Padmashree college of nursing gurukrupa layout, nagarbhavi, bengaluru



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PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
Ms. SASMITA GHIMIRE

FIRST YEAR M.Sc. NURSING

CHILD HEALTH NURSING

YEAR 2011-2013


PADMASHREE COLLEGE OF NURSING

GURUKRUPA LAYOUT, NAGARBHAVI,

BENGALURU - 560072



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION



1.

NAME OF THE CANDIDATE AND ADDRESS

Miss. Sasmita Ghimire

I year Msc. (Nursing)

Padmashree College Of Nursing

Gurukrupa layout,

Nagarbhavi,

Bengaluru- 72.



2.

NAME OF THE INSTITUTION

Padmashree College Of Nursing

Gurukrupa layout,

Nagarbhavi,

Bengaluru- 72.



3.

COURSE OF THE STUDY AND SUBJECT

I year Msc. (Nursing)

( Child Health Nursing)




4.

DATE OF ADMISSION TO THE COURSE

30-05-2011

5.

TITLE OF THE STUDY

Effectiveness Of Game- Based Learning On Knowledge Regarding The Healthy Dietary Pattern Among The School Children In Selected Government Schools, Bengaluru.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

Healthy weight- it’s not a diet, it’s a lifestyle!
School age is a period of rapid growth in human development when nutritional demand is increased and dietary habit is established. Also, emotional development is seen such as self-consciousness and one's values are established in addition to physical development.1

The growth rate is slightly slowed down but dietary habit is formed and fixed during the school age, which is thus greatly affected by stimuli through school life and peer groups. Nutrition of school age children has not only direct and short-term influence on physical and mental growth during that period but also indirect and long-term influence on the continuing growth and health of the adolescence and the health during the lifetime. The importance of nutrition in school age children has been emphasized because malnutrition during this period can decrease not only physical and mental development but also the learning ability of children.2

A population-based cohort study was conducted on, “Are dietary patterns in childhood associated with IQ at 8 years of age?” in UK. The sample comprised of 3966 children. Dietary patterns were identified using principal-components analysis and scores computed at each age. IQ was assessed using the Wechsler Intelligence Scale for Children at 8.5 years. There is evidence that a poor diet associated with high fat, sugar and processed food content in early childhood may be associated with small reductions in IQ in later childhood, while a healthy diet, associated with high intakes of nutrient rich foods described at about the time of IQ assessment may be associated with small increases in IQ.3

As the frequency of eating with the family is decreased and the number of children eating alone or preparing meal by themselves, is increased due to socioeconomic changes. It has been reported that the quality of the meal is lower when children eat alone than when eating with the family, the rate of skipping meals is increased in children eating alone and the establishment of proper dietary habit is interfered by eating alone.2


Balanced and sufficient nutritional intake is most essential for children to promote growth and development, to protect and maintain health, to prevent nutritional deficiency conditions and various illnesses and to reserve for starvation and dietary stress. 4
School age children are insufficient of general knowledge on their own health and nutrition and are not aware of the importance of health, and thus select foods on the basis of preference without proper judgement to aggravate unbalanced diets. Such dietary habits increase the intake of calorie nutrients and thus increase the incidence of obesity, malnutrition and food borne diseases.5

Firstly, childhood obesity is one of the most serious public health challenges of the 21st century. According to WHO, globally, in 2010 the number of overweight children under the age of five, is estimated to be over 42 million. Close to 35 million of these are living in developing countries. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate.6

Some nutrients such as calcium, vitamin A, thiamine, and riboflavin are deficient because of unbalanced diet, eating out and overflowing processed foods, to result in the state of nutritional imbalance with over-nutrition and nutrition deficiency at the same time.7

Secondly, malnutrition which refers to an impairment of health either from a deficiency or excess or imbalance of nutrients is public health significance among children all over the world. Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished children in the world lives in India. Malnutrition limits development and the capacity to learn. It also costs lives: about 50 per cent of all childhood deaths are attributed to malnutrition.

In India, around 46 per cent of all children below the age of three are too small for their age, 47 per cent are underweight and at least 16 per cent are wasted. Many of these children are severely malnourished.8

The other problem caused due to intake of unhealthy diet is foodborne diseases. Each day millions of people become ill and thousands die from a preventable foodborne disease. Proper food preparation can prevent many foodborne diseases. Food can transmit disease from person to person as well as serve as a growth medium for bacteria that can cause food poisoning. In industrialized countries, the percentage of the population suffering from foodborne diseases each year has been reported to be up to 30%. In the United States of America (USA), for example, around 76 million cases of foodborne diseases, resulting in 325,000 hospitalizations and 5,000 deaths, are estimated to occur each year.9
Games are an innovative and challenging educational method.. They have also been used as a teaching strategy in medical education, predominantly to review and reinforce lecture material for undergraduate medical students. One such game is snake and ladder game. It is used as a fun way of learning about a topic and can be used for topics on health, hygiene, gender, money, etc. This game has been used in health programs in many developing countries and adapted to the needs of each program. In a school environment, playing board games has many benefits for children of all ages, from helping to develop their visual alertness to increasing their attention span and assisting with memory strategies and reasoning.

An experimental study was conducted to evaluate the knowledge gained from game-based learning versus traditional case-based learning in a continuing medical education (CME) event on stroke prevention and management. Thirty two family physicians and 3 senior residents watched a 30 minute video about stroke prevention and management and were then randomly assigned into two groups (n = 17 case-based group; n = 18 game-based group). The game-based groups played “Snakes and Ladders.” All participants took a 40-point multiple choice knowledge exams. Results showed that the game based group strongly agreed that the event was enjoyable [game-based = 94%; case based = 53%], that their attention was high throughout the event [game-based = 88%; case-based = 41%], and that they would register for a similar event in the future [game-based = 82%; case-based = 41%].Hence activity based learning might help the children learn better about the healthy dietary practices.10



6.2 NEED FOR STUDY
Eat right and feel good”

Children are the gift to this world and it is the society’s responsibility to nurture and care for them. School-age years are crucial for establishing positive self-esteem and self-concept and it is during this time the child learns how to master skills and relate to others.11

Healthy eating means eating a variety of foods that gives the nutrients needed to maintain health, feel good, and have energy. These nutrients include protein, carbohydrates, fat, water, vitamins, and minerals.12

A healthy diet provides the fuel that allows the body to function properly. When children are eating an unhealthy diet during their growing years, there can be devastating consequences. Eating an unbalanced diet will affect the body in various ways. Ill health is often a symptom of an individual's poor diet and is demonstrated through conditions such as obesity, fatigue, diabetes and anorexia.13

Adequate food and nutrition are essential for proper growth and physical development to ensure optimal work capacity, normal reproductive performance, adequate immune reactions and resistance to infections. Inadequate diet may produce severe forms of malnutrition in children, Vitamin A deficiency and Iodine deficiency disorders.14

In India nearly one in four children under age of five is underweight. The problem of hidden hunger-that is deficiencies of essential vitamins and minerals, such as iron, Vitamin A and iodine - is also severe. Nutrition is therefore a serious challenge that has not received the attention it truly deserves.15

The cross-sectional study was conducted on prevalence of malnutrition in government School children in the field area of Azad nagar in Bengaluru between January and June 2010. The study showed that the prevalence of malnutrition in Government schools was 68%. The prevalence of malnutrition in males and females was 57.94% and 42.06% respectively.16

The other unhealthy dietary pattern prevalent in school children is the intake of foods purchased in vending machines which leads to poor diet quality and that may be associated with being overweight, obese or at risk for chronic health problems such as diabetes and coronary artery disease.17

Junk foods are often eaten in instead of regular food, an essential Indian diet that consists of wholesome chapatis and vegetables or snacks like upmas and idlis. Not surprisingly eating junk food leads to a sense of starvation both physically and mentally, as the feeling of satiation and contentment that comes after a wholesome meal is absent.18

Nutrition education is clearly required for the establishment of desirable dietary lifestyles in school age children and the purpose of nutrition education is not to convey simple nutrition knowledge but to actually apply nutrition knowledge to everyday life to maintain more reasonable dietary lifestyle. Elementary school children are sensitive by nature and thus this period is effective for educating basic knowledge including nutrition knowledge on general dietary lifestyle, food selection, dietary habits, and table manners with organized educational contents. Dietary habits are more difficult to change as the age of children increases and thus it is important to provide nutrition education to eat various foods with balance and with moderate amounts by correcting one-sided dietary habits in the school age children.19


Since nutritional problems are directly and indirectly related to dietary environment factors and the behaviour of an individual is decided by one's values, attitudes and knowledge, nutritional problems can be fundamentally solved after investigating and analyzing actual conditions for such factors. Thus, it is necessary to study factors influencing nutrition knowledge, nutrition attitude and dietary behaviour and the relationship among nutrition knowledge, nutrition attitude, dietary behaviour and degree of food preference.20

A school programme recognises that child’s best opportunity to learn is through play. Play helps the child to understand their world, to become socialised, to solve problems in an environment and also develop critical thinking skills. Games encourage interaction among learners, increase learners’ levels of motivation, and enhance the opportunity to learn from others. Unlike many other educational formats, game-based learning can bring fun and enjoyment to the learning experience and might encourage greater participation in group learning activities, with the potential to engage learners’ emotions, as well as their intellects.21


Children of this age group enjoy many types of games like playing board games, starts different collection, watching TV, listening music etc.22 Snake and Ladder is a very simple childhood racing board game played among these children and its see-sawing nature makes it popular. The game does not need any specific skill to play. It gives a very relaxed feel throughout the game.23

An experimental study was conducted to assess the effectiveness of snake and ladder game on ailments of children in government schools of Bengaluru. The sample comprised of 60 students. The school children were educated with the aid of snake and ladder game regarding common ailments. It was found to be effective in terms of increasing the knowledge scores. The major findings of the study were: the post-test knowledge scores were higher than the pre-test knowledge scores and the differences between the pre-test and post-test scores were statistically significant at 5% level. This indicates that GAME was an effective method of imparting information to the children regarding common ailments.24

In order that the child should internalize safe habits by means of the game, certain squares in the game have been replaced by positive drawings, in which the child carries out healthy activities, receiving prizes for these, and others in which risky activities are performed, which are penalized. The areas dealt with are: habits (nutrition, sleep, study, games, etc.), Accidents at home, road safety (pedestrian, cyclist and automobile traveller), and swimming pools. Since it is what the child knows best and where he learns his deepest attitudes, this game could be a help to parents in this difficult task.25
In the view of many of the studies, the investigator felt that the incidence of diseases among school children is mainly due to unhealthy dietary pattern and hence the investigator found the need for educating the children so that they will discuss with other children as well as the family members and everyone will be benefited. And investigator have opted teaching through the medium of play as the investigator felt the children of this age will be interested in play and game-based learning can bring fun and enjoyment to the learning experience.

6.3 STATEMENT OF THE PROBLEM

A Study To Assess The Effectiveness Of Game- Based Learning On Knowledge Regarding The Healthy Dietary Pattern Among The School Children In Selected Government Schools, Bengaluru.


6.4 OBJECTIVES OF THE STUDY

1. To assess the existing level of knowledge regarding the healthy dietary pattern among the school children.

2. To evaluate the effectiveness of game-based learning on knowledge regarding the healthy dietary pattern among the school children.

3. To explore the association between pretest and posttest knowledge scores with the selected demographic variables of the school children.




    1. OPERATIONAL DEFINITIONS


1. Effectiveness: It refers to the extent to which the snake and ladder game has achieved the desired effect on knowledge regarding the healthy dietary pattern among the school children.

2. Game- based learning: It refers to the learning method that helps the school children to acquire knowledge regarding the healthy dietary pattern with the aid of snake and ladder game in which numbers from 1-100 along with snake and ladder pictures is displayed on a playing board and numbers are marked with statement on healthy and unhealthy diet.

3. Knowledge: It refers to the correct responses of school children regarding the healthy dietary pattern which can be measured by structured questionnaire.

4. Healthy dietary pattern: It refers to the good habits of the school children that should be adopted in their life style such as taking nutritious diet, hygienic food and avoiding junk foods.

5. School children: It refers to the children of age group 9-11yrs studying at the selected government schools, Bengaluru.

6.5 ASSUMPTIONS

1. School children may have some knowledge regarding the healthy dietary pattern.

2. Game-based learning through the snake and ladder game may motivate the school children to learn easily about healthy dietary pattern.

6.6 HYPOTHESIS

H1- There will be a significant difference between the pretest and post test knowledge scores of school children regarding the healthy dietary pattern.

H1- There will be a significant association between the knowledge among school children regarding healthy dietary pattern with selected demographic variables.


6.8 REVIEW OF LITERATURE

Review of literature is a systematic identification, location, selection and summary of written material that contains information on research problems. Literature review is based on the extensive survey of books, journals and international nursing indices.26


The review of literature of the present study was collected, organized and has been presented under 4 sub- headings.
1. Literature related to prevalence of nutritional disorders in children.

2. Literature related to impact of unhealthy diet in school children.

3. Literature related to importance of healthy diet.

4. Literature related to effectiveness of teaching on healthy diet.


  1. Literature related to prevalence of nutritional disorders in children.

A cross-sectional randomized epidemiological study was conducted on prevalence of Childhood Obesity in School Children from Rural and Urban Areas in Mysore, Karnataka, India among 2189 high school students in urban and rural areas of Mysore city in the year 2008-2009.The children whose weight were more than 85th to less than the 95th percentile were considered as overweight and obese who were equal to or greater than the 95th percentile. The study concluded that the prevalence of underweight is 31.82 percent in urban and 45.33 percent in rural population. The study reports that higher frequency of overweight and obesity in urban areas as compared to the rural parts in India.27
A cross-sectional study was conducted on prevalence of nutritional and lifestyle disorders among school going children in urban and rural areas of Coimbatore in Tamil Nadu, India. The sample comprised of 2180 students from Matriculation schools, 2122 students from Corporation and 1870 from panchayat schools in the age group of 6-15 years. Nutritional deficiencies among children were recorded using the physical signs and symptoms. Lifestyle disorders, particularly the prevalence of hypertension was observed among the students by measurement of systolic and diastolic blood pressures. Anthropometric measurements like height, weight, mid upper arm circumference were done using standardized procedures. Anthropometric measurements showed that 8.44% of boys and 7.43% of girls from Matriculation schools were obese, while in Corporation schools, 5.73% boys and 4.45 % girls and in Panchayat schools 2.65% boys and 1.59% girls were found to be obese. Common nutritional deficiencies identified among the students include anemia prevalent among 24.22% boys and 21.54% girls in Matriculation schools while it was 35.43% boys and 46% girls in the Corporation schools and 34.4% boys and 41.92% girls from Panchayat schools among the pre-adolescent group. Other common nutritional deficiencies identified were vitamin A and skin infections. Thus, the extremities of obesity as well as underweight and nutritional deficiencies are prevalent among the school going children.28

A multicentric study was conducted on “Overweight and obesity prevalence and body mass index trends in Indian children,” in eleven affluent urban schools from five geographical zones of India. The sample comprised of 20,243 children in the age group of 2-17 years. WHO anthro plus was used to calculate Z-scores for height, weight and BMI. Height and weight were measured and BMI was calculated. The overall prevalence of overweight and obesity was 18.2% and 23.9%. The prevalence of overweight and obesity was higher in boys than girls.29

A cross sectional study was undertaken on prevalence of under nutrition among Kora-Mudi children aged 2-13 years in Paschim Medinipur District, West Bengal, India. The sample comprised of 119 children aged 2-13 years, 59 boys and 60 girls. Height and weight measurements were made by standard techniques. Children were considered as underweight, stunting and wasting if their weight-for-age, height-for-age and weight-for-height Z-scores <-2.0 SD of the National Centre for Health Statistics reference standards. The overall prevalence of underweight, stunting and wasting was 52.9%, 49.6% and 22.7%, respectively. About 16.0%, 24.4% and 1.7% of children were found to be severely underweight, stunted and wasted.30



  1. Literature related to impact of unhealthy diet in school children.

A study was conducted on “Cognitive development in children with chronic protein energy malnutrition,” in Corporation school in the city of Bangalore. The sample comprised of 20 malnourished and 20 nourished children. The neuropsychological battery for children sensitive to the effects of brain dysfunction and age related improvement was employed. The battery consisted of tests of motor speed, attention, visuo-spatial ability, executive functions, comprehension and learning and memory. Malnourished children performed poor on tests of attention, working memory, learning and memory and visuo-spatial ability except on the test of motor speed and coordination. Age related improvement was not observed on tests of design fluency, working memory, visual construction, learning and memory in malnourished children.31

A Longitudinal study was conducted on association of overweight with academic performance and social and behavioural problems in United States to examine the relationship between child overweight and educational outcomes. The sample comprised of 13,680 children in third grade. Students were individually administered reading and math assessments. Teachers reported how often students exhibited certain social skills and behaviours. A series of 1-way analyses of covariance and multivariate analysis of covariance was used. The results concluded that overweight children had significantly lower math and reading test scores compared with nonoverweight children in third grade.32

A study was conducted on “Under nutrition & risk of infections in preschool children,” in India. The sample comprised of 56,438 preschool children. The National Family Health Survey-3 (NFHS-3) database provided the information regarding the age, sex, weight, height, infant and young child feeding practices and morbidity due to infections of the children. Relative risk (RR) of morbidity due to infections was computed in infants and children with stunting, underweight, low BMI for age, wasting and stunting with low BMI. Comparison of the RR for infections in undernourished children showed that the relative risk of morbidity due to infections was higher and more consistently seen in children with low BMI and wasting as compared to stunting or underweight. The small group of children who had stunting with wasting had highest relative risk of morbidity due to infection.33

A cohort study was conducted on effects of fast-food consumption on energy intake and diet quality among children in a National Household Survey in United States. This study included 6212 children and adolescents 4 to 19 years old. On a typical day, 30.3% of the total sample reported consuming fast food. Children who ate fast food, compared with those who did not, consumed more total energy (187 kcal), more energy per gram of food (0.29 kcal/g), more total fat (9 g), more total carbohydrate (24 g), more added sugars (26 g), more sugar-sweetened beverages (228 g), less fibre (−1.1), less milk (−65 g), and fewer fruits and nonstarchy vegetables (−45 g). Consumption of fast food among children in the United States seems to have an adverse effect on dietary quality in ways that plausibly could increase risk for obesity.34


  1. Literature related to importance of healthy diet.

A study was conducted on effect of breakfast composition on cognitive processes in Elementary school children in United States. The sample consisted of 15 male and 15 female school children of 9 to 11 year-old. Two experiments compared the effects of two common U.S. breakfast foods (oatmeal and ready-to-eat cereal) and no breakfast on children’s cognition. Using a within-participant design, once a week for 3 weeks, children consumed one of two breakfasts or no breakfast and then completed a battery of cognitive tests. The study concluded that breakfast intake enhances cognitive performance, particularly on tasks requiring processing of a complex visual display. The results extend previous findings by showing differential effects of breakfast type. Boys and girls showed enhanced spatial memory and girls showed improved short-term memory after consuming oatmeal.35


A retrospective study was conducted on association of school performance indicators with implementation of the healthy kids, smart kids programme in the Browns Mill Elementary School in Georgia. The data included was publicly available school records from the years 1995 to 2006. Data on available school performance indicators were obtained; retrospective analyses were conducted to assess trends in indicators in association with programme implementation; each outcome was regressed v. year, beginning with the year prior to programme implementation. The study concluded that promoting nutrition and physical activity within the school environment may be a promising approach for enhancing both student health and educational outcomes.36
A prospective cohort study was conducted on “Dairy Consumption and Female Height Growth” in United States. The sample comprised of 5,101 girls. At baseline, all were premenarchal, ages 9 years and above, with no serious medical conditions. The three outcomes: annual height growth, peak growth velocity, and adult height were studied. The results showed that premenarchal girls who drank >3 servings per day of milk grew 0.11 in more the following year than girls consuming <1 serving per day. Yogurt, dairy protein predicted height growth. The study concluded that of the foods/nutrients studied, dairy protein had the strongest association with height growth.37
A review of the literature based study was conducted on the relationship between aspects of nutrition and physical health, mental health and behavioural or social outcomes of school children in London. Titles were sourced through a snowballing method that began with searches of journal databases and websites, and advice from professionals working in the field of nutrition. The search produced a wealth of literature from a range of professional disciplines, including medicine, public health, sociology and psychology. The study concluded the nutritional deficiencies prior to school entry have the potential to impact upon cognitive outcomes in school-aged and adolescent children. There is a complex interrelationship between nutrition, social and economic factors and health and education. Children with nutritional deficiencies are particularly susceptible to the moment-to-moment metabolic changes that impact upon cognitive ability and performance of the brain.38
4. Literature related to effectiveness of teaching on healthy diet.
A cluster randomised controlled trial was conducted on “Novel school-based intervention to improve nutrition knowledge in children” in a UK primary school. The samples were 12 intervention and 13 control schools children (comprising 1133 children) in years 5 and 6 (aged 9-11 years). A card game ‘Top Grub’ and a ‘healthy eating’ curriculum was developed and were recruited in a pragmatic cluster randomised controlled trial. Mean total nutrition knowledge score increased by 1.1 in intervention (baseline to follow-up: 28.3 to 29.2) and 0.3 in control schools (27.3 to 27.6). The ‘Top Grub’ card game facilitated the enjoyable delivery of nutrition education.39
A cross-sectional study was conducted to determine the changes in knowledge, attitude and practices of primary school children two districts in a south western state of Malaysia. A total of 335 students from four primary schools were assigned to either intervention or comparison group. A validated questionnaire was used to assess knowledge, attitude and practice at pre- and post-intervention. The intervention group received nutrition education taught by trained school teachers. There were significant increments in the post intervention mean scores of knowledge, attitude and practice items for the intervention group compared to comparison group. Findings of this study showed that the nutrition education intervention produced significant improvements in nutrition knowledge, attitude and practices among primary school children.40

An experimental study was conducted on “School-Based Healthy Eating and Physical Activity Intervention Improves Diet, Food Knowledge, and Self-Efficacy for Native Canadian Children” in Canada. The sample comprised of 122 students. The study design was a pre-test/post-test, single sample design. A total of 122 students completed all 4 measurements (anthropometry, 24-h dietary recall, and 2 questionnaires), at baseline and follow-up. Then a culturally adapted 1-y school-based intervention was given to the students. There were significant increases in dietary intention, dietary preference, knowledge, and dietary self-efficacy, and in the curriculum knowledge scale between baseline and follow-up. The study concluded that intervention programme was significantly associated with increased knowledge, dietary self-efficacy, and dietary improvements.41

7. MATERIAL AND METHOD

7.1 Source of data

The data will be collected from school children studying in selected government schools at Bengaluru.



7.2 Method of data collection

i. Research design:

The research design for this study is pre- experimental one group pre test and post test design.



ii. Research variables:

  • Independent variables

In this study the independent variable is the game- based learning.

  • Dependent variables:

In this study the dependent variable is knowledge of school children regarding the healthy dietary pattern.

  • Demographic variables:

It includes demographic data which gives baseline information to be obtained from the school children regarding the healthy dietary pattern such as age, gender, class studying, type of family, family income, religion, ordinal position, number of siblings and place of residence.

iii. Settings:

The study will be conducted in selected government schools at Bengaluru.



iv. Population:

Population included in this study is school children in the age group of 9-11yrs of age.


v. Sample size:

The sample size in the study will be 60 school children.



vi. Sample Technique:

Simple random sampling technique will be adopted for this study.



vii. Criteria for sample selection:

I. Inclusion Criteria

The study includes school children who

1. Are 9-11yrs of age and are studying in selected government schools, Bengaluru.

2. Can read and write in kannada.



II. Exclusion criteria

The study excludes school children who

1. Are not willing to play snake and ladder game.

2. Are not available at the time of data collection.



viii. Tool for data collection

Section A: It includes demographic data which gives baseline information to be obtained from the school children regarding the healthy dietary pattern such as age, gender, class studying, type of family, family income, religion, ordinal position, number of siblings and place of residence.

Section B: It includes the structured knowledge questionnaire to assess the knowledge of school children regarding the healthy dietary pattern.

Section C: It includes snake and ladder game.

ix. Method of data collection

Phase I: Assess the existing knowledge of school children regarding the healthy dietary pattern.

Phase II: Structured teaching will be given to the school children by snake and ladder game regarding the healthy dietary pattern.

Phase III: After a period of one week, level of knowledge will be assessed within the same group using questionnaire.

x. Plan for data analysis

Statistical analysis:

Numerical data obtained from the sample will be organised and analysed with the use of both descriptive and inferential statistics. Master sheet will be prepared based on the numerical data obtained from the sample.The data will be represented in the form of tables, graphs and figures.




  1. Descriptive statistics

    1. Frequency distribution and percentage will be used to study the demographic variable of school children on healthy dietary pattern.

    2. Mean, range and standard deviation will be used to describe the level of knowledge of school children regarding the healthy dietary pattern.




  1. Inferential statistics

    1. Paired’ test will be used to compare the pre and post test knowledge of school children regarding the healthy diet.

    2. Chi square test will be used to associate knowledge of school children regarding the healthy dietary pattern with selected demographic variables.




  • Level of significance will be set at 0.05 to interpret the hypothesis and findings.


xi. Projected outcome

As the investigator has planned for game-based learning there will be increase in knowledge of school children regarding the healthy dietary pattern.



7.3 Does the study require any investigation to be conducted on patient or animal? If so please describe.

Yes, the study requires intervention in the form of snake and ladder game. No other intervention which cause any harm will be done for the subject. The consent will be obtained from the school children before conducting the study.



7.4 Has ethical clearance obtained from your institution?

Yes, the permission will be obtained from the concerned authority and subject.



  • Privacy, confidentiality and anonymity will be guarded.

  • Scientific objectivity of the study will be maintained with honesty and impartiality.

  • Ethical clearance report has been enclosed for the verification.


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1. Chang HS, Kim MJ. Study on Dietary Behaviors of Elementary School Student in Chungnam Area. Korean Journal of Community Nutrition. 2006 Oct; 11(5): 608-617.

2. Eun-Suil Choi, Na-Ri Shin, Eun-Im Jung, Hae-Ryun Park, Hong-Mie Lee and Kyung-Hee Song. A study on nutrition knowledge and dietary behaviour of elementary school children in Seoul. The Korean Nutrition Society and the Korean Society of Community Nutrition. Nutrition Research and Practice 2008; 2(4): 308-316.

3. Laurie Barclay. Charles P. Vega. Poor Diet in Early Childhood Linked to Small IQ Reductions in Later Childhood. Journal of Epidemiology and Community Health. 2011 February 17.

4. Dutta Parul. Pediatric nursing. 2nd edition, Jaypee Publishers.47

5. Chung SJ, Lee Y, Kwon S. Factors associated with breakfast skipping in elementary school children in Korea. Korean Journal of Community Nutrition 2004 Feb 9; (1): 3-11.

6. Global Strategy on Diet, Physical Activity and Health. Childhood overweight and obesity. Serial online; Available from URL; http://www.who.int/dietphysicalactivity/childhood/en/

7. Jung SM. A study on the nutrition knowledge, the eating attitude, and the eating behaviour of elementary school students in Busan. Dong-A University of Korea 2002; (7): 12-14.

8. Jane O'Brien. Child nutrition. UNICEF. Available from URL http://www.unicef.org/india/children_2356.html

9. Centre for Disease Control and Prevention. Vital Signs: Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food, July 22, 2011.

10. Deanna Telner, Maja Bujas-Bobanovic, David Chan, Bob Chester, Bernard Marlow, James Meuser, et al. Game-based versus traditional case-based learning: comparing effectiveness in stroke continuing medical education.
Canadian family physician Médecin de famille canadien 2010; 56(9): e345-51.

11. Kyle T. Essentials of paediatric nursing. New Delhi: 2009.

12. What Does Healthy Eating Mean? Available from URL http://www.breastcancer.org/tips/nutrition/healthy_eat/

13. Effects of Poor Diet on Body. Available from URL http://www.ehow.com/list_7266804_effects-poor-diet-body.html

14. Amuta, Elizabeth Une, Houmsou and Robert Soumay. Assessment of Nutritional Status of School Children in Makurdi, Benue State. Pakistan Journal of Nutrition 2009; 8: 691-694.

15. Global Hunger Index. Available from URL. http://www.medindia.net/news/

16. Dr Izharul Hasan. A Study of prevalence of malnutrition in government School children in the field area of Azad nagar, Bangalore, India. National Institute of Unani Medicine 2010 June; (15): 23-29.

17. Madhuri Kakarala, Debra R. Keast, Sharon Hoerr. School children's Consumption of Competitive Foods and Beverages. Journal of School Health 2010; 80 (9): 429

18. Children and junk food. India Parenting Pvt.Ltd. Available from URL, http://www.indiaparenting.com/food-and-nutrition/56_1186/children-and-junk-food.html

19. Kim JH, Choi JH, Lee MJ, Moon SJ. An ecological study on eating behavior of middle school students in Seoul. Korean Journal of Community Nutrition. 1998 May3; (2): 292-307.

20. Moon SJ, Kim JY. A study of value evaluation for foods among college students. Korean Journal of Dietary Culture. 1992; 7: 25–34.

21. Marlow DR, Redding BA. Textbook of paediatric nursing. 6th ed. Philadelphia: W. B. Saunders Company; 172.

22. Potts NL, Barbara L. Paediatric nursing, caring for children and their families. Australia: Delmar Thomson Learning; 122.

23. Cessario L. Utilization of boarding gaming for conceptual models of nursing. Journal of Nursing Education 1998 Apr; 26(4): 167-169.

24. Prasanthi K. A study to determine the effectiveness of snake and ladder game on knowledge of common ailments among primary school children of selected schools of Bangalore. Unpublished M. Sc. nursing dissertation submitted to Rajiv Gandhi University of Health Sciences, Bangalore; 2007

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9. Signature of the candidate :
10. Remarks of the guide : This study is appropriate, feasible and

relevant to enhance the knowledge in the

field of child health nursing speciality.

11. Name and designation

11.1 Guide : Mrs. Arockia Mary

Professor

HOD of Child Health Nursing

11.2 Signature and seal :

11.3 Co- Guide (if any) :
11.4 Signature and seal :

11.5 Head of the department : Mrs. Arockia Mary

Professor



HOD of Child Health Nursing

11.6 Signature and seal :


12.1 Remarks of the principal : This study is relevant and appropriate to
the field of nursing and speciality chosen.
12.2 Signature and seal :



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