RAJIV GANDHI UNVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
01. / NAME OF THE CANDIDATE ANDADDRESS / REENA VARGHESE,
C/O CHRISTAIN COLLEGE OF NURSING
BANGALORE – 560043
02. / NAME OF THE INSTITUTION / CHRISTAIN COLLEGE OF NURSING
BANGALORE – 560043
03. / COURSE OF STUDY AND SUBJECT / M.Sc. NURSING FIRST YEAR
MEDICAL-SURGICAL NURSING
04. / DATE OF ADMISSION TO COURSE / 10 – 10 - 2011
05. / TITLE OF THE TOPIC / A STUDY TO DETERMINE THE EFFECTIVENESS OF A SELF- INSTRUCTIONAL MODULE REGARDING SUBSTANCE ABUSE AND ITS CONSEQUENCES ON GENERAL HEALTH AMONG THE COLLEGE STUDENTS OF SELECTED COLLEGES OF BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT DISSERTATION
6.0 BRIEF RESUME OF INTENDED WORK
INTRODUCTION
Prevalence of substance abuse is high among adolescents as they are keen to experiment the drugs to fulfill their curiosity. If their experimentation could be prevented by making them aware about the these abuse and its consequences, the prevalence of the substance abuse can be reduced.
Substance abuse has become a global phenomenon. It has affected almost every country, although its extent and characteristics differ from region to region. It is estimated that at least 40 million people throughout the world are regular substance or drug abusers. The problems of drug abuse are localized especially in the urban, semi-urban and along the border areas of India.1-2
The period of adolescence is a vulnerable period in the life of an individual. The increased vulnerability in this period related to psychological factors like curiosity, poor impulse control, run away from reality, psychological distress and so forth. The social factors like peer influence, lack of clear identity, and self or intra-familial conflict also expose the adolescent to substance abuse.3
The problem of substance abuse is a significant problem among adolescents in our societies as the problem is increasing day by day due to various factors like easy availability and rapid socioeconomic and demographic changes4. Recent studies have shown that the drug addicts registered for treatment and rehabilitation of various treatment centers are mostly adolescents and youth students5. In terms of initiating substance abuse a significant percentage of drug abuser (83%) has started using drug and other substances between 16-20 years followed by under 15 years6.
Substance abuse is associated with a variety of negative consequences, including school failure, and poor judgment which may put adolescents at risk for accidents, violence, unplanned and unsafe sex. These dangerous consequences of substance abuse on human life intensify the need for the prevention of these abuse7.
People abuse substances such as alcohol,tobacco, and other drugs for varied and complicated reasons, but it is clear that our society pays a significant cost. The toll for this abuse can be seen in our hospitals and emergency departments both through direct damage to health by substance abuse and its link to coronary artery disease, cardiovascular and other vascular effects.
Hospitals and clinics tally daily the strong connection between cardiovascular, coronary artery disease and substance dependence and abuse. The use of alcohols, cigarettes, tobacco have increased in recent years tremendously endangering healthy life of the people with some or other long-term impairment of functioning.
The abuse of alcohol is associated with chroniccardiomyopathy,hypertension, and arrhythmia. Abstinence or using alcohol in moderation can reverse these cardiovascular problems. Alcohol is also distinguished among the substances of abuse by having possible protective effects againstcoronary artery diseaseand stroke when used in moderate amounts.
Finding effective treatment for and prevention of substance abuse has been difficult. Through research, we now have a better understanding of this behavior. Studies have made it clear that education and prevention aimed at children and adolescents offers the best chance to curb abuse nationally8.
The sooner the teen gets help for drug abuse, the more likely they’ll be to avoid the long-lasting consequences25.The above studies suggested that there is an extent used of substances abuse among the school, college and university going students therefore it becomes important to assess the knowledge of the college going students regarding substance abuse and helps prevent substance abuse among them.
6.1 NEED FOR THE STUDY:
Substance abuse is a serious public health problem that affects almost every community and family in some way. Each year substance abuse results in around 40 million serious illnesses or injuries among people in the States9. Teens who abuse drugs with needles increase their risk of blood-borne diseases like HIV, AIDS and Hepatitis B and C25.
Nevertheless, experimentation with substances, particularly alcohol and tobacco, is progressively more common behavior among college students. There is casual relationship between alcohol consumption and more than 60 types of diseases and injury world wide alcoholisms estimated to cause about 20% - 30% of esophageal cancer, liver cancer, and cirrhosis of liver, homicide, epilepsy and motor vehicle accidents. World wide 1.8 million deaths and 58.3 million DALY attributed to the use of alcohol22.
Experimentation is considered problematic when substance use occurs at a very young age, with increasing frequency, while the child is alone, or in the context of behavioral or emotional difficulties. If use becomes more frequent, negative consequences can develop, including impairment at school or work, legal problems, accidents, and interpersonal difficulties. Substance use becomes abuse when an adolescent suffers negative and harmful consequences because of the use of substances—and yet continues using. Substance abuse has been strongly linked to risky sexual behavior, delinquent behavior, and low school achievement. Heavy and prolonged substance use can result in drug dependence, with a syndrome of significant distress if the drug use is stopped or reduced10.
Policies which influence the levels and patterns of substance use and related harm can significantly reduce the public health problems attributable to substance use, and interventions at the health care system level can work towards the restoration of health in affected individuals13.
Substance abuse is associated with a variety of negative consequences, including school failure, and poor judgment which may put adolescents at risk for accidents, violence, unplanned and unsafe sex. These dangerous consequences of substance abuse on human life intensify the need for the prevention of substance abuse14.
In developing countries, 80 percent of young people are enrolled in schools. Children spend their important time period in school. They can learn and develop own belief, value and vision from the information received and the activities they get involved in school. Therefore, the risk behaviors like drug abuse can be prevented by the necessary education at school15.
College students are the most vulnerable group and are at high risk of substance abuse related problems compared to other population. The prevalence rate of substance abuse is highest among young adolescents and young adults, a large majority ofwho are students16.
Substance abuse by students in secondary schools and colleges is a serious problem. As it is gaining gradual popularity among college students, it would be vital to examine their knowledge towards substance abuse. Health education is an important strategy of allthe programs toprevent and control substance abuse17.
The WHO Expert Committee on Drug Dependence (1973) endeavored to ascertain factors associated with the prevention of drug dependence and urged that it would be necessary to eliminate the ignorance and misconception about drug effects. In many parts of the world, drinking alcoholic beverages is a common feature of social gatherings. In addition to the chronic diseases that may develop in those who drink large amounts of alcohol over a number of years, alcohol use is also associated with an increased risk of acute health conditions, such as injuries, including from traffic accidents18.
A descriptive study conducted on Tobacco use and cardiovascular disease a knowledge, attitude and practice study in rural Kerala. Present study included 302 (64.7%) females and 165 (35.3%) males. Among the males 44 (38.5%) were ever smokers. Though 451 (96.6%) of the subject knew that tobacco use is harmful for health, only 101(22.5%) of the subject knew that it causes cardiovascular diseases. However more efforts are needed to make them aware about the role of tobacco smoking and chewing in causing cardiac problems24.
According to the A.D.A.M. Medical Encyclopedia, Smokers have a much higher risk of heart disease as compared to others and it also states that substance abuse is one of the risk factors of coronary heart disease20 .
Dr. Banpel (1995) says that prevention is better than cure. People’s health is in their own hands, so we need to educate people and work together as a team.
This impression led the investigator to design the present study that is aimed at assessing the knowledge of the college students regarding substance abuse and its consequences and thereby assess the effectiveness of Self Instructional Module on substance abuse and its consequences among them.
6.2 REVIEW OF LITERATURE:
Review of literature is a key step in research process. It refers to an extensive, exhaustive and systemic examination of publication relevant to the research project. Before any research can be started whether it is single study or extended project, a literature review of previous studies and experiences related to the proposed investigation should be done. Literature review makes contribution to new knowledge and scholarship of researcher. So Literature review is important aspect while doing research 23.
6.2.1 Study related to the knowledge of students regarding substance abuse.
A study was conducted to assess the knowledge and attitude of 180 undergraduate students of Kerala on drug dependence using a structured questionnaire. The result of the study showed that students‘ (98.33%) knowledge was inadequate in all the areas. The result also showed that there was significant positive relationship between knowledge and year of study, family income and drug abuse12.
A study was conducted in UK to monitor the young people‘s experience and knowledge of illicit drugs between 1969 and 1999 at intervals of 5 years among 274 peoples of 3 secondary schools of Wolver Hampton, aged 14-15 years. The study finding showed that the perception of taking drug increased from 15% in 1969 to65% in 1999 and decreased to 58% in 1999. Although the knowledge, names of drugs steadily increased knowledge of effects of drugs has remained limited among the students15.
A study was conducted to assess the awareness among college students and to determine relationship of knowledge and selected variables in 100pre-degree students (first year) from 3 colleges in Calcutta using a structured knowledge questionnaire. Stratified sampling was used. The study result showed that college students’ knowledge of drug abuse was inadequate. No significant relationship was found between knowledge, sex and mass media19.
A study showed the relation of coffee and alcohol consumption to the risk of coronary heart disease during a six-year period in a cohort of 7705 Japanese men living in Hawaii. The analysis was based on 294 new cases of coronary heart disease. There was a strong negative association between moderate alcohol consumption (up to 60 ml per day), mainly from beer, and the risk of nonfatal myocardial infarction and death from coronary heart disease. This association remained significant in multivariate analysis, taking into account smoking and other risk factors. The correlation of alcohol consumption with the level of α cholesterol (positive) and β cholesterol (negative) may partly account for the observed negative association between alcohol and coronary heart disease11.
A study conducted among undergraduate medical students in two medial colleges of Calcutta indicated that the prevalence of total and current substance abuses were 48.9% and 27.9% respectively.
Teenagers often experiment with a variety of activities and substances. Unfortunately, this experimentation can lead to substance abuse and addiction. Statistics show that drug abuse is a growing problem among teens due to lack of proper awareness. Without imparting knowledge, the effects of substance abuse on teens can lead to serious consequences now and well into adulthood25.
6.2.2 Study to determine the effectiveness of Self-instructional module.
A study showed that college students in general lacked knowledge about drug abuse and its adverse effects before the education program. Mean knowledge score was (19.95). There was marked gain in knowledge after the health education program (40.3). The difference in knowledge score was statistically significant at 0.05 level (t(119)=37.744 ,p≤0.05). A relationship between
knowledge scores and selected variables were noticed. The statistical significance was at 0.05 level 16.
A study evaluated the effectiveness of a self-instructional module developed by the investigator to prepare nursing students for dealing with the sexuality concerns of male myocardial infarction patients. Using a pretest-posttest control group design, the evaluation was carried out through field testing of the module on a convenience sample of 161 nursing students in four baccalaureate programs in the United States. Field testing consisted of administration of the module, together with pre-post testing of subjects on a knowledge inventory and a behavioral intensions/comfort inventory. Following administration of the module, experimental subjects' scores indicated significant increases in knowledge of sexuality counseling of MI patients (p less than .001) and comfort in dealing with patients' sexuality concerns (p less than .001)21.
An Analysis of data was done on the basis of objectives and hypotheses. Data analysis of level of knowledge revealed that during the assessing the effectiveness of the Structured Instructional Module on menopausal changes and its coping, the pretest and post-test data analysis by using Wilcoxon Signed Rank test revealed the mean pre-test score (2.84±1.23) was higher than the mean post-test score (17.56±1.37). Since the calculated Z value, was 6.17 and P value was 0.000, thus proving that P<0.05 (data was analyzed by using SPSS Software). Based on the analyses, the following inference was drawn. There was evident increase in the knowledge scores in all the areas included in the study after administration of Self instructional module. Thus it was inferred that the Self instructional module was effective and while the gain in knowledge score is commendable, there is still room for improvement28.
Teenagers often do not see the link between their actions today and consequences tomorrow. The reports clearly show that youngsters are not fully aware of the consequences of the substance abuse and thus lack knowledge regarding substance abuse. Kemp et al (1996) in their article on how to prevent drug and alcohol abuse writes that Educating people using Self Instruction Module on drugs is both obvious and has been shown to improve attitude, compliance.