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Indian Journal of Community Medicine

Effect of Some Health Educational Techniques in Disseminating the Knowledge About HIV / AIDS Among Adolescent Students

Author(s): S.P. Singh, N. Garg, S.C. Mohapatra, R.N. Mishra

Vol. 30, No. 1 (2005-03 - 2005-03)

Abstract

Research question: What is the comparative effects of different health educational methods in educating adolescent college students related to HIV/AIDS?

Objectives: To compare the effectiveness of three health educational methods namely lecture, participatory teaching and written assignment method (pamphlet methods) in disseminating knowledge about HIV/AIDS.

Study design: Controlled-intervention study design.

Setting: Four degree colleges of Varanasi City.

Participants: First year graduate students. 221 in intervention and 192 in control groups.

Statistical analysis: student's 't' test.

Result: Pre-intervention and post intervention mean knowledge scores in intervention and control groups were 25.88 and 26.52 respectively (statistically insignificant). Immediately after training the mean score in the intervention group increased significantly to 32.53 and after 3 months there was a marginal decline of 1.3 percent only. Overall increase in knowledge after 3 months was 24.03 and 7.7% in intervention and control groups respectively. In the three intervention groups increase in knowledge was 31.3, 23.6 and 20.3 percents respectively for lecture, participatory teaching and written assignment (pamphlet) groups. However, sustainability of the increased knowledge was 86.8, 94.8 and 105.9 percents respectively.

Key Words : Intervention study, knowledge scoring, HIV/AIDS awareness

Introduction

The Human immunodeficiency Virus (HIV) that causes Acquired Immune Deficiency Syndrome (AIDS) has brought about a pandemic that poses a unique challenge to public health planners and programme developers. UNAIDS and WHO showed that the number of people living with HIV/AIDS globally at the end of the year 2001 stood at 40 million with 5 million HIV infected people at the end of 20001. With no cure in sight, we are forced to look closely at the behavioural patterns responsible for the causes of the disease and to modify them to prevent HIV/AIDS.

The objective of the present study was to compare the effect of three educational methods (one way lecture method, participatory method and distribution of reading assignment method in the form of a two page pamphlet) in imparting knowledge.

Material and Methods

The present study was carried out among first year undergraduate students of degree colleges of Varanasi city selected by a two stage random sampling procedure. In the first stage four degree colleges were selected. Out of the seven degree colleges in the city, 3 had 'co-education' and 4 only for girls system of education. Two colleges, selected randomly from each system of education, were allocated randomly to either 'control' or 'intervention' group. In the second stage 3 first year undergraduate classes section were selected randomly from each college. All the students in these sections were included in the study.

All the selected students in the intervention and control colleges were assessed for their baseline knowledge (preintervention knowledge score) about HIV/AIDS. For this, eighteen questions releated to aetiology, mode of transmission, signs and symptoms and preventive measures of HIV/AIDS were framed. Weighted Mean Scores (WMS) were assigned to each question after consulting six experts in the field. They were asked to give score to each question after consulting six experts in the field. They were asked to give scores to each question ranging from 0-3 according to relevance and importance of the question. Information was collected on a pre-designed, semi-structured and pre-tested self-administered questionnaire.

Three methods chosen for educating the students were didactic lecture, participatory lecture and written assignment method (two page pamphlet). In the two intervention colleges, out of the three sections selected in each college, one section was chosen for one method of education. 'Post-intervention mean knowledge score' was assessed in all the 3 subgroups of the two intervention colleges immediately (Post-interv. I score) and three months after  (Post-interv.II score) the intervention programme. In the control group reassessment of the mean knowledge score was repeated after three months to see any change in knowledge brought out by other means. In total, there were 211 students in the intervention (83, 72 and 56 in the lecture, participatory and pamphlet groups respectively) and 192 in the control group. This sample size was found to be statistically adequate. Mean age of the study subjects was 18.7 years. Intervention and control groups were comparable in their socio-demographic profiles. The content of the health education was kept similar for the three intervention groups and was delivered by one person only.

Results

'Pooled effect of the three health educational methods in imparting knowledge'

Mean pre-intervention knowldge scores were 25.88 ± 5.92 and 26.52 ± 5.21 for intervention and control groups, respectively (Table I). This difference was not significant statistically (p>0.13). After health education by the three methods in the three subgroups, the pooled mean knowledge score in the intervention group was enhanced to 32.53 ± 3.89 (Postinterven. I score). This immediate increase in the knowledge score was 25.7% of the baseline knowledge score and it was highly significant (p<0.001). After three months the meanscore remained at 32.1 ± 3.47 (Post-interv. II score), a marginal decline in the mean score (1.3% of Post-interv.I score). This decline was statistically insignificant (p>0.11). The overall increase in Post-interv. II mean score in the intervention group (From Preinterv. to Post-interv.II) was 24.03 percent. The corresponding mean score in the control group was 28.57 ± 4.29, an increase of 7.7% of it's pre-interv. score.

Table I : Mean Knowledge Scores* of Students in Control and Interventioin Groups

  n (403) Pre-interv. Post-interv.I Pre-interv.II % incr. in
    Score mean + s.d Score mean +s.d Score mean +s.d knowlege**
Intervention 211 25.88 5.92 32.53 3.89 32.1 3.47 24.03
Control 192 26.52 5.21 - - 28.57 4.29 7.7
* Maximum attainable score = 38.4, ** From Pre-interv. to Post-interv II

Table II : Comparison of Mean Knowledge Scores in Three Intervention Subgroups

Intervention Groups No. Pre-interv. Post-interv.I Pre-interv.II % incr. in
    Score mean+ s.d Score mean+s.d Score mean+s.d knowlege*
Lecture 83 25.41 6.54 33.37 3.13 32.32 2.95 86.8
Participation 72 26.71 4.68 33.02 3.73 32.69 3.34 94.8
Pamphlet 56 25.50 6.35 30.67 4.52 30.98 4.08 105.9
* Percentage of increase score retained from post-interv.I to postintervention II

'Comparative effect of the three educational methods in three intervention subgroups'

The total number of students (both the intervention colleges combined together) in the lecture, participatory lecture and pamphlet group were 83, 72, and 56 respectively. The corresponding pre-intervention mean scores were 25.41 ± 6.54, 26.71 ± 4.68 and 25.5 ± 6.35 respectively (Tables II, III & IV). The differences in the pre-intervention mean knowledge scores between the three groups were statistically, insignificant. Immediately after the educational activities the mean knowledge scores (Post-interv.I score) enhanced to 33.37 ± 3.13, 33.02 ± 3.73 and 30.67 ± 4.52 in the lecture, participatory and pamphlet groups respectively. This immediate increase in knowledge scores from pre to post-interv. It was highly significant for all the three intervention subgroups. There was a marginal decline in mean knowledge scores from post-interv I to post-interv II in lecture (33.37 to 32.32) and participatory group (33.02 to 32.69). This decline was significant for lecture group (p<0.01) only. Strangely, the pamphlet group has shown a marginal increase in mean scores during follow-up assessment from post-interv Ito post-interv.II (30.67 to 30.98). 'Sustainable increase' in knowledge was calculated as the percentage of increased knowledge from pre-interv to postinterv I that was retained during post-interv II assessment. It was calculated to be 86.8, 94.8 and 105.9 percents respectively for lecture, participatory and pamphlet groups.

Table III : Test of Significance Within the Same Intervention Subgroups

Groups Lecture Participatory Pamphlet
  t p value t p value t p value
Pre-interv Vs Post-interv I 9.99 <.001 8.96 <.001 4.96 <.001
Pre-interv Vs. Post-intervII 8.77 <.001 8.83 <.001 5.43 <.001
Post-intervI Vs Post-intervII 2.21 <.01 0.56 <0.01 0.38 <0.35
Table IV : Test of Significance* Between the Different Intervention Subgroups
Intervention subgroups Pre-interv Post-interv I Post-intervII
t p value t p value t p value
Lecture Vs Participatory 1.40 >0.8 0.62 >.27 0.72 >.24
Participatory Vs Pamphlet 1.24 >.11 3.23 <.01 2.61 <.01
Lecture Vs Pamphlet 0.08 >.47 4.16 <0.001 2.26 <0.1
*One-tailed test applied

Discussion

Students of both the groups are continuously exposed to various natural sources of information e.g. mass media (TV, radio, and print media), peer group discussions, and IEC campaings by various voluntary organizations etc. The 7.7% increase in knowledge of the control group after three months duration could be attributed to these sources of information. If there had been no intervention measure, a similar increase in knowledge would have been expected in the intervention group as well. Therefore, we can say that educational methods have been able to enhance the knowledge in the intervention group by 16.33% more (24.03% minus 7.7%) as compared to control group.

We observe that there in no significant difference between post-interv.I and post-interv.II knowledge scores of lecture and participatory groups. It implies that the two methods were equally effective in enhancing the knowledge of the students. This finding is contrary to our general concept that participatory method is more effective as compared to lecture and pamphlet methods because in the participatory method of teaching there is active participation of the participants and they learn more and are able to retain the gained knowledge for longer duration also. Various explanations could be put forth for this result. Firstly, for effective participatory learning the number of subjects should not be more than 20 to 25. Here, the number of students in the two selected classes were 31 and 41. Secondly, there was a time constraint, as the educational activity had to be finished within 45 minutes (corresponding to one period). This permitted limited time for interactions. Thirdly, because of this time constraint the participatory teaching took a shape of one way lecture method.

Post-interv.I score for pamphlet group was significantly less than the other two groups. This could be because of the fact that despite our motivation it is quite likely that many of the students either did not read or partially read the leaflets. Another reason could be that as post-interv.I evaluation was done after 48 hours, it is likely that the students read the pamphlets quite early after receiving them and forgot the contents at the time of evaluation.

The increased gain in knowledge was sustained to a very high degree. It was approximately similar for lecture and participatory groups (86.8 and 94.8 percents respectively) and much higher for pamphlet group (105.9 percent). The reason for this high sustainability in the pamphlet group could be because of the reason that once the students were sensitized to a particular issue thay were more sensitive to releated informatioin through various mass media and other IEC activities going on in the area. It is also possible that students had read the pamphlets even after the post-interv.I evaluation as well.

Conclusion

In view of the above results and observation, it is concluded that all the three educational methods were effective in enhancing the knowledge of the students. It is suggested that programme implementers might chose the suitable methods required for their individual programmes. However, it is not ever suggested that these are the only methods available.

References

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Deptt. of Preventive and Social Medicine Institute of Medical Sciences Banaras Hindu University Varanasi.

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