A STUDY TO EVALUATE THE EFFECTIVENES OF HEALTH TEACHING ON

KNOWLEDE AND ATTITUDE OF POSTNATAL MOTHERS

TOWARDS KANGAROO MOTEHR CARE IN SELECTED
HOSPITAL AT BANGALORE

M.Sc. Nursing Dissertation protocol submitted to

Rajiv Gandhi University of health Sciences, Karnataka, Bangalore.

By

Ms. S. SANDEEPTHI
M.Sc. NURSING FIRST YEAR
YEAR 2009-2011

Under the guidance of

Mrs. LOKESHWARI
K.T.G. college of nursing,
HOD THE DEPARTMENTOF OBG
Sreegandhadakavalu, Hegganahalli cross
Sunkadakatte road, Bangalore-560091.
 RAJIV GANDHI UNIVERSITY OF HEALTH SCINCES,
BANGALORE , KARNATAKA.

SYNOPSIS PERMORMA FOR REGISRATION OF SUBJECT

FOR DISSERTATION

1. NAME OF THE MS. S.SANDEEPTHI

CANDIDATE FIRST YEAR M.Sc. NURSING
AND ADDRESS K.T.G. COLLEGE OF NURSING.
SREERGANDHADAKALALU,
HEGGANAHALLI CROSS.
SUNKADAKATTE ROAD,
BANGALORE- 560091
2. NAME OF THE K.T.G. COLLEGE OF NURSING.
INSTITUTION SREERGANDHADAKALALU,
HEGGANAHALLI CROSS.
SUNKADAKATTE ROAD, BANGALORE-
M.Sc. NURSING FIRST YEAR
3. COURSE OF THE STUDY AND OBSTERTICAL & GYNAECOLOGICAL
SUBJECT NURSING

4. DATE OF ADMISSION 15- MAY- 2009

TO THE COURSE

5 TITLE OF THE TOPIC A STUDY TO EVALUATE THE EFFECTIVENESS OF

HEALTH TEACHING ON KNOWLEDGE AND
ATTITUDE OF POSTNATAL MOTHERS TOWARDS
KANGAROO MOTHER CARE IN SELECTED
HOSPITAL AT BANGLORE
BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

Human babies are the most dependent young ones and for a much longer time
than the young ones of other species. In the case of other mammals the young ones immediately
after birth or very soon become independent. They learn to be independent fast and they are left
unaided very soon. For example in the case of cattle as soon as the calf in born, it learns to stand up
by itself, and suck the milk from the mother and begins to run around soon. If the new born babies
are left unaided or not taken care they cannot survive. So much care is needed to a new born infant,
especially from the mother and this care includes love, affection, warmth, protection, nutrition fro
good health.

Kangaroo Mother Care is the method of holding an infant with skin to skin contact,
prone and upright on the chest of the parents. This method was described as human incubator low
birth weight babies.
K M C satisfies all five senses of the baby.

Touch -skin to skin contact

Hearing - listens to mother’s voice and heart beat.
Taste -sucks on breast
Vision -eye contact with mother
Olfactory - smells mother’s odour.

Nils Bergman (1979) defines KMC from child’s point of view as

“Hold me, Feed me, Love me”

Milestones in the development of KMC

1979 → Dr Rey and Martinez started programme in Bogota, Columbia
In response to shortage of incubator’s and severe hospital
Infections.
1983 → UNICEF brought attention to programme, Spanish
1985 → Number of visits from U.S.A, U.K. and Scandinavia, first
English report published in the lancet by Whitelaw and sleath,
May 1985
1986 → Research in Europe and USA. Implementation widespread in
Scandinavia and Germany. Early implementation in Mozambique
And other African countries.
1991 → First review of research published by Gene Cranston Anderson.
1996 → First international workshop, Trieste Italy hosted by Adreano
Catlaneo and team. Noted over thirty different terms used, agreed
to use KMC , defining the programme of skin to skin contact,
Breast feeding and early discharge. The term ‘KC’ refers to
Intervention intra hospital maternal – infant skin to skin contact”.
1998 → First international conference on kangaroo care, Baltimore,
Maryland USA, arranged by Susan Ludington Hoe.
2000 → Third International workshop, Yogyakarta Indonesia

Milestones in the development of KMC

1979 → Dr Rey and Martinez started programme in Bogota, Columbia
In response to shortage of incubator’s and severe hospital
Infections.
1983 → UNICEF brought attention to programme, Spanish
1985 → Number of visits from U.S.A, U.K. and Scandinavia, first
English report published in the lancet by Whitelaw and sleath,
May 1985
1986 → Research in Europe and USA. Implementation widespread in
Scandinavia and Germany. Early implementation in Mozambique
And other African countries.
1991 → First review of research published by Gene Cranston Anderson.
1996 → First international workshop, Trieste Italy hosted by Adreano
Catlaneo and team. Noted over thirty different terms used, agreed
to use KMC , defining the programme of skin to skin contact,
Breast feeding and early discharge. The term ‘KC’ refers to
Intervention intra hospital maternal – infant skin to skin contact”.
1998 → First international conference on kangaroo care, Baltimore,
Maryland USA, arranged by Susan Ludington Hoe.
2000 → Third International workshop, Yogyakarta Indonesia

Need for the Study

Some 20 million low birth weight babies are born each year, because of either preterm
birth or impaired prenatal growth, mostly in less developed countries. LBW and preterm birth are
thus associated with high neonatal and infant morbidity. This represents more than a fifth. In India,
32.8% of newborn babies are LBW .Larger number of deliveries are unattended experts especially in
rural areas and urban slums. Therefore, the care of such infants becomes a burden for health and
social systems everywhere.

Modern technology is either not available or cannot be used properly, often due to the
shortage of skilled staffs incubator instance where available are often insufficient to meet local
needs or are not adequately cleaned purchase of equipments, maintenance is difficult Advanced
Technology has resulted in separation of infants from mothers. Under such circumstances good care
of preterm and LBW babies is a big problem and it leads to poor out comes.

Under the National Rural Health Mission [NRHM] programme, the government of India is
committed to improve the newborn care and bring down the neonatal and infant mortality to meet
the millennium development Goals. It is therefore important to operationalise primary health for
round the clock deliveries and upgrade the health facilities at the district hospital and referrals
centers. It is also important to build up public private partnership at each level.
According to 2000 statistics, IMR of Andhra Pradesh, was 65/1000 live births. Krishna
District has high rates of LBW and preterm births in urban and semi urban slums. The main causes
are

- Poor socio economic status

- Illiteracy
- Cultural and social factors.
 -
Depriving the baby of first milk or colors Poor nutritional
intake by mothers.
Food taboos, myths and customs.

These factors also make the mother vulnerable to various diseases and
related problems.
KMC is humanization of high technology and is an alternative for minima
neonatal care unit. In communities where majority of deliveries are at home and very limited
resources for neonatal care are available, KMC is an alternative for all low birth weight and
sick newborn babies.

Since large number of deliveries occur in hospital now –a-days we require that
sufficient knowledge should be created enough to mothers regarding “quality mothering “
through natural and universally approved easily applicable way of Kangaroo Mother Care
among staff nurses.

REVIEW OF LITERATURE

SUSAN M LUDINGTON 2008 Conducted a study on Randomized controlled trail of Kangaroo

care cardio respiratory and thermal effects on healthy term infants.

To determine the safety and effects on healthy preterm infants of 3 continuous hours of
kangaroo care compared to standard NICU care by measuring cardio respiratory and thermal
responses.

Results include cardio respiratory and temperature outcomes remained within clinically
acceptable ranges during kangaroo care.

Regular breathing increased for infants receiving KC compared to infants receiving

standard NICU care.
KADAM S BINOY 2008 conducted study on feasibility of kangaroo mother in Mumbai.
A randomized controlled trail was performed over one year period in which 89 neonates were
randomized into 2 groups Kangaroo Mother Care (KMC) and Conventional Mother Care (CMC).

The study reveals that 44 babies were randomized into KMC group and 45 to CMC .There was
significant reduction in KMC vs CMC group of hypothermia, higher oxygen saturation and decrease
in respiratory rates.

GENE CRANSTON ANDERSON conducted study on mother – newborn contact in a randomized

trail of kangaroo skin to skin care.

The research describes the type and percent time of contact 0-48 hrs post birth for mother- preterm
newborn given kangaroo care. Results were a group of mother – baby nurses formed an evidenced
based practice project team to review published. It lead to some benefits of kangaroo care include
increase breast feeding, reduction in crying, low body temperature.

DE ALENCAR AE conducted a study on effect of kangaroo mother care on postpartum

depression in Brazil.

The popular study included 177 low income mothers with their preterm infants. The mother’s
were evaluated twice at neonatal ICU admission & Kangaroo Mother Care Discharge. We found 66
mothers with depression and it decreased to 30 KMC Intervention. They concluded that KMC may
lessen maternal depression further studies may be required to clarify this preliminary findings.

SUSAN M LUDINGTON _HOE conducted study to determine he safety and effects on healthy
preterm infants of three continuous hours of kangaroo care compared to standard NICU care by
measuring cardio respiratory and thermal responses.

The result was cardio respiratory and the temperature outcomes remained with clinically
acceptable ranges during kangaroo care.

POLIT AND HUNGLER (1999) state that review of literature refers to activities involved in
identifying and searching for information in atopic and developing an understanding of the state of
knowledge on that topic as well as to the actual written summary of the state of the art on a research
problem . Both the search and the write up are important.

LITERATURE RELATED TO GENERAL ATTITUDE TOWARDS KANGAROO

MOTHRE CARE:
WHITE LAW, (1986) reported that mother’s have commented that their lactation is better
following a period of skin to skin contact.
SLEATH AND WHITE LAW, (1987) stated that after kangaroo care and breast feeding
“mother’s” gained more confidence and made comments such as “NOW I FEEL LIKE
MUMMY” and Now I feel he ‘’s getting to know me “.
AFFONSO et al (1989) said that Kangaroo care mother’s felt confidence in breast feeding
comfortable in nursery, and eager for discharge verses frequently abandoned breast feeding,
anxious in nursery and about discharge.
THOMAS, Hartsock and Larson (1979) reported that all KC mother’s attempted breast feeding
in the delivery room 9/15 controls and 13/15 KC’ers had happy maternal reaction to infant.

COLONNA et al (1990) conducted a descriptive study on 100 KC preyerm infants <1500g admitted
to KC ward for 24 hrs /day KC when was stable and sucking demonstrated. Infant’s got adlib Breast
Feeding during KC for 16 days. Report stated that there was successful lactation, no gavage feeds
and limited use of formula supplements.
Anderson (1991) reported that mother’s were more inclined to breast feeding.
Hamelin and Ramachandran (1993) submitted their report of their experience with KC in NICU
stable infants 800 -1500 g of body weight have contact with parents as much as 3 hours / day as
tolerated . They stated this encourages mothers to continue expressing milk promotes early breast
feeding and enhances breast feeding success.

LITERATURE RELATED TO EFFECTIVENESS OF HEALTH EDUCATION:

. There are many problems which can be solved through health education. it is a general belief
that people will be better off they have autonomy over their own lives including health affects on
which an informal person should be able to make decision to protect his own health. However if the
necessary behaviors changes have to take place , people must be educated through planned teaching
experience what to do and be informed and encouraged to make their own choice of a healthy life.
The results are slow but encouraging.
 According to NIHAE , health education is the translation of what is known about health into
desirable individual and community behavior pattern s by means of an educational process.
JOHN M LAST (1997) says that it is a process by which individuals and groups of people learn to
behave in a manner conclusive to the promotion, maintenance or restoration of health.
According to Alma ata(1978) says that it a process aimed at encouiraging people want to be healthy,
to know how to stay healthy, to od what they can infuvidually and collectively to maintain health
and to seek help when needed.
According to K. Park the aim and objectives are : to
•To encourage people to adopt and sustain health promoting lifestyle and practices.
1. To promote the proper use of health services available to them.

2. to above interest provide new knowledge improve skills and change attitude in making rational
decision to solve their own problems.

3. to stimulate induvidula and community and self reliance and participation to achieve health
development through individual and community involvement at any time and every step from
identifying problem to solve them..

the focus of health education is on people ad on action . its gaol is to ame realistic
improvement’s in the basic quality of life. It some way helps in the alteration of behaviour and
attitude.
Jenny et al (2007) conduted a study to assess the effeftiveness ofPYP on knowledge scoer of staff
nurses was significantly higher than the mean pretest knowledge on KMC among the staff nurses.

STATEMENT OF PROBLEM

A Study to evaluate the effectiveness of health teaching on knowledge and attitude of

post natal mothers towards Kangaroo Mother Care at selected hospital in Bangalore.

OBJECTIVES OF THE STUDY :

 1. To assess the knowledge level of Postnatal Mothers regarding KMC before and after the
health teaching on KMC.
2. To identify the attitude of postnatal mothers towards KMC before and after the health
teaching on KMC.
3. To compare the relation between pretest and post test score.
4. To compare pretest and post attitude score.
5. to determine the association between knowledge and demographic variable
6. to determine the association between attitude and demographic variable.

OPERATIONAL DEFINITIONS:

EVALUATE:
It means to form an opinion of the amount, value of quality of something after
thinking about it carefully. In this study, it refers to the evaluation of health teaching on knowledge
and attitude of postnatal towards KMC.

KNOWLEDGE:
It means information and skills gained through education or experience. In this study it
refers to the range of information and understanding gained by the post natal mother’s regarding
KMC.

ATTITUDE:
It means a way of thinking feeling about something in the present study attitude
refer’s to postnatal mother’s feeling regarding KMC and it is classified as positive and negative.

POSTNATAL MOTHER’S refer’s to: This term a women within in week of delivery.

KANGAROO MOTHER CARE:-

A universally available and biologically sound method of care for all new born , but in particularly
for premature babies with 3 component’s,

1. skin to skin contact

2. exclusive breast feeding
3. support to the mother infant dyad

HEALTH TEACHING:
In the present study it refers’s to a systematically developed health teaching programme with the
information on KMC for post natal mother’s.

EFFECTIVENESS: It means producing the intended result in the present study it refer’s to
knowledge and positive attitude gained by postnatal mother’s through the health teaching.

HYPOTHESIS:
Polit and Hungler (1995) described hypothesis as a tentative prediction or explanation of
the relationship between variables, translating the problem .statement into prediction of the expected
outcome which is subjected to empirical testing to the correction and analysis of data, guiding the
scientific enquiry extending knowledge and research.

H1 The mean post test knowledge score of postnatal mother’s will be significantly, higher than mean
pretest knowledge scores regarding KMC as evident from structured knowledge questionnaire at
0.05 level of significance.

H2 the mean post test attitude test scores of postnatal mothers will be significantly higher than their
mean pretest attitude scores at 0.05 level of significance.
H3 There will be significant relationship between knowledge of post natal mother’s with selected
demographic variable.
H4 There will be significant relationship between attitudes of post natal mother’s with selected
demographic variable.

ASSUMPTIONS:
 1. Health teaching will be effective to impart knowledge and change the attitude.
2. There will be improved bonding between the in infant and mother.
3. The course of hospitalization will be reduced.

DELIMITATIONS:

The present study is limited only to the postnatal mother’s

 Who had normal vaginal delivery
 This study includes all categories of new born such as normal , preterm and low birth
weight babies etc;
PROJECTED OUTCOME:
The post natal mother’s:- will gain knowledge, skills and confidence in Kangaroo Mother Care.
MATERIALS AND METHOD’S:
SOURCE OF DATA: Primi gravida mothers. in selected to community.

METHOD OF DATA COLLECTION:

A) RESEARCH DESIGN: - Descriptive study design was selected for the study.
B) RESEARCH APPRAOCH:- The research approach is survey approach.

SAMPLING CRITERIA:

INCLUSION CRITERIA:  .Mothers who are primi.

EXCLUSION CRITERIA:
VARIABLES UNDER THE
STUDY:
 Mothers who are willing to participate.
 Mothers who would follow Kannada.
 Mothers who are responding and interested.
 Mothers who are multi.
 Mothers who were not willing to participate.
 Mothers who are not responding and interested.
 Mothers who could not follow Kannada.

INDEPENDENT VARIABLE: In the present study the independent variable is health teaching.

DEPENDANT VARIABLE: In the present study, dependent variables are knowledge and
attitude of postnatal mother’s towards KMC.

SETTING: The study is conducted in selected maternity hospital, Bangalore.

POPULATION:
All Primi gravida mother’s admitted in selected maternity hospital in
Bangalore.

SAMPLE SIZE:
The sample size was primi gravida mothers in selected hospital in
Bangalore.

SAMPLING
TECHINQUE: Purposive sampling techniques will be adopted for the study

TOOL OF
RESEARCH: Appropriated structured knowledge questionnaire to assess the
knowledge and Likert type of attitude scale to assess the knowledge , and
practice of post natal mother’s and validated by experts and it will be used
to collect the needed data.

COLLECTION OF
Before starting the study the research will have to obtain permission
DATA:
form subject concerned for doing the study. The data collection will be
done for1month .30 samples using convenient sampling methods will be
taken using the structured interview

METHOD’S OF
DATA ANALYSIS 1. Descriptive and inferential statistics will be used.
AND 2. Mean, median and mode will be used to explain demographic
INTERPRETATION: variables.
DOES THE STUDY REQUIRE, ANY INVESTAIGATION OR INTERVENTION TO BE
CONDUCTED ON PATIENT OR OTHER HUMANS AOR ANIMALS? IF SO, PLEASE
DESCRIBE BRIEFLY.
Yes the study requires implementation of planned teaching programme to be conducted on post
natal mother‘s at Bangalore

HAS ETHICAL CLEARENCE BEEEN OBTAINED FROM YOUR INSTITUTION IN

CASE OF 7.3?
Ethical clearance will be obtained from the research committee of K.T.G. College of Nursing,
Bangalore.
LIST OF REFERENCE’S:

1.Suraj Gupta(2004). Text book of pediatrics (7 th ed,) , new delhi : jaypee brother,s 255-267.
2. treece .j. w.., and Treece J.W.E. (1980). Elements of research in nursing (4 th ed), St. Louis :
the CV. Mosby .Combany P. NO-687.
3.Wong’s D.L. and Perry, S.E. (1998). Maternal child health Nursing care (1 st ) . London:
Mosby Publications P., NO: 456.
4.Murray , S. S. (2006) . Foundations of maternal new born Nursing (4 th ed). Philadelphia :
Saunders Elsevier P.no: 556.
5.Meharaban singh (2004). Care of the newborn (6th rd), NEW delhi : sagar publications P. No:
304.
6.Miss I. Ggirardeau M. D. Miss louise Scott , Reg.N.., (1960). Pediatrics Nursing (1st ed),
Indore . the sat parchar press. P. no: 127.
7.Dutta , D.C. (2004), Text Book Of Obstetrics (6th ed) . Calcutta New central book agency.Pvt
LTD . P. no: 418.
8. abdellah , F.G and Levine (1979). Better Patient care through Nursing research .(2nd ed), New
york : MC Millan.
9. Best (1982) Research in Education . Prenctce – Hall of India ( Pvt ) . Ltd, P. No: 270.
10. Polit , D, F., and Hungler , B. P.(1999). Nursing research principles and methods . (6th ed),
Philadelphia : Lippincott Williams and wilkins.
11. Fraser , D. M, Cooper , M.A. (2003) . Myles test book for midwives .(14 th ed, ), New york :
Churchil Livingston.
12..Suraj Gupta(2004). Text book of pediatrics (7 th ed,) , new delhi : jaypee brother,s medical
publications (p) ltd .P.no: 227-233.
13. . Jayne Klosner and Nancy (2006). Introductory maternity nursing (1 st ed). Philadelplhia:
Lip[pincott Wiliam and wilikims. P. no: 241-342.
14. Kothari C.R. (2006) . Research Methdology methods and techniques (2nd ed), New Delhi :
new age international publishers .

JOURNAL’S :
1. Kumar , V. (2006) . introduction of community based skin-to skin care in rural
uttarpradesh, India , journal of perinatology. 26(10) P.no:- 597-604.
2. Gardener , S., and Goldson (2002) the mother as incubator after delivery. Journal
of obstetrics , Gynaecologic and neonatology nursing P. No:174-176.
 9 NAME & SIGNATURE OF THE MISS. SANDEEPTHI.S
CANDIDATE

10 REMARKS OF THE GUIDE The study is suitable & feasible

11 NAME AND DESIGNATION

11.1 GUIDE Mrs. LOKESHWARI

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT Mrs. LOKESHWARI

11.6 SIGNATURE

12 REMARKS OF THE PRINCIPAL The study is suitable & feasible

12.1 NAME & SIGNATURE OF THE MR. BIJU RAMACHANDRAN

PRINCIPAL

] Rajiv Gandhi University of Health Sciences, Karnataka

Curriculum Development Cell
CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION