RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Ms. ANNEPU RAJULAMMA

I year M.Sc Nursing
Community Health Nursing
Year 2008-2009.

PADMASHREE INSTITUTE OF NURSING

NAGARBHAVI,
BANGALORE-560 072.

R A J I V G A N D H I U N I V E R S I T Y O F H E A LTH S C I E N C E S ,
B A N G A L O R E , K A R N ATAK A

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

1.

NAME OF THE CANDIDATE

AND ADDRESS

Ms. ANNEPU
RAJULAMMA
First year M.ScNursing,
Padmashree Institute of
Nursing,
Nagarbhavi Circle,
Bangalore- 560072.

2.

NAME OF THE INSTITUTION

Padmashree Institute of
Nursing

3.

COURSE OF THE STUDY AND

SUBJECT

M.Sc Nursing,
Community Health Nursing

4.

DATE OF ADMISSION TO THE

COURSE

30-06-2008.

5.

TITLE OF THE STUDY

Assessment of effectivness of
structured teaching
programme on leprosy
rehabilitative measures
among leprosy patients.

Leprosy also known as Hansens diseases is a chronic infectious disease that

primarily affects the skin, the peripheral nerves, the upper respiratory tract, and the
eyes. The causative agent is an acid fast bacterium, Mycobacterium Leprae. First
identified in 1873 by the Norwegian physician, Gerhard Henrik Armauer Hansen. 1
In 1991, the world health organization and its members states committed
themselves to eliminate leprosy as a public health problem by the year 2000.At the
end of the year 2000, the deadline of the programme, 597,232 leprosy cases were
registered for the treatment and 719,330 cases were newly detected in the world.
The prevalence rate at the global level was below 1case per 10,000 persons. There
have been 690,830 newly detected patients in 2001.According to official reports
received during 2008 from 118 countries and territories, the global registered
prevalence of leprosy at the begning of 2008 stood at 212,802 cases.2
Studies have indicated that mortality rate among lepromatous patients can be
the direct cause of death unlike many other people disabled with leprosy. As a part
of prevalence of effective leprosy control and preventing deformities is early
detection and prompt treatment is one of the essential step, and second step is
rehabilitation of those patients who are having deformities either special
accessories or corrective surgical procedures have to be under taken. 3
WHO recommends a protocol of Multidrug therapy (MDT), which effectively
controls the disease, hence contributing to the global elimination programme.
Early detection of leprosy and treatment by MDT are the most important step in
preventing deformities and disabilities. Social and vocational rehabilitation are
integral component for the leprosy patients.4
In an analysis of the study on leprosy, reported that 21%to45% of all persons
affected by the disease deteriorated economically. The dilemma is to identify who
4

among leprosy affected persons need community-based rehabilitation to address

the economic and other psychosocial impact of the illness.5
The basic concepts behind rehabilitation are that the persons affected with
leprosy should be restored back to the normal social life or as near as possible.
Rehabilitation in field of leprosy requires greater efforts than the rehabilitation in
other types of disabled persons because the question of social acceptances does not
arises in non-leprosy disabled persons. In the case of orthopaedically handicapped
or blind or deaf persons their stay with the family is not prejudiced as in the case
of leprosy patients. This is due to stigma attached to the disease. Therefore, one of
the essential requirements is socioeconomic rehabilitation in the community for
social acceptance of the leprosy cured persons through advocacy methods.
A few non-governmental agencies are rendering organized socioeconomic
rehabilitation services to the affected persons by assessing their needs and at the
same time helping them to bring lasting benefits. Members of the International
Federation of AntiLeprosy Association (ILEP) are showing keen interest in the
socio economic rehabilitation and those organizations. According to ILEP
guidelines, the approaches to socioeconomic rehabilitation can be based on the
following:
1. Recognition of the impact of leprosy individual; in other words its
physical, psychological, social and economic effects.
2. Responsiveness to the concern of the individuals affected by leprosy. This
requires approaches that restore dignity and empowerment.
3. Sensitivity to the concerns of the families and communities affected by
leprosy. Members of the community have an important role to play in
rehabilitation.

Strategies with some key principles to enable people with disabilities to

participation the whole range of human activities. These principles include
participation, equity, self-advocacy, facilities and partnership sustainability.6
Rehabilitation required for people with leprosy related disabilities includes
physiotherapy, orthopedic services, occupational therapy and reconstructive
surgery and socioeconomic rehabilitation. Rehabilitation activities includes
vocational training, integrated education of childrens affected by the leprosy,
micro finance and business, creation schemes, provision or improvement of
appropriate housing and advocacy at various levels involving a variety of media.
The strategies are implementing most of the services.7
The community-based approach assumes that the people with disabilities are
able to work together to organize their own lives and their own development,
drawing their active involvement and support of their family and local community.
The scope and complexity of community-based rehabilitation is close co-operation
and communication with prevention of disabilities and those involved in
promoting social and economic well.2
In the development of community based rehabilitation and leprosy
rehabilitation five different related forces are identified that influences the further
conceptualization of rehabilitation in the community. These are:
1. From an individual to a social approach
2. Steering of process by the persons with a disabilities
3. Focus on improving livelihood of people with disabilities
4. Demand for evidenced based practice

Rehabilitation in the field of leprosy requires greater efforts than the

rehabilitation in other types of disabled persons. In case of orthopedically
handicapped, blind, or deaf persons, their stay with family members is not
prejudices as in case of leprosy patients. Preventive rehabilitation is need of
early diagnosis and treatment to prevent disabilities. Therefore, one of the
requirements in socioeconomic rehabilitation is to create suitable conditions in
the community for social acceptance of leprosy-cured persons through advocacy
methods.

6.2 NEED FOR THE STUDY

To be good is noble, but to teach others
How to be good is nobler
Leprosy is one of the most socially stigmatized diseases known today. Social
stigma is associated mainly due to the prevalent myths like its hereditary and
contagious nature, divine cure along with the physical deformities caused. The
affected people not only face physical impairment but also suffer psychological
repercussion due to the communitys attitudes. The long-term physical and
psychological restrictions slowly push the leprosy-affected persons out of the
society. With the lack of social support and self-confidence, some disability
leprosy affected persons end up as beggars. There is a need to develop a holistic

approach including both prevention of disabilities. Measures to prevent such

disabilities in future rehabilitation of leprosy have been suggested.8
Rehabilitation of the leprosy patients is a multifaceted and long drawn
process. Consisting efforts in various directions are necessary to bring success.
Community based rehabilitation has been described as strategy for leprosy
rehabilitation. Developments in community based rehabilitation services,
including socioeconomic rehabilitation.9
The basic concept of community based leprosy rehabilitation focused on
participation of the persons with a disability in their own community and
position, promoting positive attitude towards their own lifes, prevention of
causes of disabilities, provision of rehabilitative services, education and training,
occupational training, socio economic training, supporting local initiatives.10
Rehabilitation require by the people with leprosy related disability includes
physiotherapy, orthopedic services, occupational therapy and reconstructive
surgery and socioeconomic rehabilitation. Rehabilitation activities include
vocational training, integrated education of persons affected by leprosy, micro
finance and business, creation schemes, provision or improvement of appropriate
housing and advocacy.11
.
From the investigator own experience, many of the leprosy patients who got
admitted in leprosy hospital were not aware of leprosy rehabilitative measures
such as medical, surgical, occupational, socioeconomic rehabilitative measures.
So, the investigator felt that there is a need to educate the patients who are
having some leprosy disabilities with the help of structured teaching programme,
which covers the following aspects:
8

1. Medical rehabilitation
2. Surgical rehabilitation
By this structured teaching programme leprosy patients will able to improve
the knowledge on leprosy rehabilitative measures and patient can get self
confidence to carry out his activities.

6.3 STATEMENT OF PROBLEM

A study to assess the effectiveness of structured teaching programme on
leprosy rehabilitative measures among leprosy patients in selected leprosy centers,
Bangalore.

6.4 OBJECTIVES OF THE STUDY

1. To assess the pre test knowledge regarding leprosy rehabilitative measures
among leprosy patients.
2. To assess the posttest knowledge regarding leprosy rehabilitative measures
among leprosy patients.
3. To assess the effectiveness of structured teaching programme regarding
leprosy rehabilitative measures among leprosy patients.

4. To associate the post test knowledge regarding leprosy rehabilitative

measures among leprosy patients with their selected demographic variables

6.5 OPERATIONAL DEFINITIONS

1. Effectiveness

It refers to the increase in the level of knowledge of patients after

receiving structured teaching programme on leprosy rehabilitative
measures.
2 . S t r u c t u red t e a c h i n g p rog r a mme
It refers to systematically developed instructional aids designed for
leprosy patients on aspects of rehabilitative measures such as medical and
surgical rehabilitative measures

3. Leprosy rehabilitative measures

It refers to the leprosy rehabilitative measures that prevents deformities
by early detection and promote treatment of patients who are having
deformities with either special accessories or corrective surgical
procedures.
4. Leprosy patients
It refers to the patients with leprosy and taking treatment in leprosy
center.

6.6 ASSUMPTIONS
10

1. Patients may have inadequate knowledge on leprosy rehabilitative

measures.
2. Structured teaching programme will enhance the knowledge of patients
on leprosy rehabilitative measures.

6.7 RESEARCH HYPOTHESIS

HI - There is significant difference between the mean pretest and post test
knowledge of patients on leprosy rehabilitative measures.
H2 - There is significant association between the post test score of patients
and selected demographic variables.

6.8 REVIEW OF LITERATURE

Literature review is a key step in the research process, the task of reviewing
involves the identification, selection of critical analysis and reporting of existing
information on topics of interest.12
A study was conducted on socioeconomic rehabilitation; focus on the issues of
abnormal psychological behavior among leprosy-affected persons. The result
shows a high level of social stigma experienced by the leprosy affected persons.
This is high lightened in various categories including marriage difficulties,
homelessness, and negative affect on employment. The author states that the social
prejudices and deformities due to leprosy have played key role in socioeconomic

11

detoriation of affected persons. It is recommended that the leprosy rehabilitation is

more needed to implement in effectively, efficiency with active involvement. 13
A study was conducted on the process of rehabilitation among male and female
leprosy affected persons. The study gathered data from 2495 inhabitants of Bihar
and Maharashtra, including 934 who were receiving treatment and living relatively
normal lives, 300 members of their families, 1071 who had to leave at home, 100
who were rehabilitated and 90 health workers. The studies results show both men
and women were negatively affected in terms of their families and marital values,
women suffered more isolation and rejection. The author concluded that there is a
need to provide rehabilitation services. 14
A study was conducted on long-term consequences of leprosy through lack of
social support and self-confidence. The study conducted through semi structured
interview .the study shows that four of the resulting cases studies to illustrate the
process of rehabilitation. The study concludes the rehabilitation services to
worthless solution to the absents the problem.15
A longitudinal study was undertaken of 344 leprosy-affected persons attending
a leprosy clinic in Gwalior India. The results of the study showed that social
stigma was present in a variety forms, and was more prevalence among persons
who are illiterate and form a low socioeconomic groups. The need for the
socioeconomic rehabilitation is made clearly by this study.16
A study was conducted on impact of socioeconomic rehabilitation on stigma
reduction. The study combined a quantitative questionnaire with semi-structured
interview of individual participants, five focus group discuss and 10 key informant
interviews. The p-scale results showed four men suffered significant participation
restriction in finding work and in social integration. The results of the study
suggests that improved self-esteem, positive family and community support for
12

SER participants and increasing participation in community activities are

indications of stigma reduction.17
A study was conducted on impact of social inequality and prevalence in the
for of the caste system in India. A sample of 150 persons with deformities and
their families, drawn from two districts in Tamil Nadu, was selected for the study.
The study concludes that the gradual marginalization, rejection and rehabilitation
of the affected is evident. Caste status is said to be a broad indicator of the nature
and the extent of handicaps and acceptance in the family. Investigator
recommended that this factor be appropriately taken care of in rehabilitation and
disability management in leprosy control programme to work.18
A study was conducted on nature and extent of problems of leprosy affected
families having persons with deformities and their strategies to cope up with those
problems. This was carried out through data collection from 500 sample families
in two districts in Tamil Nadu, in south India. The results of the study showed that
about 20% of the families reported that they faced socioeconomic problems.
Community education on leprosy is also required to dispel myths and fear
surroundings the disease.19
A cross-sectional study was conducted on to determine the socioeconomic and
nutritional status of cured persons with residual deformity. The study involved 155
index cases with deformity, 100 without deformity, and 616 household members.
Nutritional status was evaluated using Anthropometry. A questionnaire was used to
determine disease characteristics, socioeconomic, and house hold information. The
study results that cured persons with physical deformity are more undernourished
than those without deformity.20

13

A cross sectional study was conducted on to assess the extent to which leprosy
cause physical disability on the persons. The population was two areas of leprosyaffected persons, one area from rural and other from urban, by using clustersampling method. The total study sample was 8.175 including 172 cases of
physically handicapped. This study shows that the most common causes of leprosy
disability of other than trauma and poliomyelitis. The study concludes that
disability prevention measures should be incorporated into the national
programme for the elimination of leprosy.21
A study was conducted on the general living condition, the psychological,
economical and physical situation of 161 leprosy patients. The Results point to a
negative correlation between general education and specific knowledge of leprosy
and highlight a serious psychological situation of previously treated leprosy
patient.22
A study was conducted on the living condition of people affected with leprosy.
Sample of the study includes 13,034 cases, out of 13,034 cases, 91.19% were
farmers and only 13.01% of the teenagers were at school. The conclusion of this
study is the living condition of those leprosy affected people, particularly living in
leprosy village called for special attention and the government should take
comprehensive attention to publicize the knowledge on leprosy to reduce fear and
discrimination against.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA
Patients of leprosy admitted in the leprosycenters, Bangalore.

14

7.2METHODS OF COLLECTION OF DATA

i. Research design

Quasi experimental design - one group pre test post test design.
ii. Variable

Dependent variables
Level of knowledge of patients on leprosy rehabilitative measures.

Independent variables
Structured teaching programme on leprosy rehabilitative measures.
iii. Setting

The study will be conducted in selected leprosy centers, Bangalore.

iv. Population
All the leprosy patients admitted in the leprosy centers.
V. Sample
Leprosy patients who full fill the inclusion criteria considered as sample and
sample size is 60.

vi. Criteria for sample technique

Inclusion criteria: The study includes

1. Patients with leprosy admitted in the leprosy center.

15

2. Patients who are willing to participate in the study.

3. Patients who are able to understand Kannada or English.

Exclusion criteria: The study excludes

Patients who are not available at the time of data collection.
Vii. Sampling technique
Non probability Convenience sampling technique.
Viii. Tool for data collection: The tool consists of 2sections
Section A
Demographic Performa consisting of patients age, gender, religion, occupation,
education, family income, duration of illness, source of information.
Section B
Structured knowledge questionnaire on leprosy rehabilitative measures will be
used to assess the knowledge level of the patient.

ix. Method of data collection

After obtaining formal administrative approval from concerned authorities and
informed consent from the sample, the investigator will personally collect the data.
The data will be collected in three phases.
Phase I
Pre test will be conducted to assess the existing knowledge of the patients
on leprosy rehabilitative measures with the structured questionnaire.

16

Phase -II
Structured teaching programme regarding leprosy rehabilitation will be
given about 45 minutes on the same day.
Phase -III
Same questionnaire will be administered after 7 days its effectiveness will
be measured. Duration of the study is 4-6weeks.
X. Plan for data analysis
The data will be analysed by using descriptive and inferential statistics.

Descriptive statistics
Frequency, percentage distribution, mean and standard deviation will be
used to analyze the level of knowledge of patients on leprosy rehabilitative
measures.20

Inferential statistics
Paired T test will be used to compare the pre test and post test
knowledge, chi-square test will be used to associate between knowledge of
patients with their selected demographic variables.20
Xi. Projected out come
There will be significant increase in the level of knowledge, after conducting
structure teaching programme. It will help the leprosy patients to adopt certain
leprosy rehabilitative measures.

17

7.3 Does the study require any investigations or interventions to the

patients or human or animals?

Yes, structured teaching programme will be administered as intervention for
patients of leprosy disabilities.

7.4 Has the ethical clearance been obtained from your institution?
Yes, the informed consent will be obtained from the samples. Confidentiality
and privacy of data will be maintained.

8. LIST OF REFERENCES
1 . Maya Thomas, M.J. Thomas. Challenges in leprosy rehabilitation. Asia pacific
disability rehabilitation journal.2004; vol15 (1): 96-110.
2 . Mr T Jayaraj Devadas. Socioeconomic rehabilitation in leprosy. German
leprosyandTBReliefassociation.2008;vol14(2):86-90.
www.lepra.org.uk/lr/Mar08/Lep86-90.pdf

3 . Harry Finkenflugel and sardhrule. Integrated community based rehabilitation

and leprosy rehabilitationservices.2008/Febuary; vol 9(2): 697-702.
4 . Withington Sc, john S, Baird D. assessing socioeconomic factors in relation to
stigmation impairment status and selection for socio economic rehabilitation.
Lepra publishers; the British leprosy relief association; 2006:vol74 (2): 120134.

18

5 . Kumar RB, SinghasivanonP, Kaewkungawal. Gender differences in factors

associated with treatment. Southeast Asian journal of Tropical Medicine and
public health; 2006:vol32 (2): 334-339.
6 . David Werner. The problem and challenges of disability and rehabilitation in
leprosy. Asia pacific disability publication; 2006:vol47 (3): 192-199.
7 . Walter CS, social aspects and rehabilitation. British leprosy relief association;
2007/September: vol: 85-94.
8 . Prabakar Rao R. Socioeconomic problems of leprosy IN India. The British
leprosy association publication; 2007:vol71 (4): 466-71.
9 . Dr. Warrer on prevention of rehabilitation of the individual in the issues covers
in leprosy. The journal of rehabilitation in Asia; 2006/July: 1997-99.
10.

ILO, UNESCO, WHO. Community based rehabilitation for people with

disabilities. Joint position paper publishers; Genve; 2006: Vol5 (3): 223-45.
11.

Anderson, Watson. Guidline for social and economic rehabilitation of

leprosy affected people. Indian journal of leprosy; 2005:vol75 (4): 169-182.

12.

B T Basavanthappa. Nursing Research. Review of literature. Jaypee

Publishers (p) ltd: p.49.

13.

R.P Narasimha. Therapeutics benefits of leprosy rehabilitation. Indian

journal of leprosy rehabilitation research; 2005/January; vol93 (7): 12-23.

19

14.

E.W Hrudiakpor. Aids and leprosy. International journal of leprosy

rehabilitation;2007/April:Vol93(7):226-234.
www.annals.edu.sg/pdf/36VolNo1Jan2007

15.

Bauer B, Khoa NK, Chabaud B, Chaise F, Quang HT, Comtet JJ.Flexion

digitorum superficial tendon transfer for intrinsic paralysis in leprosy. French

article.2007/June:vol26(3):136-140.
dermatology.cdlib.org/92/reviews/leprosy/ishii.html - 54

16.

Zhonghua Liu, Xing Bing, Xue Za Zhi.study on the living condition of

people affected by leprosy. Chinese article. 2005/May: vol2695):348-50.

17.Sashida M, Nagata S, Murashima S, Haruna M. social rehabilitation experience
people with a history of leprosy. Nippon publishers; 2005/Febuary: vol52 (2): 14657. www.aifo.it/english/resources/online/apdrj/apdrj202/ leprosy.pdf.
18. Baumann H, Stingl P, Van wijnen A.Psychosocial, economica and physical
status of former leprosy patients in Uganda.wesen publishers; 2000/June: vol62
(6): 342-46. www.lepra.org.uk/LR/June05/34252.pdf .
19. Sow So, Doumbia M. Leprosy as a cause of physical disability in rural and
urban areas of people.French article.sante publishers; 2006/Aug:vol 8(4):297302.
20. PSS sundarRao. Introduction to Biostatistics and Research Methods: Basis
of statistical Inference, New Delhi: prentice- Hall of India; 2006:p.66-9.
21. Shumin C Diangchang, L Bling, L Lin. Assessment of disability social and
economic situation of people affected by leprosy. Development in practice.
Indian journal of leprosy rehabilitation; 2005:vol74 (3): 215-221.

20

22. Plergerson S. Attacking social exclusion. Combining rehabilitative and

preventive approaches to leprosy. Chinees publication; 2005:vol15 (5): 692700.
23. Velema JP, Ebenso B, Fuzikawa PL.evidence of effectivness of leprosy
rehabilitation

in

the

community.

International

rehabilitaion.2008/march: 79(1): 65-82.

09. Signature of the candidate

10. Remarks of the guide

11.1 Name and designation of the guide :

11.2 Signature

11.3 Co-guide (if any)

11.4 Signature

11.5 Head of the department

11.6 Signature

:
21

journal

of

leprosy

12.1 Remarks of the principal

12.2 Signature

22