, social, physical, cognitive and educational development is

well recognized. Mental health problems will contribute significantly to the global

burden of disease in the 21st century, and for adolescents, mental health hurdles are

already as common as some physical health problems. There are limited adolescent

mental health services in India.

The global burden of mental problems is high and opportunities for

promoting mental health are neglected in most parts of the world. One in four people

in the world will be affected by mental or neurological disorders at some point in

their lives. Around 450 million people currently suffer from such conditions, placing

mental disorders among the leading causes of ill-health and disability worldwide.

Over all cases shown that one in five adult – suffer from a diagnosable mental

disorder in a given year, and over 5 million people are disabled by severe mental

illness. Half of those who will ever be diagnosed with a mental disorder show signs

of the disease by age 14, three-quarters by age 25. In recent years, about 80% of

serious cases went untreated in poor countries, 35-40% in richer countries.1

The correctional system is designed to keep society at large safe by

separating them from individuals who have committed crimes. This is brought about

by incarcerating the convicted criminal in a jail or prison. More recently, a growing

number of those who are convicted of crimes of a less serious nature are sentenced to

an in house incarceration. In this form of punishment, the guilty party remains in his

own home, but is confined there through means of an electronic device.9

 Rehabilitation-For people who are convicted in juvenile court, the main focus

of the correctional system is rehabilitation. The courts feel that these young offenders

deserve a second chance to become a contributing member of society. Thus, the

juvenile justice system focuses heavily on rehabilitation that is designed to redirect

the young offender toward education and employment while at the same time

informing them about the importance of avoiding the adult correctional system.2

"Corrections" encompasses secure detention facilities like jails and prisons,

but it also includes programs and personnel. Probation and parole, rehabilitation

training, counselling, restorative justice and drug- and alcohol-therapy programs are

all contained within the broad meaning of corrections. The function of corrections is

to separate criminals from the society in which they would operate. Most young

people at a juvenile detention centre are there because of committing unlawful acts,

including violent crimes, property crimes, drug-related offenses, public disturbances

and even homicide. The ultimate goal of a juvenile detention centre is to educate,

rehabilitate and protect young people, and to encourage them to make positive life

changes. So now the name changed from juvenile home to children’s home.1

The government plays a crucial and formative role in the spheres of

cognitive, language, emotional, social, and moral development of children through

education. Lack of attention to the mental wellbeing of adolescents, in a key phase of

socialization, may lead to mental health consequences that may remain throughout

life and reduces the capacity of societies’ socioeconomic productive it. More

precisely, it can be claimed that proper psychosocial development of adolescent is

reflected with sound academic performance, physical health and adequate social,

emotional, and psychological health. This ultimately contributes in reducing the risk

of psychosocial and behavioral problems, violence, crime, teenage pregnancy, and

misuse of drugs and alcohol. Detection of psychosocial dysfunction in the early

adolescence can be fruitful for the quality of life of the individual.6

Children’s home plays a significant role in children’s mental health care.

Promotion of mental health can be achieved by effective public health and social

intervention. These include mental health promotion activities in the children’s

home. WHO reported in addition to their central role of fostering academic

development, correction homes serve an important role in the emotional health and

development of the children. Despite variations in the amount of time spent in

children’s home, they are the institutions for socialization in many societies.9

Learning is an important developmental aspect of Man during all stages of

his/her life span; the learning curve is on an upswing during adolescence. In a

civilized society, education is a method by which learning is ensured and enhanced

in adolescents. Children’s home are the system set up to meet this goal of learning

through education care, the educational sector was the sole source of care.3

Therefore, this study aimed to estimate the magnitude of psychosocial

problem/dysfunction and its relationships with associative factors among adolescent

residing in the children’s home at Kollam. Findings from this study are expected to

bring out hidden and neglected public health issues, which could help to increase the

attention of health planners and programmers to develop sufficient adolescent mental

health program.4

NEED AND SIGNIFICANCE OF THE STUDY

Adolescents has been considered as a high risk group of great stress,

impoverished coping skill and high vulnerability to biological, psychological and

educational demands. Adolescents are in the period of exploration and

experimentation, but the young people often lack of knowledge, experience and

maturity to avoid great risk that confront them. There are a number of reasons for

adolescent’s to be feeling stressed. These include problem with environmental

factors (education, culture, religion, society, legal responsibility), psychosocial

problems (psychological, social, behaviour pattern), lifestyle (food, substance use,

morality), coping skills (adjustment), among adolescent. Adolescent’s is often

characterized by rapid intellectual and social development, Adolescents individuals

are also commonly exposed to circumstances that place them at risk for psychiatric

disorders.5

The global burden of mental illness is high and opportunities for promoting

mental health are neglected in most parts of the world. One in four people in the

world will be affected by mental or neurological disorders at some point in their

lives. Around 450 million people currently suffer from such conditions, placing

mental disorders among the leading causes of ill-health and disability worldwide.

Over 44 million people in the U.S. – one in five adults – suffer from a diagnosable

mental disorder in a given year, and over 5 million people are disabled by severe

mental illness. Half of those who will ever be diagnosed with a mental disorder show

signs of the disease by age 14, three-quarters by age 25. In recent years, about 80%

of serious cases went untreated in poor countries, 35-40% in richer countries.

Worldwide, it is estimated that 10–20% of adolescents experience mental

health conditions, yet these remain under diagnosed and undertreated. Globally,

depression is the ninth leading cause of illness and disability among all adolescents;

anxiety is the eighth leading cause. Emotional disorders can be profoundly disabling

to an adolescent’s functioning, affecting schoolwork and attendance. Withdrawal or

avoidance of family, peers or the community can exacerbate isolation and loneliness.

At its worse, depression can lead to suicide.

According to NIMHANS report, studies have shown that, in India about 50%

students suffer from mental health problems .15% of the adolescents suffer from

mental disorder like depression, anxiety, hysteria, somatoform mental disorder,

adjust reactions, alcohol and drugs and other emotional problems and not having

awareness to seek treatment.6

According to UNESCO Report 2008, India stands at ten per cent for 5-15

year olds who have a diagnosable mental health disorder. This suggests that around

50 million children under eighteen would benefit from specialist services. There are

up to 20 million adolescents with a severe mental health disorder. Around 90 % of

children with a mental health disorder are not currently receiving any specialist

services.

Programmes targeted at adolescence should include preventive and promotive

strategies. Both youth mental health promotion and disorder prevention approaches

have grown from roots and give similar recommendations for the planning of

programmes. It is important to focus on risk and protective factors to prevent mental

health problems in adulthood as well as on the promotion of positive youth

development. Successful adolescent programmes include prevention of problems and

unhealthy behaviour as well as promotion of positive youth development. From all

these, investigator in her experience felt that the adolescence is the critical period for

facing psychosocial problems by identifying and by implementing proper preventive

measures we can achieve and promote mentally healthy adolescence

Many types of mental health dilemmas appear to be setting today’s

adolescents. The most common issue for adolescents is mood disorders, followed by
general developmental issues—a relationship, intimacy, identity, independence,

family issues, plans for the future. Next come anxiety disorders—social phobias,

obsessive-compulsive disorder, post traumatic stress disorder, and general anxiety

disorder. We also see many students with eating disorders and substance abuse

disorders and as is common in all areas of mental health, many of our adolescents

deal with more than one issue or disorder. The assessment revealed that 10% of all

adolescents surveyed had been diagnosed with depression.7

Still, one can hardly dispute the fact that even a few adolescents’ suicides

constitute terrible tragedies—that the suicide of even one student is a devastating

loss. There is reason to believe that certain types of mental health problems besides

suicide are increasing on society. Moreover, adolescent students’ mental health

troubles appear to be more serious than they used to be in the correction home. Most

report a 35% increase in psychiatric hospitalizations over the last five years from

correction homes

Rather than these also we can identify the adolescents, being key and

productive citizens of the future, need to be taken care of, as they are in the

transitional period characterized by enormous changes. As the age of adolescents is

the time of both risk and opportunities, it is high time to help and support them and

suitable measures are needed to enhance skill of children’s home in addressing

various day to day stressors so that they learn the ways and means of promoting their

mental hygiene.10

Statistical report by NIMHANS of diagnosed mental illness case among

juvenile home (2010-2012) are depression among male 7.5% and female 12.0%,

stress in male 5% and female 3.4%, anxiety among male 3.5% and among female

3.1%, alcoholic among male 25.5% and among 5.4%, substance abuse mainly heroin

among male 1.7% and in female 0.5% and cannabis in male 1.9% and 0.45%.7
 Researcher has recognize from some previous experiences of caring some

adolescents with mental hygiene who came for visiting in outpatient department for

counselling having some knowledge regarding other hygiene which is common in

our society but very poor knowledge about mental hygiene though it is a cause of

centre disability of health recently. So researcher realized that if awareness program

on mental hygiene can be conduct than as young blood adolescents can get some

benefit & also can act as informant regarding mental illness awareness for their

neighbour suffering from mental disability and as well as for entire society. These

make undertake the study as field of interest on knowledge & attitude of mental

hygiene among adolescents in government children’s home at Kollam.

Video Assisted Teaching is an effective instructional method using advanced

technology in its application. It is a technique which creates interest in the learners

with its three dimensional audio and visual effects in the learner. Hence I have

interested in assessing the effectiveness of Video Assisted Teaching on knowledge

and attitude regarding mental hygiene among adolescents.

STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of video assisted teaching on knowledge

and attitude regarding mental hygiene among adolescents in Government Children’s

home at Kollam

OBJECTIVES OF THE STUDY

The objectives of the study were,

1. To assess the knowledge and attitude regarding mental hygiene among

adolescents

2. To evaluate the effectiveness of video assisted teaching on knowledge

regarding mental hygiene among adolescents.

 3. To evaluate the effectiveness of video assisted teaching on attitude regarding

mental hygiene among adolescents.

4. To find the correlation between the knowledge and attitude regarding mental

hygiene among adolescents.

5. To test the association between the knowledge regarding mental hygiene and

selected demographic variables among adolescents.

6. To test the association between the attitude regarding mental hygiene and

selected demographic variables among adolescents.

OPERATIONAL DEFINITION

Operational definition is the definition of a concept or variable in terms of the

procedures by which it is to be measured.

Effectiveness

Refers to the outcome of video assisted teaching regarding mental hygiene

which produce desired effect in the form of gain in scores on knowledge and attitude

among adolescents.

Knowledge

Refers to the ideas expressed by adolescents regarding mental hygiene as

measured by using structured knowledge questionnaire.

Attitude

Refers to the opinion of adolescents regarding mental hygiene as measured by

attitude scale

Adolescent

Refers to minor children who involved in antisocial activities aged between

12 and 18 years admitted in terms of punishment and correction in Government

Children’s home
Mental hygiene

Refers to the measures taken by the adolescents to recover from psychosocial

problems, improve the mental health and control behavioural problems.

Video Assisted Teaching

Refers to the systematically organized content with relevant audio visual aids

regarding mental hygiene to enhance the lifestyle, psychosocial well being and

coping skills of adolescents

Government Children’s home

Refers to a Government institution for adolescents who committed antisocial

activities, where they are given care to correct their psychosocial problems.

ASSUMPTIONS

Assumptions are the principles that are accepted as being true based on logic or a

reason, without proof. In the present study, assumptions were:

1. Adolescents may have some knowledge regarding mental hygiene.

2. Adolescents may have unfavourable attitude regarding mental hygiene.

3. Video assisted teaching may improve the knowledge regarding mental

hygiene among adolescents.

4. Video assisted teaching may develop favourable attitude towards mental

hygiene among adolescents.

HYPOTHESIS

H1: The mean posttest knowledge score regarding mental hygiene is significantly

higher than the mean pretest knowledge score among adolescents

H2: The mean posttest attitude score regarding mental hygiene is significantly higher

than the pretest attitude score among adolescents.

H3: There is a significant correlation between the knowledge and attitude regarding

mental hygiene among adolescents.

H4: There is a significant association between the knowledge regarding mental

hygiene and selected demographic variables among adolescents.

H5: There is a significant association between the attitude regarding mental hygiene

and selected demographic variables among adolescents.

CONCEPTUAL FRAMEWORK

Conceptual framework is a theoretical approach to the study of problems that

are scientifically based, which emphasizes the selection, arrangement and

clarification of its concepts. A conceptual framework states functional relationship

between events & is limited to statistical relationships. The purpose of conceptual

framework is to organize concept that represent essential knowledge that might be

used by many disciplines.

In this study, Imogene King Goal Attainment Theory (1960) was used. The

theory was based on assumption that humans are open system in interaction with

their environment. The theory’s focus on interpersonal systems reflects King’s belief

that the practice of nursing is differentiated from that of other health professions by

what nurses do with and for individual. The major elements of the theory of goal

attainment are seen in the interpersonal systems in which two people, come together

in a health care organization to help and be helped to maintain a state of health that

permits functioning in roles. The concepts of the theory are perception, action,

interaction and transaction. These concepts are interrelated to every nursing situation.

These terms are defined as concepts in conceptual framework.

In this study, action involves the assessment of knowledge and attitude

regarding mental hygiene by structured knowledge questionnaire and attitude scale.

Reaction involves the development of video assisted teaching content regarding

mental hygiene. Interaction phase refers to administration of video assisted teaching

regarding mental hygiene to adolescents. Transaction involves the posttest to

evaluate the effectiveness of video assisted teaching on knowledge and attitude

regarding mental hygiene among adolescents.

Perception (P)

It is each person’s representation of reality. The elements of perception are

the importing of energy from the environment and organizing it by information,

transforming, energy, processing, information, storing information & exploring

information in the form of overt behaviours. In this study, investigator perceives lack

of knowledge and attitude regarding mental hygiene among adolescence.

Adolescence perceive learning needs to gain knowledge and attitude regarding

mental hygiene.

Action (A)

It refers to the activity to achieve the goal what the individual perceives. In

this study, it is mutual goal setting to improve the knowledge and attitude of

adolescence regarding mental hygiene. Investigator prepares structured knowledge

questionnaire and checklist to assess the knowledge and attitude of adolescence

regarding mental hygiene. Action takes place by means of pretest and with the

process of interaction and communication.

Reaction (R)

Reaction is not specifically defined, but might be considered to be included in

the sequence of behaviours described in action. In reaction, the investigator prepares

the video assisted teaching programme regarding mental hygiene with appropriate

audio visual aids.

Interaction (I)

It refers to the perception and communication between a person and the

environment or between two or more persons. In this study, investigator conducts a

video assisted teaching programme to the adolescence regarding mental hygiene with

appropriate AV aids

Transaction (T)

It is a process of interaction in which human being communicates with the

environment to achieve goals that are valued and directs human behaviours. In this

study, there is a purposeful interaction between the investigator & adolescence by

assessing the posttest knowledge & attitude regarding mental hygiene.

 Action Reaction Interaction Transaction
Perception : Lack of knowledge and attitude regarding Mental Hygiene
Mutual Goal - Developing Administration Post test
setting content on of Video analysis of
preparation of Video assisted assisted knowledge and
structured teaching teaching attitude of
knowledge regarding regarding adolescence
questionnaire Mental Hygiene Mental Hygiene regarding
Investigator and check list - Preparation of Mental Hygiene
conducting pre- teaching aids
Judgment : Educating the adolescence, will improve the knowledge and attitude regarding
test Mental Hygiene

Judgment : Self assessment

Adolescence
of knowledge
in and attitude and update the knowledge and attitude regarding Mental Hygiene
a Govt
Children’s
Home at
Kollam

Negative Outcome Positive Outcome

Perception : Need to gain knowledge and attitude regarding Mental Hygiene

Significant
No improvement of knowledge and attitude regarding improvement of knowle
Mental Hygiene

Feedback
Not included in the study