A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON SWINE FLU VACCINE AMONG THE PARENTS OF UNDER 3 YEAR CHILDREN IN PEDIATRIC WARD OF SELECTED HOSPITAL DEHRADUN

Back ground:-The new human H1N1 flu strain of avian origin kept transmitting among human populations. Then, a small outbreak of swine H1N1 occurred in humans. Swine flu spread very rapidly world wide due to itshigh human to human transmission rate and due to the frequency of air travel. Swine flu is a communicable disease that is caused due to H1N1 virus. This virus enters the body through the mouth and nose and if a healthy person comes in contact with an infected individual. It attacks the immune system and causes a my riad of diseases, mainly respiratory disorders. The people who are easily susceptible to this disease are pregnant women, young children, Individuals who have a history of respiratory or lung diseases, etc. During influenza outbreak, it is critical for monitoring the spread of disease, for knowing the potential of the virus to cause a pandemic and for creating the life saving vaccines.The global approach ensures WHO system to monitor and develop critical benefits such as vaccines, antiviral drugs and scientific information. The best treatment for swine influenza infections in humans is prevention by vaccination. Methodology:-A pre experimental one group pre test post test was adopted in the present study to accomplish the objectives. Purposive sampling technique was used to select samples. The sample consisted of 60 Parents of under 3 year children. The pre test assessment of knowledge of the parents was carried out using a knowledge questionnaire followed by self instructional module session regarding vaccination for swine flu. After 7 days the post test was conducted using the same knowledge questionnaire. The collected data was analyzed by using descriptive and inferential statistics. Conclusion:-The study revealed that there was deficient knowledge regarding vaccination of swine flu. The teaching was found to be effective in improving the knowledge of the parents. It was concluded that there was a need to plan and implement educational programmes by the nurses for all parents particularly parents of under 3 year children regarding vaccination of swine flu.


Hypothesis:
1. H1-The pretest level of knowledge score of parents of children with swine flu vaccine will be lower then the posttest level of knowledge. 2. H2-There will be a significant association between the knowledge score of parents reading swine flu with selected demographic variables.

Literature related to teaching as an effective interventional strategy:
A study was conducted to assess the effectiveness of education programme on vaccination for swine flu among mothers of school children. A pre-test questionnaire on knowledge of vaccination for swine flu was administered to mothers. The study is conducted on 60 mothers of school children. The random sampling technique was used. The A comparative study was conducted to test the effectiveness of teaching programme for mothers on prevention and control of swine flu in children. The stratified random sampling technique was used, 100 samples were selected from 3 hospitals, I group contains 35 mothers, II group contains 30 mothers, III group contains 35 mothers. A structured questionnaire was given, the knowledge of mothers on prevention and control of swine flu was observed by pre-test knowledge scores, after teaching programme was conducted the post-test had been given to the same groups. The overall pre-test mean knowledge found to be 54.8% with SD of 13.1% among the respondents, the overall post-test knowledge found to be 84.77% with SD of 8.3% among the respondents. The overall mean knowledge scores of pre-test and post-test reveals that post-test knowledge score was higher when compared to pretest knowledge score. The statistical paired t test implies that the difference in the pre-test and post-test knowledge score found statistically significant at 5% level (p< 0.01) (The mean knowledge enhancement score was 29.97%) with a paired t value of 24.17%. These exists a statistical significant in the enhancement scores indicating the impact of intervention programme.

Kimura H, Abiko C, Peng G at 2009
Literature related to vaccination of swine flu: An experimental study was conducted to test the effectiveness of vaccination for swine flu among school children. This study contains 100 vaccinated children and similar number of non vaccinated control group also. Children are vaccinated live attenuated vaccine for influenza A H1N1; moreover children are the most important cause of the spread of influenza in the community, so the author wants to prove that vaccination protects the younger children against influenza A H1N1. The study result shows mean performance for vaccination in group I was higher (87.27%), than that of group II (21.81%) the t value was significant at p<0.05 level indicating better. It reveals that in vaccinated children influenza like illness is prevented and those not vaccinated shows particular influenza like illness. This study concludes that vaccination brings wide protection against overall Influenza like illness.

Ma W, Vincent AL at 2007
A evidence based study enumerates that vaccination coverage against swine flu protects the public than the isolation of infected ones. 25 Canadian students who were infected are taken as the samples. Investigation done on 10 103 students to confirm the diagnosis, they were shifted to northeast of china and isolated. The 15 students was administered swine flu vaccine. The result shows unpredictable challenge, those who were vaccinated and left in the swine exposure shows no sickness and the isolated ones unfortunately spread the infection to 5 persons who cares for them. This study concluded that vaccination is the best remedy to protect the public than the isolation.

Centres for Disease Control at 2009
Literature related to prevalence of swine flu: In developing countries the study findings have revealed t n swine flu infection in children between 3 to 6 years increased from 12.2% to25.6% between 2009 and 2010. Medical practices and clinics that want to offer the H1N1 swine flu vaccine have already registered with their state health departments. They can check with their doctor to see if she or he is offering the vaccine. Because children are especially vulnerable to H1N1 swine flu --and are especially likely to spread the disease to others --many states will be offering H1N1 swine flu vaccinations in schools.

OlsenCWAT 2009
A comparative study was conducted to determine the prevalence of swine flu and there by vaccinating for swine flu in preschool children aged between 3 to 5 years and schooler aged between 6 to 12 years. Health check-up was done for 50 children. Both the groups were noticed for frequent common sickness. Vaccination was provided to them after the prevalence result. The result revealed that overall prevalence of swine flu in preschooler was 21.1%, respectively, in schooler it was 11%, the prevalence of infection was higher in preschooler compared to schooler. It was found that the prevalence of infection decreased significantly with age from 18.5% at 3 years to 7.6% at 5 years. Significantly more preschoolers were prone to infection than the schoolers.

Towards achieving accessibility afford ability and safety of medicines. Health Action, 2009
Research Methodology:-

Research Approach:
Research approach indicates the basic procedure for conducting the study. The selection approach depends upon the purpose of the study. The present study aimed at determining the effectiveness of self instructional module on parents of under 3 year children regarding vaccination of swine flu. In view of nature of the problem selected for the study an quantitative research approach was found appropriate.
An quantitative research approach in research is commonly conducted to rate the extent to which a programme has attained its goal. Its goal is to assess or evaluate the success of a programme. A quantitative research approach was used for in this study.

Research Design:
Research design spells out the basic strategies that the researcher adopts to develop information that is accurate and interpretable.
One group pre-test post-test design is the most appropriate design for measuring the impacts or effectiveness of a programme. The design is described as two sets of cross sectional observations on the same population to find out the change in the phenomenon between two points in time. The change is measured by comparing the difference in the phenomenon at the pre-test and post-test observation.
In view of the nature of the problem and to accomplish the objectives of the study, with a one group pre-test posttest design was used to evaluate the effectiveness of the self instructional module on parents knowledge regarding vaccination of swine flu. Schematic representation of research design is given in Figure 2.

Variables:
Variables are qualities, properties or characteristics of person, things or situation that change or vary.

Independent variable:
The independent variable is the variable that stands alone and not dependent on any other. It is the cause of action. In this study, self instructional module on swine flu vaccine.

Dependent variable:
Dependent variable is the effect of the action of the independent variable and can"t exit by itself. In this study knowledge of parents were dependent variable.

Extraneous variable:
An uncontrolled variable that greatly influences the result of the study is called an extraneous variable. In this study extraneous variables are of parents, education status, occupation, work experiences, type of family, family background, area of living, effect of mass media, sourse of information.

Setting:
The location for conducting the research is referred to as the setting . The present study was conducted in Maher Hospital, pediatric centre at Dehradun (U.K)

Population:
In the present study, the population was parents of under 3 year children.

Sample:
In the parent study the sample the parents of under 3 year children attending OPD, Meher Hospital at Dehradun, who met the sampling criteris.

Sample size:
In this study, the sample size was 60 the parents of under 3 year children in selected hospital in Dehradun Sampling Technique: Convenient sampling technique was used to select 60 parents.
Sampling criteria: Inclusion criteria: 1. Parents who are willing to participate in the study 2. Parents who have under 3 year children. 3. Parents whose children were admitted in pediatric ward. Criterion measure: All item of the tools were analyses by using descriptive statistics (frequency distribution, parentage distribution and graphs) and inferential (chi-squares and t test)

Content Validity Of Research Instrument:
Validity refers to a complex concept which broadly concerns the soundness of the studies evidence that is whether the findings are convincing and well ground. Content validity was done from 3 experts including one master of medicine in pediatric in Meher hospital and 2 pediatric nurse specialists. necessary correction were made in the tools based on the suggestions obtained. Pilot study was conducted in Meher hospital, Dehradun from 14-08-2020 to 20-08-2020 in order to check the reliability, validity, feasibility and practicability.
The investigator obtained written permission from the concerned authority prior to the study. The permission was taken from principal of S.G.R.R Nursing college and director of Maher hospital, Dehradun. The topic was explained to the sample and permission was taken from the sample. Confidentiality was assured to the sample.
Tool was administered to six parents of under three year children who fulfilled the criteria of selection self instruction module teaching program was given to the parents on the same day after conducting the pre-test. On the seventh day post-test was conducted with the same tool to assess the gain in knowledge score. The analyzed data showed a significant differences in pre-test and post-test score. The study was found feasible and practicable.

Reliability Of The Tool:
Reliability of the tool is the degree of consistency with which measure the attributes is suppose to measure. It refer to the extent to which the same result is obtained repeated administration of instrument. The tool was administered on ten subject and the reliability of the tool was found by using karl pearsons co-relation co-efficient method. The reliability of the structured questionnaire was found r = 0.92. hence the tools was found to be highly reliable.

Data Collection Procedure:
Prior permission was obtained from the Director of Meher hospital for the study. Researcher herself collected the data from the sample after obtaining their consent.Pre test was conducted and self instructional module on the same date in the Meher hospital. The duration of each session was 30 minutes. After the session different questions were 107 raised by the group and explanations were given. After seven day post-test was conducted, using the same knowledge questionnaire to evaluate the effectiveness of information booklet.

Ethical Consideration:
To conduct research study in Meher hospital,written permission was obtained from Director of Meher hospital for data collection. They gave the permission to conduct the study in Meher hospital confidentiality was assured to all the subject to get,formal their co-operation. An informed consent was taken the subject before giving intervention Plan for Data Analysis: Data will be analyzed using both descriptive and inferential statistics, distribution of subjects with respect to demographic variables will be represented using frequencies and percentages. Mean standard deviation and mean percentage will be used to describe the knowledge of the parents having toddlers, regarding vaccination of swine flu. Level of knowledge will be grouped into inadequate (0-40%), moderately adequate (41-70%), and adequate (70-100%).
Descriptive Statistics: 1. Frequency,percentage and mean were used for the analysis of pre-test and post-test assessments.
Inferential statistcs: 1. t'' test was used to determine the difference between pre-test and post test in terms of increase the knowledge of swine flu vaccine among the parents of 3 year children. 2. "Chi square'' test was used to find out association between pre-test scores of parents with their selected demographic variables.
The demographic data are represented in the form of tables and will be represented by using graphs and pie diagrams. The related knowledge would be analyzed by knowledge scores. Each correct knowledge score get 1 mark.

Summary:
This chapter described the general pattern of organizing the procedure ofgathering valid and reliable data for the problem under investigation. Pre experimental approach was used to evaluate the effectiveness of information booklet. The study was conducted on 60 parents of under 3 year of children in selected hospital at Dehradun. Validity and reliability of the questionnaire and self instructional module were tested. Pilot study was conducted to find out the feasibility of the study. Data were collected from the sample after obtaining permission from the concerned authority. Collected data were analyzed using descriptive and inferential statistics and presented in the form of tables, graph and diagrams.

Chapter 4: Analysis and Interpretation of Data:
Analysis as the categorizing, ordering, manipulating and summarizing of the data, to obtain answers to the research questions. The purpose of analysis is to reduce data to an intelligible and interpretable form so that, the relations of research problems can be studied and tested. Interpretation is the most challenging and structured step in the process of research. Interpreting the research findings requires the investigator to be creative.
One group pre-test post-test design with quantitative research approach was used in the present study to assess the effectiveness of self instructional module on vaccination of swine flu among the parents of under 3 year children.  3. To find out the association between knowledge score of parents regarding swine flu vaccine with selected demographic variables.

Organization of findings:
The data and findings organized and presented under the following headings:-.

Part I:
Sample characteristics Part II: Analysis of pre-test knowledge score of parents. Association of pre-test knowledge scores and selected demographic variables.

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Percentage distribution of parents in relation to their occupation of parents shows that highest percentage of parents 48% were pvt Job. In the businessman were 32%, govt employee were 13%, in the farmer were 7%. Percentage distribution of parents in relation to their living area of parents shows that highest percentage of parents 63% belongs to urban, 37% belongs to rural.
Percentage distribution of parents in relation to their source of information show that highest percentage 83% of parents were having information from mobile, 10% having information from news paper, 7% having information from television,00% from radio.
Percentage wise distribution of parents in relation to their any previous experience on swine flu vaccination shows that 80% of No, 20% of Yes.  The diagram indicate that parents in relation to their education of parents shows that highest percentage of parents 35% were in the graduate. In the intermediate of parents were 25%, high school of parents were 20% , in the Post graduate of parents were 18.5%.  Percentage distribution of parents in relation to their occupation of parents shows that highest percentage of parents 48% were pvt Job. In the businessman were 32%, govt employee were 13%, in the farmer were 7%.

Occupation
Living Area: Percentage distribution of parents in relation to their living area of parents shows that highest percentage of parents 63% belongs to urban, 37% belongs to rural. Percentage distribution of parents in relation to their source of information show that highest percentage 83% of parents were having information from mobile, 10% having information from news paper, 7% having information from television,00% from radio.

Any Previous Experience:
Fig4:-Column diagram showing the percentage distribution of parents according to any previous experience.
Percentage wise distribution of parents in relation to their any previous experience on swine flu vaccination shows that 80% of No, 20% of Yes.
Part II: analysis of pre-test knowledge score of parents regarding vaccination of swine flu. Section A: Level of knowledge of parents regarding vaccination of swine flu.
Parents knowledge was categorized on the basis of percentage level of knowledge score between 0-14, 15-22 and 23-30.the score were interpreted as inadequate, moderately adequate and adequate knowledge respectively. The obtained chi square value of the age, education, occupation, mass media, were lower than table value indicating that there was no significant relationship between the above variables and pre-test knowledge scores. Hence the research failed to reject the null hypotheses with regard to the above variables.
However the computed chi square value of the variable living area and previous experiences of swine flu vaccination show was higher than the table value, indicating significant relationship between variable living area and previous experiences of swine flu vaccination with pre-test knowledge scores, hence the research hypotheses was accepted.  table 3 show that in Pre-test 01% of subject"s adequate knowledge and in post test that was increased to 75%. Moderate knowledge score in pre test 25% and in post test that was increased to 25%.inadequate knowledge score in pre test 73.3% that was reduced to 0% in post test. Data show in table 3 revealed that the mean post-test knowledge score of parents was significantly higher than the mean pre-test score. The calculated ""t"" value (22.19) was more than the table value at 0.05 level of significance. Therefore, it can be said that the awareness program was found to be effective self instructional module on swine flu vaccine self instructional module regarding the knowledge of swine flu vaccine among the parents of 3 year children in selected hospital, Dehradun, Uttarakhand. The To determine the effectiveness of self instructional module on knowledge regarding swine flu vaccine among the parents of under 3 year children.

Mean
Data show in table 3 revealed that the mean post-test knowledge score of parents was significantly higher than the mean pre-test score. The calculated ""t"" value (22.19) was more than the table value at 0.05 level of significance.
Therefore, it can be said that the awareness program was found to be effective self instructional module on swine flu vaccine self instructional module regarding the knowledge of parents in selected hospital, Dehradun, Uttarakhand Finding of supportive study: An evaluative study was conducted to determine effectiveness of a self instructional module on knowledge about swine flu prevention among parents of school going children. The instruments used for the study were demographic questionnaire and knowledge questionnaire. A self instructional module on swine flu prevention was developed by the reseacher. The study result shows that the mean pre-test score was 43.75% and post-test score was 79.15%. Therefore the study concludes that the self instructional module was effective in increasing the knowlegde of the parents of school children. The t" was computed to determine effectiveness of self instructional module (98) = 23.14, p<0.05. it was found that gain in knowledge was significant at 0.05 level.
To find out the association between knowledge score of parents regarding swine flu vaccine with selected demographic variables.
Data presented in table 3 show that in Pre-test 1.6% of subject"s adequate knowledge and in post test that was increased to 75%. Moderate knowledge score in pre test 25% and in post test that was increased to 25%.inadequate knowledge score in pre test 73.3% that was reduced to 0% in post test.
The result of this study contradicted by a similar study done by Lynch J. P. (2009),on parental knowledge regarding prevention of swine flu reveal that increased knowledge was associated with higher parental education and occupational status.

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The pretest level of knowledge score of Parents swine flu vaccine will be lower then the post test level of knowledge.
Hence in this the hypothesis H2 is accepted so there is significant association between the knowledge score of parents regarding swine flu. Cone diagram showing the association between mean and S.D between pre-test and post test knowledge score among parents of under 3 year children.
Finding the supportive study: These findings were supported with the findings of a similar study conducted among parents (n=60) regarding their knowledge on prevention of swine flu. About half of parents indicated that they would like to receive more information about causes and prevention of swine flu. The result showed that parental education may help to reduce or eliminate the swine flu occurrence.
The overall findings reveal that the percentage of post-test knowledge score was more; hence self instructional module was effective in enhancing the knowledge of parents on vaccination of swine flu.

Summary:
This chapter dealt with the analysis and interpretations of the findings of the study. to find out the association between knowledge score of parents regarding swine flu vaccine with selected demographic variables. The pretest level of knowledge score of parents swine flu vaccine will be lower then the post test level of knowledge. There will be a significant association between the knowledge score of parents regarding swine flu with selected demographic variables.
The findings are summarized to as follows: 1. Highest percentage of parents 40% was in the age group of above 35 years. 2. Highest percentage of parents 35% was in the education. 3. Highest percentage of parents 32% was in the businessman. 4. Highest percentage of parents 63% belongs to urban area. 5. Highest percentage of parents 83% was having information from mobile. 6. Highest percentage of parents 20% was having previous experiences of swine flu vaccination.

Conclusion:-
On the basis of findings of the study the below said conclusion were drawn. It also brings out the limitations of the study in picture.
Highest percentage of parents 40% was in the age group of above 35 years. Highest percentage of parents 35% was in the education. Highest percentage of parents 32% was in the businessman. Highest percentage of parents 63% belongs to urban area.
Highest percentage of parents 83% was having information from mobile. Highest percentage of parents 20% was having previous experiences of swine flu vaccination.
A study to assess the effectiveness of self instructional module on swine flu vaccine among the parents of under 3 year children in pediatric ward, Meher hospital Dehradun."" Data show in table 3 revealed that the mean post-test knowledge score of parents was significantly higher than the mean pre-test score. The calculated ""t"" value (22.19) was more than the table value at 0.05 level of non significance. Therefore, it can be said that the awareness program