THE PROBLEMS AND COPING STRATEGIES AMONG VISUALLY CHALLENGED CHILDREN

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THE PROBLEMS AND COPING STRATEGIES AMONG VISUALLY CHALLENGED CHILDREN

By B. Sudha

A DISSERTATION SUBMITTED TO THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR DEGREE OF MASTER OF

SCIENCE IN NURSING

MARCH-2011

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THE PROBLEMS AND COPING STRATEGIES AMONG VISUALLY CHALLENGED CHILDREN

Approved by the dissertation committee on:

Research Guide :

Prof .S.Ani Grace Kalaimathi M.Sc (N).,PGDNA.,DQA.,Ph.D.

Principal

MIOT College of Nursing Chennai -116

Nurse Guide :

Prof. S.Ani Grace Kalaimathi M.Sc(N).,PGDNA., DQA., Ph.D Principal

MIOT College of Nursing Chennai -116

Medical Guide :

` Dr. Harshita Bakshi, M.S, FRCS Consultant Ophthalmologist MIOT Hospitals

Chennai

A DISSERTATION SUBMITTED TO THE TAMILNADU DR.M.G.R MEDICAL

UNIVERSITY, CHENNAI, IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR DEGREE OF MASTER OF SCIENCE IN NURSING

MARCH-2011

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DECLARATION

I hereby declare that the present dissertation entitled THE PROBLEMS AND COPING STRATEGIES AMONG VISUALLY CHALLENGED CHILDREN is the outcome of the original research work undertaken and carried out by me, under the guidance of Prof. S.Ani Grace kalaimathi, MSc (N)., PGDNA.,DQA.,Ph.D and HOD department of Child Health Nursing, MIOT College of Nursing ,Chennai. I also declare that the material of this has not formed in any way, the basis for the award of any degree or diploma in this university or other universities.

B.SUDHA

II^nd Year M.sc (N)

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ACKNOWLEDGEMENT

I wish to acknowledge first the Lord Almighty for the abundant blessings, wisdom and strength showered on me from the beginning to the end of the dissertation.

I would like to extend my heartfelt thanks to the Managing Trustee of the MIOT Educational Institutions to carry out the study successfully.

I owe my whole hearted and sincere thanks to Prof. S.Ani Grace kalaimathi, M.Sc [N]., PGDNA.,DQA., Ph.D. Principal, Research guide and Nurse guide, HOD department of Child Health Nursing, MIOT College of Nursing for her valuable guidance, innovative suggestions, constant motivation and extreme patience which enabled me to complete the dissertation successfully.

I extent my thanks to Dr. Harshita Bakshi, M.S, FRCS, Consultant Ophthalmologist, MIOT Hospitals, Chennai, for her valuable suggestions and encouraging guidance for this study.

I am highly indebted to Prof. Mrs. Jayasri M.Sc (N), M.Phil, Ph.D, Vice Principal MIOT College of Nursing for her valuable suggestions, timely, constant guidance, and unceasing motivation and willingness to help all the time.

I am grateful to Prof. Mr. Antony Amalraj, M.Sc., Ph.D Biostatistician for his help in statistical analysis.

I extend my sincere thanks to Mrs. Kavitha, M.sc (N) class coordinator for her continuous guidance and valuable suggestion to carry out the study successfully.

My heartfelt gratitude to Mrs. Vijayakumari M.Sc(N) & Mrs. Anuratha M.Sc (N), MIOT College of Nursing for her guidance and support throughout the study

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I thank our Librarian Mrs. Bhuvaneswari M.Lis for her constant help in reviewing the literature during the course of my work.

I would fail my duty if I forget to thank my loved ones behind the scene. I am grateful to my husband, Mr. Deivakumar for his constant support me in all stages of work and his constant encouragement and motivation which enabled me to complete this study.

I have much pleasure in expressing my cordial appreciation and thanks to all the visually challenged children who participated in the study for their interest and co- operation.

With my deep gratitude, I acknowledge my friends and classmates for their concern and contribution.

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ABSTRACT

A study to assess the problems and coping strategies among visually challenged children within the age group of 15-18 years in a selected blind school at Chennai.

The conceptual framework of the study was developed on the basis of Modified Sister Callista Roy’s Adaptation Model. The study variable was male adolescent visually challenged children.

An extensive review of literature and guidance by experts formed the foundations to the development of the study instrument.

Research questionnaire were used to assess the problems and coping strategies among visually challenged children to achieve the objectives of the study .The present study was conducted in a selected blind school at Chennai, with a sample size of 100. The sample were selected through non – probability convenient sampling technique.

The investigator used demographic variables proforma, check list and coping scale for assessing problems and coping strategies to collect the data. The data collections tools were validated and reliability was established. The data was collected by using the interview method from visually challenged children. The collected data was tabulated and analyzed using descriptive and inferential statistics.

Demographic characteristics revealed that 33% of visually challenged children were 17 years, 32% were studying 11^th standard, 67% belongs to Hindu family, 71%

living in nuclear family, 28% of their fathers had primary education, 31% of their

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mothers had primary education, 61% of their family income was below Rs.5000, 64%

of them are blind from birth itself and 59% of their family members were not blind.

It was noted that, 63(63%) of the visually challenged children had mild problems 37(37%) had moderate problem and none of them had severe problem. It was also revealed that, only 3(3%) of visually challenged children had low coping, 72(72%) of them had moderate coping and 25% of them had high coping.

It also revealed that the negative correlation existed between problems and coping strategies. There was no significant correlation between problems and coping strategies, hence the null hypothesis was accepted.

The study also revealed that the significant association between level of problems with age and education of visually challenged children at p<0.05, p<0.000 hence the null hypothesis was rejected. It also shows none of the other demographic variables had association with level of problems, hence the null hypothesis was accepted. Association between level of coping among visually challenged children and demographic variables were not significant, hence the null hypothesis was accepted.

The visually challenged children had 74% of social problems at mild level.

They were having less interaction with society so by creating awareness among care givers and by providing psychological guidance and counseling to visually challenged children, the social problems could be reduced. 72% of visually challenged children are in the level of moderate coping, they need to improve their coping strategies to met their problems by social interaction, sharing problem with others, and prayers.

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CHAPTER - I INTRODUCTION

“The best and most beautiful things in the world cannot be seen or even touched.

They must be felt with in the heart”

Helen Keller

Children are the future and hope of mankind. Health is wealth. Today’s children will be the masters of future world. If children are healthy, the future generation will be healthy, resulting in a healthy nation. The physical health of a child is very crucial because of its association with good mental and social development.

Duanel Macgregor,(2001) says that, In the first 6 months of life, a visually challenged child will often shows absence or reduced eye contact and visual tracking.

There is delay in the acquisition of gross motor skills and delayed reaching. Strategies for treatment use brightly colored objects and sound making toys or equipment.

From the ages of 6-18 months, when normal motor milestones include sitting, crawling and walking, if there is an absence of vision, unusual patterns of motor development or delayed motor skills are evident. Protective reflexes – for example, the parachute response (the reflex of extending the arms to catch oneself on falling forward) are delayed – and often not present until 18 months of age. In sighted

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children, this reflex is normally present by 8-9 months. This delay in visually handicapped children suggests the response is learned and requires visual input. Blind children do not develop a pincer (or fingertip) grasp with all four fingers and a stationary receptive thumb – this is an efficient grasp and does not impede overall learning. Commonly, visually handicapped children show a dislike of, or are frightened of tactile experiences – for example they may be fearful of furry toys or animals.

Children from 18 months to 3 or 4 years of age develop confidence in movement and communication skills. Visually challenged children show poor exploratory motor activities and seem most interested in near objects – or objects which can be held for inspection and manipulation. There is marked reduction in self initiated mobility.

Developmental pediatric assessment must be modified for visually challenged children. Therapy must allow for opportunities for the blind child to understand their environment – the example above of "sound for sight" is useful. Teaching a blind child to reach for sound, must be begin at the critical developmental period for reaching -– and if successful, can eliminate maladaptive "blindisms". It is particularly important to encourage speech and communication skills as well as cognition for blind children. The child’s position in the classroom, level of environmental lighting and sound are important in ensuring optimal developmental and learning progress.

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From the beginning, my medical perceptions and stereotypical attitudes have portrayed individuals with disabilities as different, aberrant, deficient, incompetent and more. But like gender and ethnicity, a disability is simply one of many natural characteristics of being human.

“Disability does not discriminate, People with disabilities make up the largest

“minority group” and it’s most inclusive!”

U.S.Developmental disabilities act expressed that,

“A green apple is more like red apples, different in an individual with a disability which is more like people without disabilities that is the difference. Having a disability is a “natural part of human experience”

Childhood is a bliss filled state of innocence and joy but this is often not for children, who are disabled. When they play, laugh; they feel isolated as no one is beside them to hear or bear, as everyday life is a big struggle.

Disability act, (2000) stated that Disability is process to be a big hindrance in the normal day to day life of a place of negligence despair and isolation. But there is hope always in everyone’s life. One of the goals of our nation is, to have happy and healthy children who can express their full potential. Government provides education, employment creation of barrier free environment and social security to the disabled.

Disability is a condition or function judged to be significantly impaired related to the usual standard of an individual or their group. The term is often used to refer to

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individual functioning, including physical impairment, sensory impairment, cognitive impairment, intellectual impairment or mental health issue.

The World Health Organization (2006) has produced the International Classification of Functioning (ICF) on Disability and Health. It distinguishes between body functions (physiological or psychological ex-vision) and body structures (anatomical parts e.g. the eye and the related structures).

Visually challenged is the condition of lacking visual perception due to physiological or psychological factors. Various scales have been developed to describe the extent of vision loss and define "Blindness"

. WHO,(2002) estimated that the most common causes of blindness around the world are: Cataracts (47.8%), Glaucoma (12.3%), Ureites (10.2%), Age Related Macular Degeneration (AMD) (8.7%), Trachoma (3.6%), Corneal Opacity (5.1%) and Diabetic Retinopathy (4.8%). The normal vision in any human being can be made vision less due to the poisoning such as exposure to chemicals. A well-known example is methanol, found in Methylated spirits, which is sometimes used by alcoholics as a cheap substitute for regular alcoholic beverages.

Need for the study

The World Health Organization (2008) estimates that for every 5 seconds, someone goes blind but a child goes blind every single minute. At risk are those below 5 years old. Worldwide 314 million people are visually impaired, of the 314

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million, 45 million are blind, 124 million have low vision, 145 million have uncorrected refractive errors.1.4 million children under age of 15 are blind. More than 90 percent of the world’s visually impaired people live in countries below the poverty line. 75 percent of all blindness can be prevented, treated or cured. April 1-7 is observed as prevention of blindness week.

India is one among the countries that has a sizeable number of visually impaired people. Statistics reveals that over 12 million people who live in the country are visually handicapped. Prevalence of blindness is high in states like Madhyapradesh and Rajasthan. In absolute terms more than two thirds of blind persons are in Orissa Madhyapradesh Rajasthan and Tamilnadu. The most common cause for blindness across the country is cataract. Cataract accounts for 62.6 % of blindness, while an uncorrected refractive error accounts for 19.7 %, glaucoma 5.8 %, posterior segment pathology 4.7% surgical complications 1.2 % corneal opacities 0.9

% and other causes 0.5 %.

The main objective of Tamilnadu state blindness control society programme is to reduce the prevalence of blindness in the country from 14 per 1000 to 3 per 1000 population. In Tamilnadu the prevalence of blindness is 4 per 1000 population.

Recently the government associated itself with the global initiative vision 2020.The right to sight launched by the World Health Organization in collaboration with international agency for prevention of blindness and other NGOs to eliminate avoidable blindness 2020

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Folkman and Lazarus (1999) stated that, coping is an ongoing process that is subject to change depending on the context and demands of a particular situation at a particular time

Ryan Wenger (1994) coping strategies were defined as specific cognition and behavior methods to deal with stressors. Coping is used when faced with serious problems that cannot be mastered with familiar behavior.

Ohhin (2004) says that, as a result of handicap, the child has to face a number of problems in his life and he is not able to perform the role expected of him in the society. It is a common condition, which can give rise to a number of physical, emotional, social and adjustment problems in the children, whether the handicap is mild or severe, the problems faced by children are tremendous.

Tate D et al (1994) states that coping with the late effects among visually handicapped survivors identifies that the survivors were more likely to be living alone, be experiencing further health status determination, seek professional help, view their health as poor, and live in general and exhibit poorer coping outcome behaviors in relation to their disability.

Blindness is regarded as the most severe and traumatic physical handicap.

This results from any interference with the passage of light stimulus, as it travels from the outer surface to the inner surface and to the brain. Visually handicapped children are a highly heterogeneous group. They face many problems like behavioral

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problems, problems of social adjustment, problems in learning, poor intelligence, academic difficulties, slower speech etc., this is supported by a study conducted on comparison if divergent development of gross motor skills in children who were blind and sighted. The results revealed that fourty five percent of visually handicapped children had strong developmental delays in the observed skills and about twenty eight percent in extreme developmental delay.

Scientific research began 20 to 30 years ago, but recent interest in technology by the society is reflected in the literature on the blind, as a large proportion of the research is devoted to various visual and mobility aids. Longitudinal research is also needed on the behavior and, psychosocial development of children.

American Foundation for the Blind stated that, almost 1 person in every 1,000 under the age of 45 has a visual impairment of some type, while 1 in every 13 individuals older than 65 has a visual impairment which cannot be cured with glasses.

With current demographic trends toward a larger proportion of elderly, the prevalence of visual impairments will certainly increase.

The blind children are treated as burdens to their families and society, when; if properly trained they can live perfectly normal lives. At times the degree of blindness ranges from total loss to a fair degree of vision. Therefore all visually challenged children cannot be educated or treated alike. Their individual problems and needs need to be taken into consideration. To keep this in to mind an attempt is made here to study the problems faced by the visually challenged children at schools and at their

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homes. It is a known fact that a person with a sensory handicap is gifted with a talent or innate ability that needs to be tapped. We should encourage them to learn and overcome their disability and lead a fairly independent life. They can even be taught to take care of themselves and earn their own living.

Davidson (1999) says in his study the social adaptation difficulties of blind individuals, had reached the conclusion that some teenagers were isolated from their sighted peers.

S. Fraiberg (1997) details the difficulties encountered by blind children when trying to build a perception of them. Likewise, Verdugo and Caballo (1999) refer to the sensorial handicaps that negatively affect the development of the individual's self- conception.

During field visit to school for the visually challenged, the investigator observed that visually challenged children were having various problem and difficulty in coping with the situation. The researcher felt that there is need to assess problems and their coping strategies. This will help the visually challenged children are made to understand the level to which they can cope, they would be able to improve their coping abilities in future. This study will also useful for future investigators who would wish to make any interventional study on this subject.

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Statement of the problem

A study to assess the problems and coping strategies among visually challenged children within age group of 15-18 years in a selected blind school at Chennai.

Objectives

• To assess the physical, psychological, and social problems among visually challenged children.

• To assess coping strategies for problems among visually challenged children.

• To correlate the problems with coping strategies among visually challenged children.

• To associate the problems and coping strategies among visually challenged children with selected demographic variables.

Null hypothesis

• No: There is no significant correlation between problems and coping strategies among visually challenged children.

• No: There is no significant association between problems and coping strategies among visually challenged children with selected demographic variables.

Operational definitions 1. Assess

The way of finding out the problems and coping strategies among visually challenged children by check list and coping scale.

2. Problems Physical problem

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It refers to facing difficulties in walking, playing, reading and writing.

Psychological problem

It refers to disturbances in body image, self esteem and self understanding.

Social problem

It refers facing difficulties to carry out the role function of school child, student, son, daughter, brother and sister.

3. Coping strategies

The behavioral response of visually challenged children to cope with the physical, psychological, and social problems which can be measured and identified.

4. Visually challenged

It refers to facing difficulties to carry out normal activities because of defects of vision including blindness.

Assumption

• The visually challenged children may have certain problems due to their visual impairment.

• The visually challenged children are using coping strategies to overcome their problems.

Delimitations

• The study is limited to male visually challenged children.

• Visually challenged children who are willing to participate.

• The study is limited to the children within age group of 15-18 years.

• The study is limited to 6 weeks.

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Projected outcome

• Result of the study helps to identify the problem among visually challenged children.

• Result of the study helps to identify the coping strategies among visually challenged children.

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CHAPTER II

REVIEW OF LITERATURE

This chapter deals with literature review which serves a number of important functions in the research process. It elicits the activities done by the researches in identifying and searching for information related to the present study.

Review of literature is a broad, comprehensive and depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, audiovisual material and personal communication

The literature consist of,

Section I: Literature related to problems among visually challenged children.

Section II: Literature related to coping strategies among visually challenged children

Section I

Literature related to problems among visually challenged children.

Prasad and Chandra, (2000) states that the handicapped people need to be free from the bondage of their physical handicap. In many cases the educational achievements of the physically handicapped children is lowered by their disability.

These children should be encouraged to work in groups as it has been found to be useful.

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Greenberg, (2000) reveals that an analysis of the empirical literature shows that the dependence person is more likely to view their problems in somatic terms and to seek professional help for their physical symptoms than an in depended person.

Gubel steward, (2001) states that Children who are forced to limit their locomotion because of their handicap may show problems with regard to activity and coping in later life.

Gorret, (2002) defined the handicapped child as the child who deviates from the normal or average child in mental, physical or social characteristics to such an extent that he requires a modification of school practices to special educational services in order to develop his maximum capacity.

Joe Schreiber et al, (2004) reveals that the case report describes that children who have difficulty keeping up with peers with no disability are accessing and utilizing community sports and recreation facilities and are more likely to lead a sedentary life style. Children with physical disability tend to have significantly lower levels of habitual physical activity and consider themselves less fit relativeiy to their peers and report more limitations for physical activity and consider themselves less fit relatively to their peers and report more limitations for physical activity participation. Only 29%

of children with physical disabilities report themselves as being active.

Ross David,et.al ,(2009) states that, orientation and way finding are critical skills for successfully mobility of people with visual impairment. The inability to perform

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these skills successfully may result in a person becoming lost, injured, and discouraged from further mobility. At times, it may be impossible to maintain orientation .One method of improving mobility is to develop, and assist in technology that fills in the “gaps “ when available orientation cues are lacking and that intelligently augments the senses by providing relevant value added information.

World declaration on the survival protection and development of children ,(2000) states that the measures to prevent disability include change in the attitude of society from negative to positive and spread the ability of the disabled persons as differently challenged.

Richardson and Stenberg,(2001) conducted a study on the effect of physical disability on the socialization of a child shows that the handicapped child is presented from taking part in the normal course of human interaction because of two barriers of obstacles. The first barrier results from the physiological limitations inherent in the condition because the child faces difficulty in walking and playing. The second barrier is the consequences of the psychological and social limitations on the part of the child himself as a result of his handicap.

Bardyo pathy, (2001) stated that visually challenged subjects showed a greater degree of emotional disturbance than the normal. These emotional disturbances are manifested in the form of anxiety, tension, depression, irritability and suspicious mentality.

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Winker, (2002) said that a tendency of withdrawal, over aggressiveness and feelings of inferiority in disabled children is in contrast to those who were apparently normal.

JDR.Beach and JM.Robinet, (1995) investigated that the self esteem and independent living skills among visually impaired persons in Canada and found that higher self esteem was significantly related to lower level of dependence on others in performing daily living tasks and found that these results were perceived independence as one of the most important factors related to self esteem and adjustment in individuals with visual impairment.

Anderson, (2002) conducted a longitudinal study, 117 normal children with 125 visually challenged children on social competence measure that included behavioral observations. It shows that the visually challenged children have less social interaction than normal children. The child, whether is severely or mildly challenged may feel different from his siblings or his peers and is liable to be treated by them as different when in fact his basic emotional needs for security, affection, accepted to be a part of social group, achievement, recognition and self expression are the same.

Badale CM, (2003) reveals that disability is a costly affair for any country economically speaking. Disability cost millions. Socially speaking it causes un precedent suffering, both physically and emotionally. Disability is more of a social stigma than a medical one.

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Viswanathan and Avolkita B.Desai, (2003) revealed that, the challenged child looks different in some way or other from the other children and this becomes a major cause of emotional problems. These children are unable to perform normal activities and their personality development is affected adversely.

Rivaj,(2003) said, the challenged child has intellectual problems like slow thinking, easily distracted, poor concentration, difficulties in planning and organizing, difficulty in setting goals, difficulty in completing things and lack of initiative.

Mesfin Samuel, (2003) states that the Common syndrome identified in physically challenged children is aggressiveness, anxiousness, depression, delinquent, hyperactivity and non-communicative. Two additional syndromes like hostile/with drawn and insecure were also prevalent

Mayer, (2003) conducted a comparative study; he found 30 significant differences between disabled and non disabled adolescent boys and girls on a large butlery of psychological tests. The researcher sought evidence from the interview and auto biographical date that culture and social relationships within the family can influence the adjustment to a greater degree than the presence of disability.

Versev J A,et al, (2004) said that children at particular risk are those with differed behalf and feelings, distinctive personality traits, or obvious physical differences from that of the group norm. In these children teasing can have deleterious effects on their psychological well being.

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Banles M, (2004) states that the families have widely varying perspectives on the disability; these perspective influence responses to disability from the preconception and panel development stages through old age.

Wool F son,(2004) reveals that the feelings of hopelessness, social isolation of the family within the community and child behavior problems have all been reported in many families with their child diagnosed as disabled .while utilization of social support systems is usual documented in such families, less attention has been focused on the lab of psychological factors. Negative societal attitudes to disability identified by a social model of disability are interrupted with respect to how they might translate to parents’ views of their disabilities within the family

Section II

Coping strategies among visually challenged children

Richareson, (2000) stated that in addition to the usual developmental tasks, a challenged child must make unique, complex adjustments to himself, to his challenged condition, and too his immediate world. The effects of physical handicap influence all aspects of the Childs growth or development in all areas of his life.

Dodona.l,et al, (2001) conducted a study on estimation of blindness in India from 2000 through 2020, implications for blindness control policy .They conclude that the planning of blindness control in India should take into account recent population based data for number of blind persons in India is currently over 18

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million .This estimates 50% more than the figure of 12 million from a decade ago, that is still quoted widely in the blindness control policy. If avoidable blindness is to be substantially reduced in India by 2020, effective strategies against blindness due to cataract and refractive errors are needed urgently as both these conditions are relatively easy to treat. Also strategies against preventable corneal blindness need to be strengthened soon for them to show an impact over the next two decades.

Gilbert,(2002) conducted a comparative study to as see to the adjustments pattern of 50 physically challenged and 50 normal sample Patna town. Data where analyzed using the T-test. Results indicated significant difference in the adjustment patterns of challenged persons as compared to their normal counter parts. These differences could be attributed to the feelings of isolation, differentiation and negligence experienced by the challenged.

Beggs, (2002) reveals, research on the coping strategies developed by blind people has mainly been carried out with individuals who had recently acquired a condition of blindness or serious visual impairment. Some of these studies highlight in particular the importance of self-efficiency and mobility, whereas other studies focus on the evaluation of psychological factors with the aim of predicting the success or lack of success of rehabilitation programs

Aminabhavi and vijayelaxmi,(2003) conducted a study to assess the adjustment ability of 30 physically disabled (mean age 13.4year) and 30 physically abled (mean age 14.2 years) reveals that physically disabled children exhibited a

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lower level of adjustments in the areas of emotion, criminality and leadership than the other group.

Midgrey, (2003) states the challenged children are positively associated with self deprivation and negative attitude towards education and ego oriented goals. The relation between ego oriented goals and handicap was stranged in Africa Americas than European Americans. Whereas relation between negative attitude and handicaps was strange in European Americans than the African Americans.

Kandel.J (2003) says that, when the child is born with a disability, the family must hope with the stress, grief, disappointments and challenge. This may lead to a serious crisis or an even disruption of family life. The event of a child with disability is always a strategy for the family, but early interaction and support may help the family to adjust and become positively involved in the care and development of the child, even if that child is differ and in need of special treatment.

Ashar et,al, (2004) conducted a study to assess the blindness associated with midfacial fractures ,they concludes that the frequency of blindness associated with midfacial fractures in this series was attributable to the predominance of road traffic accidents as the major cause and absence of an obligatory seat belt. Early diagnosis of the exact nature of the ophthalmic injury and treatment are important, and involvement of the ophthalmologist is mandatory.

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Iverson JM,(2004) conducted a study on production and informational content of gesture and speech in congenitally blind and sighted children to assess hypothesized variations in children representations of spatial tasks .12 congenitally participants of spatial tasks. 12 congenitally blind participants age 9-18 years and 24 sighted participants’ age 9-17 years 12 of whom were blind folds engaged in route directions and small scale path description tasks. Results are discussed in terms of the link between gesture production and spatial task representation and factors affecting gesture production.

Tellanik,et.al ,(2004) introduced a article about activity based intervention for multiple disabled visually impaired people. The article describes assessment, planning and training for people with multiple disabilities and visual impairment. The impact of this project, an EU Comenius programme, addressed concern expressed by teachers of children and young people with MDVI as how they are expected to integrate the diverse curriculum elements and particular skills they have been taught into a meaningful education.

Lazarus and folk man, (2006) states that stress and coping are concepts linked with health. Stress is determined by the perceptions of the problem. Coping involves constantly changing cognitive and behavioral efforts to minimize, reduce tolerate or manage external and internal demands.

Michael,(2006) conducted a study to assess the functional disability and school activity limitations in 41,300 school age children relationship to medical

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impairments .The main purpose of the study was to examine the contribution of medical impairments to functional disability and school activity limitation in 41,300 school age children. Results revealed that functional limitation of children were distributed as mobility 12.4/1000 visually impaired children, self care 8.8/1000, communication 52.9/1000 and learning 104.6/1000.

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CONCEPTUAL FRAMEWORK Modified Sister Callista Roy’s Adaptation Model

Conceptual framework is global ideas about a concept. Conceptual models are made up of concepts that describe the mental images of phenomena and integrate them into a meaningful configuration.

A conceptual framework is a network of inter related concepts that provide a structure for organizing and describing the phenomenon of interest. It guides an investigation to know what data needs to be collected and gives discharge to research process.

The study aims at assess the various problems and coping strategies among visually challenged children. Sister callista Roy’s adaptation method was modified and on the basis, conceptual framework of the present study was developed.

According to this theory, a stimulate is any factor that provokes a response.

Persons response to stimulate depend on their own adaptive level and the stimulate the self uses biological, psychological and social mechanism to cope with their world.

Stimulate that arise from external factor include all the demographic variables and the internal factors include physical, psychological and social problems, determine whether a stimulate elicits an adequate or inadequate response.

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The child needs psychological support when his/her adaptive response are in effective, so the child need support are ineffective, so the child need support to order to home positives adaptive responses in their lives to have a good physical & mental health.

The four major concepts of phenomena are described as follows:

Physiological mode

It is associated with the physical process involved in the function and activities of the child. Thus includes activities such as walking, writing, reading, playing etc.

Self concept mode

This is a composite of beliefs and feelings about the child himself in regard to the perception of physical & personal self the physical self involves sensation and body image & personal self is made up of self esteem, self understanding and setting goals.

Role function

The role function focuses on the roles, the child occupies in the society. A role is a set of expectation about how the child occupying one position (student, son/daughter, and brother/sister) behaves towards a person occupying another position (teacher, parents, and sibling)

Interdependence

This involves the willingness and ability to give others and to accept from them. First is with the persons who are the most important to the child, like the parents, siblings, relatives, teachers, friends and others.

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Conceptual framework based on Modified Sister Callista Roy’s Adaption Model

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CHAPTER III METHODOLOGY

Research methodology is the systematic way to solve the research problem.

Pearson (2002) stated that, there is no short cut to truth. There is no way to gain the knowledge of the universe except through the gateway of scientific method.

Methodology is one which enables the researcher to project a blue print of the research undertaken.

This chapter explains the methodology followed to assess the problems and coping strategies among visually challenged children within age group of 15 – 18 years in selected blind school at Chennai

Research approach

In this study a quantitative approach was used to assess the problems and coping strategies among visually challenged children.

Research design

A Descriptive study design was used to assess the problems and coping strategies among visually challenged children.

Setting

The study was conducted in St.Louis blind school in Adyar at Chennai.

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Population

The target population of the study was male visually challenged children within age group of 15-18 years.

Sample

In this study the sample was male visually challenged children who were studying in St.Louis blind school at Chennai.

Sample size

In this study the sample consisted of 100 male visually challenged children Sampling technique

The sampling technique was used for this study is non-probability convenient sampling.

Criteria for sample selection Inclusion criteria

• Visually challenged children within age group of 15-18 years.

• Children who were willing to participate.

• Male visually challenged children were included.

• Children who were able to interact in Tamil.

Exclusion criteria

• Children who were not willing to participate.

• Female visually challenged children.

Description of the tool The tool consists of three parts

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Part I of tool, the demographic and base line data. Interview guide consist of item related to demographic and base line data.

Part II

It consisted of check list, which includes 25 questions in selected problems like physical, psychological and social problems among visually challenged children.

Yes carries 1 mark and no carries 0 marks.

The score were interpreted in percentage as follows 0-35 % Mild

35–65 % Moderate 65-100 % Severe Part III

The coping scale was used to assess the coping strategies among visually challenged children. Total numbers of items were 20. The items were scored from zero to three were characterized as never, rarely, sometimes, and always. The total possible score was 20.For negative statements, never carries 3 marks, rarely carries 2 marks sometimes carries 1 mark and always carries 0 marks. For positive statements, never carries 0 marks, rarely carries 1 mark, sometimes carries 2 marks and always carries 3 marks.

The scores were interpreted in percentage as follows:

0-50% low coping 50 – 75% moderate coping 75-100% high coping

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Validity and reliability Validity

The tool was developed through a review of literature for content validity; the instrument was reviewed by experts in the area of the study.

Reliability

The reliability of the tool was established by conducting a pilot study. The reliability was calculated by split half method. The reliability r: 0.8 was found which indicates check list and coping scale was reliable.

Pilot study

Pilot study was conducted on a sample of 7 visually challenged children .These children were excluded from the main study. The results proved that the instrument is valid and reliable.

Data collection procedure

Written permission was obtained from the headmaster, St Louis school for blind at Adyar to conduct the study. The purpose of the study was explained to every respondent to get their full co-operation and consent. The data was collected, adequate privacy was provided during data collection.

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Human rights protection

The pilot and main study were conducted only after approval of the research proposal by College of Nursing and the researcher’s dissertation committee. Permission was also obtained from the concerned blind school to conduct the study. Consent was obtained from all the participants who took part in the study.

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CHAPTER IV DATA ANALYSIS

Kerlinger define analysis on the categorizing, ordering, manipulating, and summarizing of data to obtain answers to research questions The purpose of analysis is to reduce the data into interpretable form. So that relations of research problem can be studied and used.

This chapter deals with statistical analysis of the data collected from the visually challenged children 15 to 18 years those who were studying in the St. Louis blind school at Chennai. The problems and coping strategies were tabulated, analyzed and presented in the following sections.

The organization of the analysis of the data is as follows

Section I: Distribution of sample according to demographic characteristics.

Section II: Distribution level of problems among visually challenged children.

Section III: Distribution level of coping score among visually challenged children Section IV: Correlation between problems and coping strategies among visually Challenged children.

Section V: Association between problems and coping strategies among visually Challenged children with selected demographic variables

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SECTION I

Table 1 Sample according to their demographic variables

Demographic Variables No. Percentage (%)

1. Age of the Child a) 15 yrs

b) 16 yrs c) 17 yrs d) 18 yrs

21 16 33 30

21.0 16.0 33.0 30.0 3. Education of the Child

a) 9^th Std.

b) 10^th Std.

c) 11^th Std.

d) 12^th Std.

27 22 32 19

27.0 22.0 32.0 19.0 4. Religion

a) Hindu b) Christian c) Muslim

67 12 21

67.0 12.0 21.0

5. Family Structure a) Joint

b) Nuclear

26 71 3

26.0 71.0 3.0

(44)

c) Extended

(45)

6. Fathers Education a) No formal education b) Primary

c) High School d) Hr. Sec.

e) Graduate

10 28 25 19 18

10.0 28.0 25.0 19.0 18.0 7. Mothers Education

a) No formal education b) Primary

e) Graduate

18 31 21 16 14

18.0 31.0 21.0 16.0 14.0 8. Family income

a) Below Rs. 5000 b) Rs. 5000 – 10000 c) More than Rs. 10000

61 29 10

61.0 29.0 10.0 9. Duration of Blindness

a) From birth itself b) After 5 years c) After 10 years

64 30 6

64.0 30.0 6.0

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10. No. Family Members Blind a) One

b) Two

c) Three & above d) None

16 19 6 59

16.0 19.0 6.0 59.0

Table 1 shows that 33%of visually challenged children were 17 years, 32%

were studying 11^th standard, 67% belongs to Hindu family, 71% living in nuclear family, 28% of their fathers had primary education, 31% of their mothers had primary education, 61% of their family income was below Rs.5000, 64% of them are blind from birth itself and 59% of their family members are not blind.

Through the result, majority of visually challenged children (59%) were blind from birth itself. The investigator found that congenitally affected visually challenged children had mild problems only. And also shows that majority of visually challenged children family members (59%) were not blind. This may lead the child to get moderate coping strategies, since family members guided the child properly.

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SECTION II Figure 1

Distribution Level of Problems among Visually Challenged children

Above figure displays that 41% of visually challenged children had mild physical problems, 58 % had moderate physical problem and 1 % had severe physical problem

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It also shows that, 60 % of visually challenged children had mild psychological problems, 33 % had moderate psychological problem and 7 % had severe psychological problem

Further it shows that, 74 % of visually challenged children had mild social problems, 25% had moderate social problem and 1 % had severe social problem

It indicates 63 % of visually challenged children had mild problem, and 37 % had moderate problem. This revealed that, the visually challenged children have more social problems. So the investigator felt that by encouraging participating in social functions, improving communication skills and providing proper guidance, the problems faced by visually challenged could be reduced to some extent.

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SECTION III Figure 2

Distribution Level of Coping Score of Visually Challenged children

Above figure reveals that, 3 % of visually challenged children had low coping and 72 % had moderate coping and 25 % had high coping. It indicates that most of the children had moderate coping.

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Table 2

Mean Problems score among Visually Challenged children

Descriptive

Statistics Ranges

Problem Aspects

Mean S.D. Minimum Score

Maximum Score

Physical Problem 34.50 14.45 0 75.0

Psychological Problem 32.86 19.63 0 85.71

Social Problem 26.70 12.87 0 70.0

Overall Problem 30.88 10.45 12.0 64.0

Table 2 inferred that the visually challenged children had highest mean score (m=34.5) for physical problems than psychological (m=32.86) and social problems (m=26.70).

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Table 3

Mean Coping Score of Visually Challenged children

Coping Score Descriptive Statistics

Mean 68.68

Standard Deviation 9.84

Minimum Score 45.0

Maximum Score 95.0

This table shows that overall mean coping score of visually challenged children found 68.68 with standard deviation 9.84

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SECTION IV Table 4

Correlation between Problems and Coping Score of Visually Challenged children

r-value

&

P-value Problems and coping

r = -0.125

P = 0.215 (N.S)

Table 4 reveals that the negative correlation existed between problems and coping strategies. There is no significant relation between problems and coping strategies hence the null hypothesis was accepted. This shows that the problems and coping strategies among visually challenged children was not interdependent.

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SECTION V Table 5

Association between Level of Problems of Visually Challenged children and Demographic Variables

Mild Problem (0-35%)

Moderate Problem (35-65%) Demographic Variables

No. % No. %

Chi Square value & P

value

19 6 20 18

90.5 37.5 60.6 60.0

2 10 13 12

9.5 62.5 39.4 40.0

χ 2 = 11.462, d.f = 3 P=0.009 **

3. Education of the Child a) 9^th Std.

b) 10^th Std.

c) 11^th Std.

d) 12^th Std.

23 6 21 13

85.2 27.3 65.6 68.4

4 16 11 6

14.8 72.7 34.4 31.6

χ 2 = 18.082, d.f = 3 P=0.000 ***

4. Religion a) Hindu b) Christian c) Muslim

44 8 11

65.7 66.7 52.4

23 4 10

34.3 33.3 47.6

χ 2 = 1.290, d.f = 2 P=0.525 (N.S) 5. Family Structure

a) Joint b) Nuclear c) Extended

16 46 1

61.5 64.8 33.3

10 25 2

38.5 35.2 66.7

χ 2 = 1.254, d.f = 2 P=0.534

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(N.S) 6. Fathers Education

e) Graduate

6 15 19 10 13

60.0 53.6 76.0 52.6 72.2

4 13 6 9 5

40.0 46.4 24.0 47.4 27.8

χ 2 = 4.452, d.f = 4 P=0.348 (N.S)

7. Mothers Education a) No formal education b) Primary

e) Graduate

10 21 10 12 10

55.6 67.7 47.6 75.0 71.4

8 10 11 4 4

44.4 32.3 52.4 25.0 28.6

χ 2 = 4.273, d.f = 4 P=0.370 (N.S)

8. Family income a) Below Rs. 5000 b) Rs. 5000 – 10000 c) More than Rs. 10000

36 19 8

59.0 65.5 80.0

25 10 2

41.0 34.5 20.0

χ 2 = 1.734, d.f = 2 P=0.420 (N.S) 9. Duration of Blindness

38 20 5

59.4 66.7 83.3

26 10 1

40.6 33.3 16.7

χ 2 = 1.598, d.f = 1 P=0.450 N.S)

10. No. Family Members Blind

b) One c) Two

d) Three & above a) None

11 10 2 40

68.8 52.6 33.3 67.8

5 9 4 19

31.2 47.4 66.7 32.2

χ 2 = 3.951, d.f = 3 P=0.267 (N.S)

Note: * - P<0.05, *** - P<0.001 Level of Significant, N.S. – Not Significant

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Table 5 reveals that the significant association between level of problems with age and education of visually challenged child at p<0.05, p<0.001 hence the null hypothesis was rejected. It also shows none of other demographic variables had association with level of problems hence the null hypothesis was accepted. It could be interpreted that when education improves the problems decreases, so all visually challenged children should be encouraged to acquire adequate education.

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Table 6

Association between Level of Coping of Visually Challenged children and Demographic Variables

Low Coping (0-50%)

Moderate Coping

(50.0- 75.0%)

High Coping (75.0-100%) Demographic

Variables

No. % No .

% No. %

Chi Square value & P

value

1 0 1 1

4.8 0.0 3.0 3.3

16 12 21 23

76.2 75.0 63.6 76.7

4 4 11 6

19.0 25.0 33.3 20.0

χ 2 = 2.705,

d.f = 6 P=0.845 (N.S) 3. Education of the

Child a) 9^th Std.

b) 10^th Std.

c) 11^th Std.

d) 12^th Std.

2 1 0 0

7.4 4.5 0.0 0.0

21 14 25 12

77.8 63.6 78.1 63.2

4 7 7 7

14.8 31.8 21.9 36.8

χ 2 = 6.886,

d.f = 6 P=0.332 (N.S) 4. Religion

a) Hindu b) Christian c) Muslim

2

1 0

3.0 8.3 0.0

44 9 19

65.7 75.0 90.5

21 2 2

31.3 16.7

9.5

χ 2 = 6.575,

d.f = 4 P=0.160 (N.S)

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5. Family Structure a) Joint

b) Nuclear c) Extended

1 2 0

3.8 2.8 0.0

19 50 3

73.1 70.4 100.0

6 19 0

23.1 26.8 0.0

χ 2 = 1.392,

d.f = 4 P=0.846 (N.S) 6. Fathers Education

e) Graduate

0 1 0 1 1

0.0 3.6 0.0 5.3 5.6

9 20 16 13 14

90.0 71.4 64.0 68.4 77.8

1 7 9 5 3

10.0 25.0 36.0 26.3 16.7

χ 2 = 5.211,

d.f = 8 P=0.735 (N.S)

7. Mothers Education a) No formal education b) Primary

e) Graduate

1 1 0 0 1

5.6 3.2 0.0 0.0 7.1

14 21 15 13 9

77.8 67.7 71.4 81.2 64.3

3 9 6 3 4

16.7 29.0 28.6 18.8 28.6

χ 2 = 3.907,

d.f = 8 P=0.865 (N.S)

8. Family income a) Below Rs. 5000 b) Rs. 5000 – 10000 c) More than Rs. 10000

2 0 1

3.3 0.0 10.0

44 21 7

72.1 72.4 70.0

15 8 2

24.6 27.6 20.0

χ 2 = 2.707,

d.f = 4 P=0.608 (N.S)

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9. Duration of Blindness

3 0 0

4.7 0.0 0.0

49 19 4

76.6 63.3 66.7

12 11 2

18.8 36.7 33.3

χ 2 = 5.009,

d.f = 4 P=0.286 (N.S) 10. Family Members

Blind a) One b) Two

c) Three & above d) None

0 1 0 2

0.0 5.3 0.0 3.4

12 12 5 43

75.0 63.2 83.3 72.9

4 6 1 14

25.0 31.6 16.7 23.7

χ 2 = 1.888,

d.f = 6 P=0.930 (N.S) It is inferred from the table none of the demographic variables had association with coping strategies, so the null hypothesis was accepted.

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CHAPTER V DISCUSSION

The aim of the study was to assess problems and coping strategies among visually challenged children in a selected blind school at Chennai.

This chapter deals with the discussion of the study with appropriate literature review, statistical analysis and findings of the study based on objectives of the study .the aim of the present study is to assess the problems and coping strategies of visually challenged children within age group of 15 – 18 years studying in st. Louis blind school at Chennai. A total of 100 samples were selected for the study.

Table 1 shows that, In demographic characteristics, 33%of visually challenged children were 17 years, 32% were studying 11^th standard,67%belongs to Hindu family,71%living in nuclear family,28% of their fathers had primary education,31%

of their mothers had primary education,61% of their family income was below Rs.5000,64% of them are blind from birth itself and 59% of their family members are not blind.

Through the result, majority of visually challenged children (59%)were blind from birth itself. The investigator found that congenitally affected visually challenged children had mild problems only. And also shows that majority of visually challenged children family members (59%) were not blind. This may also leads the child to get moderate coping strategies since family members guided the child properly.

(60)

The first objective of the study was to assess the physical, psychological, and social problems among visually challenged children.

Problems of visually challenged children were assessed by check list.

Interview technique using check list which help the children to understand clearly.

After conducting interview, problems were assessed. Figure 1 reveals that 58% of visually challenged children were have physical problem at moderate level,60% were have psychological problem at mild level,72%were have social problem at mild level.

It could be interpreted that as, visually challenged children are having more social problems. So the investigator felt that by improving the communication of visually challenged children the social problem could be reduced to some extent.

The second objective of this study was to assess coping strategies for problems among visually challenged children.

Coping strategies of visually challenged children was assessed by check list through interview technique which help the children to understand clearly. After conducting interview coping strategy was assessed. Figure 2 reveals that 72% of visually challenged children have moderate coping. The mean coping score of visually challenged children found 68.68 with standard deviation 9.84

The investigator found that, the visually challenged children should be encouraged to use effective coping strategies such a social interaction, getting help from others, sharing problems and prayers to improve their coping strategies.

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The finding of the study consisted with the study done by Sunilkumari (2009) on problems and coping strategies of blind children ,shows that nearly three fourth 88%

of children adopted coping strategies to pray God 80%were taking help from others ,68%were thinking through different ways to solve the problem.

The third objective of this study is to correlate problems with coping strategies among visually challenged children. The corresponding null hypothesis was stated that there is no significant correlation between problems and coping strategies

Table 4 shows that the negative correlation existed between problems and coping strategies at r value is -0.125 @ p value is 0.215.There was no significant correlation between problems and coping strategies hence the null hypothesis was accepted.

The investigator found that the problems and coping strategies among visually challenged children was not interdependent.

The fourth objective is association between problems and coping strategies among visually challenged children with selected demographic variables. The corresponding null hypothesis was stated that there is no significant association between problems and coping strategies with selected demographic variables

The table 5 reveals that the significant association between level of problems with age and education of visually challenged child at p<0.05,p<0.001 hence the null

(62)

hypothesis was rejected. It also shows none of other demographic variables had association with level of problems hence the null hypothesis was accepted. The investigator felt that when education improves the problems decreases, so all visually challenged children should be encouraged to acquire adequate education.

It is inferred from the table 6 none of the demographic variables had association with coping strategies, so the null hypothesis was accepted.

The investigator concluded when education improves the problems decreases too .so all visually challenged children should be encouraged to acquire adequate education.

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CHAPTER VI

SUMMARY, CONCLUSION, LIMITATIONS, IMPLICATION AND RECOMMENDATIONS

This chapter represents the summary, findings, conclusion, implication and recommendations, which creates a base for researcher for evidence based practice.

Summary of the study

The purpose of the study was to assess the problems and coping strategies among visually challenged children within age group of 15-18 years in selected blind school at Chennai.

Objectives of the study

• To assess the physical, psychological, and social problems among visually challenged children.

• To assess coping strategies for problems among visually challenged children.

• To correlate the problems with coping strategies among visually challenged children.

• To associate the problems and coping strategies among visually challenged children with selected demographic variables

Null hypothesis

• No There is no significant correlation between problems and coping strategies among visually challenged children.

• No There is no significant association between problems and coping strategies among visually challenged children with selected demographic variables

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The conceptual framework of the study was developed on the basis of Modified Sister Callista Roy’s adaptation model. The study variable was male adolescent visually challenged children. The level of significance selected was P<

0.05.

An extensive review of literature and guidance by experts formed the foundations to the development of the study instrument.

An research quantitative was used to assess the problems and coping strategies among visually challenged children to achieve the objectives of the study .The present study was conducted in selected blind school at Chennai , with a sample size of 100.Visually challenged children were selected through non – probability convenient sampling technique .

The investigator used a demographic variable Performa, check list on problems coping scale for coping strategies to collect the data. The data collection tool was validated and reliability was established. After the pilot study, the data was collected for main study. The interview method was used to collect data from visually challenged children. The collected data were tabulated and analyzed using descriptive (mean and standard deviation) and inferential statistics (correlation coefficient &chi- square test).

(65)

Major findings of the study The study findings were as follows

1.The demographic characteristics revealed that , 33%of visually challenged children were 17 years,32% were studying 11^th standard,67%belongs to Hindu family,71%living in nuclear family,28% of their fathers had primary education,31%

of their mothers had primary education,61% of their family income was below Rs.5000,64% of them are blind from birth itself and 59% of their family members are not blind.

2. It indicates 63 % of visually challenged children had mild problem, 37 % had moderate problem. The physical problem score was high, mean =34.50 with standard deviation 14.45

3. It also noted 3 % of visually challenged children had low coping and 72 % had moderate coping and 25 % had high coping. It indicates that most of the children have moderate coping. The mean coping score of visually challenged children found 68.68 with standard deviation 9.84.

4. The negative correlation existed between problems and coping strategies There was no significant co relation between problems and coping strategies hence the null hypothesis was accepted at r = -0.125,p = 0.215

5. The study also reveals that the significant association between level of problems with age and education of visually challenged child at p<0.05, p<0.001

(66)

hence the null hypothesis was rejected. It also shows that the association between Level of Coping of Visually Challenged children and Demographic Variables was not significant, so the null hypothesis was accepted

Conclusion

The visually challenged children had 74%of social problems at mild level. They were less interaction with society so by creating awareness among care givers and by providing psychological guidance and counseling to visually challenged children, the social problems could be reduced.72% of visually challenged children are in the level of moderate coping, they need to improve their coping strategies to met their problems by social interaction, sharing problem with others, and prayers.

Limitations

1. The study findings is limited to only male children so, the generalization is not possible.

2. The study findings is limited to only adolescent visually challenged children so, the generalization is not possible.

THE PROBLEMS AND COPING STRATEGIES AMONG VISUALLY CHALLENGED CHILDREN