T.JOHN COLLEGE OF NURSING

GOTTIGERE

BANNERGHATTA ROAD

BANGALORE-83

SYNOPSIS

REGISTRATION OF SUBJECTS FOR DISSERTATION

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA

PREPARED BY,

MS.ELBA BABY

I YEAR MSC NURSING,

T. JOHN COLLEGE OF NURSING

GUIDED BY,

MRS. P.NEELAVATHY

PROFESSOR

MEDICAL -SURGICAL NURSING

T.JOHN COLLEGE OF NURSING

0

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

PROFORM

A FOR

REGISTRA

TION OF

1

SUBJECTS

FOR

DISSERTAT

ION1. Name of the candidate and

address

(in block letters)

ELBA BABY

I YEAR M. Sc. NURSING

T JOHN COLLEGE OF NURSING

GOTTIGERE, BANNERGHATTA

ROAD,

BANGALORE-83

2

2. Name of the InstitutionT JOHN COLLEGE OF NURSING

GOTTIGERE ,BANNERGHATTA

ROAD,

BANGALORE-83

3. Course of Study and Subject M. Sc. NURSING

MEDICAL-SURGICAL NURSING

4. Date of Admission to the course 13-06-2012

5. Title of the Topic

“A study to assess the effectiveness of self-instructional module on

knowledge regarding prevention of metabolic syndrome and related

complications in interstate bus drivers working in Karnataka state

road traffic corporation[BMTC]bus station kempagowda, Bangalore.”

BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Today modern man’s brain has to work more than his other parts of

the body. That makes him more sedentary. Humanity has taken up a mode of living

without much physical activity. At every stage of his life, either a child or an adult, he

is not involved in physical activities or exercises. Advance in technology and

inventions of machineries have changed the lifestyle of modern man, making him

more sedentary. And this particular life style affecting the health of the human very

dangerously.1 The metabolic syndrome is a group of risk factors that increases the risk

for developing the major chronic illnesses in the world. It is a lifestyle disease, caused

by a`` lifestyle of too much food and too little activity’’. The Individuals with

metabolic syndrome have a two-fold increase in risk for heart diseases and a five-fold

3

increased risk for developing diabetes when compared with individuals who do not

have metabolic syndrome.2

About 250 years ago the metabolic syndrome were described, by

the Italian physician and anatomist Morgagni, later they identified its association

between visceral obesity, hypertension, atherosclerosis and relatively high level of

uric acid in blood. In the mid-20th century, the French physician Vague was the first

to identify ‘android obesity’ (upper-body adiposity) as this condition most often

associated with diabetes and cardiovascular disease. In the 1960s the high risk of

coronary artery disease was described in people with this cluster of metabolic

abnormalities.Towards the end of the 1980s, the clustering of disturbances in glucose

and insulin metabolism, obesity, dyslipidaemia and hypertension was given the

mysterious name, ‘syndrome X’ , and a few years later the term `insulin resistance

syndrome’ and then metabolic syndrome launched in 1998,3 a working definition of

the metabolic syndrome was provided by the World Health Organization(WHO) .The

WHO definition came with a list of criteria for clinical diagnosis then in 2005

IDF(International Diabetes Federation) revised this criteria .

One fact about the metabolic syndrome it does not have any immediate

symptoms the medical problems that it causes develop gradually over time only

prevention can cure this disease that is only through life style modification, as this

disease is growing one of the supporter for the killer diseases in the world like Type 2

Diabetes ,Obesity ,Hypertension ,Hypercholesterolemia ,Hypertriglyceridemia,

Cardiovascular Diseases ,Kidney Damage, Liver Damage. Other than genetic factors

this disease is purely a life style disease mainly due to inactivity. 5

Sedentary behavior refers to activities that involve less activity.

Operationally, sedentary behavior can be referred to as ‘sitting time’ rather than

simply low levels of physical activity includes activities such as lying down, sitting,

watching television, driving, using the computer and other forms of screen-based

entertainment. The International Labor Organization (ILO) and the World Health

Organization (WHO) in 2001 have published a survey result that drivers have high

prevalence of metabolic syndrome than computer users. And it reported it is due to

sitting in a fixed position for long hours while working, lack of exercise and

movement in working environment, cigarette smoking, job stress, unhealthy diet and

4

lack of physical activity, the aging work force and lack of attention and less

awareness among them.6

Again In 2004, the Federal Motor Carrier Safety Administration

(FMCSA) convened a Cardiovascular Medical Advisory Panel to develop new

guidelines to reflect the medical advances that have occurred over the last 15 years.

Panel members submitted medical review papers on their topics. The papers reviewed

the currently accepted scientific opinion on the risks, diagnoses and treatments of

numerous cardiovascular diseases among commercial drivers, it found metabolic

changes is the leading cause of medical illness among drivers and sudden death. The

life style of a driver that itself have the risk factor, because their working environment

is characterized by numerous stress factors such as lack of physical activity due to

working in a fixed position, disruption in diet, and irregular sleep habits which are not

modifiable and they cannot avoid that situation .Educational programs should be

established for promoting healthy lifestyle and also for early detection and appropriate

interventions among this group.7

6.1 NEED FOR THE STUDY

Health is a state of the organism when it functions optimally without

evidence of disease or abnormality. A person’s state of health is ever changing and

the potential to change from high level wellness to extremely ill health and imminent

death. The goal of medicines is not only to promote, preserve, and restore the health

but to prevent the occurrence .The successful prevention depends upon knowledge of

causation, identification of risk factors, groups.8

Chronic diseases are the major causes of morbidity and mortality across the

globe in developed and developing countries with socialist status. The impact of

chronic conditions has been underappreciated by society and by health systems in

terms of its lack of social awareness and economic effects on populations where more

attention has traditionally been paid to infectious diseases, in a worldwide statistics

by WHO in 2009 reported around 60 percent of all deaths worldwide with chronic

diseases are surprisingly neglected on the public health agendas of most nations and

regions, particularly in low and middle-income countries (LMICs), concentrated in

Central Asia.9An exploratory survey conducted by the US Census Bureau,

5

International Data Base, 2008. An approx 1 in 4 or 25.00% or 68 million people in

USA are affected with metabolic syndrome .In Asia, India is leading country with

this disease. One of the main reasons behind the rise in chronic diseases over the past

few decades has been the rise in the sedentary lifestyle. A lifestyle is called sedentary

if it lacks exercise or physical activity. The word sedentary has a Latin root in which

it is called "sedere", which means "to sit, Thus, the modern lifestyle promotes sitting

in one place for long.10

According to WHO statistics in 2006 approximately 34% of the

population in the world with 20 years of age are now meeting the criteria for

metabolic syndrome, and about 20% of males and 16% of females under 40 years of

age met the criteria for metabolic syndrome, 41% of males and 37% of females 40–59

years of age and 52% of males and 54% of females 60 years of age and over met the

criteria. Among that the prevalence of MS was 8.4% exclusively among obese, and

the report says, metabolic responses to obesity are more prevalent in Asians.11

A survey done by All India Institute of Medical Sciences, New Delhi, and

Thomson Scientifics, Philadelphia, PA, USA to describe the prevalence of

metabolic syndrome and obesity in Asians. Study conducted among Asian Indians,

Asians, South Asians .the result of the study was Asian Indians have a high

prevalence of metabolic syndrome.Underlying genetic tendency or early-life adverse

events may contribute to such a phenotype.12

A large cross-sectional survey carried out in urban Delhi and Ballabgarh,

on the prevalence of metabolic syndrome in India, especially regarding urban-rural

differences in the burden of metabolic syndrome an adjacent rural area. The study

demonstrates a higher prevalence of metabolic syndrome among the people living in a

major urban area in India as compared to people from an adjacent rural area. And the

south india is reporting high prevalence than urban northern India. The study suggests

that primary prevention strategies should be initiated early in this ethnic group and

studies should come up with different groups and occupational level. 13

Health has always been closely linked with occupation. Sound health in

relation to vocation and employment is the most important aspect of the very life of

an individual who works and to the society as a whole.A comparative study done by

Vijay Viswanathanand colleagues from Chennai, to compares the prevalence of

diabetes and metabolic syndrome among policemen and general population(GP) in

6

Chennai. This study reports a very high prevalence of diabetes among policemen

(32%) compared to the GP(20%). In the study report thus suggests that policemen are

at high risk of developing diabetes and cardiometabolic risk factors. The possible

reason for high prevalence could be due to poor physical activity, altered sleep cycle,

improper food habits and the tremendous work pressure and stress. The study suggest

that people should targeted according to the occupational level for therapeutic

lifestyle changes to keep themselves healthy and to prevent diabetes and metabolic

syndrome as they are the precious for of the nation, and same study can be repeated in

other sedentary workers.14

Professional driving is associated with substantial changes in lifestyle

habits. Professional drivers are prone to metabolic syndrome (MetS) and its

complications because their working environment is characterized by numerous stress

factors such as lack of physical activity due to working in a fixed position, disruption

in diet, and irregular sleep habits which are not modifiable and they cannot avoid that

situation. Driving as a profession puts strain on healthy life style practices of an

individual.15 There has been a deterioration in work conditions of bus drivers over the

last 20 years. This deterioration is largely not only the result of traffic congestion and

its associated air and noise pollution but also with the chronic illnesses.16

Karnataka State Road Transport Corporation being a large,

economically successful state government enterprise is expected to lead other

transport organizations in providing preventive and promotive health care services to

their employees according to job specific health hazards and risks.Hence this study

has been planned to provide an awareness regarding one of the leading causes of

chronic illness among them that is metabolic syndrome and to study the health

problems of bus drivers and to make recommendations for a significant improvement

in the health status of this group of professionals. As a nursing personal it is our duty

to provide proper knowledge to this particular group of people as they are high risk

for getting this disease and have less awareness about this problem.17

6.2 REVIEW OF LITERATURE

Review of literature is an important step in the development of a

research project. It involves systematic identifications, location, scrutiny and

summary of written materials that contain information and research problem.

7

A review of literature on the research topic makes the researcher familiar with

the existing studies and provides information which helps to focus on a particular

problem and lay foundation upon which to base the new knowledge. It creates

accurate picture of the information found in the subjects.19 The related literature

review was done from journals, books, unpublished theses, online. Review of

literature is divided under the following areas:

Reviews related to association of sedentary life style and metabolic

syndrome

Review related to incidence and prevalence of metabolic syndrome in

india

Review related to prevalence of metabolic syndrome and its related

complications in bus drivers.

Review related to effectiveness of SIM

1) Reviews related to association of sedentary life style and metabolic syndrome

Diabetes Research Department University Hospitals of Leicester, United

Kingdom done a study to find the Association of Sedentary Behaviour with Metabolic

Syndrome with cross sectional or prospective design include adults ≥18 years of

age,self-reported or objectively measured sedentary time. Data were pooled using

random effects models to take into account heterogeneity between studies. The result

was 95% confidence intervals for metabolic syndrome comparing the highest level of

sedentary behavior to the lowest were extracted for each study. Metabolic syndrome

were identified with Greater time spent sedentary increased the odds of metabolic

syndrome by 73% (OR 1.73, 95% CI 1.55–1.94, p<0.0001).study concluded there

were no differences for subgroups of sex and there is a strong association showed in

accordance with occupation and income. Study suggests reducing sedentary behaviors

are potentially important for the prevention of metabolic syndrome.18

A population-based, prospective cohort study  done by The Kuopio

Ischaemic Heart Disease, Singapore . among 1209 men aged 42 to 60 years .To

assess the association of the metabolic syndrome and cardiovascular diseases in Men

8

related to sedentary life .The result of study :prevalence of the metabolic syndrome

ranged from 8.8% to 14.3%, depending on the definition and criteria .There were 109

cases during the approximately 11.4-year follow-up, of which 46 and 27 were due to

CVD and CHD, respectively Cardiovascular disease and all-cause mortality are

increased in men with the metabolic syndrome, even in the absence of baseline CVD

and diabetes in association with sedentary life style. Early identification, treatment,

and prevention of the metabolic syndrome present a major challenge for health care

professionals facing an epidemic of overweight and sedentary lifestyle.19

A study done on association of physical inactivity with components of

metabolic syndrome and coronary artery disease in Chennai Urban Population ,the

total of 1399 eligible subjects (age ≥ 20 years), 1262 individuals participated in the

study. MS was diagnosed based on modified Adult Treatment Panel (ATP) III

guidelines. Details about the physical activity were collected using questionnaire,

which included job-related and leisure-time activities, and specific questions on

exercise. Study individuals were then graded as light, moderate and heavy using a

scoring system. And the Prevalence of most of the components of MS (diabetes

P < 0.001, obesity P = 0.003, abdominal obesity P < 0.001 and hypertension

P < 0.001) and MS per se (P < 0.001) increased significantly with decrease in physical

activity. Among non-diabetic subjects, HOMA-IR was significantly higher in subjects

who did light-grade activity compared with heavy-grade activity (P = 0.041). Logistic

regression analysis revealed physical activity to be significantly associated with MS

[heavy activity: reference, moderate activity, odds ratio (OR) 1.639, (P = 0.017); light

activity: OR 2.289, (P < 0.001)]. Subjects in the light-grade activity group also had

higher odds of CAD (OR 2.42, 95% confidence interval 1.40, 4.24, P = 0.011),

compared with the heavy-grade activity group.The Conclusion  was Physical

inactivity is associated with the components of MS and CAD in this urban south-

Indian population. Lifestyle changes focusing on increasing physical activity could

help to prevent the exploding epidemic of MS and CAD in India.20

A study done by the Department of Physiotherapy, Father Muller Medical

College,among employees of corporates to find out the correlation between metabolic

syndrome and physical activity at work and leisure time .As many as 197 employees

of various banks and institutions in Mangalore took part in the study. The participants

9

answered a survey questionnaire with 27 questions about their physical activity. A

fitness test was used.hen all the parameters were analysed, the result showed a strong

correlation between leisure time physical activity and physical fitness. It found that

more than half (69 per cent) the population lacked leisure time physical activity. The

study suggests that steps must be taken to encourage activity at work. People in the

groups had a metabolic syndrome that is a risk factors for heart problems.21

2) Review related to incidence and prevalence of metabolic syndrome in india

A cross sectional study aimed to estimate MS prevalence in 531 Asian

Indian families comprising of 2318 individuals in Newdelhi to assess the Prevalence

and component analysis of metabolic syndrome in Asian Indians have a high

predisposition to metabolic syndrome (MS) and coronary artery disease (CAD).

Anthropometrics and lipid profile were assessed. MS prevalence was estimated using

standard Adult Treatment Panel III (ATP-III) and World Health Organisation (WHO)

criteria and modified definitions which included lowered cut-offs for waist

circumference (WC) (≥90 cm for men and ≥80 cm for women], body mass index

(BMI) (≥23 kg/m2) and impaired fasting glucose (IFG) levels. ATP-III criteria

identified a significantly higher proportion of people with MS (N = 933; 40.3%)

compared with WHO (N = 708; 30.6%; p < 0.0001) while The number of MS subjects

was highest in the 50–59 years age group. MS was diagnosed a decade earlier in

unaffected subjects compared with those with CAD/diabetes using the modified MS

criteriaand correlated significantly with BMI and waist–hip ratio (WHR) (p =

0.000).The higher percentage contribution of WC among males and WHR among

females indicates the influence of gynecoid/android pelvis on WHR measures. 22

A community based cross-sectional study conducted by Department of Medicine,

Government Medical College Chandigarh, India To determine the prevalence of

Metabolic Syndrome in adults aged 18 years and above in Chandigarh, India To

determine the socio-demographic factors associated with Metabolic syndrome with

WHO criteria. A total 605 subjects aged 18 yrs and above were studied using

multistage random sampling. And Metabolic Syndrome was found in 287 (47.4%)

subjects and it was more prevalent among the age group of 28-38years 171 (59.6%) as

compared to female 116 (40.4%). its prevalence was more among females 141

(44.8%) than males 116 (39.5%). Higher socioeconomic status, sedentary occupation

10

and high body mass index were significantly associated with Metabolic Syndrome.

Study suggested ,Metabolic Syndrome is a major health problem in the region and

proper emphasis should be given on its prevention and control23

Department of Medicine, Monilek Hospital and Research Centre,

Jaipur done a study to assess the Prevalence of metabolic syndrome in an Indian

urban population Randomly selected adults >20 years were studied using stratified

sampling. Target study sample was 1800 with population proportionate distribution

(men 960, women 840). Evaluation of anthropometric variables, blood pressure,

fasting blood glucose and lipids was performed. Subjects (1123; response 62.4%)

were examined, fasting blood samples were available in 1091 (532 men, 559 women)

and analyzed for prevalence of metabolic syndrome.Metabolic syndrome was present

in 345 (31.6%) subjects; prevalence was 122 (22.9%) in men and 223 (39.9%) in

women (p<0.001); the age-adjusted prevalence was 24.9%, 18.4% in men and 30.9%

in women. There was a significant age-related increase in its prevalence (Mantel-

Haenzel chi(2) for trend p<0.05). Prevalence of components of metabolic syndrome in

men and women was: central obesity (waist, men >102 cm, women >88 cm) in 116

(25.6%) and 246 (44.0%: There is a high prevalence of metabolic syndrome in an

urban Indian populationand more attention is needed because cardiovascular diseases

are high in this group. 24

A study done by Department of Pharmacology, Kasturba Medical

College Mangalore To identify metabolic syndrome (MetS) prevalence using

International Diabetes Federation (IDF) 2005 guidelines in a semi urban south Indian

population of Mangalore. Population of randomly selected adults ≥20 years living

locality who were available for the house to house survey were assessed for the

following: anthropometric variables; blood pressure; fasting blood glucose and lipid

profile. Among 800 responders; 300 men, 500 women, 551 were examined Metabolic

syndrome was prevalent in 134 of 451(29.7%); men 39 (26.5%) and women 95

(31.2%). Study concluded ,the prevalence of MetS in semi urban population of

Mangalore compares with MetS prevalence identified in cross sectional studies in

India. Prevention and treatment of the predictive factors: dyslipidemias,

hyperglycaemia, hypertension, together with enhanced physical activity may together

reduce the prevalence of Metabolic syndrome, large scale study can be more

informative with specific group to provide the awareness.25

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3) Review related to prevalence of metabolic syndrome in bus drivers

A descriptive cross sectional study was conducted to find out the

Prevalence of metabolic syndrome in bus and truck drivers in university of Kasha,

Iran, to determine the prevalence of metabolic syndrome among bus and truck

drivers . All the study subjects were exclusively male (as it is common for

professional drivers in Iran). The average age of participants was 36.6 ± 10.7 (21-73)

years. 137 (i.e. 31.9%) out of 429 drivers were between 30 and 39 years old. A

number of 12 (2.8%) participants were above 60 years old. Metabolic syndrome was

met in 154 (35.9%) of individuals. Metabolic syndrome was found in 28 (93.3%)

subjects among 30 diabetic patients, as well as in 77 (64.2%) subjects among those

with blood pressure above 140/90 mmHg. Furthermore 39.8% of the subjects

recognized with the BMI in overweight range and 65.7% of obese persons revealed

metabolic syndrome. According to this study, the prevalence of metabolic syndrome

was 7% in drivers which is higher than the rates of diabetes.26

A study was conducted in china by Department of Family Medicine and

Primary Care, to assess the impact of work nature, lifestyle, and obesity on health-

related quality of life in Chinese professional drivers among a total of 3376 Chinese

professional drivers aged 18 to 70 years were recruited. Data collected as survey

method,And the findings was the Metabolic syndrome is more common in drivers

compared to overall population, and it found out as a result of sedentary inactive life,

high-calorie intake, high-fat dietary habits, occupational stresses, night-shift working,

and lack of proper attention to health care follow up. And the professional drivers

tended to be low, especially among lorry drivers and shift drivers have high

prevalence of irregular exercise, unhealthy eating, smoking, and lack of weight

control.27

A study conducted in the University of brazil to find out the General

characteristics and risk factors of cardiovascular disease among interstate bus drivers.

Data from 659 interstate bus drivers collected retrospectively, including

anthropometric characteristics, systolic and diastolic blood pressure, lipid profile,

fasting blood glucose. All participants were male, with a mean age of 41.7 ± 6.9

years, weight of 81.4 ± 3.3 kg, and BMI 27.2 ± 3.3 Kg/m²;. The clinical

12

characterization of a young male population of interstate bus drivers revealed a high

frequency of metabolic syndrome ,cardiovascular risk factors, as obesity,

hypertension, hyperlipidemia , and hyperglycemia. It suggested such as a low-

intensity activity, sedentary behavior, long duration in a sitting position, and high-

calorie diet, which lead to excessive weight gain, metabolic syndrome and CAD. 28

An exploratory study done to find out the Prevalence of metabolic syndrome

in Iranian professional drivers: results from a population based study of 12,138 men.

Among 12138 participants, 3697 subjects found to be Metabolic syndrome . The

crude and age-adjusted rates of MetS were 30.5% and 32.4% respectively. Based on

Body mass index (BMI), 5027 subjects (41.4%) were overweight (BMI ≥ 25.01-30

kg/m2), and 2592 (21.3%) were obese (BMI ≥ 30.01 kg/m2). The presence of central

obesity was more common than other components. There is a significant associations

of Metabolic syndrome with BMI, smoking, age, weekly driving duration and driving

experiences were significant in the logistic regression. 29

4) Review related to effectiveness of self instructional module(SIM)

A study done at mangalore as Effectiveness Of Self Instructional

Module On Healthy Life Style To Prevent Acid Peptic Diseases (Apd) Among Heavy

Vehicle Drivers. A one group pre-test post-test pre-experimental approach was

adopted to evaluate the “Effectiveness of Self-Instructional Module. The objectives of

the study were: 1. Determine the existing knowledge of heavy vehicle drivers

regarding healthy life style in preventing Acid peptic diseases (APD). 2. Develop and

validate the Self-Instructional Module (SIM) on prevention of Acid peptic diseases

among heavy vehicle drivers. 3. Evaluate the effectiveness of the SIM on heavy

vehicle driver’s knowledge about prevention of Acid peptic diseases by conducting

post test. The difference between pre-test and post-test knowledge scores of heavy

vehicle drivers on healthy life style to prevent APD was found to be very highly

significant (t = 41.82, p<0.001). The overall findings of the study reveal that there is

significant increase in the knowledge of heavy vehicle drivers regarding healthy life

style to prevent APD. The self-instructional module was found to be an effective

teaching strategy in increasing the knowledge of heavy vehicle drivers regarding

healthy life styles to prevent APD. 30

13

A study was conducted to determine the effectiveness of Self Instruction

Module in teaching palliative care to undergraduate medical students at the University

of Western Australia in 2008. A two-hour workshop was designed and implemented

to address certain shortcomings in the palliative care attachment of the students. Pre-

workshop and post-workshop questionnaire showed a marked increase in the self rate

competence and suggested this improvement was directly attributed to the workshop.

The study revealed that the SIM was an effective instructional format in small group

setting, and it was cost-effective with minimal use of resourses. 31

A study was conducted to determine the effects of using a self-

instructional module on teacher perceptions of attitudes and values of disadvantaged

inner-city black youth. The relationship between teacher perceptions of disadvantaged

inner-city black youth, and various demographic variables, and the effects of using a

self-instructional module on teacher perceptions of the attitudes and values of these

same disadvantaged youth. Results of an analysis of variance showed that pre-

professional teacher perceptions were not related to the following demographic

variables; sex, race, socioeconomic background, father's educational level, size of

childhood community, and previous contact with black youth. However, use of the

self-instructional module caused a statistically significant difference in pre-

professional teacher perceptions of the attitudes and values of inner-city black youth.

Because teacher perceptions became more accurate with use of the self-instructional

module, which presented positive attitudes and values of inner-city youth, the module

is valuable for teacher development in pre-service or in-service training.32

STATEMENT OF THE PROBLEM

A study to assess the effectiveness of self instructional module on knowledge

regarding prevention of metabolic syndrome and related complications in interstate

bus drivers working in Karnataka state road traffic corporation [BMTC ]bus station

kempagowda, Bangalore

6.3 OBJECTIVES.

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1.To assess the pretest knowledge score of prevention of metabolic syndrome and its

related complication among BMTC bus drivers in kempagowda bus station,

Bangalore.

2.To evaluate the effectiveness of self instructional module on knowledge regarding

prevention of metabolic syndrome and its related complications among BMTC bus

drivers in kempagowda bus station, Bangalore.

To determine the association between the post test knowledge of drivers regarding the

prevention of metabolic syndrome and its related complications with the selected

demographic variables.

6.4 HYPOTHESIS

H1: There will be significant difference between the mean pre test and post test

knowledge score of bus drivers on knowledge regarding prevention of metabolic

syndrome and related complications.

H2: There will be significant association between pre test level of knowledge and

selected socio-demographic of bus drivers

6.5 OPERATIONAL DEFINITION

Study: To acquire information from the drivers regarding the knowledge on

metabolic syndrome and its related complications.

Assess: To find out the knowledge regarding the prevention of metabolic

syndrome and its related complications.

Bus drivers: Bus Drivers engaged in active service in BMTC in Bangalore.

Effectiveness: it is the significant gain in the knowledge of bus drivers with

regards to prevention of metabolic syndrome and its related complications as

evidenced by the difference in pre-test and post-test scores.

Self instructional module: in this study, self instructional module refers to a

self contained written material which can be used by the bus drivers on

metabolic syndrome and its related complications.

Knowledge: it refers to the awareness of bus drivers regarding the metabolic

syndrome and its related complications as measured by the correct responses

to item of the structured knowledge questionnaire.

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Metabolic syndrome :

-Abdominal obesity: Waist circumference >94 cm (>37 in) and at least two of the following:

-Hypertriglyceridemia: Blood triglycerides >150 mg/dl (or on triglyceride-lowering medication)

-Low high-density lipoprotein cholesterol (HDL): Blood HDL-C <40 mg/dl in men, <50 mg/dl in women (or on HDL-C-lowering medication)

-High blood pressure: BP ≥130/85 mm Hg or already diagnosed with hypertension

-High fasting glucose: Blood glucose ≥100 mg/dl or already diagnosed with type 2 diabetes.

Related Complications : in this study ,the diseases which occur due to

metabolic syndrome are the related complications.they are Type 2

Diabetes ,Obesity ,Hypertension ,Hypercholesterolemia ,Hypertriglyceridemi

a, Cardiovascular Diseases ,Kidney Damage, Liver Damage, Other problems

associated with metabolic syndrome include obstructive sleep apnea,

increased risk of dementia with aging, and cognitive decline in the elderly.

6.6 VARIABLES UNDER STUDY

Independent variables : In this study self instructional module on metabolic

syndrome and its related complications are independent variable.

Dependent variables : in this study knowledge of bus drivers on metabolic

syndrome and its related complications are dependent variable

6.7 ASSUMPTION

Bus drivers may have some knowledge regarding metabolic syndrome and

its related complications.

Self instructional module will help to increase the knowledge of the bus

drivers regarding the metabolic syndrome and its related complication .

Bus drivers will be willing to participate in the study activity.

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Educating the bus drivers about the prevention of metabolic syndrome and its

related complications will positively influence them.

6.8 DELIMITATION

The study is limited to

Those who are willing to participate in study

Those who are available at the time of data collection

Study period is limited to 6-8 weeks

Sample size is limited to 60

Those who are not able to write and read kannada /english

7. MATERIALS AND METHOD

7.1 SOURSE OF THE DATA

The data will be collected from BMTC bus drivers from kempagowda bus

station ,Bangalore.

7.2 METHOD OF DATA COLLECTION

The investigator collects data from bus drivers from kempagowda bus station, at

Bangalore. Prior to data collection written permission will be obtained from selected

institution authority to conduct the study. The investigator introduces herself to

subject and notifies about her aims, objectives and steps of study and takes written

consent from the sample.

Phase one : Assess the pre test knowledge of bus drivers regarding metabolic

syndrome and related complications using structured knowledge questionnaire.

Phase two: Administer self instructional module to bus drivers regarding metabolic

syndrome and related complications.

Phase three: Assess their post test knowledge by using same structured knowledge

questionnaire.

7.2.1 RESEARCH APPROACH: Educative and Evaluative approach.

7.2.2 RESEARCH DESIGN: pre experimental design with single group pre -test

post-test design.

The symbolic representation of design is

group Pre-test intervention Post-test

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Single group 01 x 02

Keys:

01: pre-test knowledge bus drivers regarding prevention of metabolic syndrome and

related complications.

X: self instructional module

02: Post-test knowledge bus drivers regarding prevention of metabolic syndrome and

related complications.

7.2.3 RESEARCH SETTING

The study will be conducted at kempagowda bus station Bangalore.

7.2.4 POPULATION

BMTC bus drivers

7.2.5. SAMPLE SIZE

In this study, the sample size is 60

7.2.6. SAMPLING PROCEDURE

Purposive sampling.

7.2.7. SAMPLING CRITERIA

Inclusion criteria for sampling:

o Bus drivers in kempagowda bus station with in the age group of 25-56

o who are available at the time of data collection

o who are willing to participate.

o Who are able to read and write kannada / English

Exclusion criteria for sampling.

o who are not willing to participate

o Who are not available during the study

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7.2.8 Instrument intended to be used:

Structured questionnaire consist of two parts ,part A consist of socio demographic

variable and part B consist of multiple choice questions regarding the knowledge of

prevention and related complications of metabolic syndrome.

7.2.9. Plan for data analysis:

Descriptive statistics : Mean, mode, median, standard deviation, percentage will be

used to analyse the data.

Inferential statistics: chi square and T test will be done to evaluate the effectiveness

of self instructional module.

7.3 Does study requires any investigation or intervention to be conducted on

patients or other human or animals? If so please describe briefly.

Yes, a self instructional module will be given for the sample as intervention.

7.4 Has ethical clearance been obtained from your institution in case of 13?

Yes. Prior to the study written permission order has to be obtained from the concerned

authorities.

8. LIST OF REFERENCES

1.http://www.rightdiagnosis.com/h/hypertension/intro.htm.

2. Black JM, Hawks JH. Medical Surgical Nursing Clinical management for

Positive Outcomes. 7th ed. New Delhi: Saunders Publication; 2005.

3. http://www.nhlbi.nih.gov/health/health-topics/topics/ms/

4 Kokkinos P, Moutsatos G. Obesity and Cardiovascular disease: The role of diet and

physical activity.Journal of Cardiopulmonary Rehabilitation. 2004; 24:197-204. .

http://www.medicinenet.com/metabolic_syndrome/page4.htm

19

5.http://www.mayoclinic.com/health/metabolic%20syndrome/DS00522/

DSECTION=causesA.

6.Edwardson CL, Gorely T, Davies MJ, Gray LJ, Khunti K, et al. Association of

Sedentary BehaviourwithMetabolicSyndrome:AMeta-

Analysis.PLoSONE.7(4),Published:April13,2012 http://www.plosone.org/article/info

%3Adoi%2F10.1371%2Fjournal.pone.0034916

7. Ervin RB. Prevalence of metabolic syndrome among adults 20 years of age and

over, by sex, age, race and ethnicity, and body mass index: United States, 2003–2006.

National Health Statistics Reports, No. 13. Hyattsville, MD: National Center for

Health Statistics. Retrieved June 2011

http://www.cdc.gov/nchs/data/nhsr/nhsr013.pdf.

8 .Brown VL. The Assessment of Cardiovascular disease risk in relation to the built

environment and race. Unpublished research thesis Submitted to University of

Pittsburgh, 2010.

9 . Smeltzer SC, Bare B. Brunner and Suddarth’s Text Book of Medical Surgical

Nursing. 10th ed. Philadelphia: Lippincott Williams and Wilkins Publications;2004.

10. http://www.test.cdc.gov/nchs/data/nhanes/spq-oc.pdf

11.http://www.medicinenet.com/insulin_resistance/article.htm

12. American Heart Association (AHA). (2011a). About metabolic syndrome.

Retrieved from

http://www.heart.org/HEARTORG/Conditions/More/MetabolicSyndrome/about-

Metabolic Syndrome_UCM_301920_Article.jsp.

13. Chadha SL, Radhakrishnan S, Ramachandran R, Kaul U, Gopinath N.

Epidemiological study of coronary heart disease in urban population of Delhi. Indian

Journal of Medical Research; 92:424-430

14. Lila A.R Menon P.S “ Complications of Obesity”; The Journal of General

medicine; Jan-Mar;2009;Vol21;No1;Pg39-41.

http://eurheartjsupp.oxfordjournals.org/search?

fulltext=metabolic+syndrome&submit=yes&x=0&y=0

15. http://www.livestrong.com/article/274309-incidence-of-highcholestrol/

16. www.ahmedabad-ranks-lifestyle-disease.htm.

20

17. Agarwal AK, Yunus M, Ahmad J. An Epidemiological study of cardiovascular

diseases in Rural Community of Jawan Block, Aligarh, U.P. Indian Journal of

Community Medicine.1996; XX1 (4):

18.http://www.ncbi.nlm.nih.gov/pubmed?term=metabolic%20syndromein%20bus

%20drivers

19 http://www.ncbi.nlm.nih.gov/pubmed/15262293

20 U.S Department of Commerce, Economics and Statistics Administration, Bureau

of Census; April 1997http://www.dmsjournal.com/content/3/1/8

21.http://www.medindia.net/news/healthinfocus/metabolic-syndrome-among-adult-

sri-lankans-a-study-102889-1.htm

22 Saikat K, Jayashree S. Prevalence and component analysis of metabolic

syndrome.An Indian atherosclerosis research study perspective.2012 march

14;32(5):23.Available in URL:

http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2464750/

23. Lila A.R Menon P.S “ Complications of Obesity”; The Journal of General

medicine; Jan-Mar; 2009;Vol 21; No 1; Pg 39-41.http://www.dmsjournal.com/logon

24. Gupta R, Deedwania PC. Prevalence of metabolic syndrome in an Indian urban

population. International Journal of Cardiology .2004 June 97(2):257-261

25.http://nitte.edu.in/journal/Dec2012/POMSACC.pdf

26. Eivind A, Arne T. Low level of objectively measured physical activity and

cardiorespiratory fitness, and high prevalence of metabolic syndrome. Norwegian

journal.2011dec 20;20(3):32-45

  http://www.ntnu.no/ojs/index.php/norepid/article/view/1343

27. http://www.ncbi.nlm.nih.gov/pubmed

28. http://diabetes.about.com/od/metabolicsyndrome/a/metabsyndrome.htm

29. Aguiar IC, Nacif SR.  metabolic syndromein bus drivers. BMC Pulm Med. 2011

Dec 7;11:57. doi: 10.1186/1471-2466-11-57 http://www.ncbi.nlm.nih.gov/pubmed?

term=metabolic%20syndromein%20bus%20drivers

30 .Kumar, Raveesh. Effectiveness Of Self Instructional Module On Healthy Life

Style To Prevent Acid Peptic Diseases (Apd) Among Heavy Vehicle Drivers In

Selected Area At Mangalore. BMJ Support Palliat Care.2011jan.23(5):55

http://circ.ahajournals.org/content/110/10/1251.shor

21

31.Rosemary AN, Merryn G. Instruments used to measure the effectiveness of

palliative care education initiatives at the undergraduate level: a critical literature

review. The BMJ Publisher.2012 October 30

http://docs.exdat.com/docs/index-361276.html

32. http://www.sinhgad.edu/SinhgadNursingCollege-eJournal/auther9.html

9 Signature of the candidate

10 Remarks of the guide

11 Name and designation of(in block letters)

11.1 Guide MRS.P. NEELAVATHI

22

PROFESSOR

MEDICAL SURGICAL NURSING

11.2 Signature

11.3 Co-guide(if any) MRS. GLADISH GEORGE

ASSISTANT PROFESSOR

MEDICAL SURGICAL NURSING

11.4 Signature

11.5 Head of the department MRS.GLADISH GEORGE

11.6 Signature

12 12.1 Remarks of the principal

12.2 Signature

23