A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF OBESITY AMONG ADOLESCENT GIRLS AT

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DISSERTATION ON

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF OBESITY AMONG ADOLESCENT GIRLS AT

SELECTED GOVERNMENT HIGHER SECONDARY SCHOOL, CHENNAI.

M.Sc (NURSING) DEGREE EXAMINATION BRANCH – IV COMMUNITY HEALTH NURSING

COLLEGE OF NURSING

MADRAS MEDICAL COLLEGE, CHENNAI – 600 003

A dissertation submitted to

THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY, CHENNAI – 600 032

In partial fulfilment of the requirement for the award of degree of MASTER OF SCIENCE IN NURSING

OCTOBER 2019

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DISSERTATION ON

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF OBESITY AMONG ADOLESCENT GIRLS AT

SELECTED GOVERNMENT HIGHER SECONDARY SCHOOL, CHENNAI

Examination : M.Sc(Nursing) Degree Examination

Examination month and year : OCTOBER 2019

Branch & Course : IV – COMMUNITY HEALTH NURSING

Register No : 301726151

Institution : COLLEGE OF NURSING,

MADRAS MEDICAL COLLEGE, CHENNAI – 600 003

Sd: ____________________________ Sd:____________________________

Internal Examiner External Examiner

Date: __________________________ Date: __________________________

THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY,

CHENNAI – 600 032

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CERTIFICATE

This is to certify that this dissertation titled, “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF OBESITY AMONG ADOLESCENT GIRLS AT SELECTED GOVERNMENT HIGHER SECONDARY SCHOOL, CHENNAI”, is a bonafide work done by MS.N.ATHIBA, M.Sc(Nursing) II year Student, College of Nursing, Madras Medical College, Chennai -03, submitted to the Tamil Nadu Dr.M.G.R. Medical University, Chennai in partial fulfilment of the requirement for the award of the degree of Master of Science in Nursing Branch – IV, Community Health Nursing under our guidance and supervision during academic year 2017 – 2019.

Mrs.A.Thahira Begum, M.Sc.(N), MBA., M.Phil. Dr.R.Jayanthi,MD.,FRCP.,(Glasg).,

Principal, Dean,

College of Nursing, Madras Medical College ,

Madras Medical College, Chennai- 03.

Chennai -03.

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DISSERTATION ON

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF OBESITY

AMONG ADOLESCENT GIRLS AT SELECTED GOVERNMENT HIGHER SECONDARY SCHOOL, CHENNAI

Approved by the dissertation committee on 24.07.2018 CLINICAL SPECIALITY GUIDE

Selvi.B.Lingeswari, M.Sc (N)., MBA., M.Phil., __________________

Reader in Community Health Nursing , College of Nursing,

Madras Medical College, Chennai -03.

HEAD OF THE DEPARTMENT

Mrs.A.Thahira Begum, M.Sc(N)., MBA., M.Phil., ___________________

Principal,

College of Nursing, Madras Medical College, Chennai -03.

DEAN

Dr. R. Jayanthi, MD., F.R.C.P. (Glasg)., ___________________

Dean,

Madras Medical College, Chennai -03.

A Dissertation submitted to

THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY, CHENNAI- 600 032

In partial fulfilment of the requirement for the award of the degree of MASTER OF SCIENCE IN NURSING

OCTOBER – 2019

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CERTIFICATE OF PLAGIARISM

This is to certify that the dissertation work titled,

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF OBESITY AMONG ADOLESCENT GIRLS AT SELECTED GOVERNMENT HIGHER SECONDARY SCHOOL, CHENNAI

”, of the candidate N.ATHIBA, for the partial fulfilment of M.Sc. Nursing programme in the branch of

COMMUNITY HEALTH NURSING

has been verified for plagiarism through relevant plagiarism checker. We found that the uploaded thesis file from introduction to conclusion pages and rewrite shows _% of plagiarism ( _ % uniqueness) in this dissertation.

CLINICAL SPECIALITY GUIDE / SUPERVISOR Selvi.B.Lingeswari, M.Sc(N)., MBA., M.Phil., Reader in Community Health Nursing ,

College of Nursing, Madras Medical College, Chennai -03.

PRINCIPAL

Mrs.A.Thahira Begum, M.Sc (N)., MBA.,M.Phil., Principal,

College of Nursing, Madras Medical College, Chennai-03.

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ACKNOWLEDGEMENT

“Any time you deny the acknowledgement of God, You are undermining the entire basis for which our country exists.” …………..Roy Moore

I thank the Lord almighty for showering his blessings to make my dream of studying in an esteemed| college possible in real. He has been bestowed his blessings over me throughout the course of my study period and in completion of this dissertation successfully.

I express my sincere thanks to Dr.R.Jayanthi, MD., F.R.C.P.(Glasg)., Dean, Madras Medical College, Chennai – 03 for permitting me to conduct the study in this prestigious institution.

At the very outset, I express my wholehearted gratitude to my esteemed guideMrs.A.Thahira Begum, M.Sc.(N).,M.B.A., M.Phil., Principal, College of Nursing, Madras Medical College, Chennai -03 for her academic and professional excellence, treasured guidance, constant visionary support and untired efforts which motivated us in completion of the study successfully.

I extend my thanks to Dr.R.ShankarShanmugam, M.Sc (N).MBA, Ph.D., reader and HOD in nursing research for his great support, warm encouragement, constant guidance, thought provoking suggestions, brain storming ideas, timely insightful decision, correction of the thesis with constant motivation and willingness to help all the time for the fruitful outcome of this study

With great pleasure and proud I express gratitude to Selvi.B.Lingeswari, M.Sc(N)., Reader, Community Health Nursing Department, College of Nursing, Madras Medical College, Chennai – 03 for her constant support, calm approach, supportive guidance which helped me to complete the study peacefully and successfully.

I express my special thanks to Dr.Joy Patricia Pushparani ,M.D., professor, institute of community medicine, madras medical college, Chennai -03 for her valuable guidance and encouragement which enable me to accomplish this study

I express my sincere thanks to Ms.N.Sathyanarayani, M.Sc(N)., Reader, former lecturer in community health nursing, Ms.T.Ramanibai, M.Sc(N), Reader, Community Health Nursing Department and Ms.R.Sumathi, M.Sc(N)., Reader, Nursing Education and Administration Department, subject in College of Nursing, Madras Medical College, Chennai

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-03 for her sincere, constant supportive and motivating efforts that helped me to complete the study perfectly.

I would like to express my deep and sincere gratitude to our respectedMr. G. Mala, M.Sc. (N).,ph.D., former Nursing Tutor,Mr. K. Kannan, M.Sc. (N), Nursing Tutor, and Mrs.P.TamilSelvi, M.Sc(N)., Nursing Tutor,College of Nursing, Madras Medical College, Chennai-03 for his valuable guidance, suggestions, motivation, and support throughout the completion of this study

It is my privilege to express my gratitude to Ms.L.Shanthi, M.Sc(N), former head of the community health nursing department, College of Nursing, Madras Medical College, Chennai -03 for her constant guidance, thought provoking ideas, timely insightful decision and motivation.

I also place on record, my sense of gratitude to all the Faculty Members of College of Nursing, Madras Medical College, Chennai - 03 for their valuable guidance and suggestions in conducting this study.

I would like to express my special thanks to Dr.ShobanaGangadharan, M.Sc(N).,Ph.D, Apollo College of Nursing, Vanagaram, Chennai – 95 for provoking the tool constructed for the study and for the valuable suggestions in bringing the tool in a right way.I also express my special gratitude to Mrs.Kanchana,M.Sc (N).,Madha College of Nursing, Kundrathur, Chennai – 95 for her valuable suggestions in bringing the tool in a right way for the study.

Its my pleasure to express my heartfelt gratitude to Mr.Kumaravel pandian,I.A.S Deputy commissioner [Education], Greater Chennai Corporation, Ripon Building, Chennai.

For permitting me conducted the study in school under the ambit of Chennai Corporation. . I owe my deepest sense of gratitude toRetd.Dr.A.Vengatesan, M.Sc., M.Phil., Ph.D., Deputy Director (Statistics), Directorate of Medical Education, Chennai for his valuable suggestion and guidance in the successful completion of statistical analysis and compiling of this study.

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I special thanks to Mr.Ravi, Librarian for extending his support in providing all the necessary materials needed to complete the study in an organized manner

I have much pleasure of expressing my cordial appreciation and thanks to all the students who participated in the study with interest and cooperation

My special thanks to S.Perumal M.A,B.E.d B.T Assistant panchayat union middle school, Athananchai for editing the tool and content in English and R.Santhi ,Headmaster , P.U.M.School Athanancheri. For Editing the tool and content in for thesis work.

I express my heartfelt gratitude to The Headmistress, Chennai higher secondary school , kalyanapuram, viyasarpadi, Chennai. Who had extended cooperation during the study.

I own my great sense of gratitude to Mr.SyedHusain,B.Sc(com) Citi Dot Net and Mr.M.Ramesh B.A., MSM Xerox for their enthusiastic help and sincere effort in typing manuscript using valuable computer skills and bringing this study into a printed form.

I will be lost if I am not expressing my gratitude to my family members. I express my heartfelt thanks to my ever loving parents Mr.D.Natarajan and Mrs.N.punithalakshmi the back bone of my life who sacrificed their present for my future. They are the one who brought up me with the good attitude through their constant motivation and encouragement that has led me to work out on this study successfully. Without them I might not be successful today.

I immensely extend my gratitude to thank my lovable sistersMs.N Kalaiselvi,B.A, Ms.N.Deepa,B.A, and my brothers Mr.N.Sivakumar.EEE, Mr.N.Nethaji for her encouragement, constant support, timely help me to complete my study and the course peacefully and successfully.

I am grateful to thank my uncleMr.D.Natarajan,MA,D.Tedfor his whole consent, encouragement, support, and motivation efforts that helped me to complete the study perfectly

I would like to express my special thanks to my cousinsMr.S.Ambedkar,BE,MSW,LLB(HONS), and Mr.A.Karthik,B.Com,M.B.A, for her encouragement, constant support, timely help me to complete my study and the course peacefully and successfully.

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I would like thank to my friends Ms.S.Pabitha ,Ms.Sofia Priyadharshini, Ms.Priyadharshini, Mrs.Revathi, Ms.Sandhiya,Mr.Thirupathiand Ms.Vigneswari, for their constant encouragement towards the successful completion of my study.

I am grateful to my colleague sister Mrs.D.Madhuima, Mrs.G.Tamilarasi for extending their participant and support with timely suggestions during the time of data collection. Thathelped me to complete the study perfectly

I extend my heartfelt gratitude to those who have contributed directly or indirectly for the successful completion of this dissertation.

I thank the one above all of us, omnipresent God, for answering my prayers for giving me strength to plod on each and every phase of my life.

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ABSTRACT

Adolescent is the age of transition. The healthy adult hood has its origin from their adolescent period. Healthy youth is more productive and able to contribute for the development of the nation. Healthy living needs food which helps to grow and function actively. Many adolescents skip their breakfast by choice either because they do not have time to eat or in order to lose weight. The Nutritional transition caused due to various factors like economic development and globalization leads to rapid change in poor dietary habits combined with decreased physical activity. In addition many school children depend on junk foods for nourishment and have inadequate intake of fruit, vegetables and whole grains which have further led to an increase in overweight and obesity.

Obesity is defined as a condition where excess body fat negatively effects on health.

WHO estimates, 41 million children under five years and more than 340 million adolescent in the age group of 14 to 19 years were having overweight or obesity in the year 2016. The increased rates of obesity among adolescents are dramatically reducing the quality of young lives Obesity in adolescents are associated with complications like, poor self-esteem, depressive disorders, sleep apnea, hypertension, atherosclerosis, type II diabetes mellitus and the list goes on. Nurses are required to assess the existing knowledge, attitude andpractice towards these risky behaviors and should initiate measuresto alleviate them.

TITLE :

A study to assess the effectiveness of structured teaching programme on knowledge regarding prevention of obesity among adolescent girls at selected government higher secondary school, Chennai.

OBJECTIVES :

To assess the pre test knowledge of adolescent girls regarding prevention of obesity, To evaluate the effectiveness of structured teaching programme on knowledge regarding prevention of obesity among the adolescent girls (post test), To compare the pre test and post test knowledge regarding prevention of obesity among adolescent girls and To find the association between the post test knowledge scores on prevention of obesity among adolescent girls and selected demographic variable.

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METHODOLOGY:

The study was conducted with 60 sample [ school students] in quantitative approach. Pre experimental one group pre test post test design, sample selection was done by convenient sampling technique method. Pre existing knowledge was assessed by using semi structured questionnaires. After the pre-test, structure teaching programme was given regarding prevention of obesity among adolescent girls. After 7 days post test was conducted by using tool.

RESULTS:

The finding of the study revealed that structured teaching programme had improved the knowledge regarding prevention of obesity among adolescent girls with paired t test, p< 0.001. there is statistically significance in knowledge attainment on regarding prevention of obesity show effectiveness of structured teaching programme.

CONCLUSION :

The result of study shows that structured teaching programme was effective in improving knowledge regarding prevention of obesity among adolescent girls

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CHAPTER-I

INTRODUCTION

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CHAPTER-1 INTRODUCTION

:

‘‘Youth are the power of nation’’

-Mahatma Gandhi Adolescent is the age of transition.The healthy adult hood has its origin from their adolescent period. Healthy youth is more productive and contribute much to the development of the nation. Healthy living needs food which helps them to grow and function actively.

Many adolescents skip breakfast by choice either because they do not have time to eat or in order to lose weight. The Nutritional transition caused due to various factors like economic development and globalization leads to rapid change in poor dietary habits combined with decreased physical activity. In addition many school children depend on junk foods for nourishment and have inadequate intake of fruit, vegetables and whole grains which have further led to an increase in overweight and obesity.

Childhood overweight and obesity are global problems; obesity in childhood appears to increase risk of subsequent morbidity. 30% of totally obesity is recorded in children out of which 50% to 80% leading to obesity in adults. Adulthood outcomes related to childhood obesity includes hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, non alcoholicsteatohepatits, obstructive sleep apnea, orthopedic and psychosocial problems.

The increased rates of obesity among adolescents are dramatically reducing the quality of young lives. Obesity in adolescents are associated with complications like, poor self-esteem, depressive disorders, sleep apnea, hypertension, atherosclerosis, type II diabetes mellitus and the list goes on. Obese parents are at greater risk of having obese children which is reflected by environment and genetics. Other reasons contributing to obesity are psychological factors and child‘s body type. A lot of research has been done regarding genetic and physiology of appetite control. Polymorphism is a gene controlling appetite and metabolism which predispose individual to obesity,in spite of having sufficient calories.

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Many children fail to exercise because they are spending time doing stationary activity such as computer usage, playing video games or watching television. TV and other technology may be large factors of physically inactive children. A randomized study showed that reducing TV, viewing and computer use can decrease age adjusted BMI, reducing calorie intake also thought to be greatest contributor to the BMI decrease.

WHO states (2016) that it is estimated about 155 million children of 10-15 years of age are overweight in world and 1228 children in India are obese according to journal of Medical Nutrition. There is a paradigm shift in the quality of life in urban population resulting in substantial increase in childhood as well as adult obesity in the urban population.

As the prevalence of obesity is drastically increasing in recent years among school children, a fruitful approach should be taken to identify children who are at risk and to find way to prevent it.Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern, the term overweight rather than obese is often used in children as it is less stigmatizing.

BACKGROUND OF THE STUDY:

Obesity is a serious health problem and its prevalence has increased dramatically over the past 20 years. The proportion ofchildren and adolescents who are overweight and obese have also been increasing. The magnitude of overweight ranges from9% to 27.5% and obesity ranges from 1% to 12.9% among Indian children.WHO states that it is estimated about 155 million children of 10-15 years of age are overweight in world and 1228 children in India are obese according to journal of Medical Nutrition. Adulthood outcomes related to childhood obesity includes hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, non alcoholicsteatohepatits, obstructive sleep apnea, orthopedic and psychosocial problems.

School health nursing is one of the extended carepractices of nurses where they can reach significant portion of thepopulation during their early developmental stages. Several adultdisorders can be prevented if healthy practices are inculcated fromchildhood.

Adolescence is a crucial stage of human life wheremost of the health risk behavior is seeded into the life likesmoking, alcoholism, eating junk foods and physical inactivity.Nurses are required to assess the existing knowledge, attitude andpractice towards these risky behaviors and should initiate measuresto alleviate them.

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1.1NEED FOR THE STUDY:

"Safe and supportive environment helps children to emerge as responsible adults"

The nation’s prosperity always depends upon the quality of human resources. In current India population structured, there significant percentage adolescents ranging from 10-19 were of age represents the 22-8% (nearly 230 millions). This is almost 2/3 of the world adolescent population. The transition period of Adolescence is from childhood to adulthood.

Adolescent is frequently exposed to rapidly- changing values, modern technology and communication and hostile culture which affect their health. In Worldwide,the obesity trends are causing serious public health issues in many countries, threatening the viability of basic health care delivery. It is an independent risk factor for cardiovascular diseases and significantly increases the risk of morbidity and mortality.

Globally, the prevalence of obesity has increased to alarming levels in the last few decades, which acts as an independent risk factor leading to the development of a number of non-communicable diseases (diabetes, cardiovascular diseases and cancer). Consequently they results in increased in morbidity and mortality rates, as well as increasedburden on healthcare expenditure. In particularly, the children and adolescents are affected with obesity due to various life style changes, both in the developed and developing nations. World Health Organization WHO (1026) estimates, 41 million children below five years of age and more than 340 million adolescents in the age group of 5 to 19 years were having overweight or obesity.

The elevation in the number of obese is notified in the countries with fast growing economics especially of South East Asia. In India the prevalence of obesity is12.6% in women and 9.3% in men. In other words, more than 100 million individuals were obese in India. Obesity is associated with a higher risk of mortality and morbidity, and it is significantimportant risk factor of Non Communicable diseases like cardiovascular diseases and Diabetes mellitus.

India is experiencing a rapid health transition, with large and rising burdens of chronic diseases, which were estimated to account for from 3·78 million in 1990 (40·4% of all deaths), 53% of all deaths in 2005 and it will reach 7·63 million in 2020 (66·7% of all deaths). Many of thismortality occur in early age. India suffers the highest loss in potentially

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productive years of life than other countries, due to deaths from cardiovascular disease in people aged 35 - 64 years (9·2 million years lost in 2000).

The department of community medicine reports that Obesity is arbitrarily considered to be present when the fat content of the body is greater than 25% of body mass in men and 30% in women. Over the past two decadesthere has been a dramatic rise in the prevalence of obesitythroughout the world.It is estimated by the WHO that globally, over 1 billion (16%) adults are overweight and300 million of these (5%) are obese from their adolescent age.

Since 1980 in India it’s found to be at least one in 10 urban middle class children in India is overweight. Globally 300 million adolescents are become obese. Research studies have shown that 50 to 80 % of obese children and adolescents will become obese adults, and all complications of adult obesity are made worse. It begins in childhood and continues through adolescent period to adulthood. High risk of gestational diabetes in pregnant women causes higher birth weights in babies that could lead to the development of obesity in childhood and in adolescence.

Adolescent obesity is affecting all socio-economic groups, irrespective of age, sex or ethnicity in world wide. Aetiopathogenesis of adolescent obesity is multi-factorial and includes genetic, neuroendocrine, metabolic, psychological, environmental and socio-cultural factors. Many co-morbid conditions like metabolic, cardiovascular, psychological, orthopedic, neurological, hepatic, pulmonary and renal disorders are seen in association with childhood obesity. The treatment of overweight and obesity in children and adolescents requires a multidisciplinary, multi-phase approach, which includes dietary management, physical activity enhancement, restriction of sedentary behaviour, pharmacotherapy and bariatric surgery. A holistic approach to tackle the adolescent obesity through influencing policy makers and legislation, mobilizing communities, restructuring organizational practices, empowering providers, and community education.

T kowsalya, et al (2014) conducted a study on prevalence of overweight and obesity among adolescent girls in salem, India. in this study result reveal that the overall prevalence rate of overweight/ obese among adolescent was found to be 12.11%. the heightest prevelance was observed at the age of 15 (14.42%) years.

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FIG 1.1 ROLE OF COMMUNITY HEALTH NURSE

Community health nurse should provide standardized quality care by involving the key components of the framework. Thus community health nurse must focus on preventive aspects in order to prevent the health risk associate with obesity by importing knowledge on obesity through the structured teaching programme among the adolescent girls to promote the healthy life style and prevent complication at in early stage. Nurses play a major role and creating a awareness on obesity hence the researcher is interest to in this topic.

Individuals, carers, families and communities

Community nurse consultant

Clinical team leader/

advanced practitioner

Community health nurse (CHN

)

Community staff nurse

Administrative support Health care support

worker

Individuals, carers, families and communities

Maternity services

Independent sector care provider

Occupational health service provider Acute sector

Community hospital

Local authority teams

Children’s and young people’s services

Primary health care team

Mental health and learning disability teams

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1.2 STATEMENT OF THE PROBLEM

:

“A study to assess the effectiveness of structured teaching programme on knowledge regarding prevention of obesity among adolescent girls at selected government higher secondary school Chennai”.

1.3 OBJECTIVES OF THE STUDY

:

 To assess the pre test knowledge of adolescent girls regarding prevention of obesity.

 To evaluate the effectiveness of structured teaching programme on knowledge regarding prevention of obesity among the adolescent girls (post test)

 To compare the pre test and post test knowledge regarding prevention of obesity among adolescent girls

 To find the association between the post test knowledge scores on prevention of obesity among adolescent girls and selected demographic variable.

1.4 OPERATIONAL DEFINITION:

ASSESS

:

In this study It refers to gathering information regarding knowledge of the Adolescents about prevention of obesity

EFFECTIVENESS:

In this studyIt refers to significant of increased level of knowledge of the adolescent girls regarding prevention of obesity.

STRUCTURED TEACHING PROGRAMME

:

In this studyitrefers to systematically planned education to provide adequate information regarding meaning of obesity, aetiology, health effects , management and prevention of obesity among the adolescents girls through PPT .

KNOWLEDGE:

In this studyit refers to the necessary information gained by structured teaching programme on prevention of obesity.

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ADOLESCENT GIRLS:

In this studyIn this study adolescent girls refer to those who are studying in government higher secondary school age between 14 and 15 years.

OBESITY:

In this studyIn this study obesity is define as BMI( Body Mass Index) status of the individual more than 30 to 39.9 indicates obesity.

1.5 HYPOTHESIS

H1: There will be a significant difference between pretestand post test levels of knowledgeregarding prevention of obesity among adolescent girls

H2: There will be a significantassociation between the post test knowledge and theirselected demographic variables

1.6ASSUMPTIONS

:

 Adolescent girls may have some knowledge regarding prevention of obesity.

 Administration of Structure teaching programmed may enhance the knowledge regarding prevention of obesity among the adolescent girls.

1.7DELIMITATIONS:

 The study is limited to adolescents girls in selected government higher secondary school, Chennai

 The study limited to 4 weeks

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1.8 . CONCEPTUAL FRAMEWORK - PENDER’S HEALTH PROMOTION MODEL A conceptual framework is a process of ideas, which are framed and utilised for the development of a research design. It helps the researcher to know what idea needs to be collected and gives direction to entire research process.

Nola J Pender described the Health Promotion model.

Health

According to this model health is defined as a positive dynamic state rather than simply the absence of disease. Patient’s level of wellbeing is described at the highest level in this model

Person

The health promotion model describes Person as multidimensional as they interact within their environment to pursue health.

Environment

The health promotion model describes the areas where the person is in contact as an environment.

Focus Areas of Pender’s Model

Pender's model focuses on three areas:

 Individual characteristics and experiences,

 Behavior-specific cognitions and affect, and

 Behavioral outcomes.

Individual Characteristics and Experiences

The modelstates that each person has unique personal characteristics and experiences that affect subsequent actions.It also describes that the set of variables for behaviour specific knowledge have important motivational significance. In this study individual characteristic includes the demographic variables such as age, type of family, religion, Education, occupation and income of parents, physical activity per day, dietary habits,Practice of consuming fast & junk foods.

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Behaviour Specific Cognitions and affect

The model describes the behavioural specific cognitions includes the various activities that increases or inhibits the cognitions and understandings that brings the modifications in the healthy outcome. In this study the activities includes the structured teaching programme on prevention of obesity with the help of booklets, pamphlets and flashcards. Pre test and post test will be conducted prior and after the structured teaching programme to assess the level of understanding and gain in knowledge.

Behavioural Outcomes

Behavioural outcome is the end point in the Health Promotion Model. Behaviour specific cognitions will bring adequate gain in the knowledge which results in improved health, enhanced functional ability and better quality of life at all stages of development.

Behavioural outcome in this study is expected to have a adequate knowledge on prevention of obesity. The behaviour outcome may also be moderate or inadequate which may require reinforcement gain by education.

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Fig. 1.2.Conceptual framework based on modified penders health promotion model BEHAVIOURAL SPECIFIC

COGNITION AND AFFECT BEHAVIOURAL

CHARACTERISTICS

BEHAVIOURAL OUTCOME

PRIOR RELATED BEHAVIOUR

Previous experiences such as

 Experiences with obese persons

 Knowledge on obesity through any other sourse.

Demographic variables of adult women

 age,

 type of family,

 religion,

 Education,occupation, income of parents,

 physical activity per day, dietary habits,

 Practice of consuming fast &

junk foods.

PERCEIVED BENEFITS OF ACTION Adolescent girls participate in the study perceives

that after the teaching programme they will gain knowledge on prevention of obesity.

PERCEIVED BARRIERS TO ACTION Lack of knowledge, uninterested,unwilling, not

knowing the consequences of obesity

PERCEIVED SELF EFFICACY

Adolescent girls under the study may have previous experiences in managing obesity

ACTIVITY RELATED AFFECT After the teaching programme adolescent girls under the study will gain adequate knowledge on prevention of obesity.

INTERPERSONAL INFLUENCES Education, physical activity and socioeconomic status, life style, and behaviour of the adolescent

girls may influence in of obesity

SITUATIONAL INFLUENCES Situations like negligence, unwillingness and environment influence the occurrence of obesity

IMMEDIATE COMPETING DEMANDS AND PREFERENCES

DEMANDS: Lack of knowledge, lack of physical activity, socio economic status, life

status, eating habit.

PREFERENCES: Prevention of obesity

COMMITMENT TO PLAN OF ACTION Structured teaching

programme on prevention of obesity

HEALTH PROMOTING

BEHAVIOUR Adolescent girls participated in the study

will gain adequate knowledge in prevention

of obesity FEEDBACK

INADEQUATE RESPONSE

ASSESSMENT OF PRE TEST LEVEL OF KNOWLEDGE

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CHAPTER – II

REVIEW OF

LITERATURE

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CHAPTER II

REVIEW OF LITERATURE

This chapter deal with review of literature related to health consequences and prevention of obesity.

2.1. REVIEW OF LITERATURE RELATED TO STUDY

Review of literature is a summary of the study conducted previously study topic. The review of literature is defined as a broad, comprehensive in depth, systematic and critical review of scholarly publication, unpublished scholarly print materials, audiovisual materials and personal communication.

IN THIS STUDY, REVIEW OF LITERATURE WERECLASSIFIED:

2.1.1. Literature related to prevalence of obesity

2.1.2. Literature related to causes and complication of obesity 2.1.3. Literature related to prevention of obesity

2.1.1.Literature related to prevalence of obesity

Raja Danasekaran et al(2019)conducted a study on cross sectional school based study was done among 934 students aged 14-17 years studying Class 9 to Class 12 in selected four schools of Kanchipuram district in Tamil Nadu, India. Results reveal that study, BMI of the study population was 17.78 (SD-3.14). 39 (8.51%) were identified as overweight and 21 as obese (4.58%) among boys. Mean BMI among girls was 18.58 and 44 (9.24%) were identified as overweight and 20 (4.20%) as obese. Among the study population 83 (8.89%) were overweight, 41 (4.4%) were obese and overall the prevalence of overweight and obesity was found to be 13.28%. finally Concluded the study, the Obesity among adolescents is increasing and requires urgent attention. Standardized BMI charts for adolescents to be prepared as per Indian standards.

Yashneel Singh Rautela et al(2018)conducted a study on community-based cross- sectional study, carried out in Srikot, Uttarakhand, in 2016 among 155 adults systematically

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sampled, aged above 20 years. The result shows In the present study, 61.3% were females.

The mean age of the study participants was 38.3 (±13.6) years. The prevalence of overweight was 14.8% and obesity was 55.5%. A total of 92.9% of the study participants reported consumption of junk food. On mapping the study area, it was found that the total number of food outlets were 116. It was found that density of any food outlet per study participant was 0.7.the conclusion of this study The Srikot in Uttarakhand is in an early stage of urbanization as evident from the burden of obesity, and this might worsen by prevalent outlet density of food in the environment.

VamsiKrishnaUndavalli1 etal(2018) conducted a study on community based cross- sectional study among the309 sample in the rural field practice area of medical college from January to March, 2017 this study result In the present study prevalence of generalized, abdominal and combined obesity was 56%, 71.2% and 51.3% respectively. The study Concluded Prevention of obesity should begin in early childhood. Obesity is harder to treat in adults than it is in children. The control of obesity centres on the weight reduction.

Information Education and Communication (IEC), Behaviour change communication (BCC) is used to encourage individuals of the society to adopt healthy behaviours like dietary modifications, increased physical activity and a combination of both.

Michael AnjelloJothiRajanetal(2018)In this small review article the authors present the childhood obesity in India as on today. This might make the reader think that India is a Developed Nation, but rather it is a Developing Nation. Obesity is the sign of rich people in India. On one side we see Obessed children and on the other side we see mal-nutritioned children. The authors try to analyze this problem in the Indian point of view and throw some light on reducing obesity conclusion.Obesity is to be controlled and the government should boldly ban some of the fast foods which promote obesity. Parents and teachers and peer groups have the responsibility to tackle this problem which is not so easy to solve. But, anyhow if there is a will there is a way.

Sadhu Charan et al (2017)conducted a study on comparative, cross-sectional study was conducted from December 2016 to April 2017 among 600 children of class VI to X of two government and two private schools for overweight,obesity,and lifestyle of urban adolescent. using systematic sampling method. Pre-designed and pre-tested questionnaire was used to elicit the information on demographic variables and lifestyle behavior’s. The study Results reveal that Prevalence of overweight and obesity were 8.9% and 3.4% respectively.

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Obesity was found more among girls (3.8%) and more children from private school were obese. Association of fast food, physical inactivity with obesity was significant. Concluded of this studyOverall combined prevalence of childhood overweight and obesity was 12.3 per cent in school children. School health program should incorporate health education of teachers, students, parents and a convergence of education and health sector can reduce the modifiable lifestyle behaviour’s.

R Vishnu Prasad et al(2016) conducted a study on cross-sectional study among 10- 18-year-old students in Pondicherry. The study was conducted among 2,465 students from 5 schools and 2 polytechnic colleges. The students were classified as "overweight" or "obese"

based on the Indian Academy of Paediatrics (IAP) age- and gender-specific body mass index (BMI) guidelines. The study results reveal that the prevalence of overweight and obesity in our study participant was 9.7% and 4.3%, respectively. There was no difference in prevalence between males and females. The prevalence of overweight/obesity increased as the age advanced.

KanchanaNagendraNandiniCA etal(2016)conducted a study on cross sectional study was conducted in Urban Shivamogga Study was conducted during February 1st to July 30th 2016 for 6 months. Data was collected from house hold members aged 15-64 years The prevalence of high BMI among study subjects was nearly fifty percent (45.6%). The prevalence of obesity in the study subjects was 31.6%, the prevalence was more in females (34.9%) compared to males (28.4%). The prevalence of central/ abdominal type of obesity was 41.2%.conclusion of This study community based study demonstrated high prevalence of obesity and overweight among the productive population of urban Shivamogga.

MdZakaria Siddiqui1 et al (2015)conducted a study on prevelance of obesity the National Family Health Survey (NFHS-3) conducted in 2005 to 2006—to examine factors influencing the prevalence of overweight/ obesity in India. The dataset was disaggregated into four sub-population groups—urban and rural females and males—and multi-level logit regression models were used to estimate the impact of particular covariates on the likelihood of overweight/obesity. The multi-level modelling approach. In contrast to most studies on low-income developing countries, the findings reveal that education for females beyond a particular level of educational attainment exhibits a negative relationship with the likelihood of overweight/obesity. The results also show that the relationship between wealth and the

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probability of overweight/obesity is stronger for males than females highlighting the differential impact of increasing socio-economic status on gender.

RajalakshmiMurugan etal(2016)conducted a study oncross-sectional and institutional based study on pevelance of obesity. Data was collected in government hospitals and primary health centre (PHC’s) in Theni District. 680 samples were collected with convenient sampling technique. Appropriate descriptive and analytical were used to determine the prevalence and statistical significant association between the variables with SPSS version 20. The overall prevalence rate of overweight/obese among adults was 52.4%, more over females overweight/obese was 22.8% -34.8% and in males overweight/obese was 23.4-22%. Prevalence of obesity/overweight (BMI) age, gender, marital status, occupation, income meat/egg consumption and snack consumption were statistically significant association with Obesity (BMI) (P< P<0.05).

Jayaraj et al(2014) conducted a study on cross-sectional study for Prevalence of Overweight and Obesity Among Students of a Medical College in South India, in selected sample of 89 subjects.height and weight were taken as per WHO criteria. Body mass index were calculated and classified accordinglyas normal, overweight and obese. Details of factors influencing were obtained using a pretested questionnaire in a pilotstudy. Result revealed that study overall a high prevalence of overweight (44%) and obesity (10%). In males 35% were overweight and 11% were obese, while in females 49% were overweight and 9% were obese.

Relation with increased frequency of meals (p = 0.007), increased sleep duration (p = 0.003) and regular exercise (p = 0.047) were found tobe significant. Concluded of the study Increased prevalence of overweight among females and obesity among males in rural area were observed.

2.1.2. Literature related to causes and complication of obesity

Bhaskari Kolli1 etal ( 2017) conducted a study on cross sectional study to assess the Impact of lifestyle on weight and Body Mass Index of medical students among third semester students of Guntur medical college. Students were interviewed using predesigned and prestructured questionnaire. BMI was calculated based on height and weight of the students measured using stadiometer and weighing scale respectively.Data was entered and analyzed by using SPSS version 16.Results revealed thatA total of 195 students participated in the study out of which 127 were females and 68 were males. Overweight and obesity was found

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in 14.8%( 29) students and it is significantly more among junk food eaters and people who skip breakfast.

Childs, Benjamin R.BS Nahm et al (2015)conducted a study on Obesity Is Associated With More Complications and Longer Hospital Stays After Orthopaedic Trauma Prospective, observational. Design used result showsComplications occurred more often in obese patients(38.0% vs. 28.4%, P = 0.03), with more acute renal failure (5.70% vs.

1.38%, P = 0.02) and infection (11.4% vs. 5.50%, P = 0.04). Days in ICU and mechanical ventilation times were longer for obese patients (7.06 vs. 5.25 days, P = 0.05 and 4.92 vs.

2.90 days, P = 0.007, respectively). Mean total hospital stay was also longer for obese patients (12.3 vs. 9.79 days, P =0.009). No significant differences in rates of mortality, multiple organ failure, or pulmonary complications were noted. Medically stable obese patients were almost twice as likely to experience delayed fracture fixation due to preference of the surgeon and were more likely to experience delay overall (26.0% vs. 16.1%; P = 0.02).

Mean time from injury to fixation was34.9 hours in obese patients versus 23.7 hours in nonobese patients (P = 0.03). Conclusions of this study Obesity was notedamong 42% of our trauma patients. In obese patients, complications occurred more often and hospitaland ICU stays were significantly longer

Sharon M. Fruh PhD,et al(2017)conducted a study on Obesity Risk factors, complications, and strategies for sustainable long‐term weight management Methods of this study Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed.

Search included terms such as “obesity,” “overweight,” “weight loss,” “comorbidity,”

“diabetes,” cardiovascular,” “cancer,” “depression,” “management,” and “intervention.”

Conclusion of this studyOver one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, modest weight loss in the 5%–10% range, and above, can significantly improve health‐related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal‐setting and increased consultation frequency can greatly improve the success of weight‐management programs. Nurse practitioners have key roles in establishing weight‐loss targets, providing motivation and support, and implementing weight‐loss programs.

Shilpa N. Bhupathiraju etal (2016)conducted a study onEpidemiology of Obesity and Diabetes and Their Cardiovascular ComplicationsObesity and diabetes mellitus have reached

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epidemic proportions in the past few years. During 2011 to 2012, more than one-third of the US population was obese. Although recent trend data indicate that the epidemic has levelled off, prevalence of abdominal obesity continues to rise, especially among adults. As seen for obesity, the past few decades have seen a doubling of the diabetes mellitus incidence with an increasing number of type 2 diabetes mellitus cases being diagnosed in children. Significant racial and ethnic disparities exist in the prevalence and trends of obesity and diabetes mellitus. In general, in both adults and children, non-Hispanic blacks and Mexican Americans seem to be at a high risk than their non-Hispanic white counterparts. Secular changes in agricultural policies, diet, food environment, physical activity, and sleep have all contributed to the upward trends in the diabesity epidemic. Despite marginal improvements in physical activity and the US diet, the food environment has changed drastically to an obesogenic one with increased portion sizes and limited access to healthy food choices especially for disadvantaged populations. Interventions that improve the food environment are critical as both obesity and diabetes mellitus raise the risk of cardiovascular disease by

≈2-fold. Among those with type 2 diabetes mellitus, significant sex differences occur in the risk of cardiovascular disease such that diabetes mellitus completely eliminates or attenuates the advantages of being female.

Adela Hrubyet al(2016) conducted a study on The Epidemiology of Obesity: A Big Picture A epidemic of overweight and obesity presents a major challenge to chronic disease prevention and health across the life course around the world. Fueled by economic growth, industrialization, mechanized transport, urbanization, an increasingly sedentary lifestyle, and a nutritional transition to processed foods and high calorie diets over the last 30 years, many countries have witnessed the prevalence of obesity in its citizens double, and even quadruple.

Rising prevalence of childhood obesity, in particular, forebodes a staggering burden of disease in individuals and healthcare systems in the decades to come. A complex, multifactorial disease, with genetic, behavioral, socioeconomic, and environmental origins, obesity raises risk of debilitating morbidity and mortality. Relying primarily on epidemiologic evidence published within the last decade, this non-exhaustive review discusses the extent of the obesity epidemic, its risk factors known and novel, sequelae, and economic impact across the globe.

Jesse S. Morrell MS et al (2012)conducted a study on Metabolic Syndrome, Obesity, and Related Risk Factors Among College Men and WomenParticipants and MethodsFrom

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August 2005 to July 2008, 2,722 subjects were recruited for the ongoing, cross-sectional Young Adult Health Risk Screening Initiative project. Anthropometric, biochemical, clinical, and dietary data were collected. Resultsshows Approximately one-half of men and more than one-quarter of women were overweight or obese. MbS was identified in 9.9% of men and 3.0% of women; 77% of men and 54% of women had at least 1 MbS criterion. Intakes of saturated fat, magnesium, and fiber, as well as body mass index and reported physical activity levels were related to MbS. Conclusions of this study Because of high rates of overweight/obesity and MbS, college-age adults are at risk for developing chronic diseases including diabetes mellitus and cardiovascular disease

2.1.2 Literature related to prevention of obesity

Jacqueline Panter et al(2018)conducted a study on systematic review of the literature was completed for studies in the community, schools, and worksite, with BMI as an outcome.

A descriptive analysis was completed for all full-text articles meeting the inclusion criteria. Results shows Thirty-three articles were identified: 7 whole of community, 3 worksite, and 23 school-based interventions. The studies were largely quasiexperimental in design (21/33), with follow-up from 4 months to 8 years. The explicit use of theory was not featured in many of the studies (20/33). No consistent direction for BMI change could be identified in the whole of community interventions (2/7 positive, 2/7 negative, and 3/7 no effect) and no effect for worksite (3/3 no effect) or many of the school-based interventions (1/23 negative, 4/23 positive, 15/23 no effect, 1/23 BMI significant increase only for control group and 3/23 no data available). Conclusions of this study, There is a need to prioritise interventions with study designs of high quality, theory, and a participatory approach, for optimal implementation and evaluation of obesity prevention interventions.

NirpalKaurShukla, et al 2018 conducted a study oncross-sectional study was conducted among 2400 schoolgoing adolescent girls in Barabanki, Uttar Pradesh, India.

Multistage sampling techniqueswas used for study subjects. A pre-designed and pre-tested questionnaire was used for obtaining information related to biosocial, dietary, and physical activity-related information. Body weight and height were recorded for calculating body mass index (BMI). The WHO BMI-for-age cutoff classification of girls was used for the assessment of overweight and obesity. In this study Results revealed that studyOn multivariate analysis, middle- and upper-socioeconomic status (odds ratio [OR]: 11.82; 95%

confidence interval [CI]: 10.01–13.63, P = 0.00), general category (OR: 2.12; 95% CI: 1.98–

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2.26, P = 0.03), urban residence (OR: 1.84; 95% CI: 1.32–2.36, P = 0.01), mode of travel to school via bus (OR: 9.82; 95% CI: 7.56–10.08, P = 0.00), absence of outdoor physical activity (OR: 1.80; 95% CI: 1.66–1.94, P = 0.03), non-intake of vegetables everyday (OR:

2.21; 95% CI: 1.69–2.73, P = 0.00), and non-vegetarian dietary habits (OR: 2.08; 95% CI:

1.83–2.33, P = 0.01) were found to be the independent predictors of obesity and overweight among schoolgoing adolescent girls. Conclusion of this studyThere is need for comprehensive school-based awareness interventions with health education packages to focus importance of healthy nutrition and lifestyle for preventing obesity

Susann Weihrauch-Blüher etal(2018) conducted a study on systematic review on Current Guidelines for Obesity Prevention in Childhood and Adolescence a literature search was performed in Medline via PubMed, and appropriatestudies were analyzed. prevention programs have the best results in younger children (<12 years). Evidence-based recommendations for pre-school- and early school-aged children indicate the need for interventions that address parents and teachers alike. During adolescence, obesity prevention programs have mainly focused on behavior-oriented prevention. Recommendations for community or environment-based prevention have been suggested by the German Alliance of Non communicable Diseases the study concluded obesity prevention programs have mainly focused on behavior-oriented prevention. Recommendations for community- or environment- based prevention have been suggested by the German Alliance of Non communicable Diseases.

Sheri Volger et al(2018)conducted a study on a scoping review was conducted following Arksey and O’Malley’s framework to provide an overview of the types, effectiveness and cost-effectiveness of obesity prevention interventions and policies in children up to 6 years old . All interventions included strategies to influence individual- or interpersonal-level health behaviors, yet few removed obstacles in the healthcare system, physical/built environment, or sociocultural environment. The majority (78%) of the interventions occurred during preschool years, with 63% conducted in early childcare education settings serving low-income families. The health impact of the state-wide and national policies on children under age 6 years remains unclear. There was considerable uncertainty around estimates of the health and economic impacts of obesity prevention interventions and policies. Conclusion of this study There is a need to intensify early childhood obesity preventive efforts during critical periods of health development in the US.

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Future studies should estimate the feasibility, program effectiveess, and cost of implementing multilevel obesity prevention interventions and policies

PhebaJohnson et al( 2018)Conducted a study on a descriptive study was conducted, to assess theknowledge regarding obesity and its ill- effect among adolescent girls. 30 adolescent girls those who were studying in the B.scfourth year of Bombay Hospital College of Nursing Indore were selected by non-probability purposive sampling technique.

Thedemographic data revealed that 83.33%of adolescents were in 21 years,73.33% of adolescents were above 51Kg inweight, 90% adolescents were more than151cm in height.

The data was collected through structured knowledgequestionnaires. The findings showed that 63.33% adolescent girls had the average knowledge and 26.66% adolescentgirls had good knowledge regarding obesity and its ill- effect on health. This study concluded that adolescent girls should beprovided with adequate knowledge and awareness regarding obesity and its ill- effect on health. Based on the findings healtheducation programmes can be conducted to bring more awareness among adolescent girls to decrease the risk of obesityassociatedill- effects on health.

Dr.Jinu K Rajan et al (2017)conducted study onEffectiveness of Planned Teaching Programme Regarding Importance of Exercise in Prevention of Obesity among ChildrenThe research design was one group pre-test post-test design and the study was conducted at St.

Rita’s English Higher Primary School, Mangalore. The samples consisted of 60 school children and were selected by using simple random technique. Data collection was done by using the demographic variables, structured knowledge questionnaire for assessing the knowledge of school children regarding importance of exercise in prevention obesity. After assessing the knowledge of school children a planned teaching programme was given on the same day. A post-test was conducted on the 7th day after the PTP to find out the gain in knowledge among school children regarding importance of exercise in prevention obesity.

Result showsMajority of the subjects 37(61.7%) had very good knowledge score in the post- test whereas in the pre-test none of the samples had very good knowledge. In the post-test none of the sample had average knowledge whereas in the pre-test 46(76.7%) samples had average knowledge. The mean post-test knowledge score (20.98) was higher than mean pre- test knowledge score (12.77) suggesting that PTP helped in improving the knowledge of school children regarding importance of exercise in prevention of obesity. The mean difference between the post-test and pre- test knowledge scores of school children regarding importance of exercise in prevention of obesity was found to be highly significant at 0.05

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level. There was significant association between mean pre-test knowledge score and mother’s educational status (χ2= 4.444, p>0.05) at 0.05 level of significance.

Mary Malakellis et al (2017) conducted a study on School‐based systems change for obesity prevention in adolescents The ACT‐IYM project involved three intervention schools and three comparison schools and targeted secondary students aged 12–16 years. The intervention consisted of multiple initiatives at individual, community, and school policy level to support healthier nutrition and physical activity. Data were collected in 2012 and 2014 from 656 students. The result shows Proportions of overweight or obesity were similar over time within the intervention (24.5% baseline and 22.8% follow‐up) and comparison groups (31.8% baseline and 30.6% follow‐up). Within schools, two of three the intervention schools showed a significant decrease in the prevalence of overweight and obesity (p<0.05) conclusion of this study There was some evidence of effectiveness of the systems approach to preventing obesity among adolescents.

Jagadeesan M, etal(2017)conducted study on descriptive cross sectional type carried out among students of an engineering college in Chennai, Tamil Nadu. The study was carried out on 240 students of the engineering college. The KAP parameters were assessed using pretested structured questionnaire and physical examination done. The result show that 58.3% of the study group were males. It was found that 61% of the participants had normal BMI range and 20% fell above the range of normal BMI (i.e. ≥25) and the remaining were underweight (19%). Among the overweight and obese individuals 54.16% were males and 45.83% were females. 54.16% of the students had knowledge that they were entering into obesity and the rest felt they were normal. 73% had the belief that exercise would help in overcoming obesity. It was found that 70% of them were able to exercise but did not have a regular routine. More alarmingly 89.5% of the students did not take any steps to overcome obesity. Conclusions of The study provides the information that the participant had good knowledge and attitude regarding obesityFactors and causes

Cihad D¨undar1 et al (2015) conducted a study on cross-sectional survey was conducted on students including 1271 boys and 1206 girls selected from 20 secondary schools in Samsun, Turkey. A predesigned questionnaire was used to elicit the information on individual characteristics. Measuring the height and weight of students and calculated BMI the result showsThe mean age was 12.8 ± 0.9 years, and the prevalence of obesity was found at 10.3%. There were higher numbersof obese students in boys than in girls (X2 = 53.4;

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF OBESITY AMONG ADOLESCENT GIRLS AT

DISSERTATION ON

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF OBESITY AMONG ADOLESCENT GIRLS AT

SELECTED GOVERNMENT HIGHER SECONDARY SCHOOL, CHENNAI.

M.Sc (NURSING) DEGREE EXAMINATION BRANCH – IV COMMUNITY HEALTH NURSING

COLLEGE OF NURSING

MADRAS MEDICAL COLLEGE, CHENNAI – 600 003

A dissertation submitted to

THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY, CHENNAI – 600 032

In partial fulfilment of the requirement for the award of degree of MASTER OF SCIENCE IN NURSING

OCTOBER 2019

DISSERTATION ON

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF OBESITY AMONG ADOLESCENT GIRLS AT

SELECTED GOVERNMENT HIGHER SECONDARY SCHOOL, CHENNAI

THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY,

CHENNAI – 600 032

CERTIFICATE

CERTIFICATE OF PLAGIARISM

This is to certify that the dissertation work titled,

”, of the candidate N.ATHIBA, for the partial fulfilment of M.Sc. Nursing programme in the branch of

has been verified for plagiarism through relevant plagiarism checker. We found that the uploaded thesis file from introduction to conclusion pages and rewrite shows ___% of plagiarism ( ___ % uniqueness) in this dissertation.

ACKNOWLEDGEMENT

TABLE OF CONTENTS

CHAPTER-I

INTRODUCTION

CHAPTER-1 INTRODUCTION

1.1NEED FOR THE STUDY:

FIG 1.1 ROLE OF COMMUNITY HEALTH NURSE

Community health nurse (CHN

Children’s and young people’s services

1.2 STATEMENT OF THE PROBLEM

1.3 OBJECTIVES OF THE STUDY

1.4 OPERATIONAL DEFINITION:

ASSESS

EFFECTIVENESS:

STRUCTURED TEACHING PROGRAMME

KNOWLEDGE:

ADOLESCENT GIRLS:

OBESITY:

1.5 HYPOTHESIS

1.6ASSUMPTIONS

1.7DELIMITATIONS:

CHAPTER – II

REVIEW OF

LITERATURE

has been verified for plagiarism through relevant plagiarism checker. We found that the uploaded thesis file from introduction to conclusion pages and rewrite shows _% of plagiarism ( _ % uniqueness) in this dissertation.