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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
1 NAME OF THE CANDIDATE
AND ADDRESSMr. VIVEK VASUDEVAN 1st YEAR M.Sc. NURSING,KNN COLLEGE OF NURSING,SATTELITE,TOWN, YELAHANKA,BANGALORE-560062.
2 NAME OF THE INSTITUTE KNN COLLEGE OF NURSING, BANGALORE.
3 COURSE OF THE STUDY AND SUBJECT
1stYEAR M.Sc NURSING, MENTAL HEALTH NURSING.
4 DATE OF ADMISSION 01-07-2013
5 TITLE OF THE STUDY
EFFECTIVENESS OF COMPUTER ASSISTED TEACHING ON KNOWLEDGE REGARDING COMPULSIVE HOARDING DISORDER AND ITS EFFECT ON HEALTH AMONG POST GRADUATE STUDENTS OF SELECTED DEGREE COLLEGES AT BANGALORE.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
1
6. BRIEF RESUME OF THE INTENDED WORK
6.1. INTRODUCTION
“God prospers me not to raise my standard of living, but to raise my standard
of giving.”
― Randy Alcorn
Many of us hang on to treasures and memorabilia from the past, but our
homes are not so overwhelmed with clutter that it becomes detrimental to our health and
safety, let alone our sanity1. Collecting is undertaken by all. Most people enjoy acquiring
and using their possession and nearly everyone keeps some they don’t need or use. What
motivates collecting changes across the life span. In childhood, items are collected for
leisure or enrichment. In adulthood, it is often for monetary reasons and in old age, the
collecting of items may be for reasons of sentimentality or security. Collecting rarely
leads to distress or dysfunction and the behavior undertaken secretly.2
The earliest reference to hoarding occurred in Dante Aligheri’s Divine
Comedy, an epic poem written early in the 14th century. Other references to hoarding
have appeared in literature since then. Charles Dickens’ character, Krook, in Bleak
House (1862) was described as “possessed with documents” in a shop where “Everything
seems to be bought and nothing sold.”3
The first systematic study and definition of hoarding was published in
1993 by Frost and Gross. Here hoarding was defined for the first time as “the acquisition
of, and failure to discard, possessions which appear to be useless or of limited value”.
This study was the first to describe hoarding in a large sample of people, and it framed
our earliest picture of hoarding and the phenomena associated with that.3
Compulsive hoarding or pathological collecting, or, informally, pack
ratting is a pattern of behavior that is characterized by the excessive acquisition of an
inability or unwillingness to discard large quantities of objects that cover the living areas
of the home. Compulsive hoarding behavior has been associated with health risks,
2
impaired functioning, economic burden, and adverse effects on friends and family
members.4
Hoarding is characterized by two parts. The first is the accumulation of
things that have little or no value. The second is the inability to part with things that the
hoarder has accumulated. Typically, hoarders pile up old newspapers, food cartons, cans,
mail, lists, notes, clothes, garbage and other debris. There are also instances of animal
hoarding, where an individual collects and houses dozens to hundreds of animals.1
Hoarding usually begins slowly, but builds over time. Hoarding can lead
to a wide range of serious problems as it gets worse. For people who live in the home,
these risks include, tripping and falling over things, being hurt and even killed when
items fall on them, developing health problems from mold or pests that live in the clutter,
delays in receiving emergency care, injury or even death. In addition to these problems
that affect people who live in a hoarded home, hoarding presents risks for neighbors,
building owners, and for the property itself. These risks may include public health
problems (e.g., spread of pest infestation) for adjacent apartments and homes, structural
problems because of too many heavy items (for example, books) that are too much for the
load limits of the building, flooding when pipes are in need of repair, fire from electrical
wiring or heating systems in need of repair, lost property value and of rent income for
landlords who must make costly repairs due to hoarding or who have to pay legal fees
(e.g., to end a tenant’s lease)5
Compulsive Hoarding is a condition that is caused by both biological and
psychological factors. Because of this, it is critical that individuals facing this condition
receive specialized treatment services, In addition to helping the person struggling with
Compulsive Hoarding Syndrome, it will be equally important to include any family
members, or other support who are impacted by the condition. Often times there is
incredible frustration built up, even anger. As these emotions intensify, arguments ensue
that only serve to create a more tense and uncomfortable environment. As such, we have
a lot of tips to help guide family members and the individuals who all are undergoing
compulsive hoarding disorder.6
3
Systematic management and treatment of compulsive hoarding are under
processing. Education and increased social support plays an important role in early
dedication of compulsive hoarding disorder. Many people who hoard have very limited
social support. Supporting them will provide a way for the people to discuss their
situation, improve solutions and helps them to reduce anxiety, depression and sense of
burden. Gaining knowledge will help the hoarder to know the nature of disease.7 The
most common drug assisted treatments involve the use of the tricyclic antidepressant
clomipramine (Anafranil) and the selective serotonin reuptake inhibitors (SSRI) such as
paroxetine. Cognitive behavioral therapy (CBT) is also showing the most promising
therapy which is derived from the cognitive behavioral model for the treatment of
compulsive hoarding disorder.2
6.2. NEED FOR THE STUDY
Compulsive hoarding is a disorder characterized by difficulty discarding
items that appear to most people to have little or no value. This leads to an accumulation
of clutter such that living and workspaces cannot be used for their intended purposes. The
clutter can result in serious threats to the health and safety of the sufferer and those who
live nearby. Often people with compulsive hoarding also acquire too many items - either
free or purchased.8
Hoarding is a serious public health hazard that poses significant health and
safety risks for individuals, families, and communities. Research indicates that
compulsive hoarding is a growing social and environmental problem across the United
States, affecting as many as 2-5% of the population. Hoarders often live chaotically in
their own private clutter until it spreads so far that it evolves into medical emergencies or
can only be contained by the law.8 It is a common psychiatric condition that’s affect an
estimated 700,000 to 1.4 million Americans, but few receive adequate treatment.9
Compulsive hoarding affects approximately 2-5% of the adult population.10 Childhood
onset is the norm with one study showing that 66% began hoarding in childhood, 25% in
their twenties and 9% after the age of 24. Recent studies showing that 65% of compulsive
4
hoarders are either single or unemployed and up to 55% experienced family conflict
resulting from their condition.2
Based on estimates from a study of US college students the prevalence of
compulsive hoarding is roughly 2 - 4%. Data extrapolated from the number of those with
OCD presenting with compulsive hoarding, supplies a figure of less than 1 in 200 or
0.5%. OCD has a lifetime prevalence of 1 - 2% of the population and around 25% to
30% of patients with OCD are clinical compulsive hoarders. Recent demographics
concluded that those who have higher level education may be more likely to hoard
things.10
A study conducted found hoarding in nearly 4% of a U.S. sample and
when the researchers adjusted this figure to fit population demographics, the estimated
prevalence was 5.3%, making hoarding far more common than OCD. Hoarding occurred
more often among men than women and increased with age. A representative sample of
the German population showed a very similar prevalence rate of 4.6%, although there
were no gender differences. In a UK study of over 5,000 twins, 2.3% met criteria for
clinically serious hoarding and like the first U.S. study, men who hoarded outnumbered
women.3 It has been found that 2-4% of college students are compulsive hoarders.
Research shows that between 25-35% of all hoarders are also afflicted with obsessive
compulsive disorder.11 People who are compulsive hoarders are likely to be single due to
the fact that their social life is stunted due to their hoarding.3
A study was conducted among college students to assess hoarding
behavior. The current study examined hoarding in 563 unselected college students in US.
The study identified four domains of hoarding behaviors as measured by the 26-item
Saving Inventory-Revised: Difficulty Discarding, Acquisition Problems, Clutter, and
Interference/Distress. The result showed that the students showed significant correlations
with social anxiety, depressive symptoms, and worry. The study also concludes
that, hoarding behaviors showed a surprisingly strong relationship with anxiety
sensitivity, similar in magnitude to the relationship between hoarding and OCD
symptoms.12
5
Recent studies from India have examined the phenomenology of OCD in
children using the children’s version of the Yale-Brown Obsessive-Compulsive Scale
(CY-BOCS).In a study of 58 children and adolescents, all aged 16 years and below,
contamination obsessions were (62%), followed by obsessions related to aggression
(57%), somatic (12%), and hoarding (7%).13
A comparative study was conducted to find the health effect of
compulsive hoarding disorder such as substantial disability and functional impairment.
This present study compared compulsive hoarders and non-hoarding OCD patients across
a variety of quality of living (QOL) domains. Subjects were 171 coonsecutive adult
patients (34 compulsive hoarders, 137 non-hoarding patients with DSM-IV OCD) treated
openly between 1998 and 2004 in the UCLA OCD Partial Hospitalization Program (OCD
PHP) in US. The result showed both groups had low overall QOL scores across multiple
domains. Compulsive hoarders had significantly lower levels of satisfaction with their
safety than non-hoarding OCD patients, were more often the victims of both violent and
non-violent crime, felt less safe in their neighborhoods, and felt less protected against
attack. The study concluded that compulsive hoarders have lower QOL than non-
hoarding OCD patients in the domains of safety and living situation.14
An epidemiological study from India showed the prevalence of 0.6%. This
rate is considerably lower compared to the 2-3% rate reported in the European and North
American studies. However, similar low rate ranging from 0.5-0.9% was observed in a
study from Taiwan. It is not clear why lifetime prevalence rate of OCD is lower in some
countries although the rates are not very low compared to the conservative estimate of
1% rate of OCD. However, further research is needed into the epidemiological aspects of
OCD in India since the data available is limited.15
A study was conducted which aimed to provide data on the prevalence and
correlates of clinically significant hoarding in a large sample of patients with OCD from
the Indian subcontinent. They examined 200 patients with Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition OCD for clinically
6
significant hoarding using the Saving Inventory-Revised, followed by a clinical
interview. Twenty patients (10%) had clinically significant hoarding. In all
cases, hoarding did not appear to be related or secondary to other OCD symptoms. The
results suggest that clinically significant hoarding is relatively prevalent in Indian patients
with OCD and that it appears to be largely unrelated to the OCD phenotype.16
Hoarding has long been identified as a community health problem and has
been found to have a significant economic and social burden on communities at large. To
date, there have been no academic studies on the long-term effects of abatements, and we
know almost nothing about the financial and emotional costs of these approaches, both to
the community and the individuals who hoard and their families. This significantly limits
professional and government agencies in their ability to intervene and respond in
appropriate, effective, and ethical ways.17 Hoarding is a behavior that may manifest either
as a symptom (most commonly in OCD) or as a possible syndrome that develops with
age.18
According to the available literature the investigator has realized that the
health risks associated with compulsive hoarding disorder and studies also suggests that
researches in hoarding disorder in India is limited and it’s been concluded that further
studies should be done. It’s been seen that hoarding disorder is becoming a new
millennium disorder in developing world and the people are not aware of the ill effects
that may cause due to hoarding. Researches had indicated that people who are highly
educated are more prone to have compulsive hoarding disorder. Now in the developing
world people are so well educated and they never get mugged up and hence the
investigator felt the need to impart the knowledge regarding various aspects of
compulsive hoarding and its management among PG students in selected degree colleges
in Bangalore.
6.3. REVIEW OF LITERATURE
A review of literature refers to the activities involved in identifying and
searching for information on a topic and developing an understanding of the state of
7
knowledge on that topic. Review of literature is a crucial summary of research on a topic
of interest generally prepared to put a research problem in context to identify gaps and
weakness in prior studies so as to justify a new investigation.
Section A: literature related to incidence and prevalence on compulsive hoarding
disorder.
Section B: literature related to cause and clinical manifestation of compulsive
hoarding disorder
Section C: literature related to ill effects of compulsive hoarding disorder on health.
Section D: literature related to the management of compulsive hoarding disorder.
Section E: literature related to effectiveness of computer assisted teaching.
SECTION A: LITERATURE RELATED TO INCIDENCE AND PREVALENCE
ON COMPULSIVE HOARDING DISORDER
A study was conducted to examine prevalence and heritability of
compulsive hoarding in large sample of twins in UK. A total 5022 twins completed
validated measures of comprehensive hoarding. The prevalence of severe hoarding was
determined using empirical derived cutoffs. Genetic and environmental influences on
compulsive hoarding were estimated using liability threshold models and maximum
likelihood univariate model fitting analyses. (female twins; N=4,355). The result was
total of 2.3% of twins met criteria for caseness, with significantly higher rates observed
for male (4.1) than for female twins (2.1%) twins. Model fitting analyses in female twins
showed that genetic factors accounted for approximately 50% of variance in compulsive
hoarding with non shared environment factors and measurement error accounting for the
other half. The study concluded that compulsive hoarding is highly prevalent and
heritable, in women, with non shared environment factors.19
8
A study was conducted to examine the demographic, clinical and co-
morbid patterns in a large sample of adult subjects at OCD specialty clinic in India. The
samples Consecutive patients (n=545) who consulted a specialty OCD Clinic over 5 years
at a large psychiatric hospital in India were evaluated with the Yale-Brown Obsessive-
Compulsive Scale, and the Clinical Global Impression scale. Earlier age onset of OCD
(years) was characterized by male preponderance (19.61±7.98 vs. 25.19±10.39,
U=23453.5, p=<0.001), positive family history of OCD (19.60±10.02 vs. 22.27±9.20,
U=16590.5, p<0.001) and presence of tic disorder (16.28±8.21 vs. 22.01±9.38, OR=0.86,
p=0.001). In addition, early age of onset was associated with presence of sexual
obsessions (18.92±7.49 vs. 22.88±9.82, OR=0.96, p=0.02), hoarding (19.61±9.32 vs.
22.21±9.36, OR=0.95, p=0.009), repeating rituals (19.76±8.37 vs. 23.29±9.84, OR=0.95,
p=0.006) and need to touch compulsions (16.40±7.19 vs. 22.36±9.43, OR=0.89, p<0.001.
The findings concluded that early onset OCD could be valid and get severe as age
increases.20
A study was conducted which aimed to provide data on the prevalence and
correlates of clinically significant hoarding in a large sample of patients with OCD from
the Indian subcontinent (2012). They examined 200 patients with Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition OCD for clinically
significant hoarding using the Saving Inventory-Revised, followed by a clinical
interview. Twenty patients (10%) had clinically significant hoarding. In all
cases, hoarding did not appear to be related or secondary to other OCD symptoms. The
results suggest that clinically significant hoarding is relatively prevalent in Indian patients
with OCD.16
SECTION B: LITERATURE RELATED TO CAUSE AND CLINICAL
MANIFESTATION OF COMPULSIVE HOARDING DISORDER.
A study was conducted to examine the association between Intolerance of
uncertainty (IU) and hoarding behaviors. Participants consisted of 279 college students
from a large southern university. The results revealed that IU was a significant predictor
9
of hoarding severity after controlling for relevant covariates. Moreover, when looking at
the relationships among IU sub factors and hoarding, results indicated that Factor
1(intolerance of uncertainty) was significantly associated with hoarding. The current
study provides additional evidence that IU is an important individual difference variable
associated with various anxiety related conditions. The study concluded that uncertainty
and intolerance is a unique and robust predictor of hoarding behaviors.21
A study was conducted to examine the prevalence, co-morbidity and
etiology of hoarding symptoms in adolescence in Sweden. A population-based sample of
15-year old twins (N = 3,974) completed the Hoarding Rating Scale-Self Report. Model-
fitting analyses divided hoarding symptom scores into additive genetic, shared, and non-
shared environmental effects. The prevalence of clinically significant hoarding symptoms
was 2% (95% CI 1.6-2.5%), with a significantly higher prevalence in adults both boys
and girls. Exclusion of the clutter criterion (as adolescents do not have control over their
environment) increased the prevalence rate to 3.7% (95% CI 3.1-4.3%). The results
relatively showed hoarding symptoms in adolescents, particularly girls were distress and
emotional impairment. 22
A cross sectional study was conducted to compare demographic and
clinical features of OCD patients with and without hoarding symptoms. The samples used
were 1001 diagnostic and statistical manual of mental disorder – IV (DSM-IV) OCD
patients from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum
Disorders (CTOC). The tool used was Dimensional Yale-Brown Obsessive-
Compulsive Scale and Statistical univariate analyses. The results showed approximately
half of the sample (52.7%, n = 528) presented hoarding symptoms. Hoarding was seen as
the severe dimension with mean score of 3.89. The most common life
time hoarding symptom was the obsessive thought of needing to collect and keep things
for the future (44.0%, n = 440). It also concluded that OCD hoarding patients are more
likely to present certain clinical features like anxiety, major depression, posttraumatic
stress, attention deficit/hyperactivity disorder and compulsive buying.23
A study was conducted by comparing 235 hoarding to 389 non-hoarding
participants in Baltimore. They found that, compared to non-hoarding individuals,
10
hoarders were more likely to have symmetry obsessions and repeating, counting, and
ordering compulsions; poorer insight; more severe illness; difficulty initiating or
completing tasks; and indecision. Hoarders had a greater prevalence of social phobia and
generalized anxiety disorder. Hoarders also had a greater prevalence of obsessive-
compulsive and dependent personality disorders. Five personality traits were
independently associated with hoarding: miserliness, preoccupation with details,
difficulty making decisions, odd behavior or appearance, and magical thinking. Hoarding
and indecision were more prevalent in the relatives of hoarding than of non-hoarding
probands. Hoarding in relatives was associated with indecision in probands.24
A study was conducted to examine the relationship between clinically
significant hoarding and attention deficit hyperactivity disorder (ADHD) in California.
The samples examined were 155 OCD affected individuals (114 probands and 41
relatives; age ranges 4-82 yrs). The result showed that in total, 11.8% met criteria for
definite ADHD, whereas an additional 8.6% had probable or definite ADHD
(total=20.4%). In total, 41.9% of participants with ADHD also had hoarding compared to
29.2% of participants without ADHD. Hoarding was the only demographic or clinical
variable independently associated with ADHD (odds ratio=9.54, P<0.0001). The study
was concluded that ADHD rates elevated in the sample of individuals with childhood-
onset OCD compared to the general population rate of ADHD, and there was a strong
association between ADHD and clinically significant hoarding behavior.25
SECTION C: LITERATURE RELATED TO ILLEFFECTS OF COMPULSIVE
HOARDING DISORDER ON HEALTH.
A cross sectional study was conducted to examine the relationship
between compulsive hoarding and dengue fever. 52 adults notified by health vigilance
authorities because of inappropriate trash accumulation in vacant lots in Goiania, Central
Brazil, completed a questionnaire regarding the presence and severity
of hoarding behavior. 5 dimensions of hoarding are evaluated with instruments such as
difficulty using spaces due to clutter, difficulty discarding possessions, excessive
acquisition of objects, emotional distress and functional impairment due
to hoarding behaviors. The sample was primarily male, with an average age of 49 years.
11
The result showed that 86% percent of the sample scored 14 or greater on the hoarding
rating scale (HRS-I), indicating pathological hoarding. The study concluded that hoarding
disorder can have impact on dengue and associated with public health.26
A internet survey study was conducted to examine excessive acquisition in
hoarding. Participants, 878 self-identified with hoarding and 665 family informants (not
matched to hoarding participants). Among hoarding participants who met criteria for
clinically significant hoarding, the results 61% met criteria for a diagnosis of compulsive
buying and approximately 85% reported excessive acquisition. Family informants
indicated that nearly 95% exhibited excessive acquisition. The survey concluded that
those who acquired excessively had more severe hoarding; their hoarding had an earlier
onset and resulted in more psychiatric work impairment days; and they experienced more
symptoms of obsessive-compulsive disorder, depression, and anxiety.27
A study was conducted to examine the neural mechanisms of impaired
decision making in Hoarding disorder (HD) in patients with well-defined primary
hoarding disorder (HD) compared with patients with OCD and healthy control subjects
(HCs). The setting used was private hospital in USA. The samples were of 107 adults (43
with HD, 31 with OCD, and 33 HCs). Neural activity was measured by functional
magnetic resonance imaging in which actual real-time and binding decisions had to be
made about whether to keep or discard possessions. The results showed that, Compared
with participants with OCD and HC, participants with HD exhibited abnormal activity in
the anterior cingulate cortex and insula .Patients with HD showed relatively lower
activity in these brain regions. The findings suggested that patients with HD have
problems in identifying appropriate emotional response or decision making.28
SECTION D: LITERATURE RELATED TO THE MANAGEMENT OF
COMPULSIVE HOARDING DISORDER
A study was conducted to examine efficacy of a specialized group
cognitive and behavior therapy (GCBT) for compulsive hoarding on a large population
from US ( Females with high education, unemployed , married and non partnered ). The
samples were 31 clients diagnosed with hoarding participated in five groups. Four groups
12
met once weekly for 2 hour over 16 weeks (n=27) and one group met for 20 weeks (n=5).
All participants had two individual 90-min home sessions. Self-report assessments were
completed at baseline, mid-treatment, and post-treatment about hoarding behavior and
symptoms. The result showed significant improvement from pre- to post-treatment on the
Saving Inventory Revised. In conclusion the study demonstrates the feasibility and
modest success of cognitive and behavior therapy methods in
improving hoarding symptoms.29
A quantitative study was conducted in Germany to measure the response
to standardized pharmacotherapy in compulsive hoarders using paroxetine. 79 patients
with OCD (32 patients with the compulsive hoarding syndrome and 47 patients without
prominent hoarding symptoms) were treated openly with paroxetine (mean dose
41.6 ± 12.8 mg/day; mean duration 80.4 ± 23.5 days) according to protocol. All subjects
were free of psychotropic medication for at least four weeks prior to study entry. Subjects
were assessed before and after treatment with the Yale-Brown Obsessive-Compulsive
Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Scale
(Ham-A), Global Assessment Scale (GAS).Both compulsive hoarders and non-hoarding
OCD patients improved significantly with treatment (p < 0.001), with nearly identical
changes in Y-BOCS, HDRS, Ham-A, and GAS scores. The study suggested that
serotonin reuptake inhibitor (SRI) medications such as paroxetine are effective for
treatment compulsive hoarding disorders.30
A study was conducted to investigate the feasibility of age-adapted,
manualized behavioral treatment for geriatric hoarding in San Diego. The samples were
11 older adults (mean age: 66 years) with hoarding disorder. Treatment encompassed 24
individual sessions of psychotherapy that included both cognitive rehabilitation targeting
executive functioning and exposure to discarding/not acquiring. Hoarding severity was
assessed at baseline, mid-treatment, and post treatment. The results showed that clinical
and statistical changes in hoarding severity at post treatment. 8 participants were
classified as treatment responders, and 3 as partial responders. Partial responders reported
severe/extreme hoarding and psychiatric co morbidities at baseline, thus it concluded that
13
cognitive rehabilitation and exposure therapy has a significant effect on geriatric
hoarding. 31
SECTION-E: REVIEW OF LITERATURE RELATED TO COMPUTER
ASSISTED TEACHING.
A study was conducted to find the effectiveness of visual research method
in the treatment of compulsive hoarding disorder using computer in London. Using a
participatory photography methodology, a purposive sample of 12 members of a hoarding
therapy group was recruited. Participants were asked to take photographs which best
captured their hoarding problems. The photographs were then used to encourage narrative
dialogue in a subsequent semi structured interview. The result showed 7 key themes
emerged from the data including: Feelings of isolation and vulnerability, lifestyle
disruption, losing and misplacing, clutter and metaphor, rationalization of the acquisition
of hoarded items, failed previous support and the benefits of a therapy support group. The
study concluded that photography methodology may be particularly helpful when
generating qualitative evidence, knowledge and in the treatment of compulsive
hoarding.32
A study was conducted to find the effectiveness of Photograph-
aided assessment of clutter in diagnosis and treatment of hoarding disorder in US. 32
professionals with experience of hoarding cases were shown pictures from the inside of
10 houses and asked to decide whether the house belonged to a person with hoarding
disorder (HD). Participants also rated different features of the room appearing in each
picture (overall amount of possessions, tidiness, functionality, number of different classes
of items, and cleanliness). The result showed that sensitivity for HD was high. Rooms
belonging to HD individuals were rated as significantly more cluttered, more untidy, less
functional, containing a higher number of different classes of items, and being less clean
than the rooms from the remaining groups. The study concluded that the use of
photograph aided assessment is an effective way to diagnosis and to impart knowledge
regarding hoarding disorder.33
14
A study conducted on nursing students to learn and retain the theory and
skill of hand washing more effectively when taught using computer-assisted learning
compared with conventional face-to-face methods. Two-hundred and forty-two first year
nursing students of mixed gender; age; educational background and first language
studying at one British university were recruited to the study. Participant attrition
increased during the study. Result of study is Knowledge scores increased significantly
from baseline in both groups and no significant differences were detected between the
scores of the two groups. Skill performance scores were similar in both groups at the 2-
week follow-up with significant differences emerging at the 8-week follow-up in favor of
the intervention group; however, this finding must be interpreted with caution in light of
sample size and attrition rates. The conclusion of study is computer-assisted learning
module was an effective strategy for teaching both the theory and practice of hand
washing to nursing students and in this study was found to be at least as effective as
conventional face-to-face teaching methods34.
A study was conducted to compare the effectiveness of expert-assisted
learning (EAL), peer-assisted learning (PAL), and computer-assisted learning (CAL) on
participants' procedural skills acquisition in the simulated setting. 60 medical and nursing
students practiced urinary catheterization in an expert-, peer- or computer-assisted,
simulation-based, learning environment. Effectiveness of training was evaluated in the
simulated setting using an immediate post-test and, one week later, on a retention and
standardized patient-based transfer test. All groups performed similarly on the pre-, post-,
and retention tests. At transfer, the EAL group performed significantly better than the
PAL group as measured by global clinical performance, catheterization checklist scores,
and number of breaks in aseptic technique (P < .05). Communication and catheterization
global ratings were equivalent for all groups (P > .05). Results of study are CAL is as
effective as expert feedback for teaching procedural skills to novices in the simulated
setting.35.
6.4. STATEMENT OF PROBLEM
15
“A study to assess the effectiveness of computer assisted teaching on knowledge
regarding compulsive hoarding disorder and its effect on health among post
graduate students of selected degree colleges at Bangalore”
6.5. OBJECTIVES OF THE STUDY
1. To assess the pre-test level of knowledge regarding compulsive hoarding disorder and
its effect on health among PG students
2. To find the effectiveness of computer assisted teaching on knowledge regarding
compulsive hoarding disorder and its effects on health among PG students.
3. To determine the association between pre-test knowledge score regarding compulsive
hoarding disorder and its effect on health with selected demographic variables of PG
students.
6.6. HYPOTHESIS
H1: There will be a significant gain in mean post-test knowledge scores of PG students
regarding compulsive hoarding disorder and its effect on health after attending computer
assisted teaching as compared to the mean pre-test knowledge scores.
H2: There will be significant association between pre-test knowledge score regarding
compulsive hoarding disorder and its effect on health with selected demographic
variables of PG students.
6.7. OPERATIONAL DEFINITIONS
Assess: In this study assess refers to the activity to decide the scores on knowledge
regarding compulsive hoarding disorder through self structured knowledge questionnaire.
Effectiveness: Refers to significant gain in knowledge as determined by significant
difference between pre-test and post-test knowledge scores.
Computer assisted teaching: It is a method of teaching the PG students with the help of
computer by using power point presentation for a period of 40 to 45 minutes.
16
Knowledge: refers to the correct responses of PG students of the sample on compulsive
hoarding as elicited by structured knowledge questionnaire.
Compulsive hoarding disorder: - Compulsive hoarding otherwise known as
“pathological collecting” or “pack ratting” is a behavior of collecting excessive quantities
of poorly useable item of little value, failing to discard items and difficulty organizing
tasks.
PG students: Students studying in college who are doing their post graduation in any
course aged between 22- 42 yrs.
6.8. ASSUMPTIONS
• Students may have some knowledge regarding compulsive hoarding disorder and its
effect on health
• The students may respond to the structured knowledge questionnaire regarding
compulsive hoarding disorder and its effect on health
• Computer assisted teaching may be an effective teaching strategy in imparting
knowledge on compulsive hoarding disorder and its effect on health for PG students.
• Adequate knowledge on compulsive hoarding disorder and its effect on health may help
the PG students in early identification of the problem and reduce its ill effects on health.
6.9. DELIMITATIONS
The study is delimited to
• 50 PG students at selected degree colleges.
• 4 weeks period of data collection only.
• Effectiveness of computer assisted teaching in terms of knowledge scores only.
• Measurement of knowledge of degree students once before and after
administration of computer assisted teaching.
17
7. MATERIALS AND METHOD OF STUDY
7.1 SOURCE OF DATA COLLECTION
PG degree students in selected degree colleges at Bangalore.
7.2 METHODS OF DATA COLLECTION
7.2.1 TYPE OF STUDY OR RESEARCH APPROACH
Evaluative study, Quantitative approach
7.2.2 RESEARCH DESIGN
Pre experimental, one group pre-test- post-test design.
7.2.3 VARIABLES:
Independent variable – Computer assisted teaching on hoarding disorder and its effect
on health
Dependent variable – Knowledge of PG students on hoarding disorder and its effect
on health.
Attribute variables – Age, Sex, Educational qualification, Marital status, of P.G.
students, etc.
7.2.4 SAMPLING TECHNIQUE
Convenient sampling technique
7.2.5 SAMPLE AND SAMPLE SIZE:
50 PG students aged between 22-42 yrs.
7.2.6 SELECTION CRITERIA
INCLUSION CRITERIA:
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1. PG students who are willing to participate in the study.
2. PG students belonging to selected degree colleges.
3. PG students who are available at the time of the study
EXCLUSION CRITERIA:
1. PG Students who had attended any educational programme before on
compulsive hoarding disorder.
2. PG Students who have not given consent to participate in the study.
7.2.7 DURATION OF THE STUDY
One month period of data collection (4weeks)
7.2.8 TOOL OR INSTRUMENT
Section A: Socio demographic data.
Section B: Structured knowledge questionnaire on compulsive hoarding disorder
and its effects on health
7.2.9 DATA COLLECTION AND PROCEDURE
A formal consent from the respective degree college authorities will be obtained. Written
consent will be taken from the participants after explaining the purpose of the study. Pre-
test will be conducted using structured knowledge questionnaire to assess the knowledge
of PG students and on the same day a computer assisted teaching (CAT) will be done. On
8th day, a post-test will be conducted by using the same knowledge questionnaire.
7.2.10 PLAN FOR STATISTICAL ANALYSIS
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The data obtained will be tabulated and analyzed in terms of the objectives of the study
by using descriptive and inferential statistics.
The plan for data analysis is as follows:
Descriptive statistics:
a) Frequency and percentage distribution will be used to analyze the socio
demographic variables.
b) Mean, mean percentage and standard deviation will be used to assess the pre-test
and post-test knowledge score of PG students.
Inferential statistics:
a. Paired“t” test will be used to assess the effectiveness of computer assisted
teaching programme on compulsive hoarding disorder.
b. “Chi- square” test will be used to find out the association between pre-test
knowledge score on compulsive hoarding disorder and its effect on health with selected
demographic variables of PG students.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTION ON PATIENT OR HUMAN/ ANIMAL? IF SO,
DESCRIBE BRIEFLY
Yes, computer assisted teaching will be provided and structure knowledge
questionnaire will be administered to assess the knowledge regarding compulsive
hoarding disorder and its effect on health to the PG students.
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7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED?
Yes, ethical clearance will be obtained from the ethical committee of the institution.
Written consent will be taken from the authority of PG colleges and from the subjects,
confidentiality and anonymity of subjects will be maintained.
8. LIST OF REFERENCES
1. Hoarding: A Compulsive Mental Disorder. Available from URL :http://www.elementsbehavioralhealth.com/dual-diagnosis/hoarding-a-compulsive-mental-disoder
2. Panic anxiety. Available from URL: http://www.pamguide.com.au/anxiety/hoard.php
3. Dante to DSM-V:A Short History of Hoarding. Available from: http: www.ocfounda tion.org hoarding dante to dsm-v.aspx
4. Compulsive hoarding disorder. Available from URL : http: en.wikipedia.org wiki co Mpulsive hoarding #Symptoms
21
5. Hoarding and housing. Cristina Sorrentino Schmalisch. PhD LICSW. Available from URL http://www.ocfoundation.org/hoarding/housing_services.aspx
6. The compulsive hoarding center; Offering hope and inspiration for change. Available from URL: http://compulsivehoardingcenter.com/Compulsive_Hoarding.html
7. Sujthra-The Nursing journal of India. Vol 8. 2013 pg no- 53 “ Hoarding : A new
disorder of the millennium”
8. Specialty Programs ; USCD Obsessive-Compulsive disorder Clinic. Available from URL http://psychiatry.ucsd.edu/OCD_hoarding.html
9. Compulsive Hoarding: Over view and implication for community health nurses. Fleury G Gaudette .Available from: http://www.ncbi.nlm.nih.gov/pubmed/22857404
10. The effects of hoarding disorder on families : An integrative review Buscher TP Dyson. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/23869617
11. Compulsive hoarding syndrome; Mediangels Medical team India .Available from URL: http://www.mediangels.com/8-8-466-99-knowledge-center-Compulsive-Hoarding- Syndrome-Introduction.aspx
12. Hoarding behaviors in a large college sample. Coles ME Frost Heimberg RG Steketee G Available from URL : http://www.ncbi.nlm.nih.gov/pubmed/12547379
13. Obsessive compulsive disorder ;Y C Janardha Reddy Shoba Srinath Vol 1. 2007 pg no- 108 “Understanding and Future directions”
14. Quality of life and functional impairment in compulsive hoarding. Sanjaya saxsena Catherine R. Et.al. Available from URL: http: www.ncbi.nlm.nih.gov pmc articles PMC3009837
15. An overview of Indian research in obsessive compulsive disorder. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146215/
16. Clinically significant hoarding in obsessive-compulsive disorder: Results from an Indian study Chakraborty V Cherian AV .Et.al. NIMHS INDIA. Available from http://www.ncbi.nlm.nih.gov/pubmed/22796017
17. The Hoarding Project; Jennifer Sampson PhD; Available from URL http://thehoardingproject.org/wp-content/uploads/2013/07/Research-Sponsorship-Request.pdf
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18. Hoarding; Obsessive Symptom or Syndrome. Randy A Sansone .Et.al. Available from URL http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848465/
19. Prevalence and heritability of compulsive hoarding: A Twin Study. Alessandra C AvailablefromURL:http://psychiatryonline.org/data/Journals/AJP/3903/09aj1156.PDF
20. Impact of age of onset of illness on clinical phenotype in OCD. Narayanaswamy JC Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/22503329
21. Intolerance of uncertainty as a vulnerability factor for hoarding behaviors; Oglesby ME Medley AN Norr AM Capron DW Korte KJ Schmidt NB .Available from URL :http://www.ncbi.nlm.nih.gov/pubmed/22921482
22. Prevalence, Co morbidity and Heritability of hoarding symptoms in adolescence: A population based twin study in 15-year olds. Ivanov VZ Mataix-Cols D Serlachius E Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/23874893
23. Clinical features of obsessive-compulsive disorder with hoarding symptoms: A multicenter study. Torres AR Fontenelle LF Ferrão YA do Rosário MC. (2012) Et.al. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/22464941
24. Hoarding in obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study. Samuels JF Bienvenu OJ 3rd Pinto A Fyer AJ. Et.al. (2007) Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/16824483/
25. ADHD prevalence and association with hoarding behaviors in childhood-onset OCD. Sheppard B Chavira D Azzam A Grados MA Umaña P Garrido H Mathews CA ( 2010 ) Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/20583294
26. Psychiatry disorders and dengue: is there a relationship? Caixeta L Azevedo PV Caixeta M. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/22297880
27. Excessive acquisition in hoarding, Frost RO Tolin DF Steketee G Fitch KE Selbo-Bruns A. Available from URL http://www.ncbi.nlm.nih.gov/pubmed/19261435
28. Neural mechanisms of decision making in hoarding disorder. Tolin DF Stevens MC Villavicencio AL Norberg MM Calhoun VD Frost RO Steketee G Rauch SL Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/22868937
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29. Group cognitive and behavioral treatment for compulsive hoarding: A preliminary trial. Muroff J Steketee G Rasmussen J Gibson A Bratiotis C Sorrentino C. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/19569229
30. Paroxetine treatment of compulsive hoarding, Sanjaya Saxena, Arthur L. Brody. Available from URL : Jr.http://www.sciencedirect.com/science/pii/S00223956600086
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31. Novel Treatment for Geriatric Hoarding Disorder: An Open Trial of Cognitive rehabilitation Paired with Behavior Therapy. Ayers CR Saxena S Espejo E Twamley EW .Et.al Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/23831173
32. Visual Research Methods: A Novel Approach To Understanding The Experiences of Compulsive Hoarders: Satwant Singh, Colin Jones ; Available from URL: http: www .scopemed.org mno=18850
33. Photograph-aided assessment of clutter in hoarding disorder: Is a picture worth a thousand word. Available from URL http://www.ncbi.nlm.nih.gov/pubmed/22930673
34. Bloom field. The effect of computer assisted learning Vs conventional teaching method on acquisition and retention of hand washing theory and skills in nursing students. Available from URL http://www.ncbi.nlm.nih.gov/pubmed/19762016
35. Learning in the simulated setting: A comparison of expert peer and computer assisted learning. Walsh CM. Available from URL: http://www.ncbi.nlm.gov/pubmed/21955760
9. SIGNATURE OF CANDIDATE
10. REMARKS OF GUIDE A relevant study to prevent and
manage hoarding disorder among
highly qualified students.
11.1 NAME AND DESIGNATION OF GUIDE Mrs. Roselene Monthero
Associate Professor
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Mental Health Nursing
11.2SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF THE
DEPARTMENT
Mrs. Roselene Monthero
Associate Professor
Mental Health Nursing
11.6 SIGNATURE OF HOD
12.1 REMARKS OF PRINCIPAL A good and feasible study to
educate on preventing hoarding
disorder among PG students.
12.2 NAME OF THE PRINCIPAL Prof. Mrs. Jobi Jacob
Principal
K.N.N College of Nusing
CA 23/B A Sector
Yelahanka New Town
Bangalore – 64
12.3 SIGNATURE
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