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Volume No. : 1 Issue No. : 1 Year : 2011 ISSN Print : 2347-8632 ISSN Online : 2454-2652

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A Quasi Experimental Study to Assess The Effectiveness of Planned Teaching Programme Regarding the Management of The Breast Feeding Problems Among Postnatal Mothers in The Selected Hospitals of Punjab and Haryana Sumitpal Kaur1, P. Vadivukkarasi Ramanadin2, Kiran Bala3 1MSc. Nursing Student, Mata Sahib Kaur College of Nursing, Mohali, Punjab 2Asst. Professor, Dept. of OBG, Mata Sahib Kaur College of Nursing, Mohali, Punjab 3Lecturer, Dept. of OBG (N) Mata Sahib Kaur College of Nursing, Mohali, Punjab. *Corresponding Author Email: [email protected]

ABSTRACT: Breastfeeding is natural (physiological) and instinctive, and nearly all mothers do it. Breastfeeding is an art and a skill which needs to be learnt and mastered. Postnatal period is crucial and mothers need to be given more information regarding breastfeeding. Mothers have many doubts and fears about breastfeeding and caring for their young ones. With this aim the study was conducted to evaluate the effectiveness of a planned teaching programme regarding management of breast feeding problems. Quantitative approach with a quasi experimental randomized comparison group research design was used. By convenient sampling technique 60 primigravida women were selected out of which 30 in experimental and 30 was in comparison group. Data were collected by using self administered structured knowledge questionnaire on management of breast feeding problems and it was analyzed by using descriptive and inferential statistics. Distribution of the postnatal mothers according to their demographic variable shows that maximum postnatal mothers (50.0%) were in age group of 24-26 years, 50.0% of them were belongs to Hindu religion, 41.7% were having secondary education, more than half of the postnatal mothers (71.6%) were housewife, 56.6% of them were belongs to nuclear family, maximum postnatal mothers (55.5%) were having family income of less than Rs.5000/- and majority of the postnatal mothers (65.0%) were primigravida. The effectiveness of planned teaching programme on management of breast feeding problems was analyzed by using paired t-test (t(29, 0.05) = 31.687, 0.000) and unpaired t- test value (t(58,0.05) = 10.612, 0.000) which was highly significant at 0.05 level. The chi square value showed that there was a significant association between the knowledge of primigravida women with their age (χ2 (2, 0.05) 2 2 2 = 8.077, 0.018*), educational status (χ (2, 0.05) = 100.8, 0.002**), occupation (χ (1, 0.05) = 7.105, 0.02*) and parity (χ (1, 0.05)

= 7.377, 0.007*) at p<0.05 level. It also shows that there is no association of pretest level of knowledge with religion, type of family and family income.

KEY WORDS: Management of breast feeding problems, Planned Teaching Programme, Postnatal mothers.

INTRODUCTION: Today’s child is tomorrow’s citizen. Healthy child can be a wealthy nation. The health of the child should be preserved for making the nation wealthy. One of the basic needs of the healthy child is nutrition. By nature, the fetus gets its nutritional requirements from his mother in the womb and after delivery it is born with the natural ability to find the warm touch, self-attach and feed from the breast.2 The first year of life is crucial in laying the foundation of good health. Feeding periods are important to the infant because in addition to food they derive significant emotional and psychological benefits. Babies should be started on the breast as soon as possible after birth. It helps in stimulating the production of breast milk which is baby’s first immunization. The first milk or colostrums is most suitable for the baby because it contains high concentration of nutrients and protein that protect the baby from many infections.3 UNICEF reported that 39% of infants in developing countries are exclusively breastfed for six months and 52% continue to breastfed with complementary foods at 20-23 months. In least developed countries 34% are breastfed exclusively for six months and 63% continue to breastfeed with complementary food at 20-23 months. Exclusive breastfeeding rates in Sub-Saharan African region is 27% and East Asia is 54%5. A longitudinal cohort study on breastfeeding rates in the first six months and the reasons for stopping was conducted in New Zealand among 4286 infants during 1990-91. The findings of the study showed that at birth 93.8% of infants were exclusively breastfed. At six weeks, three months and six months the breastfeeding rates were 79.5%, (68.4% exclusive), 71.3% (47.6% exclusive), and 56% (2.5% exclusive) respectively.6 The National Family Health Survey revealed that the breastfeeding rates in different states were: Tamilnadu – 55.3%, Kerala – 55.4%, Maharashtra – 51.8%, Mizoram – 65.4%, Meghalaya – 58.6%, Orissa – 54.3%, Goa 59.7% and Assam –50.6%. Breastfeeding rates in Punjab, Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, and Delhi were below 40%. The breastfeeding rate in Karnataka is 45%. It is highlighted that compared to other states, the breastfeeding rate in Karnataka is less due to lack of awareness among women.7 A study on knowledge, attitude and practices of mothers about breastfeeding in Bihar among 8000 mothers showed that about 29% started breastfeeding within 24 hours. About two-third of the mothers discarded colostrum on their own and about one-third discarded it on the advice of elders. Most of the mothers breastfed their children up to more than one year. About 55% of the mothers introduced supplement to their infants between six to twelve months.8

SIGNIFICANCE OF THE STUDY: Breastfeeding is natural (physiological) and instinctive, and nearly all mothers do it. So one may ask what is there to learn and teach about breastfeeding. Breastfeeding is an art and a skill which needs to be learnt and mastered. Some young primiparous inexperienced mothers will need some help, especially at the beginning, though many will manage on their own, and secondly and more importantly the pertinent point of concern is that many of those who manage on their own are including some harmful practices like discarding colostrum, using pre-lacteal feeds, doing non-exclusive breastfeeding, prematurely introducing supplements and terminating breastfeeding rather early.7 It is known that most of the risk factors for mastitis are preventable if the mother is provided with a well-planned education. The findings reveal that there is a need to educate the mother in preventing the risk factors for mastitis which will enhance the breastfeeding duration and preventing breast complications. Postnatal period is crucial and mothers need to be given more information regarding breastfeeding. Mothers have many doubts and fears about breastfeeding and caring for their young ones. They also need to be adequately supported and helped by nursing staffs in preventing further complications. Teaching is an essential part of education and its special function is to impart knowledge and to develop interest and skill. Planned teaching programme is an integral part of nursing and an important means of bringing about desired healthy behaviour. Hence, the researcher being in nursing profession felt the need to educate the postnatal mothers regarding breastfeeding problems and its management so that they can promote breastfeeding and impart the same gained knowledge to other mothers in the community. OBJECTIVES: 1. 2. 3.

To pretest the level of knowledge regarding management of the breast feeding problems among the postnatal mothers. To develop and administer planned teaching programme to experimental group regarding breast feeding problems among postnatal mothers. To post test the level of knowledge regarding management of the breast feeding problems among the postnatal mothers.

4.

To evaluate the effectiveness of planned teaching programme regarding the management of the breast feeding problems among the postnatal mothers.

5.

To associate the pre test knowledge regarding the management of the breast feeding problems among the postnatal mothers with selected socio demographic variables.

OPERATIONAL DEFINITIONS: 1. Effectiveness: It refers to the outcome of planned teaching programme in increasing the knowledge of postnatal mothers regarding the management of the breast feeding problems. 2. Planned teaching programme: The systematically developed instructional aids designed for postnatal mothers on the aspects of management of breast feeding problems. 3. Management: Management refers to the regular care and activity performed for the well being of the breast of the mother during the period of one-two weeks following delivery. 4. Breast feeding problems: In this study it refers to selected breast feeding problems such as breast engorgement, flat nipple, inverted nipple, mastitis, breast abscess and cracked nipple on which the planned teaching programme will be developed by the investigator.

5. Postnatal mothers: In this study postnatal mother refers to primipara and multipara mothers who delivered in the selected hospital and are available at the time of data collection, irrespective of the method of delivery. Hypotheses: H1: There will be a difference between the pre test and post test level of knowledge regarding management of the breast feeding problems among the postnatal mothers of experimental group at 0.05 level of significance. H2: There will be a difference in post test level of knowledge regarding management of breast feeding problems among postnatal mothers between experimental and comparison group at 0.05 level of significance. H3: There will be an association between pre test level of knowledge regarding management of the breast feeding problems among the postnatal mothers with selected socio demographic variables at 0.05 level of significance.

MATERIALS AND METHODS: Research Approach: A quantitative evaluative approach was adopted for this study to determine the effectiveness of structured teaching programme on management of breastfeeding problems. Research Design: Quasi experimental non randomized comparison group research design was chosen for the present study. Research Setting: The study was conducted in the postnatal wards of Government Hospital, Phase-6 of Mohali. Target Population: The target population of the study comprised of all the postnatal mothers admitted in the postnatal ward of Government Hospital, Phase-6 of Mohali. Sample and Sampling Technique: The sample consists of 60 primigravida women, 30 mothers in experimental group and 30 mothers in comparison group. Convenient sampling technique was used to draw sample from the population. Description of the tool: 1.The Self Administered Structured knowledge Questionnaire is divided into two sections: It is divided into two sections: Part – A: Socio- Demographic Data: This section consists of seven variables to collect socio-demographic information such as age, religion, educational status, working status, type of family, family income and parity. Part B: Structured knowledge Questionnaire on Management of Breastfeeding problems: This section consists of 30 items to assess the knowledge of postnatal mothers on management of breastfeeding problems. It has divided into the following sections. Section A: Knowledge related to the breast feeding techniques, advantages This section consist of eight (8) items Section B: Knowledge related to breastfeeding problems. It includes twelve (12) items Section C: Knowledge related to management of breastfeeding problems. This part have ten (10) items. Data Collection Procedure: A formal written permission was obtained from the Civil Surgeon of Civil Hospital Phase-6, Mohali after discussing the purpose and objectives of the study with them. Also, permission from the postnatal mothers prior to the data collection was taken. Data collection procedure was carried out in February and March 2013. Before starting the data collection procedure, the investigators divided the postnatal mothers into two groups- experimental and comparison group. To prevent contamination, postnatal mothers admitted in postnatal ward (I) of Civil Hospital, Phase-6 of Mohali was taken as experimental group and postnatal mothers admitted in postnatal ward (II) was taken as comparison group. Pretest was taken from both the experimental and comparison group by administering the Self administered structured knowledge questionnaire

·

On the same day of pretest, Planned Teaching Programme was administered to experimental group

·

After one week of administration of Planned Teaching Programme, posttest was taken from both the groups by using the same Self administered structured knowledge questionnaire

·

Plan of data analysis: Coding sheet were prepared for data analysis. Data were analyzed by using descriptive and inferential statistics.

RESULTS: The data collected was entered in a master sheet and analyzed and interpreted using descriptive and inferential statistics. The data was organized and presented under the following section: Section I: Distribution of postnatal mothers according to their Socio-demographic variables Section II: Pre-test and post-test level of knowledge on management of the breast feeding problems among the postnatal mothers of both Experimental and comparison group Section III: Effectiveness of Planned Teaching Program on management of the breast feeding problems among the postnatal mothers Section IV: Association between pre-test level of knowledge management of breastfeeding problems among postnatal mothers with selected socio-demographic variables Section – I Table 1: Distribution of postnatal mothers according to their socio-demographic variables N=60 Variables Age( in years) 21-23 24-26 27-29

Experiment (f=30) f 12 12 6

% (40.0) (40.0) (20.0)

Comparison (f=30) f 7 18 5

% (23.3) (60.0) (16.7)

Total (f=60) f 19 30 11

Religion Sikh Hindu Muslim Education Primary Secondary Graduation

13 15 2

(43.3) (50.0) (6.7)

13 15 2

(43.3) (50.0) (6.7)

26 30 4

14 11 5

(46.7) (36.7) (16.7)

11 14 5

(36.7) (46.7) (16.7)

25 25 10

20 10

(66.7) (33.3)

23 7

(76.7) (23.3)

43 17

Type of family Nuclear Joint

17 13

(56.7) (43.3)

17 13

(56.7) (43.3)

34 26

(56.6) 0.000, 1, 1.000NS (43.3)

Family income < 5000/5001-15,000/-

15 15

(50.0) (50.0)

18 12

(60.0) (40.0)

33 27

(55.0) 0.606, 1, 0.604NS (45.0)

Parity Primigravida Multigravida

19 11

(63.3) (36.7)

20 10

(66.7) (33.3)

39 21

(65.0) 1.026, 1, 0.599NS (35.0)

Occupation Housewife Working

χ2,

df, p value % (31.7) (50.0) (36.7)

2.607, 2,0.272NS

(43.3) (50.0) 0.000, 2, 1.000NS (6.6)

(41.7) (41.7) 0.720, 2, 0.698NS (16.6)

(71.6) 0.739, 1, 0.567NS (28.3)

Table 1: Depicts that in Experimental and comparison group, maximum postnatal mothers (50.0%) were in 24-26 years of age and 50% belongs to Hindu religion. Most of the postnatal mothers (41.7%) in Experimental and comparison group were secondary educated. More than half of the postnatal mothers (71.6%) in Experimental and comparison group were Housewife. Majority of the postnatal mothers (55.0%) was having family monthly income of Rs.<5000. Maximum postnatal mothers (56.6%) in Experimental and comparison group were from nuclear family. Maximum (65.0%) of postnatal mothers in Experimental and comparison group were Primigravida. Table 2 denotes the comparison of level of knowledge on management of breastfeeding problems by pretest and posttest among postnatal mothers in experimental and comparison group. It was found that majority of subject in experimental and comparison group had poor level of knowledge on management of breastfeeding problems in pretest but after administration of structured teaching programme, maximum number of postnatal mothers in experimental group had good level of knowledge.

Table 3.1 reveals the unpaired ‘t’ test analysis of pretest knowledge scores of experimental and comparison group. The calculated unpaired ‘t’ value of posttest between experimental and comparison group (t(58,0.05) = 10.612, 0.000) was highly significant at 0.05 level. Thus it was inferred that in pretest, postnatal mothers of both the experimental and comparison group were having same level of knowledge on management of breastfeeding problems whereas in posttest, postnatal mothers of experimental group had gained knowledge after structured teaching programme but the knowledge of postnatal mothers in comparison group remained the same. Table - 3.2 summarizes the paired ‘t’ test analysis of pretest and posttest knowledge scores conducted on both experimental and comparison group subjects. calculated paired ‘t’ value (t(29, 0.05) = 31.687, 0.000) of Experimental group shows highly significant at 0.05 level. Hence the research hypothesis was accepted. Thus, it can be concluded that structured teaching programme was an effective tool in improving the knowledge of postnatal mothers on management of breastfeeding problems

Section - II Table 2: Comparison of pretest and posttest level of knowledge among the postnatal mothers in experimental and comparison group N=60 Level of Knowledge

Pre-test Experimental 16(53.3) 14(46.6) 0(0.0)

Poor (0-10) Average (11-20) Good (21-30)

Post-test Experimental 0(0.0) 11(36.7) 19(63.3)

Comparison 17(56.6) 13(43.3) 0(0.0)

Comparison 18(60.0) 12(40.0) 0(0.0)

Maximum score=30; Minimum score= 0 Section – III Table - 3.1: Effectiveness of planned teaching programme on management of breastfeeding problems among the postnatal mothers by unpaired ‘t’ test N=60 Knowledge Pre-test

Experimental Mean 9.0

Post-test

20.9

SD 1.4

Comparison Mean 10.3

Unpaired t test, df, p-value SD 3.7

1.4

9.4

3.0

-0.613, 58, 0.479NS 10.612, 58, 0.000**

**significant, NS= Not Significant (p < 0.05)

Table - 3.2: Effectiveness of planned teaching programme on management of breastfeeding problems among postnatal mothers by paired ‘t’ test N=60 Knowledge

Pre-test Mean 9.0 10.3

Experimental Comparison

Post-test Mean 20.9 9.4

SD 1.4 3.7

Paired t, df, p-value SD 1.4 3.0

-31.687, 29, 0.000*** -1.482, 29, 0.148

**significant, NS= Not Significant (p < 0.05)

Section- IV Table - 4.1: Association between pretest level of knowledge regarding the management of the breast feeding problems among postnatal mother and age N=60 Age(in years)

21-23 24-26 27-29 Total

f

Pretest knowledge level Poor Average f (%) f (%) 16 (84.2) 3 (15.7) 14 (46.6) 16 (53.3) 3 (27.2) 8 (72.7) 33 27

19 30 11 60

Good f (%) 00 (00) 00 (00) 00 (00) 00

2 χ

p-value

Inference

8.077

0.018*

Significant

Table 4.1 depicts that the obtained chi square value (χ2 (2, 0.05) = 8.077, 0.018) was statistically significant. Hence research hypothesis was accepted. So it is concluded that there was an association between pretest level of knowledge on management of breastfeeding problems among postnatal mothers with their age. Table - 4.2: Association between pretest level of knowledge regarding the management of the breast feeding problems among postnatal mothers and religion N=60 Religion

f

Sikh Hindu Muslim Total

Pretest knowledge level Poor Average f (%) f (%) 18 (69.2) 8 (26.6) 13 (43.3) 17 (56.6) 2 (50.0) 2 (50.0) 33 27

26 30 4 60

Good f (%) 00 (00) 00 (00) 00 (00) 00

2 χ

p-value

Inference

4.844

0.304

Non-significant

Table 4.2 depicts that the calculated Chi square value (χ2 (2, 0.05) = 4.8, 0.3) is higher at 0.05 level of significance. Hence a research hypothesis was rejected. So it is concluded that there was no association between pretest level of knowledge on management of breastfeeding problems among postnatal mothers with their religion. Table - 4.3: Association between pretest level of knowledge regarding the management of the breast feeding problems among postnatal mothers and education N=60 Education

f

Primary secondary Graduation Total

Pretest knowledge level Poor f (%) 20 (80.0) 10 (40.0) 3 (30.0) 33

25 25 10 60

Average f (%) 5 (20.0) 15 (60.0) 7 (70.0) 27

Good f (%) 00 (00) 00 (00) 00 (00) 00

2 χ

p-value

Inference

100.8

0.002**

Significant

Table 4.3 depicts that the calculated Chi square value (χ2 (2, 0.05) = 100.8, 0.002) is statistically significant. Hence research hypothesis was accepted. So it is concluded that there is an association between pretest level of knowledge on management of breastfeeding problems among postnatal mothers with their educational status. Table - 4.4: Association between pretest level of knowledge regarding the management of the breast feeding problems among postnatal mothers and occupation N=60 Occupation

Non-working Working Total

f

Pretest knowledge level

43 17 60

Poor f (%) 30 (69.7) 3 (17.6) 33

2 χ Good f (%) 00 (00) 00 (00) 00

Average f (%) 13 (30.2) 14 (82.3) 27

p-value

7.105

Inference

0.029*

Significant

Maximum score=30 Minimum score= 0 Table 4.4 depicts that the calculated Chi square value (χ2 (1, 0.05) = 7.105, 0.02) is statistically significant. Hence research hypothesis was accepted. So it is concluded that there is an association between pretest level of knowledge on management of breastfeeding problems among postnatal mothers with their occupation. Table - 4.5: Association between pretest level of knowledge regarding the management of the breast feeding problems among primigravida mother and type of family N=60 Type of family

f

Nuclear Joint Total

34 26 60

Poor f (%) 19 (55.8) 14 (53.8) 33

Average f (%) 15 (44.1) 12 (46.1) 27

Good f (%) 00 (00) 00 (00) 00

2 χ

p-value

Inference

3.128

0.077

Non-significant

Table 4.5 depicts that the calculated Chi square value (χ2 (1, 0.05) = 3.128, 0.077) is higher at 0.05 level of significance. Hence research hypothesis was rejected. So it is concluded that there is no association between pretest level of knowledge on management of breastfeeding problems among postnatal mothers with their type of family. Table - 4.6: Association between pretest level of knowledge regarding the management of the breast feeding problems among primigravida mother and family income N=60 Family income (in Rs.)

<5000 5001-15000 Total

f

33 27 60

Pretest knowledge level Poor Average f (%) f (%) 15 (45.4) 18 (54.5) 18 (66.6) 9 (33.3) 33 27

Good f (%) 00 (00) 00 (00) 00

2 χ

p-value

0.260

0.610

Inference

Non-significant

Table 4.6 depicts that the calculated Chi square value (χ2 (1, 0.05) = 0.260, 0.6) is higher at 0.05 level of significance. Hence research hypothesis was rejected. So it is concluded that there is no association between pretest level of knowledge on management of breastfeeding problems among postnatal mothers with their family income. Table - 4.7: Association between pretest level of knowledge regarding the management of the breast feeding problems among primigravida mother and parity N=60 Parity

f

Primigravida Multigravida Total

39 21 60

Pretest knowledge level Poor f (%) 30 (76.9) 3 (14.2) 33

Average f (%) 9 (23.0) 18 (85.7) 27

Good f (%) 00 (00) 00 (00) 00

2 χ

p-value

7.377

0.007*

Inference Significant

Table 4.7 depicts that the calculated Chi square value (χ2 (1, 0.05) = 7.377, 0.007) was statistically significant. Hence research hypothesis was accepted. So it is concluded that there is an association between pretest level of knowledge on management of breastfeeding problems among postnatal mothers with their parity.

RECOMMENDATIONS: Based on the results of study following recommendations are made: 1.

The study can be replicated on large sample to validate and generalize its findings.

2.

A comparative study can be conducted to assess the knowledge of postnatal mothers on management of breast feeding problems in rural and urban community.

3.

An exploratory study can be done to assess the knowledge and practice of women regarding management of breast feeding Registered User Login problems.

4.

International Advances in Nursing Management Correlation study can be Journal conducted onof knowledge and practice of breast feeding problems ISSN: 2454-2652(Online),

2347-8632(Print)

be conducted to assess the knowledge on management of breast feeding |problems Home5.| AboutComparative IJANM | Currentstudy Issue | can Archives | Editorial Board | Instructions | Paper Submission | News & Conferences | Subscription Corrigendumbetween | Contact Us primipara and multipara.

CONCLUSION: From the findings of present study following conclusions were drawn: 1.

Postnatal mothers were having poor level of knowledge on management of breast feeding problems.

2.

There was significant improvement in the level of knowledge of postnatal mothers after the administration of Planned Teaching Programme on management of breast feeding problems.

3.

Planned Teaching Programme was effective in enhancing the knowledge of postnatal mothers regarding management of breast feeding problems.

4.

Age, Educational status, occupation and Parity had an impact on the prior knowledge of postnatal mothers regarding management of breast feeding problems.

5.

Religion, type of family, family income had no influence on the prior knowledge of postnatal mothers regarding management of breast feeding problems.

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Park K. Park’s Textbook of Preventive and Social Medicine.20th ed. Jabalpur: Bhanot, 2009.

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Mallikarkuna HB, Banapurmath CR, Banapurmath S, Kesaree N. Breastfeeding problems in first six months of life in rural Karnataka. Indian Paediatrics Journal Apr 2007; 39:86 (14).

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Singh M. Care of newborn. 6th ed. New Delhi: Sagar, 2004. Sadeharju K, Knip M, Virtanen SM, Savilahti E, Tauriainen S, Koskela P, et al. Maternal antibodies in breast milk protect the child from enterovirus infections. Nursing and Midwifery Journal May 2007; 119 (5).

Received on 16.10.2013 Accepted on 16.11.2013

Modified on 22.10.2013

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