Rajiv Gandhi University of Health Sciences; Karnataka, Bangalore

ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Name of the Candidate and Address (In block letters)

MISS ALEENA MATHEW 1ST YEAR M.Sc NURSING STUDENT ATHENA COLLEGE OF NURSING FALNIR ROAD MANGALORE-575 001

Name of the Institution

ATHENA COLLEGE OF NURSING FALNIR ROAD MANGALORE-575 001

Course of study, subject

1ST YEAR M.Sc NURSING, PSYCHIATRIC NURSING.

Date of Admission to Course

01/06/2009

Title of the topic A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF ADOLESCENTS REGARDING HIV INFECTION / AIDS IN SELECTED HIGHER SECONDARY SCHOOLS AT MANGALORE WITH A VIEW TO DEVELOP A SELF INSTRUCTIONAL MODULE.

Brief Resume Of Intended Work

6.1 Need for Study Human immunodeficiency virus (HIV) is a retro virus that can lead to acquired immune deficiency syndrome (AIDS). Acquired immune deficiency syndrome is a collection of symptoms and infections resulting from the specific damage to the immune system caused by the Human immunodeficiency virus. In June 1981, scientists in the United States reported the first clinical evidence of the disease that was later known as acquired immune deficiency syndrome. World health organizations current statistics shows that globally around 40 million people contracted HIV infection / AIDS and over 25 million have died because of AIDS. As per UNAIDS global report 2007, every day more than 6,800 people get infected with HIV infection and 2.5 million people get newly infected. One person out of every six infected is a child under the age of 15 years. Of the 2.1 million people who died because of AIDS in 2007, 1.7 million were over 15 years of age and 2,90,000 were under the age of 15years.1 UNAIDS 2007, estimated that there are 5.6 million people living with HIV in India, which indicate that there are more people with HIV infection in India than many other country in the world. In 2007, following the first survey of HIV infection among the general population, UNAIDS and NACO agreed on a new estimate between 2 million and 3.1 million people living with HIV in India. In 2008 the figure was confirmed to be 2.5 million which equals to a prevalence of 0.3%. This may seem a low rate, because Indias population is so large, it is third in the world in terms of greatest number of people living with HIV infection with a population around a billion, a mere 0.1% increase in HIV prevalence would increase the estimated number of people living with HIV by over half a million. AndraPradesh, Maharashtra, Tamilnadu and Karnataka are the states which show the highest prevalence of HIV / AIDS.2 Karnataka, a diverse state in the southwest of India, has a population of around 53 million. HIV prevalence was 1% from 2003 to 2006, and dropped to 0.5% in 2007. It is also one of the 6 highest states in HIV / AIDS prevalence.3 A study was conducted in 2007 in South Delhi, India regarding

knowledge, attitude and perception of 251 adolescent urban school girls towards HIV infection / AIDS from two senior secondary schools. Result reveled that more than 1/3rd of the students in this study had no accurate understanding about HIV infection / AIDS. About 30% of the samples considered HIV infection / AIDS could be cured, 49% felt that condoms could not be available to youth, 41% were confused whether the contraceptive pill could protect the females against HIV infection and 32% thought it should only be taken by married women.4 A study conducted in 2004 regarding knowledge and attitude of 300 adolescent girls about prevention of HIV infection in Sikkim, India reveled that adolescent girls had inadequate knowledge regarding magnitude of AIDS, modes of transmission, incubation period, treatment, control and prevention of HIVinfection.5 A wide range of literature suggests that HIV infection / AIDS is associated with high-risk behaviors. Studies support that HIV infection could be prevented or controlled if adequate knowledge is provided to adolescents, which will help in behavioral changes. Adolescents experiment with sex, drugs and may engage in high-risk behaviors and they are at risk for exposure to HIV infection / AIDS. Majority of adolescents dont take precautionary measures when

engaging in high risk behaviors. If the HIV infection / AIDS epidemic has to be stopped or at least slowed, adolescents and youth need to be targeted. The researcher from her own experience and discussion with colleagues and experts realized that HIV infection / AIDS is a problem in Karnataka. If adolescents are provided with knowledge on causes and signs and symptoms, modes of transmission and prevention of HIV infection / AIDS, this might help the students to change their behavior and also influence others. Therefore the researcher chose to assess the knowledge of adolescents and their attitude towards HIV infection / AIDS and based on that to prepare a self-instructional module.

6.2 Review of Literature A study was conducted in Karnataka, to assess the knowledge, attitude and expressed behavior in relation to HIV infection / AIDS among students of

non professional colleges in Udupi District with a view to identify the learning needs. Survey research approach was used for the study and the sample consisted of 263 students selected using simple random sampling technique. Data was collected with the help of structured self administered questioners. Findings reveled that television was the main sources of information in relation to HIV infection / AIDS. Students possessed higher knowledge in the area of prevention and treatment (79.5%). The lowest knowledge was in the area of incubation period (69%). Students possessed adequate knowledge but they showed a less favorable attitude towards HIV / AIDS clients.6 A survey was conducted in Dakshina Karnataka, South India on 1669 samples (834 males and835 females) aged 19-25yrs of the general population to asses HIV infection / AIDS related knowledge, attitude and practice. Results showed that 54% of participants knew that AIDS is caused by HIV virus and 44% correctly identified all modes of transmission, 41% did not know that condoms can prevent HIV infection. Few (34%) felt that HIV infected individuals should be kept away from others and 40% were not willing to accept a family member with HIV infection. There was a significant and positive corelation between knowledge and attitude scores (P<.01). Among respondents who had sexual intercourse, significantly more males declared having more than one sexual partner. Most (62%) of the respondents were willing to undergo an HIV test if provided free of cost. This willingness to opt for HIV testing increased significantly with better knowledge score, better attitude score and higher education status.7 A study was conducted in Srinagar district of Kashmir to assess the extent of knowledge, nature of belief and current attitudes of adolescent students towards HIV infection / AIDS. A total of 2,250 girls of class 10th and 11th participated and were selected randomly from different higher secondary schools. A structured questionnaire was used and the results showed that 49.9% had no idea of causative agent. Majority (87.56%) believed that the prevalence and spread of HIV / AIDS in the society were due to degradation of moral values among people. The above findings, in general indicates a poor awareness of HIV / AIDS among educated adolescents in the capital city which indirectly reflects a much worse scenario of the illiterate rural counterparts who form bulk of the

states population.8 A study was conducted in Karnataka to find out the knowledge and attitude of undergraduate nursing students regarding HIV / AIDS. Convenience sampling technique was used and data were collected from 175 nursing students of schools and colleges of nursing. Structured knowledge questionnaire and attitude scale was used to collect data. The findings of the study suggested that there was no significant difference in knowledge and attitudes between the two student groups (BSc and GNM students). Majority of the student found to have adequate level of knowledge and attitude orientation, still there is need for improvement.9

6.3 Problem Statement A study to assess the knowledge and attitude of adolescents regarding HIV infection / AIDS in selected higher secondary schools at Mangalore with a view to develop a self instructional module.

6.4 Objectives of the Study 1. To assess the level of knowledge of adolescents regarding HIV infection / AIDS as measured by a structured knowledge questionnaire. 2. To assess the attitude of adolescents regarding HIV infection / AIDS as measured by an attitude scale. 3. To find out the relationship between mean knowledge score and mean attitude score regarding HIV infection / AIDS. 4. To find out the association between mean knowledge score and mean attitude score with selected baseline variables (age, stream of education, education of parents, occupation of parents and income).

6.5 Operational Definitions Knowledge In this study knowledge refers to the correct response of adolescents regarding HIV infection / AIDS as measured by a structured knowledge questionnaire.

Attitude In this study attitude refers to the view or opinion of adolescents to HIV infection / AIDS as measured and scored by an attitude scale. Adolescents In this study adolescents refers to the students between 15 -18 yrs of age and are studying in selected higher secondary school at Mangalore. HIV infection / AIDS Human immunodeficiency virus (HIV) is a retro virus that can lead to acquired immune deficiency syndrome (AIDS). Acquired immune deficiency syndrome is a collection of symptoms and infections resulting from the specific damage to the immune system caused by the Human immunodeficiency virus. Higher secondary schools Are the schools in Mangalore that run plus one and plus two classes. Stream of education The subjects which students have taken for their higher secondary education eg: science / commerce. Self instructional module In this study selfinstructional module refers to a learning package consisting of information regarding causes, signs and symptoms, modes of transmission and prevention of HIV infection / AIDS which will be prepared by the investigator and distributed to the students after assessing their knowledge regarding HIV infection / AIDS.

6.6 Assumptions 1. Adolescents may possess some knowledge regarding the HIV infection / AIDS. 2. Self instructional module improves knowledge regarding HIV infection / AIDS. 3. As knowledge increases more favorable attitude develops.

6.7 Delimitations The study is delimited to 1. Adolescents studying in plus one and plus two classes.

2. Adolescents studying in selected schools of Mangalore only. 3. Adolescents who are willing to participate in the study.

6.8 Projected outcome (Hypothesis) All hypotheses will be tested at 0.05 level of significance H1: There will be a significant relationship between mean knowledge score and mean attitude score of higher secondary students regarding HIV infection /AIDS. H2: There will be a significant association between mean knowledge score and selected baseline variables. H3: There will be significant association between mean attitude score and selected baseline variables.

MATERIAL AND METHOD

7.1 SOURCE OF DATA Data will be collected from adolescents who are studying in selected higher secondary school in Mangalore.

7.1.1 Research design Descriptive survey design will be used for the study.

7.1.2 Setting The study will be conducted in one of the private school in Mangalore City which is under private management.

7.1.3 Population Population of the study will consist of plus one and plus two students at selected higher secondary school in Mangalore. The student strength of the selected higher secondary school (plus one and plus two) is 3800.

7.2 METHOD OF DATA COLLECTION 7.2.1 Sampling procedure School will be selected on the basis of purposive sampling technique, and simple stratified random sampling will be used for selecting 150 plus one and 150 plus two students from the selected school.

(75 science students + 75 commerce students from plus one class= 150 75 science students + 75 commerce students from plus two class= 150) Total 300 samples.

7.2.2 Sample Size The sample size will consist of 300 higher secondary students who have taken commerce or science as their main subject.

7.2.3 Inclusion Criteria for sampling 1. Students who are studying plus one and plus two and have taken commerce or science as their main subject. 2. Students who are willing to participate in the study. 3. Students who are present at the time of data collection.

7.2.4 Exclusion Criteria for sampling Students who have undergone any training / in service education regarding HIV infection / AIDS.

7.2.5 Instruments intended to be Used The tool will consist of 3 sections Section I : Demographic Proforma Section II: Structured knowledge questionnaire regarding HIV infection to assess the knowledge. Section III: 5 point Likert scale to measure the attitude of the sample regarding HIV infection.

7.2.6 Data collection method After obtaining administrative sanction from the principal of selected higher secondary school in Mangalore, the investigator will randomly select the students. They will be made to sit in a large hall which can accommodate 300 students. The purpose of the study will be explained to them and informed consent will be taken. After obtaining their consent the tool will be administered to them. Based on the result a self instructional module will be prepared and given to the school authorities.

7.2.7 Data Analysis Plan Based on the objectives of the study data analysis will be done using descriptive and inferential statistics. Descriptive statistics such as mean percentage and frequency will be used to depict the demographic data as well as knowledge and attitude score. Inferential statistics such as Karl-Pearson corelation co-efficient r test will be used to find out the relationship between mean knowledge score and mean attitude score. Chi-square test will be used to find out the association between mean knowledge score and mean attitude score with demographic variables. Findings will be presented in the form of Tables and Figures.

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly. No investigation /intervention will be conducted on the sample. However a self instructional module on HIV infection/AIDS will be given to the school authorities.

7.4 Has ethical clearance been obtained from your institution in case of 7.3? Ethical clearance will be obtained from the ethical committee of college of nursing prior to the conduction of the study. Administrative permission will be obtained from the concerned authorities. Written consent will be obtained from the sample and confidentiality will be assured.

List of References 1. http://data.unaids.org/pub/globel report/2008/jc 1510_2008_globel report [access date 27/08/09] 2. http://www.google.com,HIV/AIDS statistics in Asia, published on July 2009, [access date 27/08/09] 3. http://www.google.com.NACO/WHO AIDS epidemic update, 2008. [access date 28/08/09] 4. Alexandra Mc Manus and Lipi Dhar. Study of knowledge, attitude and perception of adolescent urban school girls in south Delhi, India, http://www.google.com. [Access date 27/08/09]. 5. Mehrzad Taghizade. A study on attitude and knowledge of adolescent Girls about prevention of HIV infection /AIDS. The nursing journal of India 2005 February; 15 (2): 40-42. 6. Mengstu Welday. A study of knowledge, attitude and expressed behavior in relation to HIVinfection/AIDS among students of non professional colleges in Udupi District with a view to identify the learning needs. Unpublished Masters thesis, Manipal University, 2000. 7. Anand D, Menudi,Ambikadevi Amax, Aruna Roan, Sangeetha Shettyy. A cross sectional problem based study of knowledge, attitude and practice regarding HIV/AIDS in Dakshina Karnataka, India. Journal of international association of physicians in AIDS care (JIAPAC) 2008 February; 7(1):27-34. 8. Basir Gaush, Muzaffir A, Rehna K and Shabnam B. Knowledge and belief on HIV/AIDS among the female senior secondary students in Srinagar District of Kashmir. Health population perspectives and issues 2003; 26(3): 101-107. 9. Birara Tadag Yayeh. A study of knowledge and attitude of under graduate nursing students in selected schools and colleges of nursing in Udupi District, Karnataka state. Unpublished Masters thesis, Manipal University, August 2005.

Signature of Candidate

9 10

Remarks of the Guide Name and Designation of (in block letters) 10.1 Guide MR. JAMES CHAKO ASSISTANT PROFESSOR ATHENA COLLEGE OF NURSING MANGALORE 10.2 Signature

10.3 Co-Guide (if any)

NIL

10.4 Signature

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11.1 Head of Department

DR (SR) ALPHONSA ANCHERIL PROFESSOR ATHENA COLLEGE OF NURSING MANGALORE

11.2 Signature

12

12.1 Remarks of the Chairman and Principal

12.2 Signature