Title: Effectiveness of a structured teaching program on knowledge and practice regarding prevention of type 2 diabetes mellitus among adolescents in selected schools of Kerala
Abstract:
Background Type 2 Diabetes Mellitus (T2DM) is a global epidemic which has looming implications for youth. The present study was undertaken (i) to assess and compare the knowledge and lifestyle practice related to prevention of T2DM, (ii) to find the relationship between knowledge and lifestyle practice, (iii) to compare the knowledge and lifestyle practice in urban and rural areas (iv) and to find the association between pretest knowledge and lifestyle practice related to prevention of T2DM with selected variables among adolescents attending selected schools in Kerala. The study aimed to empower adolescents with knowledge to prevent T2DM by adopting a healthy lifestyle based on Health Belief Model (HBM). Methods: Experimental study with pretest posttest control experimental groups by quantitative approach was designed. Multistage stratified random sampling was used to select 975 adolescents, studying in 9th standard of 18 selected schools from two districts, who were assigned to control and experimental groups respectively. Instrument included pretested, validated questionnaire to assess knowledge and lifestyle inclusive of food habits and activity patterns, bio-physiological and demographic profile and structured teaching program (STP) on T2DM. Ethical clearance, administrative permissions, consent from Principal and assent from adolescents were obtained before pretest, followed by STP to experimental group. Posttest was given after 30 days to both groups. Data was analyzed using SPSS v.18. Results: Knowledge about risk factors (87.7%) was high while complications (43.53%) least. The mean knowledge score was (pre 7.89 ?2.08, 8.21 ?2.14 post) was high among experimental than control (pre7.64 ?2.11; post 7.78 ?2.43). Experimental group had significant gain in knowledge score (p<0.002) after STP. Rural subjects were better informed than urban (p<0.001). Lifestyle showed unhealthy food habits were similar in both groups on pretest. Unhealthy food habits reduced (48.92 ? 6.59) significantly (p<0.001) while healthy food habits (30.44 ? 7.20) remained stable (p >0.05) after STP in experimental
group. Adolescents (72% control & 56.2% experimental) reported physical activity <30 min/ day and screen time < 1 hour/day (5.2% control & 7.3% experimental) and < 2hours /day (2.4% Control & 5.2% Experimental). Majority (42.5%) spend >4 hours while 45.7% spend ≤10 hours on sedentary pursuits from control; whereas from experimental group 35.6% spend 10hours/day and 31.9% spend 24 hours /day for sedentary hobbies. Watching TV, using mobile and computer were the activities majority adolescents enjoyed. Lifestyle showed significant difference (p<0.001) on unhealthy food habits, healthy activities, and sedentary activities during holidays among experimental group after intervention. Lifestyle showed association with income, maternal occupation (p<0.001) and religion (P=0.002) in experimental group and age, gender (p<0.001) and birth order (p=0.002) in control group. WHR values reduced significantly (p<0.001) in experimental group after intervention; with control group from rural area showing similar result (p<0.001). Conclusion: The perceived possibility of prevention of T2DM had fetched significant changes in lifestyle among adolescents in accordance with HBM. Findings appeal early childhood intervention as visceral obesity was evident in nearly 50% subjects; only tip of the iceberg.
