TITLE

A study to assess risk factors and effectiveness of structured teaching

programme on knowledge regarding stroke among diabetes mellitus patients
from selected hospitals at Ernakulum

INTRODUCTION

The term Diabetes mellitus describes a metabolic disorder of multiple etiologies

characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat
and protein metabolism resulting from defects in insulin secretion or insulin
action. The biggest increase in DM cases is expected to china and India. India
currently have around 40 million cases of DM and these numbers are projected
to increase to 87 million by the year 2030.The global prevalence of DM has
risen from 4.7%in 1980 to 8.5% in 2014. Kerala is the diabetes capital of India
with a prevalence of diabetes as high as 20% in 2007.

Previously the Framingham study found 2.5 fold incidence of

ischemic stroke in men with diabetes mellitus and a 3.6 fold in women with
diabetes mellitus. A stroke is caused by the interruption of the blood supply to
the brain, usually because a blood vessel is blocked by a clot. This cut off the
supply of oxygen and nutrients to the brain, causing damage to the brain tissue.
In DM patients, excess sugar can contribute to the build-up of clots or fat
deposits inside vessels. It causes narrowing of the blood vessel or a complete
blockage. Stroke is the leading cause of disability and second most frequent
cause of death. The prevalence of diabetes in stroke patients is between 10 and
20% and has been increasing over the last 20 years.

Major risk factors for stroke include Hypertension, Diabetes,

Smoking, Dyslipidemia, Heavy alcohol consumption, Obesity. Diabetes
mellitus is an important risk factor for the development of stroke. If the patients
have adequate knowledge about the risk factors, they can control the occurrence
of stroke.

REVIEW OF LITERATURE

A study was conducted in Nigeria, a multicentre study showed that DM

was one of the leading risk factors of stroke both in the young and adults and
also reported that 4.7% of diabetic patients had stroke.

A study was conducted in the Saudi national diabetes registry (SNDR)

database, a cross sectional sample of 62,681 diabetic patients aged >25 yrs was
used to calculate ischemic stroke prevalence and its risk factors. The prevalence
of ischemic stroke was 4.42% and was higher in the old age group with longer
diabetes duration.

RESEARCH METHODOLOGY

STATEMENT OF THE PROBLEM

A study to assess risk factors and effectiveness of structured teaching

programme on knowledge regarding stroke among diabetes mellitus patients
from selected hospitals at Ernakulum

AIM OF STUDY

The aim of study is to assess risk factors and effectiveness of structured

teaching programme on knowledge regarding stroke among diabetes mellitus
patients from selected hospitals at Ernakulum

OBJECTIVE OF STUDY

1) Assess the risk factors of stroke among diabetes mellitus patients

2) Evaluate the effectiveness of structured teaching programme on
knowledge regarding stroke among diabetes mellitus patients
 3) Find out the association between the level of knowledge regarding stroke
among diabetes mellitus patients with selected demographic variables

OPERATIONAL DEFINITION

ASSESS: - To evaluate

In this study assessment stands for identifying the risk factors of

stroke

RISK FACTORS: - A risk factor is a condition that increases the chance of

getting a disease.

In this study risk factors include Hypertension, Diabetes, Smoking,

Dyslipidemia, Heavy alcohol consumption, Obesity.

EFFECT: - An effect is a change which is a result or consequences of an action

or other cause.

In this study it is the gain in knowledge regarding stroke among

diabetes mellitus patients as measured by structured knowledge questionnaire.

STRUCTURED TEACHING PROGRAMME: - Systematically designed

teaching plan to provide information.

In this study it is systematically designed teaching plan to provide

information regarding stroke.

KNOWLEDGE: - Refers to extend to which patients know about stroke which

is measured by using structured knowledge questionnaire

STROKE: - In this study stroke refers to the sudden death of brain cells due to
lack of oxygen caused by blockage of blood flow
DIABETES MELLITUS PATIENT: -Refers to people of both gender
admitted and diagnosed as having diabetes mellitus from selected hospitals at
Ernakulum

HYPOTHESIS

H1: There is significant difference in the mean pre-test and post-test level of
knowledge among diabetes mellitus patients after the intervention

H2: There is significant association between pre-test level of knowledge and

demographic variables of diabetes mellitus patients

H3: There is significant association between the level of knowledge regarding

stroke among diabetes mellitus patients with selected demographic variables

CONCEPTUAL FRAMEWORK

Conceptual framework based on Dorothea .E. Orem’s general theory

Of nursing. In this study the self-care agency is promoted through

administration of structured teaching programme regarding stroke among
diabetes mellitus patients.

RESEARCH APPROACH

Quantitative evaluative approach

RESEARCH DESIGN

Quasi experimental one group pre-test post-test design was adopted

SETTING

Selected hospitals at Ernakulum

SAMPLING

POPULATION

In this study population refers to all patient of both gender admitted and
diagnosed as having diabetes mellitus from selected hospital at Ernakulam

SAMPLE SIZE

Based on various research studies prevalence rate of stroke among diabetes

patients is considered to be 10%. Minimum sample size (n) required for the
study is calculated using the formula

4 pq
N= d∗d

p =10% =10/100 =0.1

q = 1-p =1-0.1 =0.9

d = .05 (constant value)

4∗0.1∗0.9
N= .05∗.05 = 144

INCLUSION CRITERIA

Diabetes mellitus patients who are

 Willing to participate in the study

 Available at the time of data collection
 Age less than 75 years
 Patient who are able to follow instruction

EXCLUSION CRITERIA

 Patients who are not willing to participate in the study

 Patients who are unable to follow instruction
  Age more than 75 years

SAMPLE AND SAMPLING TECHNIQUE

 Convenient sampling technique

METHOD OF DATA COLLECTION

TOOLS AND TECHNIQUE

DESCRIPTION OF TOOL

 Socio personal data sheet

 Structured knowledge questionnaire
 Stroke risk assessment tool

PILOT STUDY

A formal letter will be send to the authorities of selected hospitals. After

obtaining the permission patients will be selected on the basis of convenient
sampling. Informed consent will be taken from samples before conducting the
study. Pilot study will be done in 4 patients. Sociopersonal data will be
collected then assess risk factors followed by structured teaching programme on
knowledge regarding stroke and after 7 days test will be done. Data will be
analysed using descriptive and inferential statistics.

PLAN FOR DATA COLLECTION

A formal letter will be send to the authorities of Medical Trust Hospital. After
obtaining the permission, patients will be selected on the basis of convenient
sampling. Informed consent will be taken from 144 samples before conducting
the study. Sociopersonal data will be collected and assess risk factors followed
by structured teaching programme on knowledge regarding stroke and after 7
days test will be done

PLAN FOR DATA ANALYSIS

Descriptive and inferential statistics will be used for data analysis. The main test
used are t- test and chi square test.Mean and standard deviation of pre and post-
test is assessed. t test is used to determine the difference between pre-test and
post-test.

ETHICAL CONSIDERATION

 A formal letter along with the copy of synopsis is submitted to the ethical
committee of Medical Trust Hospital, Ernakulum and ethical clearance
was obtained
 An informed consent will be obtained from concerned authority and
subject prior to the study
 Privacy, confidentiality and anonymity will be guarded
 Scientific objectivity of the study will be maintained with honesty and
impartiality
WORK PLAN

Schedule Apr May Jun July Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Selection of
the problem
Proposal
presentation
Scientific
committee
approval
Finalization
of proposal
Submission
of synopsis
Review of
literature
Selection
and
developmen
t of tool
Pilot study
Data
collection
Statistical
analysis
Writing
research
report
Submission
to university

BUDGET

Preparation of first draft and review of literature 8000

Development of tool 10000
Pilot study 2000
Data collection and analysis 5000
Final draft 8000
TOTAL 33000

BIBLIOGRAPHY

 http://www.em-consulte.com/en/article/278563
 http://www.ncbi.nlm.nih.gov/pubmed/26989695
 http:/www.cadiresearch.org >topic> diabetes
 http:/www.ncbi.nlm.nih.gov > articles
WORK PLAN