PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO EVALUATE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING

MANAGEMENT AND PREVENTION OF DERMATITIS IN CHILDREN

AMONG MOTHERS IN SELECTED URBAN AREAS AT TUMKUR’’.

SUBMITTED BY Ms. ASHWINI.M.S

FIRST YEAR M.Sc. NURSING,

CHILD HEALTH NURSING.

SRI RAMANAMAHARSHI COLLEGE OFNURSING,

TUMKUR.

(2010-2011)1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTAION

1 NAME OF THE CANDIDATE AND ADDRESS

MS.ASHWINI .M .S

1ST YEAR M.Sc. NURSING,

SRI RAMANA MAHARSHI COLLEGE OF

NURSING.        .       

  TUMKUR.

2 NAME OF THE INSTITUTION

SRI RAMANA MAHARSHI COLLEGE OF NURSING

                  TUMKUR

3 COURSE STUDY AND SUBJECT

FIRST YEAR M.Sc. NURSING

CHILD HEALTH NURSING

4 DATE OF ADMISSION TO THE COURSE

01-06-2010

5 TITLE OF THE TOPIC “EFFECTIVENES STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING

MANAGEMENT AND PREVENTION OF

DERMATITIS IN CHILDREN AMONG MOTHERS IN

SELECTED URBAN AREAS AT TUMKUR’’

2

6. INTRODUCTION:

“There is more hunger for love and appreciation in this world than for bread.”

-Mother Theresa.

Children's health was once a part of adult medicine. It emerged in the 19th and early

20th century as a medical specialty because of the gradual awareness that the health

problems of children are different from those of grown-ups. It was also recognized that a

child's response to illness, medications, and the environment depends upon the age of the

child.1

WHO aim is to create a mission to “Create a world in which everyone, especially

adolescents enjoy the highest standards of health and development, whereby all are

protected, respected, nurtured to live their life to its full potential while ensuring that their

needs and rights are fulfilled”. It recommands that Children represent the future, and

ensuring their healthy growth and development ought to be a prime concern of all societies.

Children are particularly vulnerable to malnutrition and infectious diseases, many of which

can be effectively prevented or treated.1

The skin allergies in children can be caused by many things, such as a drug reaction, an

infection, or an allergic reaction. Dermatitis which frequently befalls during childhood is an

extremely painful inflammation of the skin. There are several different types of dermatitis.

The different kinds usually have in common an allergic reaction to specific allergens. The

term may describe eczema, which is also called dermatitis eczema and eczematous

dermatitis. An eczema diagnosis often implies atopic dermatitis (childhood eczema).1

The different types of dermatitis are classified according to the cause of the condition.

1) Contact dermatitis is the condition caused by an allergen or an irritating substance.

2. Atopic dermatitis is very common worldwide and increasing in prevalence, more seen

children.

3). Dermatitis herpetiformis.

3

4). Seborrheic dermatitis is more common in infants and in individuals between 30 and 70

years old.

5). Nummular dermatitis. 6). Stasis dermatitis. 7. Perioral dermatitis.1

The epidemiologic linkage among AD, asthma, and allergic rhinitis (also known as the

atopic triad) is particularly evident when evaluated in the context of increasing disease

severity. Dermatitis symptoms vary with all different forms of the condition. They range

from skin rashes to bumpy rashes or including blisters. The physical changes of AD can

affect pediatric patients in a variety of ways including lack of sleep, poor school performance

marked by an inability to focus, behavioral problems, low self-esteem, being teased by other

children, decreased participation in sports and other social activities, stress, and anxiety. In

children with AD, health-related quality-of-life impairment occurs.23

Diagnosis is based on the presence of a combination of (1) essential, (2) important, and

(3) associated clinical features and can present challenges because of the broad differential

diagnosis. Therefore, when diagnosing AD, physicians must be careful to exclude the

possibility of other skin conditions. To diagnose dermatitis, doctors rely on a thorough

physical examination of the skin as well as the child's account of the history of the condition.

In some cases, a biopsy of the skin may be taken in order to rule out other skin diseases that

may be producing signs and symptoms similar to dermatitis. 23

The goals for the treatment of Dermatitis are to prevent itching, inflammation, and

worsening of the condition. Successful management involves educating patients and their

parents(mothers about dermatitis. Effective management is also based on close monitoring

for changes in disease status (eg, flares). Preventing and decreasing the degree and frequency

of flares, modifying the overall disease course, and, possibly, slowing the atopic march of

eczema may involve both lifestyle changes and the use of medications. Keeping the skin

well hydrated through the application of creams or ointments (Corticosteroid creams) (with a

low water and high oil content). If itching is severe, oral antihistamines may be prescribed

the sedative type antihistamine drugs (for example, diphenhydramine [Benadryl],

hydroxyzine [Atarax, Vistaril], and cyproheptadine) and oral immunosuppressant drug

cyclosporine appear to be most effective. Topical and/or oral antibiotic therapy, typically of

short duration to avoid the development of bacterial resistance, is indicated. Antifungal

therapy has been shown to reduce the severity seborrheic areas of the skin and scalp. 23

4

Bathing may also improve penetration of topical therapies and may help debride infected

eczema. The child is bathed for several minutes in lukewarm water once or twice daily for

mild or more severe AD, respectively. Use of a moisturizing cleanser is preferred, and highly

fragranced soaps or bubble baths should be avoided. After bathing, caregivers should gently

pat the child dry, being careful not to rub the skin with a towel.23

Nowadays urban mothers are so busy in working that they don't have time to stay in their

house just to take care with their child and towards their health. Mothers of children with

atopic dermatitis turn to their primary caregivers for guidance regarding this physically

demanding and psychologically stressful condition.23

The healthy child loves playing, feels happy and keeps laughing, remains calm after

sleeping and has a face with smiling expression. Any event casts its shadow before coming.

Likewise the baby's disease is headed by some abnormal activities, which is usually

recognized by the mother who moves very close to the child. Once the disease is diagnosed

the doctor gives certain instructions to be followed along with some medicine. The mother

sees to it that the instructions are followed carefully and the medicines are given on time so

that the child comes back to normal health.

5

6.1 NEED FOR THE STUDY:

It is easier to build strong children than to repair broken men. 

~Frederick Douglass

Children's health encompasses the physical, mental, emotional, and social well-being of

children from infancy through adolescence. Improving the health of children is one responsibility

among many in the fight against poverty. Healthy children become healthy adults: people who

create better lives for themselves, their communities and their countries. Improving the health of

the world's children is a core UNICEF objective. There are serious gaps between those eligible

for health care and a parent's ability to afford health care.1

Some women have no choices in Indian cities, they are single who must work. Nurturing

and caring for young children is essential. The doctor only prescribes medicines but only the

mother who stays with the child all the time will be able to say whether the child is recovering or

getting worse. The child gets irritated and exited due to the disease and due to the failure of

understanding capacity. But the mother should give treatment paying kind attention and hence

helps the child to get over the disease. The mother is so much close to the child that she finds the

difference between normal health and diseases state of the child. She recognizes when the child

is sick in the beginning itself so that she refers to the doctor at an early stage in order that the

sickness can be brought under control easily. 23

When suffering from dermatitis, a child may not be able to sit stil and The child may feel

tired and drowsy because of the constant urge to scratch. It's very difficult for the child to resist

scratching, but constant scratching will irritate the skin and cause a flare-up. Excessive

perspiration during physical activity and certain materials used in some arts and crafts may put

the child at risk of a flare up. Dermatitis on the child's fingers may make it difficult for the child

to hold a pair of scissors or even a crayon or pen. 23

Drowsiness, fatigue, and poor concentration may be caused by sleepless nights due to the

constant itch and physical discomfort. This may even affect their ability to complete homework

6

assignments at times. To help children with eczema get through the school year with flying

colours, to receive complimentary fact-based information that you can pass along to your child's

teachers, guidance counsellors and school nurse. Stronger relationships between parents and

teachers may help children cope with eczema.24

Dermatitis can affect people of any age although, there is increasing evidence that the

prevalence of dermatitis in children has increased over the past 30 years, although the reasons for

this increase are unknown. The current prevalence is estimated to be between 10.0% to 15.6%. A

similar trend has been observed in India over the past 30 years. In an Indian study from Bihar in

1972(9), the overall incidence of AD was 0.38% of the total number of cases of skin diseases; of

these, 38% had "infantile AD". In another study done two decades later, AD comprised 28.46%

of the total pediatric skin diseases(10). The disease starts early with 35% to 60% of symptoms

manifesting in the first year of life and 47% to 85% by 5 years of age.23

Hospital-based North Indian study later on documented an incidence of 29.9% of total

patients. The population comprised of 125 patients, including 26 infants and 99 children,

showing a mean duration of disease of 3 months in infants and 6 years in children. The male to

female ratio was 2.25:1, with a mean onset of 4.5 months. The urban population had more

prevalence of infantile and childhood AD at 76.9% and 68.7%, respectively, than the rural one. 23

Kanwar. AJ, et al. (1998), conducted study on Epidemiology and clinical pattern of atopic

dermatitis in a North Indian pediatric population. Various epidemiologic factors and clinical

patterns of atopic dermatitis (AD) were evaluated in 672 children. Of these, 210 were infants (up

to 1 year) and 462 were children. Mean age at onset and mean duration of the disease were 4.2

months and 3.3 months, respectively.In the "childhood AD" group the corresponding figures

were 4.1 years and 1.9 years. In both groups, patients from urban areas significantly

outnumbered those from rural backgrounds. In the childhood AD group, 15.35% had a personal

history of atopy, 36.44% had a family history of atopy, and 7.36% had both a personal and

family history of atopy. A history of drug allergy was reported in 3.16% of children.22

Banerjee R, etal (2010), conducted study on Atopic dermatitis in infants and children in

India.. The universal occurrence of Dermatitis is no longer debated. However, published material

about its natural history, etiopathogenesis, epidemiology, clinical patterns and management leave 7

a lot to be known in the Indian scenario. In the present write-up, They will try to explore the

wealth of knowledge about the disease available in our country and try to unfurl the complex

interplay of different factors that are implicated for the development of this condition. The

diagnosis of Dermatitis is based on a constellation of signs and symptoms. There is no laboratory

"gold standard" for the diagnosis of Dermatitis.21

Dhar S, et al. (1995), conducted study on Grading of severity of atopic dermatitis in north

Indian children. Severity of atopic dermatitis (AD) was assessed in 80 children (up to 12 years),

48 boys and 32 girls, using grading system as suggested by Rajka and Langeland. Thirty three

(41.25 percent), 44(55 percent) and 3 (3.75 percent) patients had mild, moderate and severe

diseases respectively. Mean severity scores were 3.5, 5.7 and 8.3 respectively in these 3 groups.

Boys had a more severe disease than girls. Patients with early (0-3 months) and late onset(6-9

years) of disease had maximum severity, mean severity scores being 5 and 5.3 respectively.

Patients with moderate AD had a more prolonged course than those with mild disease.16

The child's life is mostly dependent on the mother especially during infancy and childhood.

The mother's role is to protect the child from sickness and while the child is sick the mother

takes good care of the child so that the infant feels better and gets back to normal health. The

mother explains to the doctor about the indications of the illness and takes great care in giving

the proper medicine at regular intervals. Apart from medicine the child needs to be given special

food during sickness and the mother takes care of it. So the mother plays the important role in a

child's life in protecting him from disease. The researcher therefore has chosen this study as an

opportunity to educate the mothers regarding prevention and management of dermatitis. So that

mothers can incredibly enhance their knowledge regarding prevention and management of

dermatitis.20

8

6.2 REVIEWS OF LITERATURE:

One of the most important early steps in a research subject is the conducting of literature

review. A literature review is an account of what has been published on a topic by accredited

scholars, researchers. In writing the literature review, your purpose is to convey to your reader

what knowledge and ideas have been established on a topic, and what their strength and

weakness are. A literature review discusses published information in a particular subject area and

sometimes information in a particular subject area within a certain time period.

The review of literature can be divided under following headings.

1. Studies related to dermatitis

2. Studies related to assessment of knowledge regarding management and prevention of

dermatitis.

3. Studies related to structured teaching programme.

1. Studies related to dermatitis.

Kumar B et al. (2007), conducted study on a mixed longitudinal study of physical growth

in children with atopic dermatitis. Objective is to look for the effect of atopic dermatitis on

growth attainment of Indian preschool children. They selected the growth patterns of 62 children,

aged 3-5 years and suffering from atopic dermatitis were studied in terms of body weight, height

and head circumference. Sixty-eight normal healthy children matched for age, sex and

socioeconomic status were taken as controls. Severity of the disease was determined by the

scoring atopic dermatitis index. Results showed that Growth velocities were lower in patients

than in controls. Mean changes in body weight of patients of both sexes showed close similarity

to controls. Mean values for height and head circumference were found to be significantly lower

in girls than in the girls of the control group at majority of the age levels. In contrast, in boys,

these values for the patients remained comparable or higher than in the boys of the control group

9

at some of the ages. Finally concluded as Growth retardation was observed among children with

severe forms of atopic dermatitis may impair a child's linear growth temporarily.13

Martelli, et al. (2004), conducted study on Dietary treatment of childhood atopic

eczema/dermatitis syndrome (AEDS). In school children, objective is to eliminating allergenic

foods in the management of atopic eczema/dermatitis syndrome (AEDS). The data source from

PubMed, clinical studies of AEDS, diet therapy and food allergy in all children to October 2003.

Also included is a commentary based on the authors' clinical experience in the allergy unit of a

university hospital in Italy. Diverse trial designs, diagnostic criteria, types of dietary intervention

and length of observation periods precluded meta-analytic methods. Finally the study concluded

as diagnostic evaluation of food allergy should be performed in all children with eczema,

particularly in younger children and those with severe forms of the disease.7

Simon SD, et al. (2007), conducted study on Atopic dermatitis in children in the United

States, 1997-2004: visit trends, patient and provider characteristics, and prescribing patterns. The

aims of this study were to examine trends in visits for atopic dermatitis in children in the United

States between 1997 and 2004, identify factors that were associated with a pediatric visit for

atopic dermatitis, and assess changes in the treatment of atopic dermatitis over time. Visits for

atopic dermatitis by children (0-18 years) to office-based physicians and hospital outpatient

departments using 1997-2004 National Ambulatory Medical Care Survey and National Hospital

Ambulatory Care Survey databases were analyzed .Results showed that 7.4 million visits for

atopic dermatitis. Between 1997 and 2000, topical corticosteroids were prescribed in 34% of

visits, decreasing to 25% between 2001 and 2004. Between 2001 and 2004, topical calcineurin

inhibitors were prescribed in 23% of visits. In the same period, topical corticosteroids were

prescribed in 24% of visits by children who were younger than 2 years; topical calcineurin

inhibitors were prescribed in 22% of visits. Finally concluded as visits for atopic dermatitis in

children are increasing. A recommended first-line treatment was prescribed in a minority of the

visits.8

Kameyoshi Y et al. (2007), conducted study regarding Taking showers at school is

beneficial for children with severe atopic dermatitis. Objective is to evaluated the usefulness

of taking shower at the school for the management of AD in summer. They were selected fifty-

10

eight school children with moderate or severe atopic dermatitis were enrolled in the study.

Subjects were allocated to one of following groups, group A: no shower (n=15), group B: 4-

weeks shower (n=22), group C1: 2-weeks shower in the first half (n=11), or group C2: 2-weeks

shower in the latter half (n=10), and took (or did not take) shower at the school from the

beginning of September. Results showed that significant improvements in SCORAD scores after

4 weeks were observed only in groups B and C1. Similar results were obtained with a modified

SCORAD score in which subjective symptoms were excluded. Finally it was concluded as it is

useful to take showers at the school for the management of AD for the children with severe

disease.11

Ben-Gashir MA, et al. (2003), conducted a study on Quality of life and disease

severity are correlated in children with atopic dermatitis. Objective is to document the impact of

AD on children's QOL and its relationship to disease severity. They were selected the children

with AD aged 5-10 years from a primary care setting. Eczema severity was assessed using the

SCORAD (SCORing Atopic Dermatitis) index. The Children's Dermatology Life Quality Index

(CDLQI) was used to quantify the impact of AD on children's QOL. The results showed that of

the 116 children attending the first QOL assessment visit, 78 were able to complete the CDLQI.

The children's QOL was affected in 65 (92%) and 55 (77%) children attending the first and

second visits, respectively. Finally it was concluded as a positive correlation between children's

QOL and disease severity on cross-sectional and over time observation. It also draws attention to

the long-term effect on children's behaviour and development. 3

Horwitz AA et al. (2009), conducted a study on Correlates of outcome for atopic

dermatitis. Objective was to identify significant correlates of persistent AD would be clinically

valuable information. The methods used were Potential correlates of AD, including race, onset

age, age of solid food introduction, breastfeeding, sinopulmonary infections, other atopic

diseases, peripheral eosinophilia, total IgE level, and eosinophilic cationic protein levels, were

investigated in 177 patients aged 5 to 18 years. Correlates were compared with AD remission vs

nonremission status. Results showed that total of 133 patients (75.1%) were not in remission at

the age of 5 years or older and were, thus, classified as having persistent AD. Patients with

histories of peanut allergy (odds ratio [OR], 2.92; 95% confidence interval, egg allergy , or dust

mite allergy were significantly more likely to have persistent AD than those without these 11

factors. Finally it was concluded that Egg, peanut, and dust mite allergies are significant

correlates of AD persisting beyond school age. 4

Williams H et al. (2000), conducted a study on Systematic review of treatments for

dermatitis. The objectives of this scoping review are two-fold. To produce an up-to-date

coverage 'map' of randomised controlled trials (RCTs) of treatments of dermatitis. To assist in

making treatment recommendations by summarising the available RCT evidence using

qualitative and quantitative methods. Data sources included electronic searching of MEDLINE,

EMBASE, the Cochrane Controlled Clinical Trials Register. Results showed that a total of 1165

possible RCTs were retrieved in hard copy form for further scrutiny. Quality of reporting was

generally poor, and limited statistical pooling was possible only for oral cyclosporin, and only

then after considerable data transformation. There was reasonable RCT evidence to support the

use of oral cyclosporin, topical corticosteroids, psychological approaches and ultraviolet light

therapy. 5

R Balkrishnan, et al. (2003), conducted study on Disease severity and associated family

impact in childhood atopic dermatitis. Objective is to examine the association between childhood

atopic dermatitis (AD) severity and family impact at baseline and after an intervention by a

physician specialist, using validated measures of both severity and family impact. Method used

Cross sectional self administered survey of parent–caregivers of 49 randomly selected children

with AD; 35 parents were available for follow up. Family impact was measured using a modified

AD Family Impact Scale. Result showed that in multivariate regression models, the parent–

caregiver's estimate of severity remained the single strongest predictor of family impact before

and after receipt of dermatologist care, as well as the difference in impact between pre and post-

dermatologist care. Finally concluded as there is evidence to support the ability of parent–

caregivers of children with AD to accurately determine severity of their child's AD; Treatment of

a child by a physician specialist is associated with reductions in both perceived severity, as well

as family impact of this condition. 13

Absolon CM, et al. (1997), conducted study on Psychological disturbance in atopic eczema: the extent of the problem in school-aged children. This study was

designed to find out the degree of psychological difficulty experienced by children with atopic eczema. They investigated 30 school-aged children with atopic eczema

for psychological problems using the Rutter parent scale and compared them with 30 children with relatively minor skin lesions such as viral warts. Mental distress in

12

mothers was assessed using the General Health Questionnaire. The Family Support Scale was used to get a measure of the social support experienced by the families

The difference was statistically significant for children with moderately severe eczema and severe eczema, but not for children with very mild eczema. Levels of mental

distress were no greater in mothers of children with eczema than in parents of the control group and there was no difference in the degree of social support experienced

by their families. These findings indicate that school-aged children with moderate and severe atopic eczema are at high risk of developing psychological difficulties,

which may have implications for their academic and social development.14

D S Krupa Shankar, et al.(2008) conducted study on 470Atopic patch testing.Aim is to 1.

Patch testing to reproduce an eczematous reaction by applying prick test allergens under

occlussion on intact skin. 2. To find the allergen associated with atopic dermatitis. 3. To find the

specific allergen which causes or exacerbates atopic dermatitis in a given subject. They selected

Seventy five subjects with atopic dermatitis were included in our study and patch tests using

prick test allergens were applied to the back. Reading was done after 48 and 72hours. Result

showed that Out of the 75 subjects tested, 47% showed positive reactions, parthenium accounted

for 42% of all positive reactions. Finally concluded as epicutaneous application of prick test

antigen on intact skin can produce a reaction. Parthenium is commonest allergen in Bangalore.

Counselling based on patch test reports may help to reduce morbidity and improve quality of

life18.

2. Studies related to assessment of knowledge regarding management and

prevention of dermatitis.

Lawton S,et al conducted study on Supporting the parents of children with atopic eczema.

Atopic eczema is a chronic skin condition affecting between 5% and 20% of children aged up to

11 years, and the numbers are increasing. While eczema is often seen to be a minor problem,

research has shown that it can cause considerable disruption to the lives of children and their

carers, and can incur significant cost for the family and the healthcare system. Access to good

quality, relevant information on the seriousness of atopic eczema, problems that are likely to

occur during the illness, and how these may affect the child and his/her family's everyday life is

an important consideration when providing care. This article focuses on the information needs

and the role that support groups can have in relation to caring for children and their families

living with atopic eczema.24

13

Ring J,et al (1986), conducted study on Psychosomatic aspects of parent-child relations in

atopic eczema in childhood. II. Child-rearing style, the family situation in a drawing test and

structured interview. Objective is to evaluate the style of education in this group of children,

"scale versions" according to Stapf were used. Mothers of atopic children were found to be

significantly more "strict" in their educational approach compared with control mothers (P less

than 0.01). There was no significant difference between the two groups of fathers. In particular,

mothers of atopic children significantly more often favored "grown-up" behavior in their

children and the capacity to enjoy the joy of children was significantly less pronounced

compared with controls. In the children's drawings, children with atopic eczema lacked the

"friendly atmosphere" expressed in drawings of control children. Fathers of atopic children were

drawn significantly smaller than the respective mothers. In animal drawings, children with atopic

eczema mostly selected unpleasant or dangerous animals to describe their parents, brothers, or

sisters. From the structured interviews, the following points were remarkable: atopic children

more often display aggressive thoughts or behavior against their parents than do controls.

Mothers of atopic children react less spontaneously and less emotionally to children's emotions.

Maternal affection often takes place as a hygienic ritual or in a body and achievement-oriented

fashion. Mothers of atopic children like them to behave in a "grown-up" manner.25

3. Studies related to structured teaching programme.

Cork MJ, et al. (2006), conducted a study on comparison of parent knowledge,

therapy utilization and severity of Atopic eczema before and after explanation and demonstration

of topical therapies by a specialist dermatology nurse. Objective is to determine the effect of

education and demonstration of topical therapies utilization and severity of atopic dermatitis.

They were selected fifty-one children with atopic dermatitis attending a pediatric dermatology

clinic were followed for up to 1 year. At each visit the parent's knowledge about atopic eczema

and its treatment and therapy utilization was recorded. The severity of the eczema was recorded

using the six area, six sign atopic dermatitis severity score (SASSAD) and parental assessment of

itch, sleep disturbance and irritability. At the first visit a specialist dermatology nurse explained 14

and demonstrated how to use all of the topical treatments. This education was repeated at

subsequent visits depending on the knowledge of the parent. Result shwed that there was an

89% reduction in the severity of the eczema. The main change in therapy utilization was an

800% increase in the use of emollients (to 426 g weekly of emollient cream/ointment) and no

overall increase in the use of topical steroids, accounting for potency and quantity uses. It also

confirms the opinion of patients, patient support groups, dermatologists and best practice

guidelines that the most important intervention is to explain its causes and demonstrate how to

apply topical therapies.9

Theodor Nilsson, et al. (April, 1999), conducted study on Patient Education for Adults

with Chronic dermatitis. The aim of the education program was to maintain and improve health

by providing knowledge in self-care treatment. Material for the education was elaborated upon in

an information pamphlet and a checklist Subjects. They selected seven patients, six women and

one man, participated in this pilot study. The patients were between 21 and 65 years of age. They

conducted a nine-item questionnaire was designed for this study regarding the need for

information covering the impact of the dermatitis on daily living. The patient's need of

information was established by asking questions concerning the use of topical steroids, use of

emollients, personal hygiene practice, and skin protection. The results of this study indicate that

Patient education should, at least partly, be accomplished individually encourages the patients to

their self-treatment and damage to the skin, should be one of the fundamental components in the

education. Finally the study revealed as before the education, the patients considered themselves

to play an important role in achieving improvement and healing. This consideration was

strengthened by the education. Providing patients with a variety of emollients encourages them

in their habit of using topical treatments. This model has worked well in clinical practice. Thus,

patient education can be helpful in providing support to patients with chronic dermatitis.

Schnopp C, et al. (2006), conducted a study on age related, structured educational

programmes for the management of atopic dermatitis in children and adolescents: multicentre,

randomised controlled trial. Objective is to determine the effects of age related, structured

educational programmes on the management of moderate to severe atopic dermatitis in

15

childhood and adolescence. In seven hospitals in Germany, they took samples are Parents of

children with atopic dermatitis aged 3 months to 7 years (n = 274) and 8-12 years (n = 102),

adolescents with atopic dermatitis aged 13-18 years (n = 70), and controls (n = 244, n = 83, and n

= 50, respectively). The results showed that significant improvements in severity of dermatitis

and subjective severity were seen in all intervention groups compared with control. Parents of

affected children aged less than 7 years experienced significantly better improvement in all five

quality of life subscales, whereas parents of affected children aged 8-12 years experienced

significantly better improvement in three of five quality of life subscales. Finally it was

concluded as age related educational programmes for the control of atopic dermatitis in children

and adolescents are effective in the long term management of the disease.10

Welbourne S, et al. (2007), conducted a study on Psychological and educational

interventions for atopic eczema in children. Objective is to assess the effectiveness of

psychological and educational interventions in changing outcomes for children with atopic

dermatitis. Selection criteria usd was RCTs of psychological or educational interventions, or

both, used to manage children with atopic dermatitis. The method used as independently applied

eligibility criteria, assessed trial quality and extracted data. Results showed that five RCTs met

the inclusion criteria. Three educational studies identified significant improvements in disease

severity between intervention groups. A recent German trial evaluated long term outcomes and

found significant improvements in both disease severity. Finally it was concluded as lack of

rigorously designed trials (excluding one recent German study) provides only limited evidence of

the effectiveness of educational and psychological interventions in helping to manage the

condition of children with atopic dermatitis. Evidence from included studies and also adult

studies indicates that different service delivery models (multi-professional eczema school and

nurse-led clinics) require for different health systems.6

Williams A, et al. conducted an intervention study to assess the effectiveness of a nurse-led

eczema workshop in reducing the severity of atopic eczema in infants, children and adolescents.

Ninety-nine new patients referred to the Dermatology Department of The Royal Children's

Hospital in Melbourne, Australia, for the management of atopic eczema were randomized to

receive care from an eczema workshop or a dermatologist-led clinic. Patients were followed-up 4

16

weeks after the intervention. The primary outcome was the severity of eczema as determined by

scores obtained using the Scoring of Atopic Dermatitis (SCORAD) index at a 4-week follow-up

visit. The secondary outcome was a comparison of treatments used in both clinics. At the 4-week

review the mean improvement in SCORAD was significantly greater in those patients attending

the eczema workshop than those attending the dermatologist-led clinic (-9.93, 95% confidence

interval -14.57 to -5.29, P < 0.001). In this study, patients attending the eczema workshop had a

greater improvement in eczema severity than patients attending a dermatologist-led clinic,

supporting collaborative models of service provision.19

STATEMENT OF THE PROBLEM:

“ EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE

REGARDING MANAGEMENT AND PREVENTION OF DERMATITIS IN CHILDREN AMONG

MOTHERS IN SELECTED URBAN AREAS AT TUMKUR’’.

6.3 OBJECTIVES OF THE STUDY:17

1. To assess the pretest knowledge score of mothers of urban regarding identification of

dermatitis in children.

2. To develop and implement structured teaching program.

3. To assess the post test knowledge score regarding the identification of dermatitis in

children

4. To determine the difference between pre-test and post-test knowledge.

5. To determine the association between the post-test knowledge score with their

demographic variables.

6.4 OPERATIONAL DEFINITIONS:

Assessment: It refers to organized, systematic and continues process of collecting

data from urban mothers regarding identification of dermatitis in children.

Effectiveness: It refers to the extent to which the planed teaching programme has

achieved the desired effect.

Structured teaching program: It refers to the written health teaching material

prepared on identification of prevention and management of dermatitis in children in

selected urban areas.

Knowledge: It refers to` awareness of the mothers regarding identification of

prevention and management of dermatitis in children .

Dermatitis: It refers to the inflammation of skin.

Mothers: Refers to the individuals who have obtained school children.

6.5 RESEARCH HYPOTHESES:

H1: There is a significant difference between pretest and posttest knowledge scores

of the mothers regarding prevention and management of dermatitis in children.

H2: There is a significant association between posttest knowledge score with selected

demographic variables

6.6 ASSUMPTIONS:

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The tool prepared by the researcher will be adequate to measure the level of

knowledge of mothers and the effectiveness of structured teaching program.

Mothers could positively utilize the knowledge regarding prevention and

management of dermatitis in children as an effective means to reduce the risk factors.

Structured teaching program will improve the knowledge level of mothers regarding

prevention and management of dermatitis in children.

6.7 DELIMITATIONS OF THE STUDY :

Mothers who are available at the period of study only.

Are willing to participate in the study.

Sample size is limited to 100 mothers who are staying in selected urban areas.

Measurements of scores for knowledge once before and after structured teaching

program only.

6.8 PILOT STUDY:

The pilot study will be conducted on 10 samples and are excluded from the main study.

The purpose of pilot study is to find out the feasibility of conducting the study and design

on plan of statistical analysis. The findings of the pilot study samples will not be included

in the main study.

6.9 VARIABLES :

Variables are an attribute of a person or objects that varies or takes different values.

INDEPENDENT VARIABLE: structured teaching program on prevention and management of

dermatitis.

DEPENDENT VARIABLE: knowledge level of mothers regarding. prevention and

management of dermatitis.

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7. MATERIALS AND METHODS :

This study is designed to assess the effectiveness of STP on knowledge regarding

prevention and management of dermatitis among urban mothers.

7.1 SOURCE OF DATA COLLECTION:

The data will be collected from the mothers in selected urban areas at Tumkur.

Research design: pre-experimental one group pretest, posttest research design is

selected to assign the knowledge of mothers regarding prevention management of and

dermatitis .

Research approach: An evaluative approach is considered appropriate for this

study.

Research setting: The setting for the study is selected urban areas at Tumkur.

Accessible Population: The population for the study is selected urban moth at Tumkur.

Sample size: The total study sample consists of 100 urban mothers at Tumkur.

SAMPLING CRITERIA

Inclusion criteria

The mother.those who are willing to participate in the study.

Those who are available at the time of data collection.

Exclusion criteria:

Urban mothers who are not willing to participate in the study.

Urban mothers who are absent at the time of study.

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7.2 METHODS OF COLLECTION OF DATA:

The data collection procedure will be carried for a period of 3 weeks. The study will be

conducted after obtaining permission from the concerned authorities and informed

consent from the samples.

The data will be collected on three phases:

PHASE 1: a pre test will be administered to the urban mothers using a structured questionnaire

to assess their knowledge on prevention and management of dermatitis.

PHASE 2: A structured teaching program on knowledge regarding prevention and management

of dermatitis will be conducted for about on the same day immediately after pre-test.

PHASE 3: After an interval of 7 days a post-test will be conducted for the samples using

structured questionnaire to assess the effectiveness of STP.

Sampling technique: non probability convenient sampling technique will be used to select the

samples.

Setting of the study: Study will be conducted in selected urban areas at Tumkur.

DATA ANALYSIS PLAN:

The data will be analyzed by using appropriate statistical method and the findings will be

presented in the form of figures and tables.

Descriptive statistics:

Frequency and percentage for analysis of demographic data; mean,mean percentage and

standard deviation will be used for assessing the level of knowledge.

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Inferential statistics:

“Paired t-test” will be conducted to find out the significant difference between pre-test

and post-test knowledge of urban mothers regarding identification of prevention and

management of dermatitis.

“Chi-square test” will be used to find out the association between knowledge and selected

demographic variables.

TIME AND DURATION:

The time and duration of the study will be limited to 3 months as per the guidelines of the

university.

TOOLS FOR DATA COLLECTION:

Part-1: A schedule to assess the demographic data of urban mothers such as age, sex, education

qualification, experience.

Part-2: The investigator will develop structured questionnaire on prevention and management of

dermatitis to assess the knowledge on dermatitis.

Part-3: STP on prevention and management of dermatitis and the content validity will be

established by requesting the experts to go through the developed tool and give their valuable

suggestions.

7.3: DOES YOUR STUDY REQUIRE ANY INTERVENTIONS OR INVESTIGATIONS

TO CONDUCT ON CHILDREN OR OTHER HUMANS OR ANIMALS? IF SO,

DESCRIBE BRIEFLY.

Yes, structured teaching programme will be administered as an intervention to the urban

mothers at tumkur.

7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION.

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Yes, the pilot study and the main study will be conducted after the approval of the

research committee. Permission will be obtained from the concerned head of the

institution. The purpose and details of the study will be explained to the study subjects

and an informed consent will be obtained from them. Assurance will be given to the

study subjects regarding the confidentiality and anonymity of the data collected from

them.

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