0

SYNOPSIS FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

SUBMITTED TO:
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

IN PARTIAL FULFILLMENT
OF
M.Sc (N) IN PSYCHIATRIC NURSING

SUBMITTED BY:
MS.DHANYA MARIA SEBASTIAN
I YEAR M.Sc (N)

UNDER THE GUIDANCE OF:

PROF. DOROTHY DEENA THEODORE

PRINCIPAL
NARAYANA HRUDAYALAYA COLLEGE OF NURSING

NARAYANA HRUDAYALAYA COLLEGE OF NURSING

NO: 258/A, BOMMASANDRA INDUSTRIAL AREA
ANEKAL TALUK, BANGALORE-99
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1 NAME OF THE CANDIDATE MS.DHANYA MARIA SEBASTION

AND ADDRESS I YEAR M.Sc NURSING,
NARAYANA HRUDAYALAYA COLLEGE
OF NURSING,
#258/A BOMMASANDRA INDUSTRIAL
AREA, BANGALORE – 99.

2 NAME OF THE INSTITUTION NARAYANA HRUDAYALAYA COLLEGE

OF NURSING.

3 COURSE OF STUDY AND 1ST YEAR M.Sc NURSING

SUBJECT (PSYCHIATRIC NURSING)

DATE OF ADMISSION TO
4 O8-06-2009
COURSE

TITLE OF THE TOPIC EFFECTIVENESS OF STRUCTURED

5
TEACHING PROGRAMME
REGARDING MENTAL HEALTH
PROMOTION AND EARLY
IDENTIFICATION OF MENTAL
ILLNESS IN TODDLERS AND
PRESCHOOLERS AMONG ANGANWADI
WORKERS.
 2

PROBLEM STATE MENT

AN EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME REGARDING MENTAL

HEALTH PROMOTION AND EARLY IDENTIFICATION OF MENTAL

ILLNESS IN TODDLERS AND PRESCHOOLERS AMONG ANGANWADI

WORKERS.

.
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6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Toddlers and preschool years are periods of rapid development,

particularly related to emotional and behavioral regulation and control. According to

Erickson, during the first 3 years, children’s physical development allows them to

increase their autonomy and establish greater contact with the surroundings. If the child

fails to master the skills, self doubt and hostile rejection of all controls, both internal and

external may develop. Children become increasingly active between 3 to 6 years, they

undertake new projects and conquer new challenges. If they encounter severe criticism

and punishment, they learn to feel guilty of their own actions.1

Egger and Angold (2006) suggested that to understand early onset of psychiatric

disorders. “we can start no later than preschool period .” 1

Some problems common to adults may start in childhood or be influenced by

events that occurred early in life. Some problem may resolve with neurological

development or emotional maturity or with a stable, supportive environment. With

effective interventions and early identification of risk of common childhood mental

disorders and reducing the risk of development of psychological disorders at a later stage

is recognized as a major public health goal. The rates of childhood mental problems

continue to increase and interventions carried out later on in childhood appear limited in

effectiveness in many conditions.

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In India there is a lack of mental health services, more so for this age group. 1 There is

also a lack of qualified personnel to cater to these needs. Under these circumstances, the

role of the anganwadi worker in early detection and prevention of mental problem is

essential. The anganwadi workers spend most of their time with children under 5 years of

age group. Therefore they are the ideal personnel who will be in the position to identify

the childhood mental disabilities early and reduce the risk for psychiatric disorders

reaching into their adult life. There is very limited knowledge in the area of effectiveness

of training the anganwadi workers in identifying those children at risk and promoting

mental health among toddlers and preschoolers.

With this concept in mind the researcher decided to take up a structured

teaching programme for anganwadi workers regarding mental health promotion and early

identification of mental health problems.

6.1: NEED FOR THE STUDY

Professor Oberklaid says” mental health problem can emerge at any time, from

as early as infancy, but are often unrecognized until later years.”

The global burden of diseases study indicates that by the year 2020,

childhood neuropsychiatric disorders will increase more than 50% internationally to

become one of the five most common causes of morbidity, mortality and disability

among children in the world. Mental illnesses that develop before the age 6 can interfere

with critical aspects of the child’s emotional, cognitive and physical development. So too,
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prior anxiety, behavior and mood disorders all increase likelihood of child having

psychiatric problems as an adult.2

According to WHO report 2000, 20% of children suffer from mental

disability. According to U.S surgeon general previous research suggested that depression

affects about 2% of U.S preschoolers .Luy’s research team followed more than 200

preschoolers ages 3 to 6 years for duration of 2 years, he found 75 children diagnosed

with major depression.

Studies from India revealed prevalence rate of 12.5% in 0 to 16 years in a community

based sample from Bangalore. Prevalence of mental retardation is estimated 2.0% with a

range from 1.0 to 2.5%.A recent epidemiology study reported prevalence of 2/1000 of

autistic disorder, Aspergers disorder is estimated as 1/1000 in children. Data indicates

25% of 5 year old children present with language and speech disorders. 3The above

mentioned statistics points towards the need for mental health promotion of toddlers and

preschoolers.

These statistics concerning psychiatric problem among children are alarming.

NIMH estimates that “only 50% of children are diagnosed before kindergarten” they also

state that 44% of primary care providers report caring for at least 10 children with

autism1. Early childhood education is considered to be a significant input to compensate

for early environmental deprivation at home by providing an appropriately stimulating

environment in children. Many studies in country have demonstrated a significantly

positive impact of early childhood educational experience on retention rates.

There are 100 child guidance clinics across nation. The largest service for

children is provided at NIMHANS, Bangalore. This center caters to nearly 1000 mentally
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retarded and 800 child psychiatric cases a year. It has 4 psychiatrists, 3 clinical

psychologists, 2 psychiatric social workers and 5 nurses. It offers 3 months training in

child mental health at post graduate level, there is little commitment a serious of concern

about the child mental health. There is no available survey of the facilities offered in the

so called 100 or so child mental health services across the country, but anecdotal

information is that the services are poorly manned and more often than not headed by

people who have little training in child psychiatry. This reveals the lack of health care

professionals and infrastructure to cater to the needs of these children. Therefore

anganwadi workers who are already taking care of the toddlers and preschoolers become

the available alternative. Therefore she should be adequately trained in early detection of

psychiatric disorders and promotion of mental health among this age group.4

In India mental health of the children under 1 to 5 years is not given much

consideration. This may be due to lack of mental health promotion services, this

predisposes the children to mental health problems which may in turn lead to psychiatric

disorders in later adulthood. Evidences have shown that interventions for preventing

chronic behavior problems are effective if applied early in life. 1 A chance of success in

promoting mental health is more if it is carried out through the ICDS system. There fore

there is a need for training for anganwadi workers regarding mental health promotion

activities for children belonging to the age group of 1 to 5 years .

6.2: REVIEW OF LITERATURE

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The review of literature is discussed under

Section A- Mental health among preschoolers and toddlers

Section B- Knowledge of Anganwadi workers in among mental health of toddlers and

preschoolers

Section 3- Effectiveness of teaching to anganwadi workers

SECTION A- Mental health in among preschoolers & Toddlers

The 2009 World Mental Health Day global awareness campaign which was

celebrated on the 10th of October 2009 focused on the theme “Mental Health in primary

care enhancing treatment & promoting mental health” this has led to the focus on the

often neglected fact that mental health is an integral element of individual’s overall health

& well being. The importance of psychological well being in children for their healthy

emotional, social, physical, cognitive & educational development is well recognized

.So steps to promote mental health should be identified and importance needs to be

given the often neglected age group, namely the preschoolers & toddlers 5

Not much information is available regarding childhood mental health problems in

the community, this again reinforces the fact that these children belonging to this age

group belong to the neglected group. However, studies conducted in mental health care

centers provide some literature. In 2001 a data was released by Indian council of Medical

Research (ICMR), this study conducted in Bangalore and Lucknow in 1997 shows the

prevalence of 12.8% psychiatric disorders in 1-16 year old children. 6

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The depth for literature regarding this aspect has let to the consideration of the

following study. A multicentre study of the pattern of child psychiatric disorders among

children attending the psychiatric OPD was conducted in 1997. The study reveals that

among the age group of 0 to 5 years 33 % had been diagnosed to have hyperkinetic

syndrome, mild MR was present in 22 % children .It was also found that abnormal

psychosocial factors were associated with conduct disorders and emotional disorders. 7

A study conducted by Robert. & Clifford to estimate prevalence of

psychopathology among children of 1-18 years of age group was carried out over 20

countries in1998 revealed that most of the countries including the United States & United

Kingdom, the prevalence estimate ranged from1% to nearly 51 %. Mean rates were 8 %

for preschoolers. 8

A statistical survey was made for purpose of conducting an epidemiological study

of autism in Japan in 1984. The survey revealed a prevalence of 0.13 %, which is 3 times

the usual reported rate 9

A study conducted on prevalence of pervasive development disorders among pre-

school children (4-6 yrs) in Stafford U.K in2005 concludes the prevalence rate was 58.7

per 10,000 populations of which 29.8%had MR. The study concluded that the rate of

pervasive developmental disorders is higher than reported 15 years ago.10

Among 796, four year old children taken for the study to examine the

epidemiology of preschoolers psychopathology in Chicago, the most common disorders

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identified were attention deficit, hyperactivity disorder, and oppositional defiant disorder.

Generalized anxiety disorder and depressive disorders comprised of less than 1 % of

sample. Approximately only 3 % of individuals receiving a diagnosis had received

mental health services. 12

SECTION B- Knowledge of Anganwadi workers regarding mental

health of Toddlers & preschoolers

Very little literature is available regarding this aspect. However a study was

conducted in Gorakpur1985 in to evaluate the role of Anganwadi worker for detection

and prevention of disability in children below 6 years of age. It was found that trained

AWW identified mental disability. The mental disability rate was found to be 2654 per

100,000. This study supports the researcher’s assumption that anganwadi workers can

help in early detection and appropriate management of preventable childhood

disabilities.13

SECTION C- Effectiveness of teaching to Anganwadi workers.

WHO report examined the extent of the gap between a prevalence and

treatment of psychiatric disorders globally. They found that one in every five children has

a mental health issue. If we invest in identifying the problems early and intervene at the

right time, it will be more cost effective, as we will be preventing further breakdown and
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avoid an adult treatment and rehabilitation program which is much more expensive. As it

is rightly said “Prevention is better then cure” it is possible to prevent majority of

behavioral disorders in the preschool and school environment itself.14

A study was carried out to assess the impact of non-formal preschool

education component of ICDS on mental and cognitive development of rural and urban

Punjabi urban children. Fifteen anganwadi workers were randomly selected both from

urban and rural areas. Comparisons were made with non ICDS attenders. It was observed

that mental health knowledge of attenders was significantly better than non attenders in

urban and rural areas.15

About 180 anganwadi workers in H.D Kote taluk, 250 Km from

Bangalore were taken up the project which covers a total 4000 population. The

anganwadi workers were trained in promoting psychosocial development, identifying

behavior and emotional problems and disabilities in children below 5 years. They are able

to identify 55 children with varying disabilities like mental retardation, enuresis,

hyperactivity and speech problem.16

Verma(1984) reported training of anganwadi workers in an ongoing

Bangalore program. Six batches of students were trained. The results showed that

vignettes on MR revealed the anganwadi workers had difficulty in identifying its

severity, deciding on management plan, and advice to be given.17

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Krishnamurthy(1985) dealt with training of anganwadi workers in

identifying mental retardation, behavioural problem ,epilepsy in children and their

management with drugs and counseling.35 anganwadi workers took part in training

programmed .It was found that workers were able to detect and manage the cases in

community .However their counseling abilities were not satisfactory.18

Chandrasekar reports the observations made at Sakalwara, which is the

rural mental health center managed by NIMHANS, Bangalore. The Center is trying to

design and develop a training module to give skills to anganwadi workers to identify

,manage and prevent mental retardation and behavioral problem in children .AWW are

being observed to be doing a good job in managing 2 to 3 MR children, they are able to

give time to both the child and parents and train them. A total of 225 AWW were trained
19
.

6.3: OBJECTIVES OF THE STUDY

 .To assess the knowledge of anganwadi workers   regarding promotion of mental

health and early identification of mental health problems among toddlers and

preschoolers.
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 To assess the effectiveness of structured teaching programme on knowledge of

anganwadi workers regarding mental health in preschoolers and toddlers.

 To determine association between selected demographic variables

and Knowledge of anganwadi workers.

6.4:OPERATIONAL DEFINITIONS

 Assess- It refers to evaluate the knowledge of anganwadi workers regarding

mental health promotion & early identification of mental illness among

preschoolers and toddlers using a structured questionnaire.

 Effectiveness-It refers to gain in knowledge among Anganwadi workers 

regarding mental health & early identification of mental health problems

following a teaching programme as evaluated by the score obtained using a

standardized questionnaire.

 Structured teaching programme-It refers to teaching in the form of a one day

workshop on following aspects.

 Growth and development of children between 1 to 5 years.

 Needs of children in this age group.

 Physical needs

 Social needs

 Emotional needs

 Mental needs

 Common mental health problems of this age group & its signs and

symptoms.
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 Recognition and early identification of mental problem among

children of this age group.

 Role of anganwadi workers.

 Knowledge-It refers to extent to which anganwadi workers are aware about

mental health promotion & early identification of mental health problems

among preschoolers and toddlers.

 Anganwadi workers –It refers to workers with an education of 10th standard and

above appointed as Anganwadi workers in Anekal Taluk

 Mental health promotion- Promoting optimal development physical, mental,

intellectual and emotional development of preschoolers and toddlers so that it is

comparable with that of others.

 Toddlers- It refers to children of 1 to 3 years of age who attend the anganwadi.

 Preschoolers-It refers to children of 3 to 5 years of age who attend the

anganwadi.

6.5 :ASSUMPTION

 Anganwadi workers can help in early detection and appropriate

management of preventable childhood disabilities.

 The planned teaching programme will assist the anganwadi worker in

promoting mental health & early identification of mental health problems

of toddlers and preschoolers

6.6 : HYPOTHESIS
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 H1-There will be significant improvement in knowledge of anganwadi workers

regarding mental health  & early identification of mental illness in toddlers and

preschoolers following structured teaching programme at 0.05 level Of

significance

 H2-There will be significant improvement in knowledge of anganwadi workers

regarding mental health  & early identification of mental illness in toddlers and

preschoolers following structured teaching programme as compared with the

control group at 0.05 level of significance

 H3-There will be some association between selected demographic variables

and the knowledge score.

6.7 :DELIMITATION

 The study is delimited to anganwadi workers in Anekal taluk.

 The study is delimited to 6 weeks of study

7. MATERIALS & METHODS

7.1 Sources of data ;Anganwadi workers(346) in Anekal taluk

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7.2 Materials & Methods

7.2.1 Type of study : Experimental study

7.2.2 Research Design : Pre test- Post test design with control group

7.2.3 Sample size : The size of the sample is 90(experimental -45

&control –45)

7.2.4 Sampling technique : Random Sampling.

7.2.5 Sampling Criteria

Inclusion criteria

1.Anganwadi workers in Anekal taluk.

2.Anganwadi workers who are willing to participate.

3.Anganwadi workers who know Kannada

Exclusion criteria

1. Anganwadi workers who are not available at the time of data collection.

2. Anganwadi workers who have attended similar workshop with in 6 months

7.2.6 Setting

Anekal taluk which has a total population of 33160 .

7.2.7 Data collection technique

- Self prepared & standardized questionnaire

Description of tool

SECTION A-Demographic profile consisting age, qualification, years of work experience

,age of the children of anganwadi workers

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SECTION B-According to the mentioned topics for workshop questions will be

prepared. The Questionnaire will be given to experts in the field for assessing the face

validity and test retest method will be used to assess the reliability

 Data collection procedure

Pretest: Before administration of teaching programme

Postest: will be conducted immediately and after one week of implementation of

programme

7.2.8 Data Analysis

 Data obtained will be analyzed in terms of objectives. Plan of data analysis

include, descriptive & inferential statistics

 PLAN FOR DATA ANALYSIS

Descriptive statistics;

 Assessment of the socio demographic variables

 Assess knowledge of anganwadi workers in different sub- areas

Inferential statistics;

 Assess the effectiveness of structured teaching programme pretest and

post test using independent t test

 Assess the effectiveness of structured teaching programme with

experimental group and control group using independent t test .

 The association between demographic variable such as age ,qualification,

years of experience by chi square test. And t- test

7.3. Does the study require any investigation or interventions to be conducted on

patients or other humans or animals? If so, please describe briefly ?

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Yes, the study requires structured teaching programme among anganwadi worker in the

Anekkal taluk. in the form of one day workshop on mental health promotion and early

identification of mental illness among toddlers and preschooler.

7.4 Has ethical clearance been obtained from your institution?

The ethical clearance is obtained before study.

BIBLIOGRAPHY

1. Carrihill,Susan M Breitenstein. Understanding disruptive behaviour problems in

preschool children.Journal of paediatric nursing.2009jan;24(1):7 -9.

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2. Stuart G.W. Principles and practice of psychiatric nursing.Missioure, :Elsevier

publication;7th edition.2005.

3. USAtoday.Depression can hit even preschoolers.

http://www.usatoday.com/news/health/2009-08-03-depression-kids_N.htm

4. Kapoormalavika.An integrated

approachtochildmentalhealthservices.JIACAM.vol1(1):2

5. Thomas H. Borneman.Making mental health a global

priority.oct2009.www.wfmh.org.pdf

6. Sobha shrinath,Sathish Chandra,etal.Epidemiological study of child and

adolescent psychiatric disorders in urban and rural areas of Banglore.Indian

journal of medical Research122.2005july .

http://medind.nic.in/iby/t05/i7/ibyt05i7p67.pdf

7. http://cogprints.org

8. Robert.E.Robert.etal.American journal of psychiatry.Prevalence of

psychopathology among children and adolescents.june 155(6):715-25

http://ajp.psychiatryonline.org/cgi/content/full/155/6/715

9. Toshrio sugiyama.Tuguchiro Abe.Journal of autism and developmental

disorders.prevelence of autism in Nagoya,Japan.vol 19 march 1989:87-96

10. American journal of psychiatryvol;162,No;6,june,2005,pg no.1133-1141

11. www.ncbi.nlm.nih/pubmed/16175102

http://www.britannica.com/bps/additionalcontent/18/39567356/
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12. John v Lavigane,Helen j Binnes,etal,prevalence of ADHD,ODD ,depression and

anxiety in community sample.May 2009.

http://www.britannica.com/bps/additionalcontent/18/39567356/

13. Mathur gp,Mathur s,etal.Detection And Prevention of childhood disability with

help of anganwadi workers.1995 july32(7):773-7

http://www.ncbi.nlm.nih.gov/pubmed/8617553

14. Indian pediatrics,1995 ,vol 32,pp 773-777

15. Sachar RK; Krishnan J; Bhatia RC.etal.Indian Journal of Community Medicine.

1996 Jan-Dec; 21(1-4): 16-21.

16. Kapoormalavika.An integrated

approachtochildmentalhealthservices.JIACAM.vol1(1):4

http://openmed.nic.in/172/01/jiacam05_1_4.pdf

17. Verma n.Anganwadi workers andchild mental health care.Workshop on child

mental health in India

18. krishnamurthy k.Anganwadis in child mental health care –Hydrabad experience

.paper presented in worshop on community mental health in India.

9 Signature of Candidate
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10. Remarks of the Guide

11. Name & Designation Prof. Mrs. Dorothy Deena Theodore

11.1Guide : Principal
Mental health Nursing,
Narayana Hrudayalaya College of Nursing.

11.2 Signature :

11.3 Co-Guide (if any) :

11.4 Signature :

11.5 Head of Department : Prof .Mrs.Dorothy Deena Theodore

Principal
Mental health Nursing,
Narayana Hrudayalaya College of Nursing

11.6 Signature :

12. 12.1 Remarks of the Chairman & Principal

12.2 Signature