PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

RELU ANNI CHERIAN

1ST YEAR M.Sc.( NURSING )

MEDICAL SURGICAL NURSING

YEAR 2013 -2015

ST.PHILOMENA’S COLLEGE OF NURSING

#4 CAMPBELL ROAD, VIVEKNAGAR P.O

BANGALORE 560047

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

1
 BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

Ms.RELU ANNI CHERIAN

1. NAME OF THECANDIDATE ST.PHILOMENA’S COLLEGE OF NURSING
AND ADDRESS #4 CAMPBELL ROAD,
VIVEK NAGAR P.O.
BANGALORE-560047

ST.PHILOMENA’S COLLEGE OF NURSING

2 NAME OF THE
INSTITUTION

3 COURSE OF THE STUDY 1ST YEAR MSc.(NURSING),

AND SUBJECT MEDICAL SURGICAL NURSING

4 DATE OF ADMISSION TO 01-07-2013

COURSE
A STUDY TO ASSESS THE EFFECTIVENESS
OF SELF INSTRUCTIONAL MODULE ON
5 TITLE OF THE STUDY KNOWLEDGE REGARDING PREVENTION
OF OCCUPATIONAL LUNG DISEASES
AMONG WOMEN WORKING IN SELECTED
GARMENT FACTORIES, BANGALORE.”

6. BRIEF RESUME OF THE INTENDED WORK

2
6.1. NEED FOR THE STUDY

“EVERY HUMAN BEING IS THE AUTHOR OF HIS OWN HEALTH OR

DISEASE” 1

-GAUTAM BUDDHA

Globalization and Industrialization have reached its heights and provides ample
job opportunity .One of the largest manufacturing sector in India is garment factory
which accounts for around 25% of India’s import and 40% of total export. There are 800
garment factories situated in Bangalore which provides job opportunities for nearly 28%
male workers and 45% female workers. Nearly (80%) of the workers in the industries
comprises of women folk. The occupational group in garment factories consists of
tailors, helpers, checkers, cutters, trimmers, supervisors and those working in ironing and
finishing units. This garment factory work requires plenty of physical labour, stress and
strain. Studies also shows that women are mostly affected by occupational health
problems in comparison with men probably due to dual responsibilities at work place and
home.2

The workers employed in the garment industry usually comprises of unskilled or

semiskilled workers. It is the fact that the majority of workers in the garment factories
comprises of women who belongs to rural areas around Bangalore.2

As much as job opportunities are more, health issues are hardly addressed by
employees. There is an acute need for training in preventive, promotive and curative
health services for occupational health hazards as the part of industrial health programme.
The occupational health programmes can literally contribute vastly in developing
countries like India.3

Major occupational diseases identified and commonly reported are silicosis,

musculoskeletal injuries, pneumoconiosis, chronic obstructive lung diseases, byssinosis
and noise induced hearing loss. The occupational health nurse serves as an employee
advocate, making every effort to promote measures to reduce the exposure of workers to
industrial products. Laws require that the work environment be ventilated properly to

3
remove any noxious agent. Dust control can prevent many of the pneumoconiosis. Dust
control includes ventilation, spraying an area with water to control dust, effective and
frequent floor cleaning. Air samples need to be monitored. Toxic substances should be
enclosed and placed in restricted areas. Workers must wear or use protective devices
(facemasks, hoods, industrial respirators) to provide a safe air supply when a toxic
element is present. Employees who are at risk should be carefully screened and followed4

Millions of workers continue to be at risk of pneumoconiosis due to widespread

exposure to silica, coal, asbestos and various mineral dusts in mining, quarrying,
construction and other manufacturing processes. In China, pneumoconiosis makes up
more than 80 % of all cases. In recent years, between 10,000 and 23,000 new cases has
been registered annually.5 (INTERNATIONAL LABOUR ORGANIZATION, 2012)

In India, about 10 million workers employed in mining, construction and various

industries are exposed to silica dusts. Some studies show that silicosis prevalence rates
are 54.6 % while coal workers pneumoconiosis prevalence rate is 18.8 %. 14 (NATIONAL
INSTITUTE OF SURVEILLANCE HEALTH,2013)

The rate of occupational lung conditions was highest for education and health
service workers in private industry and local government workers at 3 .8 and 5 .9 per
10,000 full time workers, (American Lung Association) 7

In Karnataka, epidemiological studies show that between 30 % and 50 % of

workers in primary industries and high risk sectors suffer from silicosis and
pneumoconiosis. In Bangalore, 70% of the industrial workers suffer from byssinosis and
occupational asthma (NIOSH) 6

A study was conducted by National Institute of Occupational Health in 2011

which showed the prevalence of some of the occupational lung diseases such as
Byssinosis-Textile Mills (blow room) 30%, (card room) 38%, Jute mills 48.8%.
Asbestosis- Asbestos mine & mill 11%, Asbestos Textile workers 9%.7

From the above study, the researcher realized the threats of occupational lung
diseases in the society and further reviewing the literature motivated to create awareness

4
through an educational programme in the form of self instructional module regarding
prevention of occupational lung diseases among women working in garment factory.

6.2. REVIEW OF LITERATURE

Review of literature is organized under the following headings:

6.2.1 Literature related to general health problems in garment factories.

6.2.2 Literature related to prevalence of occupational lung diseases.

6.2.3 Literature related to effectiveness of educational programmes on occupational

lung diseases.
6.2.4 Literature related to effectiveness of self instructional module on occupational
lung diseases.

6.2.1. Literature related to general health problems in garment factories

A study was conducted on health appraisal of 3858 garment workers.

Among them 571(14.8%) were males and the remaining 3287 (84.2%) were females. 79
(96.8%) of them reported musculoskeletal problems, (19.3%) of them with
gastrointestinal tract disorders (10.9%) of them with gynecological problem and
Bronchitis (81%).8

A community based cross-sectional study was carried out in three main

slum areas of Kolkata, where almost all those engaged in the small scale garment
industry reside. A complete enumeration of all workers was done. The study findings
revealed that about 69.64% had musculo-skeletal problem, 5.36% had menstrual problem
and 37.5% had mal nutrition.22

A cross – sectional study was conducted on a sample of 100 workers in a

woollen textile factory for identification of health related problems in Belgaum district.
The sampling technique used for the study was convenient sampling. The data was
collected with the help of questionnaire and personal interview with the workers. The

5
study showed that 91% of subjects had at least one work related musculo-skeletal
problem.11

A descriptive study was conducted to observe the patterns of absenteeism

related to the work in garment industry in Bangalore. The sample size was 388. Stratified
random sampling technique was used to select the samples for the study. The study
revealed that tiredness and musculo-skeletal problems were the two significant reasons
for the workers’ absenteeism.21

A Cross-sectional study was conducted on a sample of 100 women working

in garment factory who volunteered their cardio-respiratory and musculo-skeletal profile
before, during and at the end of work. In addition, information on their health status in
general was collected in advance. The study revealed that there was no significant change
in respiratory function. The musculo-skeletal problems were found to be abundantly
present with pain in 91% of the subjects. Region-wise mapping of pain revealed that
postural pain in low back was present in 47% while in neck was 19%. 8

A study was conducted on the physical and psychological health problems of

garment workers. Majority of the garment workers were women. The main physical
health problems faced by workers are: 'Occupational fatigue syndrome', body pain, low
back pain, obesity, bladder and kidney problems. The major psychological problems were
work stress and depression. Work stress and depression are caused by 'intensification of
work' to meet daily targets, strict factory rules and regulations, poor pay, poor working
conditions, in-human abuse and fear of job loss. Since garment workers do not have
much education and skills they have no other option but to work for the garment industry
and suffer in silence.9

6.2.2. Literature related to prevalence of occupational lung diseases

A study investigated a total of 25,413 asbestosis deaths in the United States to
describe the demographic, geographic, and occupational distribution of asbestosis
mortality. Data analysis revealed that the overall U.S. age-adjusted asbestosis death rate

6
was 4.1 per million populations per year; the rate for males (10.4) was nearly 35-fold
higher than that for females (0.3). It increased significantly from 0.6 to 6.9 per million
population and then declined to 6.3 (p=0.014). High asbestosis death rates occurred
predominantly in coastal areas. Industries with highest proportionate mortality ratios
(PMRs) included ship and boat building and repairing (18.5; 95%) and miscellaneous
non-metallic mineral and stone products (15.9; 95%) Occupations with highest PMRs
included insulation workers (109.2; 95%) and boilermakers (21.3; 95%).24
A cross-sectional and analytic study in which workers directly exposed to
cotton dust are compared with those not directly exposed to cotton dust at one point in
time was conducted. A total of 735 workers were interviewed and 437 workers had
respiratory examinations carried out on them. Byssinosis was diagnosed in 8 out of 405
workers (prevalence of 1.98%) who were not directly exposed to cotton dust, and 21 out
of 330 workers (prevalence of 6.36%) who were directly exposed to cotton dust. The
difference was found to be statistically significant (p<0.001). The spinning department
had the highest prevalence of 11.5%. Study concluded that byssinosis and other
respiratory problems were more prevalent in sections of the textile mill industry that were
directly exposed to cotton dust. 13

A study was conducted to investigate the respiratory health profile of textile mill
workers in Bangladesh.20 samples were selected. Forced vital capacity was measured by
peak expiratory flow rate measurement among 20 samples with the help of questionnaire
and checklist, family history, occupational history and health status were determined.
Among them 42.9% had symptoms of cough with or without phlegm, 5.7 % had a history
of chronic bronchitis / asthma and 4.3% experienced chest tightness or breathlessness.
The result showed that a high degree of respiratory related illness symptoms were present
among the workers in the blow /card rooms and the workers in the spinning section.10

A descriptive study with the sample size of 600 was conducted to determine the
prevalence of rhinitis and asthma in a textile and clothing vocational training centre in the
Mona stir area and to describe their epidemiologic and clinical profiles. Results revealed
that one hundred twenty apprentices (20%) developed allergic respiratory reactions due
to exposure to textile dust (exclusively cotton) during their training. Twenty eight
apprentices (4.6%) presented symptoms of asthma. Rhinitis was associated with asthma
7
in 45% of cases. Study concluded that the frequency of respiratory disorders caused by
allergens remains high in the textile and clothing industry.11

A study was conducted on a cohort of 5770 workers exposed to chrysotile

asbestos in North Carolina, USA to describe mortality among workers and evaluate the
relationship between lung cancer and asbestos fiber exposure. Data analysis showed that
lung cancer was significant higher than expected, with standardized mortality ratios
(SMRs) of 1.47 for all causes, 1.41 for all cancer and 1.96 for lung cancer. SMRs for
pleural cancer, mesothelioma and pneumoconiosis were also elevated. The risk of lung
cancer and asbestosis increased with cumulative fiber exposure.20

A study was done to assess the health status of the workers working in a cotton
mill. Sample size was 223 employees. They were interviewed using semi-structured
questionnaires, the obtained data were analyzed. The findings of the study revealed that
the most complaints were chest tightness (20.3 %) and wheezing (11.5%), byssinosis was
present in 28 out of 223 (12.5%) employees.13

6.2.3. Literature related to effectiveness of educational programmes on

occupational lung diseases

A study was conducted to assess the level of knowledge of

sedentary workers regarding occupational lung diseases. Structured knowledge
questionnaire was used.60 samples were selected.The study result showed that mean and
standard deviation was 18.35 ± 2.61, which is 83.40 % of total score. Thus ,there was
Significant difference between pre test and post test knowledge score in relation to
knowledge and prevention of occupational lung diseases at p-value <0.05. Hence ,
distribution of information booklet was found to be effective in assessing the knowledge
of sedentary workers regarding occupational lung diseases.

A descriptive study with the sample size of 223 was conducted to assess the
knowledge regarding safety measures for occupational lung diseases among textile
workers working in selected textile industries. They were interviewed by structured
knowledge questionnaire and the data obtained was analyzed using descriptive and
inferential statistics. The study concluded that administration of health educational

8
pamphlet was very effective for the workers in gaining the knowledge regarding safety
measures for occupational lung diseases.

6.2.4. Literature related to effectiveness of self instructional module on

occupational lung diseases

A study was conducted to assess the effectiveness of self instructional

module on prevention of selected occupational lung diseases.60 workers were selected.
The study was conducted for 30 days. Non-probability purposive sampling was used to
select the samples for the study. The study result showed that the incidence of chronic
bronchitis was 21.9%, pneumoconiosis was 39% and chronic cough was 20%.The
analysis of data showed that there was significant difference between pretest and post test
knowledge scores. Hence self instructional module significantly brought about
improvement in the knowledge of workers regarding prevention of occupational lung
diseases.

A study was done to assess the knowledge regarding occupational lung

diseases by administering self instructional module among 30 samples. Purposive
sampling was used to select the samples for the study. The result showed that the
prevalence of byssinosis is 1.98%.the spinning department had the highest prevalence
11.5 % .Hence, study concluded that byssinosis and respiratory problems were found to
be more prevalent. Thus, self instructional module was found to be significant in
improving the knowledge regarding occupational lung diseases.

6.3 .STATEMENT OF THE PROBLEM

“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL

MODULE ON KNOWLEDGE REGARDING PREVENTION OF
OCCUPATIONAL LUNG DISEASES AMONG WOMEN WORKING IN
SELECTED GARMENT FACTORIES, BANGALORE.”

9
 6.4. OBJECTIVES OF THE STUDY

• To evaluate the effectiveness of self instructional module on knowledge regarding

prevention of occupational lung diseases among women working in garment factory.

• To determine the association between the pretest knowledge scores of women with
selected baseline variables such as age ,religion, years of experience, educational status,
episodes of cough and cold for past three months, hours of work per week ,section of
work, use of protective devices , source of information regarding occupational lung
diseases.

6.5. HYPOTHESES

H1:There will be a statistically significant increase in the level of knowledge following

administration of self instructional module regarding prevention of occupational lung
diseases among women as measured by structured knowledge questionnaire at P<0.05
level.

H2: There will be a statistically significant association between pretest knowledge scores
of women regarding prevention of occupational lung diseases with selected baseline
variables at P<0.05 level.

6.6 .RESEARCH VARIABLES

• Independent variable: Self instructional module on prevention of occupational lung

diseases.

• Dependent variables: knowledge of women regarding prevention of occupational lung

diseases.

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• Extraneous variables: Age,religion,years of work experience, educational status,
episodes of cough and cold for past three months, hours of work per week, section of
work, use of protective devices, source of information regarding occupational lung
diseases.

6.7. OPERATIONAL DEFINITIONS

 Effectiveness:
It refers to the extent to which the self instructional module has achieved the
desired change in the knowledge of women regarding prevention of occupational lung
diseases.

 Self instructional module:

It refers to systematically printed educational material designed for women
regarding prevention of occupational lung diseases which covers various aspects such as
causes, signs and symptoms, management and its prevention.

 Knowledge:

It refers to possible responses of women regarding prevention of occupational lung

diseases as elicited by structured knowledge questionnaire.

 Occupational lung diseases:

It refers to lung diseases such as silicosis, pneumoconiosis, asbestosis, byssinosis and

allergic alveolitis caused by the inhalation of dusts or chemicals in the garment
factory.
 Garment factory:
It refers to a garment manufacturing unit which includes tailoring, helping,
checking, cutting, sampling, sewing, ironing and finishing departments.

6.8. ASSUMPTIONS:

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 • Women working in garment factory may have some knowledge regarding prevention of
occupational lung diseases.

• Self instructional module may increase the knowledge of women regarding prevention of
occupational lung diseases.

6.9 . DELIMITATION
This study is delimited to women working in selected garment factories,
Bangalore.

7. MATERIALS AND METHODS

7.1. SOURCE OF DATA

Women working in garment factory.

7.1.1 RESEARCH DESIGN

Pre-experimental - one group pre-test post-test design.

O1 X O2
Pre-test Intervention Post-test

Structured Structured
Self instructional
knowledge knowledge
module regarding
questionnaire questionnaire
prevention of
regarding regarding
occupational lung
prevention of prevention of
diseases.
occupational
7.1.2.lung
RESEARCH SETTING occupational lung
diseases diseases

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 The study will be conducted among women working in Design Apparels and
Nethra Design at K.R.puram, Bangalore, which consists of several sections such as
cutting, sampling, sewing and finishing sections .The approximate number of workers are
200 and each section consists of 40 workers. Among them 160 workers are female and 40
are male.

7.1.3. POPULATION

Women working in garment factory.

7.2. METHODS OF DATA COLLECTION

7.2.1. SAMPLING PROCEDURE

Non-probability purposive sampling technique

7.2.2. SAMPLE SIZE

N=60 women working in garment factory.

7.2.3. INCLUSION CRITERIA

• Women between the age group of 18-50 years.

• Women who can read and write in Kannada and English.

• Women who are available at the time of data collection.

7.2.4. EXCLUSION CRITERIA

• Women who are not willing to participate in the study.

7.2.5. METHOD OF DATA COLLECTION

Instruments used for the study:

The tools consist of three sections:

Section A: Baseline variables such as age,religion,years of work experience, educational

status, , episodes of cough and cold for past three months, hours of work per week,

13
 section of work, use of protective devices, source of information regarding occupational
lung diseases.

Section B: Structured knowledge questionnaire regarding prevention of occupational

lung diseases.

Section C: Symptoms checklist

7.2.6. DATA COLLECTION METHOD

• Formal administrative permission will be obtained from the respective authority of the
garment factory.

• Ethical clearance has been obtained from the Institutional Ethical Review Board of
St.Philomenas Hospital, Bangalore.

• Informed consent will be obtained from women who are willing to participate in the
study.

• Subjects will be selected by using non probability purposive sampling technique.

• Pilot study will be conducted to check the feasibility of the study and availability of
subjects in a similar setting.

• Pretest knowledge will be assessed using structured knowledge questionnaire and

symptoms checklist.

• Self instructional module regarding prevention of occupational lung diseases will be

administered following pre test.

• Post test Knowledge will be assessed after 1 week using same structured knowledge
questionnaire.

7.2.7. DATA ANALYSIS PLAN

The Data will be analyzed by using descriptive and inferential statistics.

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 Descriptive statistics:

• Frequency and percentage distribution will be used to analyze the baseline variables.

• Mean and standard deviation will be used to assess the knowledge of women regarding
prevention of occupational lung diseases.

 Inferential statistics:

• Statistical paired t-test will be used to compare the pre-test and post-test knowledge
scores.

• Chi-square will be used to determine the association between pretest knowledge scores
of women with selected baseline variables.

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

patients or other humans or animals?

Yes, intervention will be in the form of self instructional module regarding

prevention of occupational lung diseases.

7.4. Has ethical clearance been obtained from your institution?

Ethical clearance has been obtained from the Institutional Ethical Review Board of
St.Philomenas hospital, Bangalore.

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15
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