RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,
KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 NAME OF THE CANDIDATE Mr.STEFFIN MAMPALLY
AND ADDRESS Ist YEAR M.Sc. NURSING STUDENT,
N.D.R.K. COLLEGE OF NURSING
B.M. ROAD HASSAN, KARNATAKA.
2 NAME OF THE INSTITUTION N.D.R.K. COLLEGE OF NURSING, B.M. ROAD,
HASSAN, KARNATAKA.
3 COURSE OF STUDY AND MASTER OF SCIENCE IN NURSING
SUBJECT
(MEDICAL SURGICAL NURSING)
4 DATE OF ADMISSION TO THE 15-06-2009
COURSE
5 TITLE OF THE TOPIC / “A STUDY TO EVALUATE THE EFFECTIVENESS
STATEMENT OF THE OF STRUCTURED TEACHING PROGRAM(STP) ON
PROBLEM KNOWLEDGE REGARDING HEALTHY LIFE STYLES
TO PREVENT HYPERTENSION AMONG
ENGINEERING STUDENTS IN SELECTED
ENGINEERING COLLEGES OF HASSAN”
1
INTRODUCTION
“Your life style, how you eat, emote, and think determines your health.
To prevent disease you may have to change how to live.”
BRIAN CARTER
Hypertension affects world wide at epidemic rates affecting on estimated 1 billion people. Hypertension: High
blood pressure, defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above 140
with a diastolic pressure above 90.It is an important medical and public health issue 1. The main risk factors and causes of
hypertension are, increased sodium intake, excessive conception of alchohol,altered rennin angiotensin
mechanism,stress,increasing age, cigarette smocking, elevated serum cholesterol level and sedentary life style. Among the risk
factors for hypertension, stress, especially work stress, has drawn increasing attention. Another potential work-related risk
factor for hypertension identified in the past few years is work hours. 17
High blood pressure is regarded as the silent killer. More and more efforts are being undertaken to deal with
hypertension, more and more it is spreading. More than 38%of adult urban population (mostly males) is suffering from this
monstrous disease and are victims of its dreadful complications. In fact, hypertension is not a disease; it is only a symptom of
poor inner health. If not taken seriously and dealt friendly it can lay foundation stone for number of diseases and some of them
can be life threatening too. Now the world has experienced that hypertension can only be managed only with tablets and
cannot be cured or reversed. No sooner medicine is discontinued; Hypertension comes back with greater intensity. 18
People who are overweight, who worry too much, have lot of stress, who overwork and even those who are lazy are
susceptible for hypertension. In industrially developed countries hypertension is reaching epidemic proportions.
While there are several causes of high blood pressure, there are several things one can do, to prevent Hypertension.
A report from Nurses Health study found that Hypertension could be significantly prevented by adherence to
modifiable life style, and dietary factors including maintaining normal weight, daily vigorous exercise, eating a diet rich in
fruits, low sodium and tacking folic acid supplement 19.
6. BRIEF RESUME OF THE INTENDED WORK
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6.1. NEED FOR THE STUDY
Hypertension is one of the fatal diseases in the world. Estimated 600 millions people are affected by
Hypertension worldwide. Every year 5 million premature deaths are occurring due to Hypertension.
Overall, 26.4% (95% CI 26.0–26.8%) of the adult population in 2000 had hypertension (26.6% of men
[26.0–27.2%] and 26.1% of women [25.5–26.6%]), and 29.2% (28.8–29.7%) were projected to have this condition
by 2025 (29.0% of men [28.6–29.4%] and 29.5% of women [29.1–29.9%]). The total number of adults with
hypertension in 2000 was 972 million (957–987 million); 333 million (329–336 million) in economically developed
countries and 639 million (625–654 million) in economically developing countries. The number of adults with
hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54–1.58 billion)1.
The prevalence pattern of hypertension in developing countries is different from that in the developed
countries. In India, , community surveys have documented that between three and six decades, prevalence of
hypertension has increased by about 30 times among urban dwellers and by about 10 times among the rural
inhabitants. Various factors might have contributed to this rising trend and among others, consequences of
urbanization such as change in life style pattern, diet and stress, increased population and shrinking employment
have been implicated. In India according to WHO prevalence of hypertension is 1.2-4%2.
Recent research suggests that long work hours may also be a work environment risk factor for hypertension. Long
work hours may increase the risk of development of hypertension through several pathways. First, working longer hours
implies shorter time available for recovery, and insufficient time for sleep is thought to be associated with disruption of
physiological processes. Second, long work hours are thought to be linked to hypertension risk related to lifestyles and
behaviors, including smoking, unhealthy diet, and sedentary lifestyle. Furthermore, long work hours expose workers for longer
periods of time to noxious psychosocial factors in the work environment, such as job strain and effort–reward imbalance,
which are believed to be biological arousal. These risk factors, in turn, may lead to permanent physiological changes, such as
hypertension14.
Hypertension is an important independent predictor of cardio vascular disease, cerebro- vascular accident
and death. The prevalence of cardio vascular disease and Hypertension is rapidly increasing. Hypertension has been
reported to be responsible for 57% of stroke death and 27% of cardio vascular death in Asians .Hypertension is the
cause for 16%of new cases of end stage renal disease.3
A study was conducted in National institute for Psychosocial factors and health, divisions ,Sweden proved
that exposure to psychosocial factors that arouse anger may accelerate the onset of Hypertension, particularly if the
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subject is not allowed to respond constructively with the factor that evoke it. People exposed to repeated stress may
develop Hypertension more frequently than others.4
An experimental study was conducted in relationship of work stress and development of Hypertension in
America. Assessment included physical examination and recording of work load and blood pressure reactivity. The
study concluded that increased systolic blood pressure reactivity to work stress is associated with long term risk of
Hypertension.5
A Prospective cohort study was conducted in Hard ward medical school, Boston, on the association between
combination of law risk life style factors and the risk of developing Hypertension. The study included 83.882 adult
women(age 27-44 yrs)who did not have hypertension, diabetes or cancer in 1991.The study concluded that a law
risk life style that is associated with reduced risk of developing hypertension.6
The above studies show that the people who are working under severe stress and long work hours will
develop Hypertension. It is not possible to cure Hypertension, so it is better to prevent the occurrence than to
control it by medications. Engineering students will be exposed to these risk factors and so they will be prone to
develop Hypertension in their professional life. Hence the researcher is planning to give education to them on
healthy life styles to prevent hypertension.
6.2. REVIEW OF LITERATURE
Review of literature is divided into four parts;
6.2.1 Literature related to incidence and prevalence of hypertension
6.2.2. Literature related to healthy life styles to prevent hypertension
6.2.3. Literature related to knowledge regarding hypertension
6.2.4. Literature related to structured teaching program.
Literature related to incidence and prevalence of hypertension
4
Global: A population-based cohort study was conducted to find the prevalence and incidence of hypertension using
linked administrative data for adults aged 20 years and older in Ontario, Canada's most populous province with
more than 12 million residents. Using a validated case-definition algorithm for hypertension, they examined trends
in prevalence from 1995 to 2005 and in incidence from 1997 to 2004.The result shows that number of adults with
hypertension more than doubled from 1995 to 2005. The age- and sex-adjusted prevalence increased from 153.1 per
1000 adults in 1995 to 244.8 per 1000 in 2005, which was a relative increase of 60.0% (p < 0.001). The age- and
sex-adjusted incidence of hypertension increased from 25.5 per 1000 adults in 1997 to 32.1 per 1000 in 2004, which
was a relative increase of 25.7% (p < 0.001). The study findings indicate that the rise in hypertension prevalence
will likely far exceed the predicted prevalence for 2025. Public health strategies to prevent and manage
hypertension and its squeal are urgently needed7.
National: A Meta analysis study was conducted on hypertension epidemiology in, Jaipur, India. The study reveals
the following facts. Indian urban population studies in the mid-1950s used older WHO guidelines for diagnosis (BP
> or =160 and/or 95 mmHg) and reported hypertension prevalence of 1.2-4.0%. Subsequent studies report steadily
increasing prevalence from 5% in 1960s to 12-15% in 1990s. Hypertension prevalence is lower in the rural Indian
population, although there has been a steady increase over time here as well. Recent studies using revised criteria
(BP > or =140 and/or 90 mmHg) have shown a high prevalence of hypertension among urban adults: men 30%,
women 33% in Jaipur (1995), men 44%, women 45% in Mumbai (1999), men 31%, women 36% in
Thiruvananthapuram (2000), 14% in Chennai (2001), and men 36%, women 37% in Jaipur (2002). Among the rural
populations, hypertension prevalence is men 24%, women 17% in Rajasthan (1994). Hypertension diagnosed by
multiple examinations has been reported in 27% male and 28% female executives in Mumbai (2000) and 4.5% rural
subjects in Haryana (1999). There is a strong correlation between changing lifestyle factors and increase in
hypertension in India.. Pooling of epidemiological studies shows that hypertension is present in 25% urban and
10% rural subjects in India. At an underestimate, there are 31.5 million hypertensive in rural and 34 million in
urban populations8
Regional: A study was conducted to detect prevalence of essential hypertension and to identify various risk factors
in Mysore ,India. Blood pressure was recorded in 503 apparently normal students in group as per standard
guidelines. Detailed clinical examination was done in all cases. 6.16% of adolescents had high blood pressure at the
end of fourth screening. Both systolic and diastolic hypertensions were documented. Increased body mass index
and reduced consumption of vegetables and fruits were found to be statistically significant risk factors for
hypertension. The study concluded that there is a high prevalence of essential hypertension amongst adolescents in
Mysore city with modifiable risk factors for hypertension9.
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Literature related to healthy life styles to prevent hypertension.
An experimental study was conducted with an objective to motivate the hypertensive
patients to maintain healthy life style with respect to smoking, physical activity, alcohol conception and diet at
London. The study was conducted on 5231 men and 6292 women aged at least 50 years. They analyzed the
prevalence of smoking, heavy drinking, sedentary behavior and vigorous physical activity in relation to self
reported hypertension. Hypertensive patients were more likely to be heavy drinkers and to be sedentary and not
engaging in vigorous physical activity. The study recommended counseling to hypertensive individuals to improve
healthy behaviors, which can reduce hypertension.10
.A study was conducted to find out the roles of obesity, overweight, nutritional factors, alcohol,
physical activity and smoking in the prevention and treatment of hypertension in America. The study concluded
that there is a direct strong relationship between weight and blood pressure. In general overweight is associated
with a two fold to six fold increase in the risk of hypertension. Clinical trials have proved that weight loss is
effective in primary prevention of hypertension as well as in the reduction of both systolic and diastolic BP. An
increased intake of dietary sodium has been demonstrated to have a hypertensive effect. A consistent relationship
has been noted between consumption of alcohol and increased blood pressure. An inverse relationship exists
between BP and physical activity.BP was also increased in tobacco users in comparison with non users. The study
concluded that healthful lifestyle can prevent and control hypertension11
Literature related to knowledge regarding hypertension
A study was conducted to assess the risk factor knowledge in young adults, its association with 10-
year changes in risk factor levels, and variables related to risk factor knowledge of cardio vascular diseases.. A total
of 4,193 healthy persons (55% female, 48% Black; mean age=30 years) from four urban US communities were
queried about risk factor knowledge in 1990-1991 and were reexamined in 2000-2001. Of six risk factors
considered (hypertension, hyperlipidemia, smoking, overweight, sedentary lifestyle, and unhealthy diet),
participants mentioned a mean of two; more than 65% were not aware of any risk factors, and less than 35%
recognized being overweight as a risk factor. More knowledge was marginally associated with less increase in body
mass index 10 years later (p=0.06) but was unrelated to other risk factor changes. The study concluded that
Knowledge of CVD risk factors was very low in these young adults but increased with the presence of risk factors15.
A study was conducted to evaluate the perception, knowledge and practices of Nigerian employees
regarding hypertension and lifestyle modification measures. A pre-tested structured interviewer-administered
questionnaire was used to collect data. Questions were categorized to elicit patients’ demographic characteristics,
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knowledge, perception and practice of various lifestyle-modification measures. This study has shown a poor level
of perception of hypertension and awareness of the lifestyle-modification measures through the mass media, but a
high level of willingness to adopt the lifestyle measures. Concerted strategies are required to change the perception
of hypertension and increase the awareness of the lifestyle-modification measures in the world.16
Literature related to structured teaching program
An experimental study with pretest – posttest control group design was carried out in four selected
schools with similar settings of Nepal on effectiveness of structured teaching program in improving knowledge and
attitude of adolescent students. All the subjects were divided into two groups: experimental and control, each
comprising of two subgroups of 50 boys and 50 girls Structured teaching program consisting of information on
human reproductive system was used as a tool of investigation for the experimental group, whereas conventional
teaching method was used for the control group. The result of the study shows that the structured teaching program
is effective for improving the knowledge and attitude of students12.
A quasi experimental study was conducted on effectiveness of structured teaching program on improving
the knowledge of staff nurses regarding health care and management. 50 staff nurses working in burns unit, plastic
surgery unit, trauma / casualty and intensive care units of selected hospitals of Ludhiana, Punjab. Purposive
sampling technique was adopted to collect the data. The sample consisted of two groups of staff nurses:
experimental group and control group. The study results show that the structured teaching program was effective in
improving the knowledge of nurses13.
■STATEMENT OF THE PROBLEM
A Study to evaluate the Effectiveness of Structured Teaching Programme (STP) on knowledge regarding
Healthy life style to prevent Hypertension among Engineering students in selected Engineering Colleges of
Hassan.
6.3OBJECTIVES
6.3.1. Asses the pretest knowledge scores of engineering students on healthy life styles to prevent hypertension
before intervention.
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6.3.2. To assess the post test knowledge scores of engineering students to evaluate the effectiveness of structured
teaching program after intervention.
6.3.3. To find out the association between the knowledge scores of engineering students with their selected
sociodemograhic variables.
■HYPOTHESIS
H1= There will be significant increase in the knowledge of engineering students regarding healthy lifestyles to
prevent hypertension after structured teaching program.
H2. = There will be a significant association between knowledge scores of engineering students with their selected
sociodemographic variables.
■ASSUMPTIONS
1. Engineering students may not be aware of healthy life styles to prevent hypertension.
2. The engineering students expressing willingness to learn and understand about healthy lifestyles to prevent
hypertension.
3. The structured teaching program on healthy lifestyles to prevent hypertension will improve the knowledge of
engineering students; thereby they can prevent the occurrence of hypertension in future.
■OPERATIONAL DEFINITIONS
1. Effectiveness: It refers to the out come of the structured teaching program on healthy lifestyles to prevent
hypertension. Among engineering students. It measured in terms of the difference between pretest and post test
scores
2. Knowledge: It refers to the understanding of engineering students regarding the healthy lifestyles to prevent
hypertension.
3. Structured teaching program: It is the lecture given by the researcher to provide information to engineering
students regarding healthy lifestyles to prevent hypertension.
4. Healthy life styles: It includes six criteria of life styles that includes, diet adopted to stop hypertension (DASH),
sodium restriction, moderate alcohol consumption, regular aerobic physical activity, and avoidance of tobacco.
5. Hypertension: It is the high blood pressure [systolic BP ≥140mmHg, diastolic BP≥90mmHg] developing mainly
due to working stress and lifestyle.
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6. Engineering Students: In this study engineering students refers to those who are studying in the selected
engineering colleges of Hassan.
7. MATERIALS AND METHODS
7.1 SOURSE OF DATA
Data will be collected from the engineering students of selected engineering College at Hassan.
7.2 METHODS OF COLLECTION OF DATA
7.2.1 RESEARCH APPROACH
Evaluative approach
7.2.2. RESEARCH DESIGN
Quasi-experimental single group pretest posttest design.
Schematic plan of the study
GROUP Pre test Intervention Post Test
DAY-1 Day-8
SINGLE GROUP O1 X O2
[60 engineering students]
KEY
O1=Pre-test Knowledge of engineering students on healthy life styles to prevent hypertension.
X=Structured teaching program
O2=Post test knowledge of engineering students on healthy life styles to prevent hypertension.
7.2.3. POPULATION
Engineering students studying in Engineering Colleges of Hassan.
7.2.4. SAMPLE
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Engineering students of selected engineering colleges of Hassan who fulfill the inclusion criteria.
7.2.5. SAMPLE SIZE
Samples consist of 60 engineering students.
7.2.6. SAMPLING TECHNIQUE
Probability sampling technique – The simple random Sampling technique will be used.
7.2.7SELECTION OF TOOL
Structured questionnaire consist of two sections
Section A-Socio-demographic variables
Section B –Knowledge questionnaire on healthy life styles to prevent hypertension
7.2.8. CRITERIA FOR SAMPLE SELECTION
Inclusive criteria
1.Male and female students.
2. Those who are willing to participate in the study.
3. Present during the time of data collection.
Exclusive criteria
1. Who are not willing to participate in the study.
2. Students who are on leave or vacation during data collection
7.2.9 DELIMITATIONS OF THE STUDY
The study is delimited to,
1.60 engineering students in selected engineering colleges of Hassan.
2. Data collection will be delimited to Period of 4 weeks
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7.2.10 SIGNIFICANCE OF THE STUDY
The study signifies the importance of structured teaching program on healthy life styles to prevent hypertension and
it will enhance the knowledge of engineering students regarding healthy life styles to prevent Hypertension.
7.2.11 CONCEPTUAL FRAMEWORK
Ludwig von BertalanffyGeneral System Theory (1968)
7.2.12. SETTING OF THE STUDY
The study will be conducted in the selected Engineering Colleges of Hassan.
7.2.13 PILOT STUDY
Pilot study is planning with 10%of population which will be conducted in selected Engineering Colleges and they
will be excluded from main study.
7.2.14. VARIBLES
Independent Variable: structured teaching program on healthy life style to prevent hypertension among
engineering students.
Dependent variables: Knowledge of students on healthy life style to prevent hypertension
Extraneous variables: Age, sex, religion, area of living, type of family, educational status of father and mother,
occupation of father and mother, income of family per month,sources of information.
7.2.15. DATA ANALYSIS METHOD
It includes descriptive and inferential statistics
Descriptive statistics: The descriptive statistics includes frequency, percentage, mean and standard deviation.
Inferential statistics: It includes paired t-test and chi-square test.
7.3DOES THE STUDY REQUIRES ANY INTERVENTIONS TO BE CARRIED OUT ON
PATIENTS OR OTHER HUMANS OR ANIMALS?
Yes. The Structured teaching program will be conducted on the students of engineering college.
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7.4 HAS ETICHAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION?
Permission will be obtained from the research committee of N.D.R.K.College of nursing and authorities of
selected engineering college at Hassan. Informed consent will be obtained from subjects whom are selected for the
study.
7.5 DURATION OF THE STUDY
December 2009-February 2011
8. LIST OF REFERENCES
1. Kearney; P.M.Welton; Reynolb,”Risk of Hypertension”, Journal of global burden of Hypertension,
2005:365(9455): 217-23. 2005 Jan 15-21; 365(9455):217-23.
2. www.whoindia.org/
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3. Aya Higashiama et al;”Does self reported history of Hypertension predict cardio vascular death? a prospective
stydu”;Journel of Hypertension;2007;25(5);959-964.
4. Theorel T.,”Coping with unfair treatment at work”; Journel of Psychother psychosom; 2000; 69; 86-94.
5.Robert M Rose et al “Cardiovascular reactivity to work stress predicts subsequent onset of Hypertension”;Journel
of Psychosomatic Medicine;2004;66;459-465
6.John P Foramen “Adopting law risk dietary and life style factors related to lower incidence of hypertension”;
Journal of American Medical Association ;2009July;302(4);401-411
7. Haiou Yang; Peter L. Schnall; Maritza Jauregui; “BakerPrevalence and incidence of hypertension from 1995 to
2005: a population-based study”;
8. Gupta R;. Trends in hypertension epidemiology in India; Journel of Human Hypertens;. 2004 Feb; 18(2):73-8.
9. R. Savitha et al;” prevalence of essential hypertension in early and mid adolescents”; Indian journal of pediatrics;
2007 March; 74(11); 1007-1011.
10. Staptoe A,Mc Munna;”Heath behavior pattern in relation to Hypertension”; Journal of
Hypertension”;2009February;27(2);224-30.
11. Dickey R.A, Janick.j.j;”Life style modification in prevention and treatment of hypertension”; Journal of
Hypertension”; 2001Sep-oct;7(5):392-399.
12 Dhital AD1, Badhu BP2;”effectiveness of structured teaching program in improving knowledge of adolescents”;
Kathmandu University Medical Journal (2005), 3 (12); 380-383
13. Prabhjot Saini, P Ranadive, R Mahal ;”Effectiveness of structured teaching programme on improving the
knowledge of nurses”;The nursing Journel of India;July 2007;c(7)
14. Haiou Yang; Peter L. Schnall;” Work Hours and Self-Reported Hypertension among Working People”; Journel
of Hypertension. 2006; 48; 744-750
15. Lynch EB, Liu K, Kiefe CI, Greenland P”Cardiovascular disease risk factor knowledge in young adults and 10-
year change in risk factors.” American Journel of Epidemiology;2006 Dec 15;164(12):1171-9.
16. S. Ike, P. Aniebue, U. Aniebue;”Knowledge, perceptions and practices of lifestyle-modification measures
among adults in Nigeria” Transactions of the Royal Society of Tropical Medicine and Hygiene; 104, (1),55-60
17. Lewis;”Medical surgical nursing’; seventh edition; Mosby Publication; page no.768-70
18. N. Sarraf-Zadegan, M. Boshtam;” Eastern Mediterranean Health Journal”; 5( 5), 1999, 992-1001
19. Marian C. Limacher, MD;” Nurses' Health Study Identifies Risk Factors for Sudden Cardiac Death”; Journal
Watch Women's Health; 2003 Apr 29; 107:2096-101
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