http://doi.org/10.33698/NRF0185 – Shefali Chawla, Monika Pebma
Abstract : A cataract is a clouding of the lens in the eye that affects vision. Increasing age is associated with an increase in prevalence of cataract. The objective of the study was to assess the impact of Structured Teaching Programme on knowledge on prevention and management of senile cataract among adults. An experimental research approach was employed. The subjects were taken from two villages in Derabassi, Distt. Mohali, Punjab by lottery method. Total sample of 60 adults were selected by systematic random sampling technique that were further divided into experimental group (30) and control group (30). An interview schedule was prepared to obtain data regarding demographic variables and knowledge of adults on prevention and management of senile cataract. Structured Teaching Programme on Prevention and Management of Senile Cataract was administered to experimental group by one to one teaching method with the help of power point presentation. The average time taken per adult to administer Structured Teaching Programme was 30 minutes. After 4 days of lapse post-test was taken from both the groups. The Findings depicts that Structured Teaching Programme was effective in improving the knowledge of the subjects related to cataract as per t test. As the post test mean (23.8 ± 2.4) was significantly higher is experimental group as compared to control group (mean ± SD 11.2 ± 3.4) where as there was no significant difference in the pre test mean in both the groups. Hence it was concluded that Structured teaching programme was effective in prevention and management of senile cataract among adults.
Keywords:Cataract, Structured Teaching Programme, Adults
Correspondence at Ms. Shefali Chawla House No. 2531/2 Sec 44 C, Chandigarh
Introduction:A cataract is a clouding of the lens in the eye that affects vision. It is related to aging. Increasing age is associated with an increase in prevalence of cataract.It is the main cause of visual loss globally. Contrary to popular belief, It is not caused by eye strain or reading too much, but is a result of aging, injury, steroid use, exposure to UV light, smoking & diabetes. It is a natural process of eye aging.Almost every person develops cataract changes as the eye ages.4According to the World Health Organization (2010), Cataract is the leading cause of blindness in the world. There are approximately 30 million blind people in the world, half of them are due to cataracts. Senile Cataracts contribute to 75% of blindness in India. A major proportion of blind reside in the rural, remote and underserved areas of our country. In India, the estimated blindness prevalence rate is 77.3 per 1000 population 4.Some people develop cataracts during their middle-aged years (40s and 50s) although it is more common after 60 years of age. Cataract can be congenital, traumatic, senile, and secondary cataract (drug induced). But most common among these is the senile cataract or age related cataract. It is a vision-impairing disease characterized by gradual, progressive thickening of the lens. It is one of the leading causes of blindness in the world today. This is unfortunate, considering that the visual morbidity brought about by age-related cataract is reversible. In developing world, its prevalence is believed to be greater and the onset at earlier ages, making the social and medical cost of blindness from cataract highly disproportional in the areas of the world that can afford them. The lens is a portion of the eye that is normally clear. The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image striking the retina will be blurry and the vision will be blurry. The extent of the visual disturbance is dependent upon the degree of cloudiness of the lens.5 So, if the risk factors are avoided then we can prevent the occurrence of cataract in early age. Middle age people can prevent cataracts by taking proper diets, reducing direct exposure from sunlight, eye check- ups annually, taking vitamin A prophylaxis in childhood, avoiding smoking and ingestion of alcohol, maintain normal blood sugar levels, blood pressure and weight. Though cataract is easily curable through a simple surgery which is available all over the world today yet cataract remains a public health problem in many developing countries and this is a very serious issue. Hence it is important that through regular teaching programmes the community should be made aware of prevention and management of senile cataract encourage them to understand the need for routine eye check- ups to prevent major eye disorders.9 The studies based on knowledge and awareness of cataract shows that the population had limited knowledge of common eye diseases. Educational programmes to enhance public awareness may be needed to improve the effectiveness of health promotion and thus prevent unnecessary blindness.7 One of the goal of National Rural Health Mission is increase the number of cataract operations, which is only possible if people have enough knowledge regarding cataract. So, there is a need to prevent the cataract in early age by reducing its risk factors. Although there is no way to cure or reverse the effects of a cataract, prevention strategies can slow the rate at which a cataract forms or even prevent one from developing in the first place. So, If people will have adequate knowledge about prevention and management of senile cataract then only they will take preventive measures. Hence, the need was felt to assess the existing level of knowledge on senile cataract among adults and to aware them regarding prevention and management of senile cataract through a structured teaching programme.
Objective:The objective of the study was to assess the impact of Structured Teaching Programme on knowledge related to prevention and management of senile cataract among adults residing in selected villages of Dera Bassi, Distt. Mohali (Punjab).
Materials and Methods:An experimental research design was employed in the study to evaluate the effectiveness of structured teaching programme among adults. Null hypothesis was that there is no significant effect of structured teaching programme in improving knowledge on prevention and management of senile cataract among adults at 0.05 level of significance. The study was conducted among adults residing in selected villages of Dera Bassi, Distt. Mohali Punjab. The present study was conducted in Village Issapur and Village Dera Jagadhari of Derabassi, Distt. Mohali, Punjab. The subjects in experimental and control group were taken from different villages in order to prevent the contamination. Village Dera Jagadhari was taken as Control group whereas Village Issapur was chosen as experimental group by lottery method. The sample size for the present study was 60 adults (≥40 years) i.e. 30 in experimental group and 30 in control group. Villages were selected by Lottery Method. Sampling technique used for the selection of subjects in experimental and control group was systematic random sampling and every 5th house was surveyed to identify adults willing to participate in the study. The tool consisted of two sections i.e. an Interview schedule was prepared to obtain data regarding demographic variables and knowledge of adults on prevention and management of senile cataract. The data collection was done in the month March and April 2013. Prior permission was obtained from authorities. After obtaining written consent from the respondent, they were asked to complete the pre- test structured knowledge questionnaire on prevention and management of senile cataract. The structured teaching programme (STP) on prevention and management of senile cataract was developed with the help of literature and validated by experts in the field of community health nursing and medical surgical nursing. The STP constitutes the introduction, definition, causes, sign and symptoms, diagnostic methods, prevention and management of senile cataract. The STP was administered by one to one basis using power point presentation to experimental group only The average time taken per adult to administer Structured Teaching Programme was 30 minutes. and on 4th day post-test was conducted of both groups to evaluate the knowledge on prevention and management of senile cataract, tools were collected back and scoring was done according to following criteria. Total score was 30 and which was categorized into good (21-30), average (11-20) and poor (0-10) score. Data was analyzed using Descriptive (mean and standard deviation) and Inferential statistics (t-test and chi square test).
Results:As per socio demographic variables summarized in the table 1,30% of adults were in the age group 40-45 years in experimental group and 43% in control group respectively. Among 60 adults, 73% were females as compared to only 27% males in experimental group whereas 67% were females and only 33% were males in control group. According to religion, 83% of adults belong to Sikh religion in
Table 1: Socio demographic profile of subjects
| Characteristics | Experimental Group n=30 | Control Group n=30 | Chi square, df, p value |
| Age
40-45 years 46-50 years 51-55 years 56 & above |
9(30) 16(20) 5(17) 10(33) |
13(43) 4(14) 6(20) 7(23) |
7.267 3 0.0637 |
| Gender
Male Female |
8(27) 22(73) |
10(33) 20(67) |
0.317
1 0.5731 |
| Religion
Hindu Sikh |
5(17) 25(83) |
13(43) 17(57) |
5.079
1 0.0241 |
| Education Illiterate Primary
Middle Secondary |
13(43) 8(27) 3(10) 6(10) |
16(53) 7(23) 4(14) 3(10) |
6.519 3 0.1634 |
| Occupation Government Job Self Employed Labourer
Homemaker |
7(23) 1(3) 4(14) 18(60) |
4(13) 5(17) 6(20) 15(50) |
6.339 3 0.1751 |
| Type of Family
Nuclear Joint |
8(27) 22(73) |
89(27) 22(73) |
0.000
1 1.0000 |
| Total Monthly Family Income
<5000 5000-10000 10001-15000 Above 15000 |
11(37) 11(37) 3(10) 5(16) |
14(47) 14(47) 0(0) 2(6) |
5.005 3 0.1713 |
| Previous Knowledge
Mass Media Medical Personnal’s Experience shared by relatives and friends |
2(7) 2(7) 26(86) |
2(7) 2(7) 27(86) |
0.000 2 1.0000 |
| Cataract Affected Adults
Yes No |
2(7) 28(93) |
2(7) 28(93) |
0.000
1 1.0000 |
experimental group and 57% adults in control group. Among all adults, 27% had primary education in experimental group and 23% had primary education in control group and 43% in experimental group and 53% in control group were illiterate.Among subjects, 60% of adults were Homemakers in experimental group and 50% were homemakers in control group. Most of adults (73%) had joint families in both groups and no adult had extended family in both groups. According to income, 37% of adults had total monthly family income less than Rs. 5000/- and between Rs. 5000/- and 10000 in experimental group and 47% in control group. In previous knowledge, majority (94% in experimental group and 90 % in control group) of adults had knowledge on senile cataract through experiences shared with relatives and friends. Most of adults were not suffering from cataract (93%) in both the groups and only 3% had cataract in both groups. Both the groups were homogenous in relation to socio demographic profile as per chi square test (p>0.05) except religion i.e. significantly higher percentage of sikh subjects (83%) were there in experimental group as compound control group (57%).
Table 2: Effectiveness of Structured Teaching Programme on knowledge on Prevention and Management of Senile Cataract in Experimental and Control group
| Experimental Group n=30
Mean SD |
Control Group n=30
Mean SD |
t value (df)
p value |
|
| Pre Test | 11.2 3.60 | 10.96 3.97 | 0.132NS (57),
0.989 |
| Post Test | 23.8 2.40 | 11.2 3.43 | 16.495 (58),
p < .01 |
| Paired T Test |
t=15.845, df = 28, p<0.05 |
t=0.5519, df=28, p<0.05 |
*Significant
NS Non SignificantTable 2 shows that value of t (unpaired) test in experimental and control group was 0.1324 p>0.05 at df=57 which was less than the tabulated value and the difference was considered to be statistically not significant whereas during post test the calculated t- value was 16.495 (p<0.05) at df=58 which was higher than the tabulated value and the difference between them was considered to be highly significant. After applying paired t test in experimental group, the calculated ‘t’ value was 15.845 (p<0.05) at df=28 which is higher than the tabulated hence statistically significant whereas in control group the calculated ‘t’ value was 0.5519 (p>0.05) at df=28 which was lesser than the tabulated value and statistically non-significant. Hence, it is concluded that before the intervention both the groups i.e experimental and control group were homogenous in knowledge level. Whereas post test knowledge scores of experimental group was significantly higher than control group (p<0.05 as per t test). Hence, the structured teaching programme on prevention and management of senile cataract was effective in improving the knowledge of subjects. So, the null hypothesis is rejected and research hypothesis is accepted.
Table 3 depicts that during pre test majority of adults (50%) had average knowledge on prevention and management of senile cataract in experimental group whereas in control group majority of adults (60%) had poor knowledge on prevention and management of senile cataract but no adult had good knowledge on prevention and management of senile cataract in both groups. During post test, majority of adults (80%) had good knowledge on prevention and management of senile cataract but no adult had poor knowledge after implementation of structured teaching programme whereas in control group as no structured teaching programme is given, 50% adults had average and 50% had poor knowledge on prevention and management of senile cataract but no adult had good knowledge.
Table 3: Percentage Distribution of Adults according to their Level of Knowledge in Experimental and Control Group
| Knowledge level % (Experimental group) | Knowledge level % (Experimental group) | |||||
| Good | Average | Poor | Good | Average | Poor | |
| Pre Test
Post Test |
6(3%)
24(80%) |
15(50 %)
6(20%) |
9(47%)
0(0%) |
10(3%)
0(0%) |
12(37%)
15(50%) |
18(60%)
15(50%) |
Table 4 depicts that during pre test in experimental group half (50%) of adults had poor knowledge and half had average knowledge but none of the adult had good knowledge scores in the area of introduction and prevention of senile cataract whereas in control group majority (70%) adults had average knowledge scores but none of the adult had good knowledge scores in the area of introduction of senile cataract. In the area of prevention of senile cataract, in control group majority 60% adults had poor knowledge, 40% had average knowledge but none of the adult had good knowledge. In the area of management of senile cataract, 60% adults had average knowledge and 40% had poor knowledge but none of the adult had good knowledge in experimental group whereas in control group half (50%) of adults had poor knowledge and half had average knowledge but no adult had good knowledge.During post test, in experimental group majority (70%) adults had good knowledge, 30% had average knowledge in the area of introduction of senile cataract, 90% had good knowledge and 10% had average knowledge in the area of prevention of senile cataract and in the area of management of senile cataract, 80% adults had good knowledge and 20% had average knowledge but none of the adult had poor knowledge in all the areas. On the other side, in control group half (50%) of adults had average knowledge and half had poor knowledge in all the areas of senile cataraci.e introduction, prevention and management but none of the adult had good knowledge.Hence it can be said that majority of adults had poor and average knowledge in the prevention and management of senile cataract in experimental and control group initially and there was increase in the knowledge of adults of experimental group after implementation of structured teaching programme on senile cataract whereas there was no change in the knowledge level of control group.
Table 4: Knowledge Scores of Adults in different aspects of Senile Cataract
| Areas | Knowledge Score
(%) |
||||||
| Experimental
group |
Control
group |
||||||
| Good | Average | Poor | Good | Average | Poor | ||
| Pre Test | Introduction | 0(0) | 15(50 ) | 15(50 ) | 0(0) | 21(70 ) | 9(30) |
| Prevention | 0(0) | 15(50) | 15(50 ) | 0(0) | 12(40) | 18(60) | |
| Management | 0(0) | 12(40 ) | 18(60) | 0(0) | 15(50) | 15(50 ) | |
| Post Test | Introduction | 21(70 ) | 9(30) | 0(0) | 0(0) | 15(50 ) | 15(50 ) |
| Prevention | 27(90) | 3(10) | 0(0) | 0(0) | 15(50 ) | 15(50 ) | |
| Management | 24(80) | 6(20) | 0(0) | 0(0) | 15(50 ) | 15(50 ) | |
Table 6: Item Wise of Knowledge of Adults on Prevention and Management of Senile Cataract in Experimental Group and control group.
N=30
| Items | No. of Correct responses | |||
| Experimental group | Control group | |||
| Pre test n(%) | Post test n(%) | Pre test n(%) | Post test n(%) | |
| Introduction of Senile Cataract
Cloudiness of the lens is the meaning of cataract. |
16(53) |
29(97) |
12(40) |
14(47) |
| Lens is the affected part in cataract. | 8(27) | 28(93) | 6(20) | 10(33) |
| Senile cataract is the most common type of cataract. | 25(83) | 29(97) | 26(87) | 24(80) |
| The age group more affected with senile cataract is above 60 years and above. | 8(27) | 23(77) | 12(40) | 15(50) |
| The age of onset is 40 years and above. | 26(87) | 27(90) | 27(90) | 28(93) |
| Old age is the most common cause of cataract. | 25(83) | 28(93) | 23(77) | 23(77) |
| Excessive smoking and taking alcohol is the main risk factor for
occurrence of senile cataract in early age. |
21(70) | 30(100) | 18(60) | 14(47) |
| Cloudiness is the most common symptom of senile cataract. | 6(20) | 22(73) | 5(17) | 4(13) |
| Squint is not a symptom of senile cataract. | 6(20) | 15(50) | 7(23) | 7(23) |
| Consult a physician if u r suffering from decreased vision. | 25(83) | 29(97) | 27(90) | 27(90) |
| Avoid smoking, eating healthy foods and avoiding sun exposure are the measures for prevention of senile cataract. | 4(13) | 13(43) | 0(0) | 1(3) |
| Surgery is the measure for treating senile cataract in early age. | 18(60) | 29(97) | 20(67) | 20(67) |
| Once in a year a routine eye check up is required. | 2(7) | 23(77) | 1(3) | 2(7) |
| Vitamin A is effective in prevention of senile cataract | 6(20) | 14(47) | 4(13) | 5(17) |
| Prevention of senile cataract
Sweet Potato is the richest source of Vitamin A rich diet. |
0(0) |
25(83) |
1(3) |
1(3) |
| Proper eye checkups annually and maintaining normal sugar levels helps in prevention of senile cataract among diabetics. | 3(10) | 10(33) | 0(0) | 1(3) |
| Wearing sunglasses is a precautionary measure for prevention of senile cataract during sunlight exposure | 11(37) | 28(93) | 10(33) | 12(40) |
| 2.5m is the minimum distance required for watching television. | 1(3) | 18(60) | 6(20) | 5(17) |
| Maintaining normal weight is the measure for prevention of senile cataract among obese people in early age. | 29(97) | 28(93) | 28(93) | 28(93) |
| The vitamin A Immunization is given to children upto 5 years of age. | 1(3) | 20(67) | 4(13) | 5(17) |
| Management of Senile cataract
Surgery is the effective treatment for senile cataract |
16(53) |
29(97) |
16(53) |
16(53) |
| When the cataracts are mature and when there is difficulty in vision go for cataract surgery. | 4(13) | 14(47) | 2(7) | 3(10) |
| The most common complication of cataract surgery are infection and bleeding. | 4(13) | 24(80) | 10(33) | 9(30) |
| The big innovation in cataract surgery is laser surgery | 20(67) | 27(90) | 24(80) | 22(73) |
| Itching and mild discomfort is considered normal after cataract surgery. | 11(37) | 27(90) | 6(20) | 4(13) |
| Strenuous activity is avoided after cataract surgery. | 4(13) | 23(76) | 7(23) | 9(30) |
| The patient get discharge within 1 day after cataract surgery. | 1(3) | 22(73) | 4(13) | 6(20) |
| Wearing eye shield is important after cataract surgery. | 4(13) | 25(83) | 4(13) | 6(20) |
| Avoid rubbing your eye after cataract surgery. | 27(90) | 29(97) | 16(53) | 22(73) |
| Washing hands before touching your eye is important measure to prevent infection after cataract surgery. | 5(17) | 27(90) | 3(10) | 3(10) |
Table 6 shows that during pre test in experimental group majority 87% of adults responded that the age of onset is 40 years & above whereas only 17% responded that cloudiness is the most common symptom of senile cataract and squint is not a symptom of senile cataract in the area of introduction of senile cataract. In the area of prevention of senile cataract 97% adults responded that maintaining normal weight is the measure for prevention of senile cataract among obese people in early age and none of the adult knew that sweet potato is the richest source of Vitamin A. In the area of management of senile cataract 90% adults responded that one should avoid rubbing of eye after cataract surgery and only 3% adults knew that the patient get discharge within 1 day after cataract surgery. On the other side during post-test, all adults responded that excessive smoking and taking alcohol is the main risk factor for occurrence of senile cataract in early age and only 50% responded that squint is not a symptom of senile cataract. In the area of management of senile cataract 97% knew that surgery is the measure for treating senile cataract and only 33% responded that proper eye check-ups annually and maintaining normal sugar levels helps in prevention of senile cataract among diabetics. In the area of management of senile cataract 97% adults responded that surgery is the effective treatment for senile cataract and avoid rubbing the eye after cataract surgery whereas only 47% responded that when the cataracts are mature and when there is difficulty in vision go for cataract surgery.During pre-test in control group majority (90%) of adults responded that if they suffer from decreased vision they will consult a physician and only 17% responded that cloudiness is the most common symptom of senile cataract in the area of introduction of senile cataract. In the area of prevention of senile cataract 93% adults responded that maintaining normal weight is the measure for prevention of senile cataract among obese people in early age and none of the adult knew that proper eye check-ups annually and maintaining normal sugar levels helps in prevention of senile cataract among diabetics. In the area of management of senile cataract 80% adults responded that the big innovation in cataract surgery is laser surgery and only 7% adults knew that when the cataracts are mature and when there is difficulty in vision go for cataract surgery. On the other side during post test, 93% adults responded that the age of onset is 40 years & above and only 13% responded that cloudiness is the most common symptom of senile cataract in the area of introduction of senile cataract. In the area of prevention of senile cataract 93% knew that maintaining normal weight is the measure for prevention of senile cataract among obese people in early age and only 3% responded that proper eye checkups annually and maintaining normal sugar levels helps in prevention of senile cataract among diabetics and sweet potato is the richest source of Vitamin A. In the area of management of senile cataract 73% adults responded that the big innovation in cataract surgery is laser surgery and avoid rubbing the eye after cataract surgery whereas only 13% responded that itching and mild discomfort is considered normal after cataract surgery.
Discussion:A cataract is a clouding of the lens in the eye that affects vision. Age is associated with an increase in prevalence of cataract. The main cause of blindness among elderly is cataract. Contrary to popular belief, It is not caused by eye strain or reading too much, but is a result of aging, injury, steroid use, exposure to UV light, smoking & diabetes. Almost every person develops cataract changes as the eye ages.The study findings revealed that the baseline knowledge on prevention and management of senile cataract in present study was average or poor in majority of adults in experimental and control group. These findings are supported with the findings of study conducted by Ali and Neeraja6 which also showed that in pre-test all the clients had low knowledge regarding cataract .After implementation of structured teaching programme on prevention and management of senile cataract among adults during post-test, majority of adults (80%) had good knowledge on prevention and management of senile cataract but no adult had poor knowledge in experiment group. In control group as no structured teaching programme is given hence all the adults had average or poor knowledge on prevention and management of senile cataract. This implicates the effectiveness of structure teaching programme on experimental group. These findings were supported with the findings Ali and Neeraja6 which showed that in post-test, the clients attained 60 percent of average knowledge and 40 percent of high knowledge implicating the effectiveness of STP intervention.Structured knowledge questionnaire showed that both the groups i.e. experimental group and control group had less knowledge on prevention and management of senile cataract. Structured teaching programme on prevention and management of senile cataract was very effective in increasing the knowledge of adults in experimental group. Hence it is recommended that teaching on cataract should be regular feature of community health nurses and other health professionals working in community to enhance the knowledge of community for prevention and management of cataract which in turn can prevent blindness. The study can be replicated to a large sample to enhance the generalization of findings.References
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