Full Research On MR Children

A QUASI EXPERIMENTAL STUDY TO EVALUATE THE
EFFECTIVENESS OF THE STRUCTURED TEACHING PROGRAMME

ON THE FAMILIAL CONCERNS AMONG THE MOTHERS OF THE
MENTALLY CHALLENGED CHILDREN IN THE SELECTED SPECIAL
SCHOOLS IN BANGALORE, KARNATAKA
By
DEEPA JACOB
Dissertation Submitted to
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment
Of the requirement for the degree of
Master of Science in Nursing
in
Community Health Nursing
Under the guidance of

Mrs. Kanakaratnam M.Sc (N),
Professor
Department of Community Health Nursing
New Sri Shanthini College of Nursing
Madanayakanahalli, Dasanapura, Hobli,
Bangalore-562123
2012
i
Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation/thesis entitled “A QUASI EXPERIMENTAL
STUDY TO EVALUATE THE EFFECTIVENESS OF THE STRUCTURED TEACHING
PROGRAMME ON THE FAMILIAL CONCERNS AMONG THE MOTHERS OF THE
MENTALLY CHALLENGED CHILDREN IN THE SELECTED SPECIAL SCHOOLS
IN BANGALORE, KARNATAKA” is a bonafide and genuine research work carried out by
me under the guidance of Mrs.Kanakaratnam M.Sc (N), Professor, Department of
Community Health Nursing, New Sri Shanthini College of Nursing, Bangalore.
Date:
Place: Bangalore Mrs. Deepa Jacob
ii
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A QUASI EXPERIMENTAL STUDY TO
EVALUATE THE EFFECTIVENESS OF THE STRUCTURED TEACHING
IN BANGALORE, KARNATAKA” is a bonafide research work done by Mrs. Deepa Jacob,
in partial fulfillment of the requirement for the Degree of Master of Science in Community
Health Nursing.
Date:
Place: Bangalore Professor
Head of the Department
iii
ENDORSEMENT BY THE HOD, PRINCIPAL/ HEAD OF THE
INSTITUTION
This is to certify that the dissertation entitled “A QUASI EXPERIMENTAL STUDY
TO EVALUATE THE EFFECTIVENESS OF THE STRUCTURED TEACHING
IN BANGALORE, KARNATAKA” is a bonafide research work done by Mrs. Deepa Jacob
under the guidance of Mrs,Kanakaratnam M.Sc(N) Professor, Department of Community
Health Nursing, New Sri Shanthini College of Nursing, Bangalore.
Signature and Seal of HOD Mrs. Vahitha Khanam

Principal
Sri Shanthini College of Nursing
Date: Date:
Place: Bangalore Place: Bangalore
iv
COPYRIGHT
Declaration by the Candidate
I hereby declare that the Rajiv Gandhi University of Health Sciences, Bangalore,
Karnataka shall have the rights to preserve, use and disseminate this dissertation / thesis in print
or electronic format for academic / research purpose.
Date:
Place: Bangalore Mrs. Deepa Jacob
© Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka
v
ACKNOWLEDGEMENT
I praise and thank Almighty God for his abundant grace, blessings, guidance, strength and
unconditional love showered on me throughout the study.
My hearty thanks to the management of New Sri Shanthini College of Nursing, for
extending their help in completing my study.
It is my pleasure to express my sincere gratefulness and genuine thanks to my guide
Mrs.Kanakaratnam M.Sc(N) HOD, Community Health Nursing, of New Sri Shanthini
College Of Nursing, Bangalore for their valuable suggestions, untiring efforts, cooperation and
inspirations on me for the completion of this dissertation.
I express my deep sense of gratitude to my Principal Mrs. Vahitha Khanam and other
faculties of New Sri Shanthini College of Nursing, Bangalore, for their unconditional support,
guidance, valuable suggestions and co-operation which has continuously motivated me for the
successful completion of this dissertation.
My sincere thanks to the library and office staffs and all the faculty members and student
friends of my college.
I wish to convey my gratitude to Professor Mr. Dinesh Selvam and Mr. E.Bhaskar and
Mrs. Geena for their guidance and support; in statistical analysis of the data and in various
others ways.
I extend my heartiest thanks to all the experts who have validated the tool and guided me
in this study.
I am grateful to the Authorities of St. Mary’s Opportunity School, Bangalore for granting
me permission to conduct the study. I am also grateful to all mothers who willingly participated
and cooperated in the study to make it a success.
I sincerely, would like to thank my husband Fr. Jacob Joseph, and my children Hansel
and Georgy, because of whom I got encouraged; who were a guiding force and loving support,
strength and inspiration for the completion of my dissertation.
vi
No words can express gratitude to my greatest asset my father, Late Mr. A.T Mathai
whose blessing and dream was to see me in greatest heights.
I also thank my mother Mrs. Lyssamma Mathai, my In-Laws Mr. P. T. Joseph and Mrs.
Ammini Joseph, my brother-in-law and sister-in-law Mr. Thomaskutty and Mrs. Amminikutty
and Mr. Jijomon, and my brother Mr. A. M. Thomas and family and Ms. Cijy, my sister for
their timely financial and physical help and prayers.
I express my thanks to my classmates, friends (Sijo, Vinod and Joby) and all well wishers
for their help and best wishes at all time to complete my study.
Last but not the least, I thank all others who were directly or indirectly involved in
finishing my study. I express my thanks to friends and all well wishers for their help and best
wishes at all time to complete this study.
Date: Mrs. Deepa Jacob

Place: Bangalore
vii
LIST OF ABBREVIATIONS
1. X2 : Chi square
2. df : Degree of freedom
3. P value : Probable value
4. < : Less than
5. > : Greater than
6. % : Percent
7. STP : Structured Teaching Programme
8. SD : Standard Deviation
9. M.R : Mentally Retarded
10. I.D : Intellectual Disability
11. IQ : Intelligence Quotient
12. H : Hypothesis
13. n : Sample Size
14. r : Correlation Coefficient
15. f : Frequency
viii
ABSTRACT
Background of the Study
“Family” is the first institution; which is encountered by a mother. The mother by nature
has a very special role to play in all fields of life of the family i.e. in the society, health,
education etc. In all these, the roles are complicated, difficult and tedious to perform. In order to
achieve these tasks a sound mind and stress free life is of utmost concern. A mentally retarded
child is a source of greater effort that demands extra attention and nurturing. For a mentally
retarded person one should be cautious not to ignore the facts that they are born so not because
of their own choice but by the design of nature. Maternal knowledge and behaviors are linked to
culturally embedded beliefs, educational backgrounds and uniqueness of her family settings;
which directly or indirectly affects the child rearing practices. Lack of knowledge relating to
these various aspects of how to deal with the pitfalls that could be avoided and positive steps that
could be taken up dealing with inevitable situations can be brought about with this study. Hence
the investigator had undertaken this study “A quasi experimental study to evaluate the
effectiveness of structured teaching programme on the familial concerns among the mothers of
the mentally challenged children in the selected special schools in Bangalore.
Objectives
1. To assess the existing knowledge on the familial concerns among the mothers of the
mentally challenged children before administering structured teaching programme.
2. To develop planned structured teaching programme regarding the familial concerns

among the mothers of the mentally challenged children.
3. To assess the effectiveness of structured teaching programme by conducting post-test.
4. To find out the association between the pre-test knowledge of the mothers of the
mentally challenged children with their selected demographic variables.
ix
Hypothesis
H1: There is significant difference between pre-test and post-test knowledge of the mothers
regarding the familial concerns about the various aspects of care of the mentally challenged
children.
H2: There is significant association between post-test knowledge scores with their selected
demographic variables of mothers of the mentally challenged children.
Methodology
A quasi experimental, one group pre-test and one group post-test design was adopted to
assess the effectiveness of structured teaching programme on the familial concerns among the
mothers of the mentally challenged children. An evaluative research approach was adopted to
collect the data; the structured interview schedule was administered to simple randomly selected
samples of 60 mothers of the mentally challenged children in selected special schools in
Bangalore, Karnataka. The collected data’s were analyzed and interpreted based on the
objectives of the study by using descriptive and inferential statistics.
Findings
The majorities 41(68.33%) of the respondents were in the age group of 39 and above years
and majority 29 (48.33%) of them were Muslims. Majority 31 (51.67%) of them had education
up to higher secondary. Majority 32 (53.33%) were home makers. Majority 28 (46.67%) had
monthly income of Rs 4001 to 6000.Most 44 (73.33%) were from unconsangious marriage.
Majority 30 (50%) lived in the joint family system. Most of them 21 (35%) had 2 normal
children. As much as 50 (83.33%) had only 1 mentally challenged children in their house.
Majority 39 (65%) had been caring for their mentally challenged child for more than 10 years.
Majority 33 (55%) did not have any previous experience with the care of the mentally challenged
child. Most 14 (51.85%) of the mothers received the knowledge through special schools. The
mean percentage of pre-test knowledge was 15.34% as compared to post-test knowledge was
x
68.43% and with an enhancement of knowledge as 53.09% establishing the statistical
significance at 5% level (t=31.14).
Knowledge level of mothers regarding familial concern on the care of mentally retarded
children was inadequate before the administration 0f the planned structured teaching programme.
The effectiveness of planned structured teaching programme could be seen as there were
increases in the levels of knowledge among the mothers of the mentally challenged children.
Further, the overall knowledge aspects in the post-test score was high compared to pre-test
scores as revealed by paired “t”-test.
In relation to the variables; religion, educational status and monthly income, type of
marriage, type of family, number of mentally challenged children and the years of caring, all
these variable did not show any association with level of knowledge, whereas age of the mother,
occupation, number of normal children, previous knowledge and the source of knowledge had
significant association with the level of knowledge of the mothers on the familial concerns of the
mentally challenged children.
Conclusion
The most important role of a community health nurse is to identify and provide knowledge
among the mothers of the mentally challenged children to the various easeful techniques and
strategies that are available in order to prevent stress in life and thus be productive to the family,
community and the nation at large. Structured teaching programme was significantly effective in
increasing the knowledge among the mothers of the mentally challenged children.
Key words: Knowledge, Mother, Mentally Challenged Children, Familial Concern, Effectiveness,
Structured Teaching Programme.
xi
TABLE OF CONTENTS
Sl. No. Contents Page No.
1. Introduction 1-7
2. Objectives 8-13
3. Review of Literature 14-29
4. Methodology 30-40
5. Results 41-70
6. Discussion 71-77
7. Conclusion 78-83
8. Summary 84-88
9. Bibliography 89-95
10. Annexures 96-151
xii
LIST OF TABLES
Table No Tables Page No
Frequency and percentage distribution of demographic variables such as 44

1.1
age, religion, education status, occupation, monthly income.
Frequency and percentage distribution of demographic variables such as 49
type of marriage, type of family, number of normal children, number of
1.1a
mentally challenged children, years of caring, previous knowledge and
its source.
Percentage and frequency distribution of the pre-test level of knowledge 55
2.1 of the mothers regarding the familial concerns of the mentally challenged
children.
Mean, SD and Mean% knowledge on the familial concerns among the 57
2.1 a
mothers of the mentally challenged children through pre-test.
Percentage and frequency distribution of the post-test level of knowledge 58
2.2 among the mothers regarding the familial concerns of the mentally
challenged children.
2.2 a
mothers of the mentally challenged children through post -test.
Comparison between pre-test and post-test knowledge on the familial 62
2.3a
concerns among the mothers of the mentally challenged children.
Paired “t”test showing the significant difference between the pre-test and 64
2.3b post-test mean knowledge scores and statistical significance of the
mothers on the familial concerns of the mentally challenged children.
Association between the pre-test knowledge on familial concerns among 67
3.1 a the mothers with the selected demographic variables such as age,
religion, education, occupation, monthly income.
Association between the pre-test knowledge of the mothers with their 69
selected demographic variables such as type of family, type of marriage,
3.1 b
number of normal children, number of mentally challenged children,
years of caring, previous knowledge and source of knowledge.
xiii
LIST OF FIGURES
Sl. No Figures Page No
1. Conceptual Frame Work 13
2. Schematic Outline of Research Design 31
3. Schematic Representation of the Research Design 32
4. Schematic Representation of the Research and Analysis 43
LIST OF GRAPHS
Sl. No Graphs Page No

Percentage distribution of mothers of the mentally challenged children 46
1.
according to age.

2.
according to religion.

3.
according to educational status.

4.
according to occupation.

5.
according to monthly income.

6.
according to type of marriage.
7. Percentage distribution of mothers of the mentally challenged children 51
according to type of family.
xiv
8.
according to number of normal children.

9.
according to number of mentally challenged children.

10.
according to years of caring.

11.
according to previous knowledge.

12.
according to source of previous knowledge.
Percentage and frequency distribution of the pre-test level of knowledge 56
13. on the mothers regarding the familial concerns of the mentally

14.
mothers of the mentally challenged children through pre-test.
Percentage and frequency distribution of the post-test level of 59
15. knowledge among the mothers regarding the familial concerns of the

16.
mothers of the mentally challenged children through post -test.
Comparison between pre-test and post-test level of knowledge on the 63
17. familial concerns among the mothers of the mentally challenged
children.
xv
LIST OF ANNEXURES
Sl. No Content Page No
1 Letter Seeking Permission to Conduct Research Study 96
2 Letter granting permission to conduct research study 97
Letter Requesting Opinion and suggestion of Experts for

3 98
Establishing Content Validity of Research tool.
4 Criteria Rating Scale for Validity of the Tool 99-102
5 Content Validity Certificate 103
6 List of Experts for Content Validity 104
Consent form
7 • English 105-106
• Kannada
8 Certificate of English Editing 107
9 Certificate of Kannada Editing 108
Structured Interview Schedule

10 • English 109-118
• Scoring Key
Structured Teaching Programme
11 • English 119-129
Structured Interview Schedule

Structured Teaching Programme (Kannada) 130-151
12
• Flip card
xvi
1. INTRODUCTION
Mentally challenged or mental retardation or intellectual disability is a descriptive
term used for sub average intelligence and impaired adaptive functioning arising in the
developmental period that is less than eighteen years. Most individuals with significant
intellectual impairment have no discernible structural abnormalities of the brain. The
terms Mental retardation or intellectual disability has been challenging as the term carry
significant social and emotional stigma. The American Association for Intellectual and
Developmental Disability has changed the term and now refer to mental retardation as
intellectual disability.1
Mental retardation is a problem of serious social concern. In view of the large
number of persons considered to be mentally challenged, such concern is certainly
justified. Using the conventional criterion of 3 per cent of the population, the U.S.
President’s Panel on Mental Retardation estimated that almost 5.5 million children and
adults in the United States are mentally retarded. The frequency of MR/ID of all degrees
ranges from 1.6-3% of the population. The statistical definition of sub average
intelligence would indicate a predicted prevalence of 2.5 percentages although prevalence
rates vary from country to country.2
The birth of a baby is usually anticipated with great excitement and expectations of
a future filled with happiness and success. But having a handicapped child born into a
family and grow into adulthood is one of the most stressful experiences a family can
endure. Parental reactions to the realization that their child is exceptional usually includes
shock, depression, guilt, anger, sadness, and anxiety. Individuals handle each of these
feelings differently and may stay in certain stages longer than others. Some parents
1
perceive the handicapped infant as an extension of them and may feel shame, social
rejection, ridicule or embarrassment. Parental reactions may be affected by economic
status, personality traits and marital stability. An initial parental response may be a form
of emotional disintegration. This may evolve into a period of adjustment and later into
reorganization of the family’s daily life. Some parents cannot cope beyond the emotional
disintegration. However, the concern here is with the family that chooses to raise their
special youngster at home.3
The family is the basic unit of growth and experience, fulfillment or failure. It is
also the basic unit of illness and health according to Nathan W. Ackermar. The state of
ill-health to any one of the family members particularly to the children brings about
imbalances in the total rhythm of the family. In tune with this thought the presence of
mentally challenged child or children may affect the family balance among the parents,
particularly to the mother. This circumstance requires support of emotional stability and
flexibility from all the members of the family.4
The future of a family to a very great extends lies on the mother. It is also depended
very much on the home condition, health, support system, services and amenities in the
household setting. According to Kanta Sharma, a sociologist and researcher who
concentrates on Indian women and problems, points out that “those who are careful
enough to take a comprehensive view of the human life, attach as much value to the
mothers’ activities of producing and nursing children and keeping a family together. This
statement proves to be best in an Indian context as mothers and their efforts inside the
home are confined to their homes.5
2
Illness or disabilities are a challenge to the serenity and harmony in the dwelling, as
it pulls on extra time, effort, energy, finance, etc to all residing in the home. According to
Bonnie Holladay, “the birth of a chronically ill infant has outcomes that further increases
familial stress”. Mental retardation brings more undesirable trials to all the members of
the family and in that it directly or indirectly affects mothers the most in an Indian
scenario. The child has special needs other than the basic needs to which the mothers
could find themselves overwhelmed by attending and stressful. Whether the special needs
of the child are minimal or complex they are inevitable.6
Raising a child who is mentally challenged requires emotional strength and
flexibility in the part of the mothers. In the Indian context the soul responsibilty of
nurturing the children are vested mostly on the mothers. Whether the special needs of the
child are minimal or complex, the parents are inevitably affected. Support from family,
friends, the community or paid caregivers are critical to maintaining balance in the
home.7
Strengthening the mother is critical for development of the mentally challenged child
as well as the rest of the family with positive actions and inputs. The description of the
“energized family” characterized the healthy family unit by examining its link to the
community, interaction between family members, coping efforts, role structure and
freedom and responsiveness.’ The healthy family constantly modifies its structure to
promote effective functioning.”8
Most children will muddle their way through life with some relatively assured
measure of success, but as for the mentally challenged child they feel; “the output of a
special child is often a direct reflection of your inputs and efforts of stimulation.”9
3
Personal attentions are needed for the mothers from the time the diagnosis is made. It is
not enough to give worried parents an explanation on just one occasion. They need to
hear the explanation several times before they can absorb all its implication. Adequate
time must be allowed to explain the prognosis, indicate what help can be provided and
discuss the part the parents can play in helping their child to achieve full potential.
Pediatrician and health visitors are usually involved in this process” is the explanation
given by Michael Gilder, Richard Mayou, and Philip Cowen to have a gradual adaptation
pattern possible in entering such crisis situations.10
Murphy asserts that in addition to practical assistance the parents need continuing
psychological support, which may be provided as a program for the whole family.11 A
significant concern related to the fact that very often one comes across a child who has
not been able to progress to the extent he is capable of due to the lack of knowledge on
the part of the parents. There are so many cases of children between the age of 10 and 12
or even older, which are capable of acquiring basic self-help skills but haven’t done so
because either the parents haven’t realized that they are capable of learning them, or they
have no idea how to go about them.12
The same is true of many other developmental areas of such children. This situation
often happens due to the unnecessary and undue stress on families particularly upon the
mothers. In other words the presence of a disability in a child deals a blow of such a great
magnitude of stress and worries to the parents especially to mothers. The family, as a unit
will have to share the responsibility although, at times, the active responsibility may fall
on only one parent. An inability to recognize this reality has lead to much family
breaking up because of the differences in perception of carrying the burden by different
4
members of the family. In addition to the lack of knowledge of the handling the mentally
challenged children by the mothers, there are other leading factors to the stress and
worries for the mothers as financial instability in the family, physical exhaustion, school
related issues, health and other factors.13
Need for the Study
In the present era, mental disability is a major public health problem in the society.
The disabled constitute a small part of the population of any society, their upbringing,
welfare and rehabilitation is obligatory for individuals closely related or committed to
them .The households, which have disabled persons, need to be helped by the community
health programme for rehabilitation and health care. Community health workers, social
workers are the better personnel’s to deal with these issues as they engage
comprehensively in the care of the given community.14
Many of the mental disabilities are correctable if detected and managed early.
There are 600 million persons with disabilities in the world today. 80% of them live in
developing countries. A staggering 90 million people in India are disabled. That's almost
one in every ten. It is significant to note that Karnataka with 1.8%, is one of the states
with low disabled populations.15
This statistics indirectly means that families of these disabled children or
individuals are one or the other way struggling with various forms of stress. Among them
mothers will be more sufferers and thus their contribution to the society will be few. As
these are the minority group, the suffering that they undergo will be mostly unmet and
even unheard due to self denial and social neglects. The latest phase in the development
of mental health services in India has been the community care approach. “Community
5
mental health is all-encompassing, focusing on helping the individual, the family, and the
community to interact in more adaptive ways so that the best adjustment possible is
achieved and maintained.”16
According to the “Cornucopia of Disability Information” disability statistics given
by the Congressional Committee Findings state that “43 million are disabled, about 17
percent of 250 million; almost 1 out of 5 persons are disabled. The Mentally Challenged
is a fifth of all Disability Rag’s clients.”17
In one of the Indian statistical studies in an Indian Urban settings shows it is very
urgent to address the issues of mothers since the number of mentally challenged children
are very high in those areas. The data are as follows “As per census 2010, statistical
analysis of mentally challenged population in Kolkota (India) reports that in the urban
setting there are 1, 81,981 mentally challenged population and in the rural setting the
population are 88,861 making a grant total of 2,70,842. As per 2011 census Karnataka
has showed a disabled population of 9, 40,643 out of which 6, 61,139 live in villages and
2,79,904 in urban areas. The literate disabled population is 4,73,844, which constitutes
51.40 percentage of the total disabled population. Most of the families with disabled
persons live below poverty line. Lack of facilities and opportunities prevent disabled
people from gaining suitable, education, training and employment. 18
In contemporary India, the joint family system is slowly giving way to the nuclear
family system. With the frequency of nuclear family systems in the urban settings it is
clear that the nature and extent of crisis faced by the mothers would be more as they are
working and may find relatively little sources of support from other family members and
thus assigns the responsibility solely on mothers. It is imperative to have a system by
6
which the mothers need to be supported by the extended families, friends and support
groups in order to gather the knowledge of raising the mentally challenged children so as
to foster independence by developing self help skills in the child.19
The student researcher had been working with the mentally challenged children
for 4 years; where the student researcher had close association with the parents;
particularly the mothers. The findings of the interactions with them opened up the deep
rooted challenges faced by the mothers in their life. These mothers were from the varied
social strata’s with various differences. Nevertheless, there were areas where they had
difficulties in dealing with these children and their growth and development. There are
issues that make their life miserable due to the familial and societal ignorance in adapting
with their stressful and conflicting situations.
Thus, the familial and societal strengthening of the parents of these children is
essentially significant, when we deal with the problems related with the any kind of
handicaps, particularly with the mentally challenged. Moreover, such parents might
consider their children as a liability in their life mainly due to the ignorance in indulging
meaningfully in managing their situations.
It is in this context, the student researcher would like to go deep into the various
specifications of the familial concerns of the parents and thus provide with structured
teaching programs in order to recommend the possible suggestions that are concentrating
in strengthening the mentally challenged children in the urban settings like Bangalore.
The early intervention and the prevention of further disabilities are ideally possible only
by promoting optimal development in the holistic approach to the family health
particularly among the mothers.
7
2. OBJECTIVES
Statement of the Problem
A quasi experimental study to evaluate the effectiveness of the structured teaching
programme on the familial concerns among the mothers of the mentally challenged
children in the selected special schools in Bangalore, Karnataka.
Objectives
1. To assess the existing knowledge on the familial concerns among the mothers
of the mentally challenged children before administering structured teaching
programme.
2. To develop planned structured teaching programme regarding the familial
concerns among the mothers of the mentally challenged children.
3. To assess the effectiveness of structured teaching programme by conducting
post-test among the mothers of the mentally challenged children.
4. To find out the association between the pre-test knowledge scores of the
mothers with the selected demographic variables.
Operational Definitions
Knowledge: In this study, knowledge refers to the “information and understanding on the
familial concerns among the mothers of the mentally challenged children.”
Structured Teaching Programme (STP): It refers to systematically organized and
designed instructions and teaching aids for 45 to 60 minutes in lecture cum discussion
method which are intended to increase the knowledge regarding the familial concerns.
Familial concerns: In this study, it refers to the home care, daily living skills, emotional
areas, financial areas, disciplining and behavior and prevention.
8
Mentally challenged children: In this study it refers to the group of children from the
age group of 5 to 20 years with the IQ levels below 70 percent.
Mothers: In this study, it refers to biological mothers who are directly involved in the
care of the mentally challenged children.
Assumptions
• The mothers of the mentally challenged children will have poor pre-test
knowledge regarding the coping patterns on the familial concerns.
• Structured teaching programme to the mothers of the mentally challenged can
enhance the knowledge of the mothers.
• The mothers of the selected special school children will be willing to participate
in the study actively.
Hypothesis
H1: There is significant difference between pre-test and post-test knowledge of the
mothers regarding the familial concerns about the various aspects of care of the mentally
H2: There is significant association between pre-test knowledge scores with their selected
demographic variables of the mothers of the mentally challenged children.
Limitations
• The study is limited to 60 mothers belonging to selected special schools in
Bangalore.
• The study did not use any control group.
• The data collection period is limited to the period of 4 weeks.
• The study results are confined only to selected special schools in Bangalore.
9
• Only a single domain that is knowledge is considered in the present study.
Conceptual Framework
Concept is defined as complex mental formation of an object, property or event
derived from the individual’s perception and experience. Conceptualization is the process
of forming ideas, which are utilized and form conceptual framework for development of
research design. It helps the researcher to know that what data’s need to be collected and
give direction to research process.
The conceptual framework used in this study is based on the general systems theory
which consists of input, throughput, output and feedback introduced by Von Ludwig
Bertanlanffy (1968). The present study is intended to assess the knowledge of the
mothers regarding the various familial concerns while caring for their mentally
According to the theory, a system is a group of elements that interact with one
another in order to achieve the goal. An open system depends on the quality and quantity
of the input, through put, output and feedback. The input consists of information, material
or energy that enters the systems, after the input is observed by the system. It is processed
in a way useful to the system. This information is called throughput. The output of a
system is any energy, matter or information given out by the system as a result of its
throughput and feed back is the mechanism by which some of the out put of a system is
returned to the system as input. In the present study these concepts can be explained as
follows.
10
Input
In the present study, input refers to ‘mothers of the mentally challenged children’
with demographic variables such as age, religion, education, occupation, monthly
income, type of marriage, type of family, number of normal children, number of mentally
challenged children, years of caring, previous knowledge and source of information are
considered as inputs.
Throughput
It is the action needed to accomplish the desired effect. In this study, throughput is
through the structured teaching programme which consist of various familial concerns of
the mothers of the mentally challenged such as definition, cause, signs and symptoms,
classification, home care, daily living skills, emotional needs, financial needs,
disciplining and behavior modification and prevention of further disability in the
Output
Output is the created product, energy or information that is transferred from the
system to the environment. The output in the present study consists of gain or rise in the
level of knowledge on various familial concerns among the mothers of the mentally
challenged children by post-test.
Feedback
Feedback is the information channeled back in to the system from environment
that describes the condition of the system. In this study, the feed back is not included .If
there is inadequate increase in the level of knowledge then the mothers can be again
given the structured teaching programme. Thus it is a continuous process, which takes
11
place in the system, and this in turn helps to gain adequate knowledge. The conceptual
frame of the study is depicted in figure 1.
12
THROUGHPUT / PROCESS OUT PUT
INPUT
Demographic characteristics • Development of
• Age structured
Adequate
teaching and
• Religion Knowledge
Interview
• Educational status Evaluation of
schedule.
• Occupation • Pilot study, effectiveness of STP Moderate
• Monthly income
Knowledge
reliability, (Post-test) by
• Type of marriage validity administering same
• Type of family • Assess Inadequate
structured interview Knowledge
• No: of normal children knowledge
schedule.
regarding
• Number of M.R
various familial
children
concerns of the
• Years of care
mothers of the
• Previous knowledge mentally
• Source of knowledge challenged
children by
pretest.
• Conducting STP
……..…………….……………………………………………………………
FEED BACK
..
Included in the study …………………………….not included in the study
Fig-1. Conceptual Frame Work
13
3. REVIEW OF LITERATURE
Review of literature provides a basis for future investigations, Justifies the need for
replication, throws light on the feasibility of the study, indicates constrains of data
collection and helps to relate the finding of one study to another. It also helps to establish
a comprehensive body of scientific knowledge in a professional discipline from which
valid and pertinent theories may be developed.19
Review of literature is a critical summary of research on a topic of interest
generally prepared to put a research problem in context or to identify gaps and weakness
on previous studies to justify a new investigation.20
The review of literature for the present study has been done from published articles,
textbook, reports, and med line search on the familial concerns of the mothers of the
mentally retarded children. The content of the literature is classified as follows:
• Literature reviews related to various issues with mentally retarded children.
• Literature reviews related to maternal stress in relation to the mentally challenged
children.
• Literature reviews related to maternal adaptation to the mentally challenged
children.
• Literatures related to structured teaching programme.
Literature Reviews Related to Various Issues With Mentally Retarded Children.
A study was conducted by the department of Preventive and Community Dentistry,
Darshan Dental College and Hospital, Udaipur, Rajasthan, India to understand the
determinants for oral hygiene and periodontal status among mentally disabled children
and adolescent. The aim of the study was to assess the impact of socio-demographic and
14
clinical variables on the oral hygiene and periodontal status in a sample of mentally
disabled subjects. Study sample comprised of 171 mentally disabled subjects attending a
special school in Udaipur, India. The conclusion highlighted that the oral hygiene and
periodontal status of the present study population is poor and was influenced by medical
diagnosis, IQ level, disabled sibling, parent's level of education and economic status.21
A study was initiated among 23 subjects to assess the positive clinical effects of
neuro feedback among the children with Trisomy 21 and other forms of mental
retardation. As many clinicians use neuro feedback in Attention Deficit Hyperactivity
Disorder and Generalized Learning Disability cases, the study proved that the outcomes
of a clinical case series using Quantitative EEG (QEEG) guided in neuro feedback the
treatment of mental retardation. The subjects were very poor in reading and some had
illegible handwriting, and most subjects had academic failures, impulsive behavior, and
very poor attention, concentration, memory problems, and social skills. Fourteen out of
23 subjects formerly took medications without any improvement. This study provided the
first evidence for positive effects of neuro feedback treatment in mental retardation. 22
In Netherlands, a research on emotional and behavioral problems in adolescents
with intellectual disability with and without chronic diseases was studied. Adolescents
with intellectual disability and adolescents with chronic diseases were both more likely to
have emotional and behavioral problems. The aim of this study was to assess the
association between chronic diseases in intellectually disabled and adolescents and
emotional and behavioral problems in a large school-based sample. 1044 students with
intellectual disability and adolescents, aged 12-18 years, attending secondary schools in
the Netherlands were considered. Results proved that rates of emotional and behavioral
15
problems were generally high in intellectually disabled-adolescents with chronic diseases
(45%), compared with intellectually disabled-adolescents without chronic diseases
(17%).The study showed that chronic diseases in Intellectually disabled adolescents, in
particular mental chronic diseases, largely increase the likelihood of emotional and
behavioral problems. This should be taken in the provision and planning of care for
intellectually disabled -adolescents.23
A study was developed at Utrecht University, in Netherlands to analyze behavior
problems in children with mild intellectual disabilities and borderline intelligence. A
clinical sample of 130 children with mild intellectual disabilities and borderline
intelligence receiving intramural treatment, main, moderating and mediating effects of
impulse control and aggressive response generation on aggressive behavior were
examined by conducting hierarchical linear multiple regression analyses. The results
showed that independent main effects of both impulse control and aggressive response
generation on aggressive behavior were found. Results also indicated that low impulse
control and aggressive response generation each explain unique variance in aggressive
behavior. They concluded that as this study is the first that has shown both impulse
control and aggressive response generation to be important predictors for aggressive
behavior in children with mild intellectual disabilities and borderline intelligence.24
An inter-relationship between adaptive functioning, behavior problems and level of
special education was studied in 186 children with IQs ranging from 61 to 70. The
objective was to increase the insight into the contribution of adaptive functioning and
general and autistic behavior problems to the level of education in children with
intellectual disability. Children from two levels of special education in the Netherlands
16
were compared with respect to adaptive functioning, general behavior problems and
autistic behavior problems. In the children with the highest level of mild intellectual
disability, adaptive functioning seems to be the most important factor that directly
influences the level of education that a child attends. Autistic and general behaviour
problems directly influenced the level of adaptive functioning. Especially, autistic
problems seemed to have restrictive effect on the level of adaptive functioning that
children did not reach the level of education that would be expected based on IQ.25
At Louisiana State University, USA a research study on the social skills deficits
and excesses were established to learn the relationship between social skills and
maladaptive behaviors. A number of studies demonstrated that the social competence of
individuals with mental retardation and co-morbid psychopathology could be enhanced
with social skills training. However, to design an effective training package, an accurate
assessment of adaptive and social functioning must first be conducted. Thus, they
concluded that a clinician must often rely on observable behavior and caregiver report
rather than self-report. The three most common methods for assessing social skills are
behavioral observations, role-playing, and checklists.26
At the University Of Cape Town, South Africa, a study with a sample of 355
children with intellectual disability attending special schools in Cape Town, South Africa
was organized. They aimed to assess the intellectually disabled children on the
Developmental Behavioral Checklist-Teacher Version. A prevalence rate of 31% for
psychopathology was found. Boys manifested more behavior problems than girls,
especially in relation to disruptive, self-absorbed and antisocial behaviors. Children with
severe and profound levels of intellectual disability showed more behavioral difficulties
17
than those in the mild and moderate categories. Epilepsy, but not cerebral palsy was
associated with higher total behavior scores. Ambulant children were more disruptive and
antisocial, while non-ambulant children were more anxious. Non-verbal children had
higher scores on all of the subscales except for disruptive behaviour.27
In Japan a study of cognitive development and behavior problems in mentally
retarded children was conducted. Cognitive development in seventy-one mentally
retarded children i.e. 19 autistic, 52 non-autistic; aged 7-19 years from a school for
handicapped children was studied. The study reported the relationship between cognitive
development level and behavior problems in mentally retarded children. In non-autistic
children, most behavior problems in feeding, elimination and sleeping, hyper kinesis,
hypo kinesis, stereotyped behaviors, self-injurious behavior and licking were closely
associated with cognitive development level, and were more often noted in children of
lower cognitive development level rather than only in the severely mentally retarded
children. Some behavior problems may often occur in the sensor motor period and hardly
occur in the symbolic representational period.28
Literature Reviews Related to Maternal Stress in Relation to the Mentally
Challenged.
A study was conducted on the issues that pediatricians faced with the difficult task
of providing management services to mentally retarded children and their families are
confronted with a number of difficult problems. These range all the way from deciding
how to inform parents that their child is retarded to dealing with grandparents who are a
source of stress. Successful handling of these problems requires recognition that
management is central to the care of the mentally retarded child. The study resulted with
18
stating that the needs of mentally retarded children and their families will not be met by
interacting with families only around issues of acute physical illness. Attention must be
directed toward psychosocial as well as medical variables and the emphasis must be on
the total family system.29
A structured interview survey was conducted in a major city in Taiwan to explore
and compare older and younger family primary caregiver’s well being and their future
care giving plans for the adults with intellectual disability. The sample size was 315
caregivers who were 55 years or older and who cared for adults with intellectual
disability and 472 similar caregivers who were under 55 years of age. The results
indicated that the older caregivers compared with younger ones reported a lower quality
of life, less family support, a more negative perception of having a family member with
intellectual disability, and greater worries about the future care arrangements of the adult
with intellectual disability. Statistical analysis showed that predisposing, enabling, and
need factors influenced the caregivers' future care giving options.30
In Canada, a study with The Family Quality of Life Survey 2006 was developed as
the result of increased interest in family quality of life among families with a member
who had an intellectual disability was carried out. The instruments included nine life
domains and six dimensions reflecting the main areas and characteristics of family
quality of life. The aim of the study was to provide a descriptive analysis of the domains
and dimensions of the survey and to explore their relationship to one another and to
global satisfaction. A convenience sample of 35 participants with a family member who
had an intellectual disability completed the “Family Quality of Life Survey 2006” in a
large urban centre in Canada. The data were analyzed using descriptive analyses. The
19
findings showed that although participants differentiated between different domains and
dimensions, as reflected in their variability, stability was also found. Moreover, they
highlight the need to examine each life domain according to its various dimensions.31
In China, Medical University Hospital at Taiwan explored caregiver's strain. The
relationship between social support and caregiver's strain and the predictors of caregiver's
strain among mothers with school-aged intellectually disabled children in Taiwan was
initiated. Cross-section correlation design was used and data collection consisted of face-
to-face interviews combined with a structured questionnaire. In total, 127 mothers
completed the questionnaire. Results showed that mothers with intellectually disabled
children had a rather high level of strain and received inadequate social support. Social
support and strain had a significant and negative correlation. Stepwise regression analysis
revealed that mothers' health status, social support and amount of time spent as a
caregiver, as well as the intellectually disabled children's dependent degree of daily living
activity, were major predictors of caregiver's strain, which accounted for 38.4% of the
total variance. The results provided a guide for healthcare professionals in designing
effective interventions and preventive care to reduce the level of strain in mothers with
intellectually disabled children.32
In USA, a study examined parent perspectives of transition for 128 young adults
with severe intellectual disability, specifically, parent satisfaction with transition. Results
suggested that transition satisfaction is related to young adult, family, and environmental
characteristics, with environmental characteristics being the strongest predictors of
transition satisfaction. Furthermore, transition satisfaction is related to multiple measures
20
of family well being, indicating the tremendous need for considering the broader family
system when planning for a young adult's transition.33
This study was aimed to estimate the extent to which differences in well-being in
parents of children with and without intellectual disability in Sweden can be accounted
for by differences in the presence of the risk factors like child disability, socioeconomic
disadvantage, household composition and parental characteristics. The results showed
that mothers of children with ID had lower levels of well-being than fathers and control
parents, but the presence of a child with ID did not in itself predict poorer maternal well-
being. Well-being of parents with a child with ID is dependent upon the interplay of risk
and protective factors and research needs to address these variables simultaneously.34
In Ireland, a study focused on the contributions of a community and campus based
day programme to the quality of life of programme participants with a severe level of
intellectual disability from the perspective of parents and staff. Qualitative interviews
were carried out with parents and staff to explore the contribution that the two
programmes had with the participants’ quality of life in the 6 months since the
community based programme began. Results indicated that the community based
programme contributed more to participants' quality of life over the preceding 6 months
than the campus based programme. This study revealed that community based
participants' new-found social roles, their hobbies and their work opportunities had a
positive effect on their quality of life.35
In Birmingham, a study examined predictors of excess psychological morbidity in
parents of children with intellectual disabilities. Thirty-two parents of children with
intellectual disabilities and 29 parents of typically developing children completed the
21
Hospital Depression and Anxiety Scale, and measures of social support, child problem
behaviors, sleep quality, and perceived caregiver burden. Results showed that parents of
children with intellectual disabilities registered high depression and anxiety scores, and
the majority met the criteria for possible clinical depression and/or anxiety. The strongest
predictor of psychological morbidity was caregiver burden. Caregiver burden, in general,
and its guilt component, in particular, predicted symptoms of depression and anxiety in
parents of children with intellectual disabilities. Assisting such parents to resolve their
feelings of guilt should benefit their psychological status.36
This study described the impact of having a sibling with Down syndrome or Rett
syndrome using a questionnaire completed by parents. The parents of 186 Western
Australian children with Down syndrome and 141 Australian girls and women with Rett
syndrome participated in the study. In the Rett syndrome group, families from outer
regional areas were the least likely to mention disadvantages and those with a smaller
family more likely to note disadvantages. In both groups, more socio-economically
advantaged families were more likely to report disadvantages. In the Down syndrome
group, benefits were also more commonly reported by parents who were socio-
economically advantaged, and by larger and two-parent families. The major
disadvantages for siblings were centered on parental and personal time constraints,
relationships and socializing, restrictions, parental emotion and burden of helping. Major
benefits were related to personality characteristics. They concluded by saying that parents
identified both benefits and disadvantages to the siblings of their child with either Rett
syndrome or Down syndrome.37
22
A study on the behavior problems in severely mentally handicapped children was
undertaken in two health districts. Prevalence figures for behavior problems were
presented. A stratified random sample of 200 families was drawn from the population.
Detailed structured interviews were carried out with the children's parents. The children
were divided into two groups, comprising those with behavior problems and those with
no problems. There was a significant association between behavior disorder and
incontinence, lack of self-help skills, poor reading, writing and counting skills, and poor
communication skills. The behavior problems were more common in one-parent families.
An association was found between maternal stress and problem behavior. The possible
mechanisms underlying this association are discussed.38
In Scotland, a study was done. Open-ended interviews were conducted with 12
people with a mental handicap who had left parental homes in order to live as tenants in
community residential hostels. Parents and hostel staff were also interviewed. The nature
of life in the family home, and the tenant's role in the move, reasons for leaving home and
expectations for the future were explored. It was found that social life, autonomy and
opportunities to develop self-help skills had been limited at home. The tenants who had
the widest social experience and the greatest use of self-help skills at home were the most
active in changing their situation. Tenants hoped to gain more freedom by leaving home,
although they were also in agreement with parents and staff about the value of learning
new skills.39
A comparative analysis was made of some familial and demographic characteristics
in 3 groups of mentally retarded patients with varying intensity of deficiency. The
hypothesis of different etiology of mild and severe mental retardation was confirmed.
23
Appreciable differences were found in the micro social characteristics in the intermediate
group of patients with marked debility. It was also found that certain characteristics were
similar to the gravest patients whereas in some others, to the group with mild grades of
intelligence it was underdeveloped. This fact can be accounted for by the heterogeneity of
the intermediate group.40
Literature Reviews Related to Maternal Adaptation to the Mentally
Challenged Children Care
A study was carried out in a governmental school for mentally disabled children in
El-Minia. Assessment for maternal adaptation and the relationship between maternal
socio demographic factors and adaptation as well as examining maternal distress was
carried out. Only 35.0% of the mothers adapted positively to their child's condition; and
62.9% of them had female children. Negatively adapted mothers were slightly older than
positively adapted mothers and had more children. The studies revealed that knowledge
of mothers about their child's condition significantly affected adaptation as well as the
dependency of children in eating, drinking and sleeping. Two-thirds of mothers had high
levels of psychopathology.41
A study was done in Karnataka Institute of Mental Health, Dharwad, and Karnataka
upon fathers and mothers of 628 mentally challenged individuals in order to assess their
perceived stress using Family Interview for Stress and Coping in Mental Retardation.
Results showed that mothers reported higher stress compared to fathers, the difference
being significant at 0.001 levels. Most of the parents report mild to moderate stress and
none of them reported very high stress. In the areas of care, emotional and social stress,
mothers reported higher stress and in the area of financial stress, both fathers and mothers
24
reported equal levels of stress. It was noticed that more than one mentally challenged
children in the family; higher levels of behavior disorder; lower age of the mentally
challenged individual and parents; and lower income of the family were associated with
higher stress.42
An exploratory study on the attitude of parents towards their mentally retarded
children: a rural area examination was undertaken in the department of psychology at
University of Zululand to help identify problem areas. The subject pool consisted of 62
parents of mentally retarded children in KwaZulu-Natal. In this study, it seemed parents
had feelings of embarrassment towards their mentally retarded children. Five themes
were drawn from the questionnaire and these included: love and acceptance, harassment,
frustration, disappointment and over-protection. Of the 13 fathers of mentally retarded
children 8 (62%) expressed positive attitudes towards their affected children and 5 (38%)
indicated negative attitudes. Forty four (90%) of mothers who had mentally retarded
children indicated positive attitudes and in 5 (10%) cases negative attitudes were
expressed. In conclusion, the present study found that parents in rural areas of Zululand
had positive attitudes towards their mentally retarded children.43
In the Child Guidance Clinic at the Institute of Psychiatry and Human Behaviour,
Goa, a study was carried out on the stress and anxiety in parents of the mentally
challenged from January 2000 to February 2001. 180 subjects were selected and
categorized into three groups: A, B and C.Group A consisted of 60 parents (30 mothers
and 30 fathers) of profound to moderately mentally retarded children (mean IQ: 38.63).
Group B consisted of 60 parents (30 mothers and 30 fathers) of mild to borderline
mentally retarded children (mean IQ: 63.2). Group C consisted of 60 parents (30 mothers
25
and 30 fathers) of physically healthy children with normal intelligence (mean IQ: 107.7)
from a city primary school. A semi-structured Performa was prepared for this study
which included specific variables and socio-demographic variables of the child. Parents
were then administered the Family Interview for Stress and Coping in Mental
Retardation. The parents were rated on a 5-point.The absence of stress was rated as zero
and a score of four was given for a very high level of stress. The study concluded that
demographic variables had an impact on parents in groups A and B as compared to those
in group C. Multifaceted factors had made these parents more vulnerable to stress than
parents in the control group. The high level of stress experienced by parents in group A
could be related to subjective factors such as a feeling of being restricted, social isolation
and dissatisfaction, and might have paved the way for the manifestation of anxiety
symptoms. 44
In India, at Varanasi, a study was conducted to assess the impact of level of mental
retardation of children on the perception of psychosocial problems and needs by parents
of mentally retarded children in providing care to them. The study was conducted on a
purposive sample of 100 parents (100 mothers and 100 fathers) of mentally retarded
children. These samples were collected from various clinics and hospitals having the
facility to provide treatment and care for mentally retarded children. The responses of
parents of mentally retarded children were recorded on structured questionnaire and
analyzed. Result of the research showed that the level of psychosocial problems faced by
the parents of mentally retarded children increased with the level of mental retardation of
the child. Parents of moderately retarded children registered more problems, in all
aspects, compared with parents having mildly retarded children.45
26
In the United Arab Emirates, a study was designed to identify predictors of parental
stress and psychological distress among parents of children with mental retardation. It
examined the relative contributions of child characteristics, parents’ socio-demographics,
and family environment to parental stress and psychological distress. Participants were
parents of 225 mentally retarded children, of whom 113 were fathers and 112 were
mothers. Measures of parental stress, psychiatric symptom index and family environment
scale were administered in an interview format. Hierarchical multiple regression was
used to predict parental stress and psychological distress. The results indicated that the
model containing all three predictor blocks, child characteristics, parent’s socio-
demographics, and family environment, accounted for 36.3% and 22.5% of parental
stress and parent’s psychiatric symptomatology variance, respectively. The age of the
child was significantly associated with parent’s feelings of distress and psychiatric
symptom status, and parental stress was less when the child was older. Parents reported
more psychiatric symptomatology when the child showed a high level of dysfunction. An
orientation toward recreational and religious pursuits, high independence, and intellectual
and recreational orientations were associated with lower levels of parental stress. On the
other hand, parents in achievement-oriented families showed elevated levels of parental
stress.46
In Lebanon, a cross-sectional study was designed to assess the predictors of coping
behaviors of 147 Lebanese parents (101 mothers and 46 fathers) with a child with
intellectual disability. It assessed the contribution of children and parent's characteristics,
informal social support, and stress on the coping behaviors of fathers and mothers.
Multiple regression analysis confirmed that the father's education, informal social
27
support, and stress were the best predictors of coping. The child's age, severity of illness,
and parental health did not significantly contribute to predicting coping behaviors. In
contrary to expectations, in a Middle Eastern culture, both fathers and mothers reported
similar levels of stress, perceived informal social support, and coping. The study ended
by saying that although informal social support cannot be forced on parents, health
professionals can mobilize resources that are culturally sensitive, such as home visitation
by nurses or support from other parents. 47
Reviews related to Structured Teaching Programme
In UK, a case study of the use of a structured teaching approach in adults with
autism in a residential home in Greece was conducted. Using interview questionnaires
and systematic naturalistic observations, this case study explored the effectiveness of the
training programme in the residence for the 12 adolescents and adults with autism, who
had never received any other intervention or training. The instruments used for the
evaluation were the Childhood Autism Rating Scale, the Vineland Adaptive Behavior
Scales and structured observations. The categories evaluated were personal
independence, social abilities and functional communication. After a period of 6 months
the results showed significant progress in these three areas of functioning for all of the
residents. 48
A study to assess the effectiveness of structured teaching programme on blood
transfusion among student nurses in selected nursing institutions at Raichur, was
conducted. A one group pre-test and post- test pre experimental design was adopted for
the study. A pre-test was conducted later, structured teaching programme was intervened
and again a post test was conducted to assess the effectiveness of structured teaching
28
programme after a group of 7 days. Results showed that in pretest, the mean score of the
sample was 23.45 and the post-test mean score was (SD= 6.48) with paired‘t’ value of
49.57. This showed that the structured teaching programme was effective in enhancing
the knowledge level of the sample regarding blood transfusion. There was a statistically
significant association found between the post-test knowledge score of the sample with
selected variables like gender, type of family and exposure to clinical experience. This
indicated a marked improvement in the knowledge level of participants.49
A quasi experimental study was carried out at rural health centre at South
Pitchavaram in Tamil Nadu. This study sought to assess the effectiveness of Structured
Teaching Programme (STP) regarding tobacco consumption among the subjects
attending Rural Health Centre (RHC) at south Pitchavaram in the year 2006- 2007 by
making comparison between pre-test and post-test among the subjects. Sixty subjects
who fulfilled the criteria were selected as samples and pre-test was conducted. After that
STP was given with appropriate audiovisual aids. After one month of STP, post-test was
conducted and data were analyzed. Out of 19 smokers about 6 (31.6%) had the highest
level of readiness to quit their behavior. Out of 28 tobacco chewers 15 (53.6%) had
highest level of readiness to quit their behavior of chewing tobacco. Outcome of the
study proved that there was significant increase in the level of knowledge, attitude, but
there was a significant reduction in the practice of the subjects between pre-test and post-
test. A positive relationship existed between knowledge and attitude level of the subjects
and the demographic variables.50
29
4. RESEARCH METHODOLOGY
This chapter deals with the description of methodology and different steps, which
were undertaken for gathering and organizing data for the investigation. It includes
description of research approach, research design, setting, sample and sampling
technique, development and description of tool, development of teaching strategies, pilot
study, data collection and plan for data analysis.
The rationale for choice of research approach, the tool, the setting, the sampling
technique, the pilot study, the data collection procedure and the plan of data analysis are
included in this chapter.
Research Approach
A research approach tells us to what data are to be collected and how to analyze it.
In view of the nature of problem selected for the study and the objectives to be
accomplished, an evaluative research approach was considered for the study.
Research Design
The research design is the plan for how the study will be conducted. It is concerned
with the type of data that will be collected and the means used to obtain this data.
The research design adopted for this study was a quasi experimental, one group
pre-test and post-test design, to measure the effectiveness of structured teaching
programme on a sample of 60 respondents.
30
Selected group Pre Test Intervention Post test
Selected mothers of Knowledge Structured teaching Knowledge
the mentally (O1) programme (O2)
challenged children (X)
Fig-2: Schematic outline of Research Design
The symbols used were described as
O1 : Pre-test knowledge of mothers of the mentally challenged children before
STP (intervention)
X : Teaching strategy on familial concerns while caring for mentally challenged
children.
O2 : Post-test knowledge of selected samples regarding the familial concerns
while caring for mentally challenged children after STP (Intervention).
31
Analysis
Sample and
Purpose Setting
Sample size
Assessing the Selected
60 mothers of
Knowledge special school
mentally
challenged.
Pre assessment Development of Sampling

Pre-test knowledge tool technique
on various familial Structured Simple random
concerns of the interview sampling technique
mentally challenged. schedule/STP
Intervention Post test Findings and

Conducting 45 mins assessment Analysis
planned structured discussion
teaching programme
Fig-3 -Schematic Representation of Research Design
32
Variables
Dependent variables: Knowledge of mothers of the mentally challenged children on the familial
concerns.
Independent variables: Structured teaching programme on familial concerns of the mothers of the
mentally challenged children
Demographic variables: Age, religion, education, occupation, income, type of marriage, type of
family, number of normal and mentally challenged children, number years of care, previous
knowledge, source of information.
Research Setting: The setting is the location where a study is conducted. This study was conducted
in St. Mary’s Snehalaya Opportunity School in Bangalore, Karnataka.
Population: Population refers to the aggregate or totality of all the objects, subjects or members that
conform to a set of specifications. In the present study the population comprised of mothers of the
mentally challenged children in selected special school in Bangalore, Karnataka. The total strength
of the school was 112 mentally challenged students.
Sample and Sampling Technique: Sample consists of a sub set of a population selected to
participate in a research study. Sampling is the process of selecting a group of people, event,
behavior or other elements with which to conduct a study. The sample for the present study
consisted of 60 mothers from selected special schools in Bangalore, Karnataka.
Sample size: Sample consisted of 60 mothers of the mentally challenged children attending the
special school.
Sampling Technique: In this study simple random sampling with lottery technique was used in
selecting 60 mothers.
33
Sampling Criteria
Inclusive Criteria
• Mothers who accompanied their children to the special school in Bangalore.
• Mothers who could speak or understand Kannada or English.
• Mothers who were the biological parent to the child.
Exclusive Criteria
• Mothers who were not available at the time of data collection.
• Mothers who were not able to communicate in Kannada or English.
• Mothers who were not willing to participate.
Data Collection Procedure
The word ‘Data’ means the information that is systematically collected in the course of the
study and the ‘method’ refers to the means of gathering the data. In the present study, the data was
collected by using the structured interview schedule.
Development of Tool
“Tool is the device or technique that a researcher uses to collect the data”. The tools act as a
best instrument to assess and collect the data from the respondents of the study. The instrument
selected in a research must be the vehicle that obtains the best data for drawing conclusions to the
study. In the present study structured interview schedule was selected and developed on the various
familial concerns that the mothers faced during the care for their mentally challenged child. In the
present study 35 items were prepared for structured interview schedule under six aspects as home
care, daily living skills, emotional areas, financial areas, disciplining and behavior, prevention.
The tool for the present study was developed by the investigator based on the following objectives:
• Review of related literature
• Consultation with the experts in the field of community health nursing
34
• Investigators personnel opinion.
A. Review Of Literature
The review of literature was included from text books, journals, articles, newspapers, reports,
and studies from internet. Researcher has included the studies related to issues with the mentally
retarded children, maternal stress, maternal adaptation to the various concerns and studies related to
effectiveness of structured teaching programme.
Description of the Tool
The structured interview schedule comprised of two sections:
Section A: Consisted of demographic data which included information of respondents about age,
religion, education, occupation, income, type of marriage , type of family, number of normal and
mentally challenged children, number years of care, previous knowledge, source of knowledge .
Section B: Consisted of 35 items of objective type questions related to knowledge on various
concerns on the care of the mentally challenged children. All the items were scored. Each correct
answer was given a score of 1 and wrong answers a score of 0. The scores ranged from a minimum
of ‘0’to a maximum score of 35.
Score Interpretation
The levels of knowledge had been classified based on the scores obtained:
• Inadequate knowledge (Up to 50 percent of scores)
• Moderate knowledge (51-74 percent of scores)
• Adequate knowledge (above 75 percent of scores )
Content Validity of the Tool
Validity refers to whether a measuring instrument accurately measures what it is supposed to
measure. Validity of the tool was established after consultation with ten experts from the fields like
community health nursing, psychiatric nursing expert and statistician. Minor modifications were
35
made on the basis of recommendations and suggestions of experts. After having consulted the guide
and the statistician, final tool was reframed. The final tool consists of (a) background information -
12 items (b) knowledge aspects-35 items, later the tool was edited by English language experts. A
person proficient in Kannada language translated the tool in to Kannada and another expert in the
same language computed its validity.
Preparation of Structured Teaching Programme
A first draft of structured teaching programme was developed keeping in mind the
objectives, structured interview schedule, literature review and the expert’s opinion. The main
factors that were kept in mind while preparing structured teaching programme was literacy level of
the mothers, method of teaching, simplicity of language, relevance of teaching aids and attention of
the mothers and their availability. The structured teaching programme was first drafted in English
and translated to Kannada.
Content Validity of Planned Structured Teaching Programme
The initial draft of structured teaching programme was given to experts who comprised of 6
Nursing experts, 1 psychiatric nursing expert, and 5 community health nursing expert and 1
statistician along with criteria of questionnaire. The experts were requested to validate the structured
teaching programme based on criteria of questions and to give suggestions on the adequacy and
relevance of content. There was 90% of agreement on meeting the criteria, 10 percent agreement on
partially meeting the criteria of the content commuted by the experts with suggestion. The
suggestion was accepted and this ensured the clarity and the validity of tool.
Preparation of the final draft of structured Teaching Programme
The final draft of structured teaching programme was prepared after incorporating expert
suggestions.
36
Description of Planned Structured Teaching Programme
The structured teaching programme was titled “familial concerns of mothers regarding the
care for their mentally challenged children”. It included, introduction, general and specific
objectives and references. The structured teaching programme was planned and prepared to enhance
the knowledge of mothers regarding the care for their mentally retarded children. It consists of the
following content area.
• Definition
• Causes
• Signs and symptoms
• Classification
• Home care
• Daily living skills
• Emotional areas
• Financial areas
• Disciplining and behavior
• Prevention
Translation of the STP
The teaching plan was translated to Kannada by the expert to determine the appropriateness.
Reliability of the tool
Reliability of research instrument is defined as the extent to which the instrument yields the
same results on repeated measures.
The tool after validation was subjected to test for its reliability. Reliability of the tool was
established from the data of 10 samples by using split half method. This was done by splitting the
items into odd and even items. Odd items were considered X and even items were considered Y.
37
Using these values the correlation co-efficient was computed and the reliability was obtained for the
tool as r = 0.8, since the computed correlation of knowledge score was high; the tool was found to
be reliable for the study.
Pilot Study
Pilot study is a small preliminary investigation of the same general characters
as the major study, which is designed to acquaint the researchers with the problem
that can be corrected in preparation for a larger project.
10 mothers were selected randomly for pilot study. After having obtained formal
administrative approval, a pilot study was conducted for a week’s time. On 2.11.2011 the mothers
were introduced with the whole programme after the self introduction. A written consent was taken
for their willingness to participate in the study. Then the pre-test was conducted with structured
interview schedule on knowledge of the mothers on the familial concerns of the mentally challenged
children. After 50 minutes the questionnaire was collected. Then the structured teaching programme
on the familial concerns of the mentally challenged children was administered for 45 minutes with
A.V aids. After a period of 7 days i.e. on 9.11.2011, post test was conducted by the same structured
interview schedule on knowledge. The respondents who were selected for the pilot study were
excluded from the main study.
The objectives of the pilot study
1. To Evaluate the effectiveness of Structured teaching programme
2. To find the feasibility of conducting the final study
3. To determine the method of statistical analysis.
The investigator did not face any significant problem and the planned structured teaching
programme was found feasible in terms of improved knowledge and understanding by getting
relevant feedback on questions asked.
38
Procedure for Data Collection and Implementation of Planned Structured Teaching
Programme in Main Study
Data collection is the gathering of information needed to address a research problem. The
investigator collected the data’s from St Mary’s Snehalaya Opportunity School in Bangalore on 12th
of November 2011. Prior permission was taken from the Headmistress. The main study was planned
for a period of 4 weeks that is 12th of November 2011 to 6th of December 2011. Initially investigator
approached each individual visiting the school with the permission from the headmistress. Total of
112 mothers were there in the school. Among them 60 were selected with the simple random
sampling technique (lottery method).
Phase I: The mothers were introduced with the whole programme after the self introduction then
written consent was taken for their willingness to participate in the study.
Phase II: The pre-test was conducted by distributing the structured interview schedule on
knowledge of the mothers on the familial concerns of the mentally challenged children. After 50
minutes the questionnaire was collected. Then the structured teaching programme on the familial
concerns of the mentally challenged children was administered for 45 mins with A.V aids.
Phase III: After seven days the post test was done on the same 60 mothers by using the structured
interview schedule on knowledge of the mothers on the familial concerns of the mentally challenged
children. All the subjects were very cooperative and the investigator expressed her gratitude for their
cooperation and expressed their desire to know more.
Plan for Analysis of Data
The data obtained was planned to be analyzed on the basis of the objectives and hypothesis
of the study by using descriptive and inferential statistics.
39
Descriptive Statistics
Frequency and percentage distribution were used to study the demographic variables of the
mothers of the mentally challenged children like age, religion, education, occupation, income, type
of marriage ,family, number of normal and mentally challenged children, number years of care,
previous knowledge, source of knowledge .
• Mean, mean percentage, standard deviation of pre-test and post-test scores were used to
determine the level of knowledge of the mothers of the mentally challenged children.
• Distribution of the scores of knowledge regarding various familial concerns of the mothers
are interpreted by summarizing in three categories such as inadequate, moderate and
adequate.
Inferential Statistics
• Paired t test was used to determine the effectiveness of structured teaching programme on
the knowledge of the mothers of the mentally challenged children.
• Chi-square was used to find out the association between the pre-test levels of knowledge of
the mothers on the familial concerns of the mothers of the mentally challenged children with
the selected demographic variables.
Ethical Consideration
For the current study the investigator took the ethical issues. There were no ethical issues
confronted while conducting the study.
• The study was approved by the research committee and formal permission was taken from
the Head of the Institution.
• Prior information was obtained from the School authorities to conduct the study.
• Informed consent was obtained from the mothers.
• The subjects were informed that their participation was purely on the voluntary basis & they
can withdraw from the study at any time.
40
5. RESULTS
The data themselves do not provide us with the answers to our research questions. In order to
meaningfully answer to the research questions, the data must be processed, analyzed systematically
and arranged orderly in a coherent fashion so that pattern and relationship can be designed.
Statistical analysis is a method of rendering quantitative information and elicits meaningful and
intelligible form of research data. Analysis is the process of organizing and synthesizing data so as
to answer to research questions and test hypothesis. Kerlinger (1976) has defined analysis as
categorizing, ordering, manipulating and summarizing of data to obtain answers to research
hypothesis questions.
An evaluative research approach was adopted to assess the knowledge of mothers of the
mentally challenged children on the various familial concerns as they care for their mentally
challenged children. The data collected from the mothers were tabulated, analyzed and interpreted
by using descriptive and inferential statistics. The analysis and interpretation was based on the data
collected and the objectives of the study.
Objectives of the Study
among the mothers of the mentally challenged children.
41
3. To assess the effectiveness of structured teaching programme to the mothers of the
mentally challenged children on the various familial concerns by conducting post-test.
4. To find out the association between the pre-test knowledge scores of the mothers with
Presentation of Data and Analysis
The Data are Organized and Presented in the Following Sections
Section 1: Data on the demographic variables of the mothers of the mentally challenged children on
the various familial concerns.
Section 2: Assess the level of knowledge of mothers of the mentally challenged children on the
various familial concerns before and after the STP.
Section 3: Association between knowledge level and demographic variables of the mothers of the
mentally challenged children on the various familial concerns.
42
Target Population
All the mothers of the mentally challenged children in selected specials schools in
Bangalore as per the inclusive and exclusive criteria
Sampling & Sample size
Simple random sampling & n=60
Demographic Knowledge on the familial Knowledge on the

Data’s familial concerns of the
concerns of the mothers of the
Of the mothers of the mothers of the mentally
mentally challenged mentally challenged children challenged children
children after STP
before STP
Chi-square test Mean, SD, mean % and

paired t-test
Results & Discussion
Figure 4: Schematic representation of research and analysis
43
SECTION:1
Description of demographic variables of mothers of the mentally challenged children.
Table-1-(1): Frequency and percentage distribution of demographic variables such as age,
religion, educational status, occupation, monthly income.
n=60
Sl.No Demographic Variables No %
a. 18-28 years 6 10
Age of the mother b. 29-38 years 13 21.67

1
c. 39 and above 41 68.33
a. Hindu 16 26.67
b. Christian 15 25.00
Religion
c. Muslim 29 48.33
2
d. Any other (Specify) 0 0.00
a. Illiterate 0 0.00
b. Primary 7 11.67
3
Educational status
c. Higher secondary 31 51.67
d. Graduate and above 22 36.67

a. Government 2 3.33
b. Private 24 40.00
4 Occupation c. Home maker 32 53.33
a. Below 2000 5 8.33
b. 2001—4000 16 26.67
5
Monthly Income (in Rs)
c. 4001—6000 28 46.67
d. 6001 and above 11 18.33
44
Table-1.1: Frequency and percentage distribution of demographic variables
• According to the age the majority 41 (68.33%) mothers were in the age group of 39years and
above, 13 (21.67%) were in the age group of 29-38 years and 6 (10%) were in the age group
of 18-28years.
• With regard to religion 29 (48.33%) were Muslims, 16 (26.67%) were Hindus and lastly 15
(25%) were Christians.
• According to the educational status the mothers with primary education were 7 (11.67%), 22
(36.67%) were graduate and above, and 31(51.67%) were with higher secondary
qualification. None of them were illiterate.
• According to the occupation the majority 32 (53.33%) were home makers, 24 (40%) were
working in Private sectors, and 2 (3.33%) mothers were engaged in government and other
works respectively.
• According to the monthly income majority mothers 28 (46.67%) had an income of Rs 4001-
6000/-,16 (26.67%) had an income of Rs 2001-4000/-,11 (18.33%) had an income of Rs
6001 and above, and 5 (8.33%) of mothers had an income below Rs 2000/-
45
80%
68.33%
70%
60%
50%
P erc entag e
40%
30%
21.67%
20%
10%
10%
0%
Ag e
18‐28 29‐38 39 and above
Graph 1:Percentage distribution of mothers of the mentally challenged children according to
age
Graph 2:Percentage distribution of mothers of the mentally challenged children according to
religion
46
51.67%
60%
50%
36.67%
40%
P erc entag e 30%
20% 11.67%
0%
10%
0%
Illiterate P rimary Higher G raduate
S ec ondary and above
E duc a tion
Graph 3: Percentage distribution of mothers of the mentally challenged children according to

educational status
occupation
47
46.67%
26.67%
18.33%
8.33%
B elow 2000
2001‐4000
4001‐6000
6001 and above
INC OME (in R s.)
income.
48
Table-1.1a: Frequency and percentage distribution of demographic variables such as type of
marriage, type of family, number of normal children, number of mentally challenged children,
years of caring, previous knowledge and its source.
n=60
a.Unconsangious marriage 44 73.33

6 Type of Marriage
b.Consangious marriage 16 26.67
a. Nuclear family 26 43.33
b. Joint family 30 50.00
7 Type of family
c. Single parent 4 6.67
a.1 14 23.33
Number of normal b.2 21 35.00
8.
children c. 3 18 30.00
d. 4 and above 7 11.67
a. 1 50 83.33
Number of mentally b. 2 7 11.67
9
challenged children c. 3 2 3.33
d. 4 and above 1 1.67
How long have you a. 1-5 years 4 6.67
been caring for this/
10 b. 5-10 years 17 28.33
these children
c. 10 and more years 39 65.00
Do you have any
previous knowledge a. Yes 27 45.00
11 in the care of
mentally challenged
b. No 33 55.00
children?
If yes, Source of a. Mass Media 2 7.41
12 previous knowledge b. Special School 14 51.85
c. Health personnel 11 40.74
49
Table-1.2 depicts the frequency, percentage distribution of demographic variables.
• With regard to type of marriage out of the 60 mothers 44 (73.33%) were of unconsangious
marriage and 16 (26.67%) were of consangious marriage type.
• As per type of family the majority 30 (50%) were from the joint family, 26 (43.33%) were
from nuclear family, and 4 (6.67%) were single parents.
• According to the number of normal children out of the 60 mothers 21(35%) respondents
had 2 normal children, 18 (30%) had 3 normal children and 14 (23.33%) had 1 normal child
and finally 7 (11.67%) had 4 and more normal children in their houses.
• According to the number of the mentally challenged children, 50 (83.33%) of the mothers
had 1 mentally challenged child and 7 (11.67%) had 2 mentally challenged children, 2
(3.33%) had 3 mentally challenged children and only 1 (1.67%) had 4 and more mentally
• As per the years of care to mentally challenged children majority mothers 39 (65%) had
more than 10 years of experience and 17 (28.33%) had 5-10 years experience and 4 (6.67%)
had 1-5 years of experience.
• According to the previous knowledge among the mothers in the care of the mentally
challenged child 27 (45%) said yes and 33 (55%) said they had no previous knowledge about
the care for the mentally challenged children.
• With regard to the source of previous knowledge special schools played the major source of
knowledge 14 (51.85%) and health personnel with 11 (40.74%) and mass media with 2
(7.41%).
50
type of marriage

type of family
51
the number of normal children.
90%
83.33%
80%
70%
60%
P erc entag e
50%
40%
30%
20%
11.67% 1.67%
10% 3.33%
0%
1 2 3 4 and above
Num be r of m e nta lly c ha lle ng e d c hildre n

the number of mentally challenged children
52
Y ears of C aring
70% 65.00%
60%
50%
P erc entag e
40%
28.33%
30%
20%
10% 6.67%
0%
1‐5 yrs 5‐10 yrs 10 and more yrs
the years of caring
Graph 11: Percentage distribution of mothers of the mentally challenged children
according to the previous knowledge
53
the source of knowledge
54
Section:2
Knowledge scores among the mothers of the mentally challenged children before and after
structured teaching programme.
Table-2.1 Percentage and frequency distribution of the pre-test level of knowledge on the
mothers regarding the familial concerns of the mentally challenged children.
n=60
No of Respondents
Level of knowledge Score
No %
Inadequate < 50% 52 86.7
Moderate 50-75% 08 13.3
Adequate > 75% 0 0
The above table depicts the scores relating to the pre-test level of knowledge among 100%
(60) mothers of the mentally challenged children. Majority 52 (86.7%) of mothers of the mentally
challenged children had inadequate knowledge, 8(13.3%) of mothers of the mentally challenged
children had moderate knowledge and 0% (0) had adequate level of knowledge about the familial
concerns of mentally retarded children.
55
Graph 13: Percentage and frequency distribution of the pre-test level of knowledge of the
56
Table-2.1a Mean, SD and Mean% knowledge on the familial concerns among the mothers of
the mentally challenged children through pre-test.
n=60
Max Max
Domain Range Mean SD Mean%
Statement Score
Pre-test
35 35 2-12 5.37 2.12 15.34
knowledge
The above table represents the Mean, Standard deviation and Mean percentage knowledge
on the familial concerns among the mothers of the mentally challenged children through pre-test. It
revealed that the knowledge on the familial concerns at the pre-test level had a range 2-12, a mean
of 5.37 with standard deviation of 2.12 and mean percentage as 15.34%.
16 15.34
14
12
10
8
5.37
6
2.12
4
2
0
Pre-test Mean SD Mean %
knowledge
Graph 14: Mean, SD and Mean% knowledge on the familial concerns among the mothers of
the mentally challenged children through pre-test
57
Table-2.2 Percentage and frequency distribution of the post-test level of knowledge on the
mothers regarding the familial concerns of the mentally challenged children
n=60
No of Respondents
Level of knowledge Score
Frequency Percentage
Inadequate < 50% 0 0
Moderate 50—75% 42 70
Adequate > 75% 18 30
The above table depicts the scores relating to the post-test level of knowledge among 60 (100%)
mothers after education about the various familial concerns of the mentally challenged children. The
test results showed enormous improvement in levels of knowledge regarding the familial concerns
among the mothers. Majority 42 (70%) of the mothers of the mentally challenged children had
moderate level of knowledge, 18 (30%) of mothers had adequate level of knowledge and 0 (0%) had
inadequate level of knowledge about the familial concerns of the mentally challenged.
58
70%
70%
60%
50%
Percen tag e
40% 30%
30%
20%
10% 0%
0%
Inadequate (< 50%) Moderate (50-75%) Adequate (> 75%)
Post-test
Graph 15: Percentage and frequency distribution of the post test level of knowledge on the
59
Table-2.2a Mean, SD and Mean% knowledge on The Familial Concerns among the Mothers
of the Mentally Challenged Children through Post-Test.
n=60
Max
Domain Max Score Range Mean SD Mean%
Statement
Post-test knowledge 35 35 18-34 23.95 4.32 68.43
The above table represents mean, SD and mean% knowledge on the familial concerns among
the mothers of the mentally challenged children through post-test. It revealed that their was a
tremendous improvement in the level of knowledge among the mothers on the familial concerns
which is proved by the post test scores showing a range of 18-34, mean of 23.95, standard deviation
of 4.32 and mean percentage of 68.43%.
60
70 68.43
60
50
40
23.95
30
20 4.32
10
0
Post-test Mean SD Mean %
knowledge
Graph 16: Mean, SD and Mean% knowledge on the familial concerns among the mothers of
the mentally challenged children through post -test
61
Examining the Effectiveness of STP
2.3a: Comparison between Pre and Post-Test knowledge on the Familial Concerns
among the Mothers of the Mentally Challenged Children
n=60
Pre test Post test

Level of knowledge
No % No %
Inadequate 52 86.7 0 0
Moderate 8 13.3 42 70
Adequate 0 0 18 30
The above table depicts the score of relating to level of knowledge among the 60 (100%)
population. Of which mothers have the several levels of knowledge at the pre-test level.86.7% (52)
of the population have inadequate knowledge 13.3% (8) have moderate knowledge and 0% (0) have
adequate knowledge about the familial concerns of the mentally challenged children. After the
education about the familial concerns of the mentally challenged children, the test results have
shown enormous improvement in one’s level of knowledge about the familial concerns of the
mentally challenged children.70% (42) of population have moderate level of knowledge and 30%
(18) of population have adequate level of knowledge and 0%(0) had inadequate knowledge about
the familial concerns of the mentally challenged children.
62
Pre-test, 86.7%
Post-test, 70%
90%
80%
70% Post-test, 30%
60%
Percen tag e
50%
40% Pre-test, 13.3%
30% Post-test, 0%
Pre-test, 0%
20%
10%
0%
Inadequate Moderate Adequate
Graph 17: Comparison between pre and post test knowledge on the familial concerns among
the mothers of the mentally challenged children
63
Table 2.3b: Paired “t” test showing the significance of difference between the pre-test and
post-test mean knowledge scores and statistical significance in the mothers on the familial
concerns of the mentally challenged children.
n=60
Sl.No Paired ‘t’

Domain Range Mean SD Mean%
test
1 Pre-test knowledge 2-12 5.37 2.12 15.34 31.14**
2 Post test knowledge 18-34 23.95 4.32 68.43 31.14**
3 Enhancement 7-29 18.58 4.62 53.09 31.14**
Note: **significant at p<0.01 level, df 59
The above table 2.3b revealed the range, mean, and mean percentage, SD, mean, enhancement
and paired “t” value of knowledge score among mothers on the familial concerns of the mentally
challenged children in pre-test and post-test levels. In the post-test, scores were, range was 18-34,
mean value was 23.95, mean percentages were 68.43% and SD was 4.32. The values in the pre-test
showed, range as 2-12, mean as 5.37, mean percentage as 15.34% and SD as 2.12 and the
enhancement between pre-test and post-test range was 7-29, mean was 18.58, mean percentage was
53.09% and the SD was 4.62. The observed “t” value was 31.14 which showed greater than the
0.01% level. It was highly significant at p<0.01.
64
0.7 Post-test, 68.43%
Enhancement,
0.6 53.09%
0.5
0.4
Mean Percentage
0.3
Pre-test , 15.34%
0.2
0.1
0
Pre-test Post-test Enhancement
Knowledge
Graph 18: Paired “t”test showing the significance of difference between the pre-test and post-
test mean knowledge scores and statistical significance of the mothers on the familial concerns
of the mentally challenged children.
65
Hypothesis Testing
In order to evaluate the effectiveness of structured teaching programme on knowledge of the
subjects of the sample, research hypothesis was formulated.
Research hypothesis -1
H1: There is significant difference between pre-test and post-test knowledge of the mothers
regarding the familial concerns about the various aspects of care of the mentally challenged
children.
Inference: This study provides evidence (Table No: 2.3a and 2.3b) that the structured teaching
programme is significantly effective on improving the knowledge regarding the familial concerns of
the mothers while caring for the mentally challenged children. So the research hypothesis is
accepted.
66
SECTION: 3
Section 3: Association between pre-test knowledge scores with their selected demographic
variables of mothers of the mentally challenged children.
Table 3.1a: Association between the pre-test knowledge on familial concerns of the mothers
with the selected demographic variables such as age, religion, education, occupation, monthly
income.
n=60
Level of Knowledge
Sl.No Demographic Variables No % <Median ≥Median Chi-square

(27) (33)
No % No %
Age of the mother
6 10 4 14.8 2 6.1 9.4*
a. 18--28 years
1. df =2
b. 29--38 years 13 21.67 10 37.0 3 9.1 S
c. 39 and above 41 68.33 13 48.1 28 84.8
Religion
a. Hindu 16 26.67 8 29.6 8 24.2
0.33
2. b. Christian 15 25.00 7 25.9 8 24.2
df =2
c. Muslim 29 48.33 12 44.4 17 51.5
NS
d. Any other(Specify 0 0.00 0 0.0 0 0.00
Educational status
a. Illiterate 0 0.00 0 0.0 0 0.0
3.7
3. b. Primary 7 11.67 5 18.5 2 6.1
df=2
c. Higher Secondary 31 51.67 15 55.6 16 48.5
NS
d. Graduate and above 22 36.67 7 25.9 15 45.5
Occupation
a. Government 2 3.33 0 0.0 2 6.1
9.5*
4. b. Private 24 40.00 15 55.6 9 27.3
df =3
c. Homemaker 32 53.33 10 37.0 22 66.7
S
d. Any other (Specify) 2 3.33 2 7.4 0 0.0
Monthly income (in Rs.)
a. below 2000 5 8.33 3 11.1 2 6.1
5. 2.1
b. 2001-4000 16 26.67 7 25.9 9 27.3
df=3
c. 4001-6000 28 46.67 14 51.9 14 42.4
NS
d. 6001 and above 11 18.33 3 11.1 8 24.2
N.S- Not significant *S- Significant at p<0.05 level

67
Table 3.1a: Showed the association between selected demographic variables and pre-test knowledge
of the mothers of the mentally challenged children. In relation to the age and occupation the chi-
square value obtained was 9.4 and 9.5 respectively which showed significance at p<0.05 levels (df:
2, tabled value: 5.99).
In relation to the variables religion, educational status and monthly income it did not show any
association with the level of knowledge and hence, there is no significant association of pre-test
level of knowledge with the demographic variables.
68
Table 3.1b: Association between the pre-test knowledge of the mothers with the selected
demographic variables
n=60
Level of Knowledge
<Median ≥Median
Sl.No Demographic Variables No % Chi-square
(27) (33)
No % No %
Type of Marriage 0.49
6. a.Unconsangious marriage 44 73.33 21 77.8 23 69.7 df 1
b.Consangious marriage 16 26.67 6 22.2 10 30.3 NS
Type of family
a. Nuclear family 26 43.33 14 51.9 12 36.4
1.7
7. b. Joint family 30 50.00 11 40.7 19 57.6
df 2
c. Single parent 4 6.67 2 7.4 2 6.1
NS
d. Any other (Specify) 0 0.00 0 0.0 0 0.0
Number of normal
children
a.1 14 23.33 11 40.7 3 9.1
8. 8.5*
b.2 21 35.00 8 29.6 13 39.4
df 3
c. 3 18 30.00 6 22.2 12 36.4
S
d. 4 and above 7 11.67 2 7.4 5 15.2
Number of mentally
challenged children
a. 1 50 83.33 24 88.9 26 78.8
9. 2.6
b. 2 7 11.67 3 11.1 4 12.1
df 3
c. 3 2 3.33 0 0.0 2 6.1
NS
d. 4 and above 1 1.67 0 0.0 1 3.0
How long have you been
caring for this/ these
10. children
a. 1-5 years 4 6.67 2 7.4 2 6.1 2.2
b. 5-10 years 17 28.33 10 37.0 7 21.2 df 2
c. 10 and more years 39 65.00 15 55.6 24 72.7 NS
Do you have any previous
knowledge in the care of
mentally challenged
11. children?
a. Yes 27 45.00 5 18.5 22 66.7 13.9*
df
b. No 33 55.00 22 81.5 11 33.3 S
If yes, Source of previous
knowledge
12. a. Mass Media 2 7.41 2 28.6 0 0.0 6.7*
b. Special School 14 51.85 2 28.6 12 60.0 df 2
c. Health personnel 11 40.74 3 42.9 8 40.0 S
N.S- Not significant *S- Significant at p<0.05 level
69
Table 3.1b: Represents association between the pre-test knowledge on familial concerns of the
mothers and the selected demographic variables such as type of family, type of marriage, number of
normal children, number of mentally challenged children, years of caring, previous knowledge and
source of knowledge.
In relation to the variables; number of normal children, previous knowledge and source of
previous knowledge, the chi-square value obtained was 8.5, 13.9 and 6.7 respectively which showed
significance at p<0.05 levels.
The chi-square value of demographic variables such as type of family, type of marriage,
number of mentally challenged children, and years of caring, did not show statistical significance in
association with the pre-test level of knowledge at 5% level of significance.
Research Hypothesis-2
H2: There is significant association between pre-test knowledge scores with their selected
demographic variables of the mothers of the mentally challenged children.
The results of Chi-square analysis presented in the table 3.1a and 3.1b indicated that there
was significant association between knowledge score with the age, occupation, number of normal
children, previous knowledge and source of knowledge. The remaining variables were not
significant. So, the research hypothesis is accepted.
70
6. DISCUSSION
The present study was conducted to evaluate the effectiveness of structured teaching
programme on knowledge of mothers on the familial concerns of the mentally challenged children.
In order to achieve the objectives of the study, one group pre-test and post-test design with quasi
experimental approach was adopted. Simple random sampling technique was used to select the
sample. The data was collected from 60 mothers of the mentally challenged children before and
after the structured teaching programme by structured interview schedule. The findings of the study
are discussed with reference to the objectives, hypothesis, review of literature and conceptual
framework.
Characteristics of Demographic Variables of the Mothers of the Mentally Challenged
Children
Table-1.1 depicts the frequency, percentage distribution of population. According to the age of
the mothers, majority of samples 41 (68.33%) were in the age group of 39 years and above, almost
29 (48.33%) were Muslims, 31 (51.67%) were educated with higher secondary qualification, most
32 (53.33%) were homemakers, majority 28 (46.67%) were incurring a monthly income between
Rs. 4001 to Rs. 6000.
Table-1.2 depicted that majority of the mothers of the mentally challenged children 44
(73.33%) were from the unconsangious type of marriage, most 30 (50%) came from the joint family,
21 (35%) had 2 normal children in their houses,50 (83.33%) had 1 mentally challenged children,39
(65%) had been caring for the children for more than 10 years,33 (55%) said that they did not have
any previous knowledge about the care of the
71
mentally challenged children, majority 14 (51.85%) said to have gained the knowledge from the
schools.
The first objective was to assess the existing knowledge on the familial concerns among
the mothers of the mentally challenged children before administering structured teaching
programme regarding the familial concerns of the mentally challenged children.
As represented in table 2.1 the level of knowledge was assessed and depicted in figures and
tables. Out of 60 mothers of the mentally challenged children, assessment of level of knowledge in
the mothers revealed that majority 52 (86.7%) mothers had inadequate knowledge and few 8(13.3%)
had moderate knowledge.
The mean and standard deviation of knowledge of the mothers of the mentally challenged
depicted in the table 2.1 revealed that mean score was 5.37 and the SD was 2.12 and the mean
percentage was 15.34%
A similar study was done by Mafullul YM on burden of mothers of mentally retarded elders in
Lancashire. The objectives was to compare the burden of supporting mentally retarded elders in an
English community; to determine the prevalence of emotional distress in carers and to investigate
the relationship between carer well being and duration of care giving. A cross-sectional study of
mothers of the elderly was referred to a psycho geriatric service, using a questionnaire investigating
carer socio-demography, carer-dependant interpersonal relationship in relation to care giving and
care-recipient dependency needs using a modified version of the CADI; and, the 28-item GHQ. The
results showed that 91 (72%) mothers of mentally retarded elders participated
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in the study. Carers (n=48) experienced significantly more burden, including psychological and
physical health problems than carers (n = 43) of the non-retarded elders (P = 0.001). The prevalence
of emotional distress in all carers was 42% (M.R supporters = 56%, non-M.R supporters = 26%).
Emotional distress in supporters was directly related to the degree of difficulties (particularly lack of
private time, loss of control in care giving tasks, patient behavioral problems) experienced in care
giving, and, the degree of dependency needs. Carer interpersonal relationship tended to worsen as
care giving progressed; however, no significant association was established between duration of care
and emotional distress in carers. Out of 51 carers receiving respite admission services, six (12%)
considered such admissions as additional burden. In conclusion the mothers burden of the M.R
elders care were, including psychological and physical health concerns, was comparatively greater
than in carers of the non-M.R elders. Respite care services although beneficial to most care givers,
may constitute further burden to some. To ameliorate carer burden, measures enabling greater
availability of private time, and, improving care giving skills, should be encouraged.51
The Second Objective was to Assess the Effectiveness of Structured Teaching
Programme Regarding the Familial Concerns of the Mothers on the Care of the Mentally
Challenged Children.
The distribution of mothers of the mentally challenged children according to the level of
knowledge as described in the table -2.2b showed that in post test, majority of the subjects had 42
(70%) moderate knowledge and 18 (30%) had adequate knowledge where as knowledge at the pre-
test level 52 (86.7%) mothers had inadequate knowledge, 8 (13.3%) had moderate knowledge and 0
(0%) had adequate knowledge about the
73
familial concerns of the mentally challenged children. This indicates that second objective to assess
the effectiveness of structured teaching programme regarding the familial concerns of the mothers
on the care of the mentally challenged children proved effective.
Comparison of the mean, standard deviation and mean difference of knowledge scores of pre-
test and post test in tables 2.3a revealed that the obtained post-test mean value 23.95 was higher than
the pre-test mean value 5.37. The mean difference between the post-test and pre-test mean value was
18.58 and the obtained paired “t” test value was 31.14.The observed “t” value is 31.14 which are
greater than the 0.01% level. It was highly significant at p<0.01 as shown in table 2.3b.
Therefore, Hypothesis H1 as stated “There is significant difference between pre-test and post-test
knowledge of the mothers regarding the familial concerns about the various aspects of care of the
mentally challenged children.” was accepted.
This study was supported by the study of Bilgin S on reducing burnout in mothers with an
intellectually disabled child: an education programme. This study was conducted to examine the
effect of participating in an education program on burnout for mothers of children with an
intellectual disability. The intervention group participated in an interactive education programme for
1 hour, in addition to using an educational booklet designed and presented by the researchers. The
control group received the same intervention separately after completing the post-test. Intervention
group members reported fewer episodes of emotional burnout compared to the control group,
indicating that participation in a nursing education programme reduced the level of burnout
experienced by mothers who have an intellectually disabled child. Nurse-administered
74
education should be provided for mothers who have an intellectually disabled child in order to
reduce the degree of emotional burnout that these mothers typically experience.55
Hence the research hypothesis H1 which stated that the mean post test knowledge score of the
mothers of the mentally challenged children is significantly higher than the mean pre-test knowledge
scores. Thus the hypothesis was accepted.
The Third Objective was to Assess the Effectiveness of Structured Teaching
Programme by Conducting Post-test among the Mothers of the Mentally Challenged Children.
The table 3.1a showed the association between selected demographic variables and pre-test
knowledge of the mothers of the mentally challenged children. In relation to the age and occupation
the chi- square value obtained was 9.4(df:2) and 9.5(df:3) respectively which showed significance at
p<0.05 levels.
In relation to the variables that did not show significance were religion, educational status and
monthly income and they did not show any association with level of knowledge. Hence, there is no
significant association of pre-test level of knowledge with these demographic variables.
Table 3.1b showed the association between the pre-test knowledge on familial concerns of the
mothers and the selected demographic variables such as type of family, type of marriage, number of
normal children, number of mentally challenged children, years of caring, previous knowledge and
source of knowledge.
75
In relation to the variables number of normal children, previous knowledge and source of previous
knowledge, the chi square value obtained were 8.5, 13.9 and 6.7 respectively which showed
significance at p<0.05 levels.
The chi-square value of demographic variables such as type of family, type of marriage,
number of mentally challenged children, and years of caring, did not show statistical significance in
association with the pre-test level of knowledge at 5% level.
A similar study was done by P Kapoor on the mothers of 80 children of mild (IQ 50-70) and
moderate (IQ 35-49) mental retardation. A carefully developed home training programme was
utilized to train half of the mothers, the other half forming the control group for the study. The
experimental and the control groups were matched for age and IQ of the children, and age of the
mothers. In the experimental group there was a significant increase in the IQ and improvement in
the behavior of the children and significant improvement in the marital adjustment score, parental
attitude and social burden felt by the mothers. There was no significant change in the control group
in any of this variables.52
Hence the research hypothesis, H2 (There is significant association between pre-test knowledge
scores with their selected demographic variables of the mothers of the mentally challenged children)
had significant association between knowledge score with the age, occupation, number of normal
children, previous knowledge and source of knowledge. The remaining variables were not
significant. The hypothesis is significant for the five variables and not for the remaining seven
variables.
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From all the above findings it can be concluded that most of the mothers had poor or average
knowledge regarding familial concerns on the care of the mentally challenged children before the
education. After administration of the planned structured teaching programme, knowledge level of
majority of mothers considerably increased to a higher score in post-test. Thus the structured
teaching programme was effective.
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7. CONCLUSION
This chapter presents the conclusions drawn, implications, limitations, suggestions and
recommendations. The focus of this study was to evaluate the effectiveness of planned structured
teaching programme on the familial concerns among the mothers of the mentally challenged
children in the selected special schools in Bangalore. A Quasi experimental design and evaluative
approach was used in the study. Then the data was collected by using structured interview schedule
by interview method. The samples were selected by simple random sampling technique.
The conclusion drawn from the research study was as follows:
The majority interestedly participated in the study. The mothers had some knowledge about
selected aspects of the familial concerns. The mothers were more enthusiastic in seeking the
information on the various aspects of familial concerns in regard to the mentally challenged
children. The study was based on the general system theory. It provides a comprehensive systematic
framework for effectiveness of planned structured teaching programme to enhance the knowledge of
mothers on selected aspects of familial concerns of the mentally challenged children.
The Conclusions Drawn on the Basis of the Findings of the Study Includes
Majority 41 (68.33%) of the mothers were in the age group of 39 years and above and
majority 29 (48.33%) of them were Muslims. Almost 31 (51.67%) had education up to higher
secondary. Majority 32 (53.33%) mothers were home makers. Almost 28(46.67%) had a monthly
income of Rs 4001 to 6000. As much as 44 (73.33%) were from unconsangious marriage.
Majority 30 (50%) lived in the joint family type. Most of them 21 (35%) had 2 children. As
much as 50 (83.33%) had 1 mentally challenged children in their house. As for years of experience,
39 (65%) had experience with their mentally challenged child for more than 10 years. Majority 33
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(55%) did not have any previous experience with the care of the mentally challenged children. Most
14 (51.85%) of them received the knowledge through special schools. The mean percentage of pre-
test knowledge was found to be 15.34% as compared to the post test knowledge was 68.43% with an
enhancement of knowledge to be 53.09% establishing the statistical significance at p<0.01 level
(t=31.14).
Knowledge level of mothers regarding familial concerns of the care of mentally challenged
children was inadequate before the administration of planned structured teaching programme.
The planned structured teaching programme was effective in increasing the knowledge of the
mothers. Further, the overall knowledge aspects in the post test score were high compared to pre-test
scores as revealed by paired “t”-tests scores.
In relation to the variables in tables religion, educational status and monthly income, type of
marriage, type of family number of mentally challenged children and the years of caring, all these
variable do not show any association with level of knowledge and hence, there is no significant
association of pre-test level of knowledge with these demographic variables, whereas age of the
mother, occupation, number of normal children, previous knowledge and the source of knowledge
had significant association with the level of knowledge of the mothers on the familial concerns of
the mentally challenged children.
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IMPLICATIONS OF THE STUDY:
The findings of the study can be used in the following areas of nursing profession
NURSING PRACTICES
Nurses are the key persons of the health team who play a major role in effective health
promotion and maintenance. Nursing care is an art and science in providing quality care. Present
study would help the nurses to understand the knowledge level mothers of the mentally challenged
children regarding familial concerns of the mentally challenged children. The nurse can use this
planned structured teaching programme to educate their client in clinics and general public in
community. This will be an innovative teaching strategy for a community health nurse.
NURSING EDUCATION
The nursing curriculum should consist of in depth content in theory instructions and in
developing skills of student nurses in making use of such methods of education in imparting the
knowledge regarding different health aspects among the selected groups in the community.
As a nurse educator, there are abundant opportunities for nursing professionals to educate the
mothers as well as their family members regarding selected aspects of mental retardation, their
familial concerns.
Student nurses can make use of the planned structured teaching programme on the various
familial concerns of the mentally retarded children. The nurse educator needs to conduct health
campaigns and use of different informational modalities, teaching strategies in educating these
communities which promotes mothers of the community.
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The head of the institution can make use the product of such studies; that is planned structured
teaching programme by making them available in the institution which served for the students as a
reference in preparing or planning similar activity in their community health nursing field
experience.
NURSING ADMISTRATION
The nursing administrator can take part in developing protocols, standing orders related to
familial concerns of mental retardation and in designing the health education programme to update
nursing personnel’s knowledge regarding various concerns of the mentally challenged children in
different work settings.
The nursing administrator can mobilize the available resource personnel towards providing the
health education to workers regarding various concerns of the mentally challenged children.
The nurse administrator should take interest in providing information on selected aspects of
mental retardation and their care and parental counseling’s. She should be able to plan and organize
programmes taking into consideration the cost effectiveness and carryout successful educational
programmes. The nurse administrator should have periodical plan to organize continuing education
programme for the nursing personnel may be in the schools and colleges, hospital and mainly in the
community health nursing setup, to organize the campaigns on the topic regarding the various
The nurse administrators should explore their potentials and encourage innovative ideas in the
preparation of appropriate information and modalities. One should organize sufficient man power,
money and material for disseminating health information.
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NURSING RESEARCH
This study helps the nurse researchers to develop appropriate health education plans for
educating the mothers regarding various concerns in caring the mentally challenged children
according to their demographical characteristics. Nurses should come forward to take up unsolved
aspects in the areas of stress and adaptation, alternative coping patterns to carryout studies and
publish them for the benefit of mothers, caregivers, siblings, public and nursing fraternity.
The study will motivate the beginning researchers to conduct same study with different
variables on a large scale. The public and private agencies should also encourage research in this
field through materials and funds.
LIMITATIONS
• The study was limited to 60 mothers belonging to selected special school in Bangalore.
• The study did not use any control group.
• The data collection period was limited to the period of 4weeks.
• Only a single domain that is knowledge is considered in the present study.
• The study results are confined only to selected special school in Bangalore.
RECOMMENDATIONS
On the basis of the findings the studies following recommendations have been made:
• A similar study can be replicated on a large sample to generalize the findings.
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• An experimental study can be under taken with a control group for effective comparison of
the result.
• A study can be conducted by including other related additional demographic variables like
the parents, reaction or attitudes of the siblings, caregiver Vs mothers etc.
• A comparative study can be conducted between rural and urban settings.
• Manuals, information leaflets and self instructional modules may be developed in all
dimensions and aspects of mental retardation, their care and family counseling etc.
• A study can be carried out to evaluate the efficiency of various teaching strategies like STP,
pamphlets and leaflets on mental retardation and their concerns for the mothers.
• Similar study can be conducted on different settings like rehabilitation centers, residential
institutions and psychiatric centers specially designed for the mentally challenged children.
• A comparative study can be conducted among the parents, the siblings, caregiver Vs mothers
etc.
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8. SUMMARY
The present study was conducted to evaluate the effectiveness of structured teaching
programme on the familial concerns among the mothers of the mentally challenged children in the
selected special schools in Bangalore.
Objectives:
among the mothers of the mentally challenged.
3. To assess the effectiveness of structured teaching programme by conducting post-test.
4. To find out the association between the pre-test knowledge scores of the mothers with
The study was based on the assumption that
• The mothers of the mentally challenged children will have poor pre-test knowledge
regarding the coping patterns on the familial concerns.
• Structured teaching programme to the mothers of the mentally challenged can enhance the
quality of life of the mothers.
• The mothers of the selected special school children will be willing to participate in the study
actively.
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Hypothesis were Stated as Follows
H1: There is significant difference between pre-test and post-test knowledge regarding the familial
H2: There is significant association between post-test knowledge scores with their selected
demographic variables of mothers of the mentally challenged children.
The conceptual framework adopted for this study was based on general system theory of
Ludwig Von Bertanlanffy. This model is characterized by Input, Throughput and Output.
The tool developed for the data collection was structured interview schedule containing
knowledge questions to assess the knowledge of mothers of the mentally challenged children
regarding various familial concerns before and after giving planned structured teaching programme.
The structured interview schedule was constructed in two sections-A, and section-B.
Section A: It consist 12 items on demographic characteristics of the mothers.
Section B: It consist 35 knowledge questions regarding meaning, causes, signs and symptoms,
management, home care, daily living skills, emotional areas, financial areas, behavior
and disciplining, prevention.
Content validity of the tool and structured teaching programme was established by 8 experts.
A pilot study was conducted in Bangalore on 2nd November till 9th November 2011. The reliability
of the tool was established by using split half technique. The reliability co-efficient of correlation of
the tool was found to be reliable and feasible.
85
Simple random sampling technique was used for selection of mothers. The sample consists of
60 mothers. The data collected were categorized and analyzed by using descriptive and inferential
statistics based on the objectives stated in the study.
MAJOR FINDINGS:
The major findings of the study are summarized as follows:
a) Findings related to demographic data:
• Majority 41 (68.33%) of the respondents out of the 60 mothers were found in the age
group of 39 years and above years
• Most 29 (48.33%) of them were Muslims.
• Almost 31 (51.67%) of them had education up to higher secondary.
• Majority 32 (53.33%) were home makers.
• Almost 28 (46.67%) had a monthly income of Rs 4001 to 6000.
• 44 (73.33%) were from unconsangious marriage.
• As much as 30 (50%) lived in the joint family type.
• Most of them21 (35%) had 2 children.
• As much as 50 (83.33%) had only one mentally challenged children in their house.
• As for experience, 39 (65%) had experienced caring for their mentally challenged
child for more than 10 years.
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• Majority 33 (55%) did not have any previous experience with the care of the
mentally challenged child.
• Most mothers 14 (51,85%) of them received the knowledge through special schools.
• In the pre-test, out of the 60 mothers, 52 (86.7%) of mothers had inadequate
knowledge.
• The pre-test knowledge on the familial concerns at the pre-test level had a range 2-
12, a mean 5.37 with standard deviation of 2.12 with the mean percentage of 15.34%.
• In the post test the test results have shown enormous improvement in levels of
knowledge about the familial concerns among the mothers. 42 (70%) of the mothers
had moderate level of knowledge, 18 (30%) of mothers had adequate level of
knowledge and 0 (0%) has inadequate level of knowledge.
• In the post-test, level of knowledge on the familial concerns which is proved by the
post-test had shown a range of 18-34, mean of 23.95, with standard deviation of 4.32
and with the mean percentage of 68.43%.
• The enhancement between pre-test and post test mean was 18.58, mean percentage
was 53.09%, SD was 4.62 and range was 7-29 and the observed “t” value was 31.14
which is greater than the 0.01% level. It was highly significant at p<0.01.
• In the pre-test, out of the 60 samples the mean pre-test knowledge was found to be
15.34% as compared to post test knowledge was 68.43%.
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• In relation to the pre-test knowledge demographic variables like age, occupation,
number of children, previous knowledge, source of information the chi- square value
obtained was 9.4, 9.5, 8.5, 13.9 and 6.7 respectively which showed significance at
p<0.05 levels.
• In relation to the other variables religion, educational status, monthly income, type of
marriage, type of family, number of children and the years of caring did not show
any association with level of knowledge.
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ANNEXURE-1
96
ANNEXURE-2
97
ANNEXURE-3
LETTER SEEKING EXPERTS OPINION AND SUGGESTIONS FOR ESTABLISHING

CONTENT VALIDITY OF RESEARCH TOOL AND STRUCTURED TEACHING
PROGRAMME.
From:
Mrs. Deepa Jacob,
II year M.Sc Nursing,
New Sri Shanthini College of nursing,
Bangalore.
To,
______________________________
______________________________
Sub: Requesting the opinion and suggestions of experts for establishing content validity
of the tool and structured teaching programme.
Respected Sir / Madam,
I am Mrs. Deepa Jacob, II year M. Sc Nursing Student of New Sri Shanthini College of
Nursing, Bangalore has selected the following topic for my research project, to be submitted to
Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, in partial fulfillment of
University requirement for the award of Master of Nursing degree.
TITLE OF THE TOPIC
“A Quasi experimental study to assess the effectiveness of the structured teaching programme
on the familial concerns among the mothers of the mentally challenged children in selected
special schools in Bangalore.”
I request you to kindly give your valuable suggestions regarding the appropriateness of the tool and
structured teaching programme, which I have enclosed.
Your kind co-operation and your expert judgment will be very much appreciated.
Thanking you,
Place: Yours Sincerely

Date Mrs. Deepa Jacob
98
Annexure-4
Criteria rating scale for validity of the tool
Dear Sir/Madam,
Kindly go through the evaluation criteria checklist for validation of the tool. There are two
columns given for your response (yes, No) and a column for remarks. Kindly place tick mark ( )
in the appropriate column and give your remarks.
Sl. No Content Yes No Remarks

Baseline data:
1 All characteristics necessary for the
study are included
Questionnaire:
• Covers the adequate content about
2 familial concerns of the mentally
retarded.
• Questions are arranged in a logical
order.
• Language is simple and easy to
follow.
• All items necessary to achieve the
objectives of the study are included.
• Any technical terms that can be
replace by simple terms.
99
Respected Madam/Sir,
Kindly go through the content of collected data in the following columns ranging from very
relevant to non relevant. When found to be not relevant and needs modification, kindly give your
valuable opinions and suggestions in the remark column.
Section-A
Sl. No Item Very Relevant Needs Not Remarks

Relevant Modification Relevant
2
3
10
11
12
100
Section-B
Structured interview schedule to assess the Knowledge of mothers regarding the care of the
mentally challenged.
Sl. No Item Very Relevant Needs Not Remarks

Relevant Modification Relevant
1.
2.
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4.
5.
6.
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101
Total 35 Questions.
Date:
Place:
SUGGESTIONS:-
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
____________________________________________
SEAL/SIGNATURE OF THE EXPERT
NAME AND DESIGNATION
102
Annexure-5
Content validity Certificate
I hereby certify that I have validated the tool of Mrs. Deepa Jacob MSc(n) student, who is
undertaking “A Quasi experimental study to assess the effectiveness of the structured teaching
program me on the familial concerns among the mothers of the mentally challenged children
in the selected special schools in Bangalore, Karnataka.”
Place: Sign and Seal of the Expert
Date: Name and Designation
103
Annexure-6
List of Experts for Content Validity
1. Prof. Dinesh Selvam MSc. (N)

Principal and HOD Community Health Nursing,
Padmashree Institute of Nursing,
Bangalore.
2. Prof. Lakshmi MSc. (N)

HOD Community Health Nursing,
Sarvodaya College of Nursing,
Bangalore.
3. Prof. Sangmesh Nidagundi MSc. (N)

Principal and HOD Community Health Nursing,
Kalabhaireshwari Swamy College of Nursing,
Bangalore.
4. Mrs Vahitha Khanam

Principal and HOD Psychiatric Nursing,
New Sri Shanthini College of Nursing,
Bangalore.
5. Prof. H.H.Dasegowda
HOD Psychiatric Nursing,
Government Nursing College,
Bangalore.
6. Prof. Bhaskar
Bio-statistician
Bangalore.
104
Annexure-7
Consent Form- English
I hereby give the consent for the above study knowing that all the information provided by me
will be treated with utmost confidentiality by the investigator.
Date: Signature of the Participant
Place: Bangalore
105
Annexure-7
Consent Form- Kannada
I hereby give the consent for the above study knowing that all the information provided by me
will be treated with utmost confidentiality by the investigator.
Date: Signature of the Participant
Place: Bangalore
106
Annexure-8
Certificate of Language English Editing
This is to certify that dissertation entitled “A quasi experimental study to assess the
effectiveness of structured teaching program on the familial concerns among the mothers of
the mentally challenged children in selected special schools in Bangalore” done by Mrs.Deepa
Jacob, 2nd year M.Sc.Nursing, New Sri Shanthini College of Nursing, Bangalore has been edited by
me.
Date Sign and Seal
Place Name and Designation
107
Annexure-9
Certificate of Kannada Editing
This is to certify that dissertation entitled “A quasi experimental study to assess the
effectiveness of structured teaching program on the familial concerns among the mothers of
the mentally challenged children in selected special schools in Bangalore” done by Mrs.Deepa
Jacob, 2nd year M.Sc.Nursing, New Sri Shanthini College of Nursing, Bangalore has been edited by
me.
Date: Sign and seal
Place: Name and Designation
108
Annexure-10
Structured interview scheduled to assess the effectiveness of structured teaching programme
on the knowledge among mothers regarding various familial concerns while caring for the mentally
challenged child.
The investigator will write the appropriate answer in the given bracket.
Section-A
Demographical Data
1) Age of mother _______ [ ]

a. 18-28 Years
b. 29-38 Years
c. 39 and above
2) Religion [ ]
a. Hindu
b. Christian
c. Muslim
d. Any other (Specify)
3) Educational status [ ]
a. Illiterate
b. Primary
c. Higher secondary
d. Graduate and above
4) Occupation [ ]
a. Government Employee
b. Private firm
c. Homemaker
5) Monthly income (in Rs): [ ]

a. Below 2000
b. 2001-4000
c. 4001-6000
d. 6001 and above
109
6) Type of marriage: [ ]
a. Unconsangious marriage
b. Consangious marriage
7) Type of family [ ]
a. Nuclear family
b. Joint family
c. Single parent
8) Number of normal children [ ]

a. 1
b. 2
c. 3
d. 4 and above
9) Number of mentally challenged children [ ]

a. 1
b. 2
c. 3
d. 4 and above
10) How long have you been caring for this/these children? [ ]
a. 1-5 years
b. 5-10 years
c. 10 and more years
11) Do you have any previous knowledge about the care of the mentally challenged children?
a. Yes [ ]
b. No
12) From where did you get previous knowledge about the care of the mentally challenged children?
[ ]
a. Mass media
b. Special school
c. Health personnel
d. No information
110
Section-B
Structured Interview Schedule to assess the knowledge of mothers of the mentally retarded
children regarding the familial concerns.
Instructions
This section consists of multiple choice questions. Each question has three options in which
one option is correct and the other options are incorrect. Every correct response is given a score of
“1” and every incorrect or unanswered question is given a score of “0”.The information obtained
will be kept confidential and will be used only for the intended work.
General Information
1) What is mental retardation? [ ]

a. Disability to the intellectual function
b. Disease to the brain
c. Ways of behaviour
2) What is the IQ level of mentally retarded person? [ ]

a. IQ with 7.5
b. IQ above 70
c. IQ below 70
3) What is the consequence of mentally retardation? [ ]

a. Physical disability
b. Cognitive disability
c. Developmental disability
4) What kind of disease is a mental retardation? [ ]

a. Curable
b. Preventable
c. Non curable
111
5) Marriage with who is called a consangious marriage? [ ]
a. Marrying a relative
b. Marrying a friend
c. Marrying a neighbor
6) Which nutritional deficiency causes mental retardation? [ ]

a. Vitamin A
b. Vitamin C
c. Iodine
7) Absence of which gene factor causes mental retardation? [ ]

a. Y single gene
b. X single gene
c. XY gene
Home Care
8) What aim should be kept when encouraging home care by the mother? [ ]
a. To be a dependent child
b. To be an indiscipline child
c. To be a self reliant
9) What should the mother keep in mind while training home care skills? [ ]
a. Understand the child’s potential and weakness
b. Understand the Childs growth and development
c. Understand the Childs level of knowledge
10) What must be done at the end while teaching skills in daily living practices with the mentally
challenged child? [ ]
a. Take it as granted for any accomplishments
b. Reinforce and reward for all the activities
c. Scold when not responding to instruction
112
Activities of Daily Living
Eating
11) What kind of behavior is encouraged for eating? [ ]

a. Disciplined
b. Disturbed
c. Less oriented
12) How to identify the hunger in a mentally challenged child? [ ]

a. Sits quietly.
b. Feels sleepy.
c. Shows temper tantrum
Dressing
13) How do mentally challenged children follow the instruction for dressing the best?
a. By made to feel [ ]
b. By being shown
c. By being told
14) Which method will be easy for a mentally challenged child to tie a skirt/shirt?
a. Buttons [ ]
b. Velcro
c. Hooks
Toileting
15) What is the best way to toilet train a mentally challenged child? [ ]
a. Taking the child every one hour to the toilet
b. Leaving it to the child
c. Whenever mother gets time
16) How often should the presence of the mother be there, while toilet training?
a. At the end [ ]
b. Sometimes
c. Always
113
Grooming /Hygiene
17) How long a mentally challenged child takes to brush his teeth? [ ]
a. 1 minute
b. 5 minutes
c. 10 minutes or more
18) Which part of the brush should the child hold, while teaching to brush? [ ]
a. Bristle
b. Middle
c. Bottom
Issues with Emotional Process
19) What are the reactions to the birth of a mentally challenged child in the house?
a. Sad [ ]
b. Grief
c. Anger
20) Who are blamed first for the birth of the mentally challenged child? [ ]
a. Self
b. Relative/s
c. Spouse
21) Who are sought in the period of despair? [ ]
a. Priest
b. Black magicians
c. Relatives
22) What is the response, when a parent understands that they are blessed with a mentally
challenged child? [ ]
a. Blessing
b. Curse
c. Fate
114
23) When stressed or burnt out, what action should be taken by the mother, while caring a
mentally challenged child?
[ ]
a. Isolate yourself
b. Show anger on other family members
c. Take a break
24) What is your reaction when your mentally challenged child behaves undesirably in public
places? [ ]
a. Enthusiastic
b. Irritable
c. Elevated
Issues with Financial Areas
25) Special privileges for the travel are offered from the government to mentally challenged
children for which kind of transportations? [ ]
a. Rented vehicle
b. Own vehicle
c. Public transport
26) Who provides stipends monthly for the mentally challenged people as a financial support?
[ ]
a. Government
b. Private sectors
c. Individuals
27) Which community event for these children are run by non governmental organizations?
[ ]
a. Chess tournaments
b. Special Olympics
c. Billiards
115
Issues with Disciplining and Behavior
28) How to develop social skills in mentally challenged children? [ ]

a. Attending outings and social functions
b. Restricting from social activities
c. Disciplining in the house
29) Which is the best way to discipline a child with mentally challenged? [ ]
a. Learning and understanding about the siblings growth
b. Learning and understanding about the siblings behavior
c. Learning and understanding about Childs diagnosis
30) What must be maintained with the care team of the mentally challenged child?
a. Good communication [ ]
b. Good friendship
c. Good knowledge
Prevention
31) How can we suspect mental disability in a child? [ ]

a. By recognizing the neonatal reflexes
b. By observing a developmental delay
c. By seeing the social smile
32) Which therapy given to mentally challenged child will prevent risk of further disability
among the mentally challenged children?
[ ]
a. Birth spacing
b. Weaning
c. Physical therapies
116
33) What should be encouraged to increase the confidence and skills among the mentally
challenged children?
[ ]
a. Change in the patterns of living
b. Daily routines in monotonous pattern
c. New models in the patterns of living
34) What will initiate the early stimulation for the development of the mentally challenged
children? [ ]
a. Early intervention
b. Running
c. Swimming
35) Who are the best examples for the comprehensive growth and development of the mentally
challenged children? [ ]
a. Friends
b. Family members
c. Neighbours
117
Answer Key
Q.1 a Q.32 c
Q.2 c Q.33 b
Q.3 b Q.34 a
Q.4 c Q.35 b
Q.5 a
Q.6 c
Q.7 b
Q.8 c
Q. 9 a
Q.10 b
Q.11 a
Q.12 c
Q.13 a
Q. 14 b
Q. 15 a
Q.16 c
Q. 17 b
Q. 18 c
Q.19 b
Q.20 a
Q.21 c
Q.22 a
Q.23 c
Q.24 b
Q.25 c
Q.26 a
Q.27 b
Q.28 a
Q.29 c
Q.30 a
Q.31 b
118
Annexure-11
STRUCTURED TEACHING PROGRAMME ON FAMILIAL CONCERNS OF MOTHERS REGARDING THE CARE FOR
THEIR MENTALLY CHALLENGED CHILDREN
Name of the Investigator : Mrs. Deepa Jacob.

Topic : Familial Concerns of mothers regarding care of mentally challenged children
Date/ Time :
Duration : 45 Minutes
Method of Teaching : Lecture cum discussion
A.V. Aids : Flash Cards and Charts
General Objectives : At the end of the class, the group will gain in-depth knowledge regarding.
Specific Objectives : The group will be able to:
1. Define mental retardation.
2. List out the causes for mental retardation.
3. Able to list the signs and symptoms.
4. Classify mental retardation.
5. Home care children with mental retardation.
6. Train in daily living skills i.e.
- Eating
- Toileting
- Dressing
- Grooming/ Hygiene
119
7. Care for the emotional needs.
8. Manage financial needs.
9. Encourage the child to grow as well disciplined and behavior child.
10. Prevent further disability in the mentally challenged children.
Sl. Time Specific Content Teaching and A.V. Aids Evaluation

No Objective learning
activity
Getting ready Flip card What do you

1 4 Introducti Mentally challenged is a condition where the child or adult has an IQ to receive know about
mins on to the below the average of a normal child and is often combined with deficits knowledge. mental
topic in adaptive behavior. retardation
At least 2% of Indian population are said to be suffering from one or
other kind of mental disability. Previously the terms used to be were
“Idiot”, “Moron” and “Imbecile”. Later they were replaced by “Mental
Handicaps”, “Mentally challenged” or “Retardation” respectively.
Positive connotations like “Differently able” and “Special Children”
were also used to denote these individuals.
The most recent terms used are Intellectually disabled or challenged.
However, mental retardation is the subtype of Intellectual disability.
Early intervention, support and teaching to parents, care takers teachers
can enable these children to train to be self reliant in their life.
120
Flip card
2 2 Define Mentally challenged or otherwise called mentally retarded is defined as Learner What is
mins mental intellectual function that is below average and co exists with adaptive listens Mental
retardation deficits. Retardation?
3 3 CAUSES Learner Flip card What are the

mins What are 1. Genetic condition: Abnormal genes inherited from parents, Errors clarifies causes of
the causes when genes combine, or other factors doubt. M.R?
of M.R?
2. Problems during pregnancy.
• Alcoholic mothers.
• Infection like rubella.
3. Problems at birth.
Decreased oxygen supply:
-during labor
-at birth.
-brain damage.
4. Exposures to certain types of diseases or toxins.
5. Very low Birth-Weight infants.
6. Central Nervous System damage.
7. Malnutrition, Iodine deficiency etc.
Demonstr
4 2 What are SIGNS AND SYMPTOMS Learner ation What are the
mins the S/S 1. Delays in oral language development. listens S/S?
2. Deficit in memory skills.
121
3. Difficulty in learning social skills and problem solving skills.
4. Delays in the development of adaptive behavior such as self
help or self care skills.
5. Lack of social inhibitors.
Listens to Black
5 2 What are CLASSIFICATION lecture -board What are the
mins the WHO gave the following classifications for M.R: classifications
classificati Mild M.R : IQ: 50-70 for MR?
ons for Moderate M. R : IQ: 35-49
Mentally Severe M. R : IQ: 20-34
challenged Profound M. R : IQ : under 20
?
6. 5 How to HOME CARE Clients listen Demonstr How to home

mins home care Firstly, “Mentally challenged or retardation is a disability not a to lecture. ation care children
children disease.” with Mentally
with Secondly, there is no “cure” for an established disability. challenged?
Mentally Home Caring for the Mentally challenged Child:
challenged Mothers can make significant changes in the view of retarded child
provided they need to have 3 important factors.
• Perseverance
• Commitment
• Patience
Things to be kept in mind are
122
- Give an extra share of love, care and concern in order to live as Demonstr How to home
independently as possible in their homes and communities at ation care children
large. Clients listen with Mentally
to lecture challenged?
- Allow the child to stay in the family.
- Allow the child to take part in community life to learn and pick
up his /her social skills.
- Adopt professional training methods both for mother and child
based on the level of retardation and skills to learn personal care.
- Understand the child’s potential and weakness and involve in
Community Alternatives Program for the Mentally challenged
child in order to understand that everyone born has a purpose in
the earth.
- Encourage sign language as acceptable in the community in case
of difficulty in communication.
- Encourage and reinforce self-dependency.
- Develop a strong bond with family as well as others in the family.
- Never let the child feels neglected or avoided by the family.
- Reinforce and reward for all the activities like dressing, eating,
grooming etc whenever achieved successfully or even on partial
success.
- Hang calendars with large squares to write special occasions,
daily routines with pictures.
- Follow the calendar and use a timer for brushing or bathing or
eating.
- Monitor an open communication between school personnel and
parents to ensure continuity and success from one environment to
123
another.
7. 7 How to Daily Living Skills Listener Demonstr How to train

mins train in a. EATING: listens ation in daily living
daily skills?
living - Sitting behaviors to be reinforced.
skills?
- Running and moving interfere with sitting at a table which needs
to be redirected by handing a chips bag or juice or milk bottles.
- Provide gaps between snacks and meal time.
- Encourage to assist in setting the table for meals. Encourage hand
washing before and after food.
- If not interested in an activity, don’t force the child.
- Provide food of their choice and encourage skills in eating with Clients listen
How to positive reinforcement.
train
toileting?
b. TOILETING
- Routine and consistent manner of toileting to be enforced.
Learner Demonstr How to train
- Entering, exiting, voiding, flushing, dressing and proper hand
listens ation toileting?
washing must also be taught regularly.
How to - Timing for toileting should be maintained.
train for
dressing? - All successful attempts should be immediately rewarded with
verbal praise.
124
c. DRESSING Mothers Demonstr How to train
How to clarify ation for dressing?
train for - Closely observe the child to see what items they remove on doubts
grooming/ their own.
hygiene?
- Children learn more rapidly by sensing how things feel
rather than by being told or shown.
- Assist by using hand-over-hand method of taking through all
steps of the task.
- Velcro, elastic, waist band etc are easy to handle for these
children. Demonstr How to train
ation for grooming/
hygiene?
d. GROOMING/HYGIENE Mothers
- Encourage the child to hold the comb or brush by keeping a mark clears doubts
at the holder to understand where to hold.
- Encourage activities by singing rhymes they say about
“Brushing”, “Combing” etc.
- Direct the child to brush by teaching how to grasp, hold, and put
toothpaste, open the mouth etc. first on oneself then on the child.
- Hand-over-hand guidance throughout and most stages of the
activity.
8. 5 How to Mothers Black- How to care

mins care for EMOTIONAL AREAS: listens to board for the
the lecture emotional
emotional Mothers of mentally challenged children commonly experience a gamut needs?
needs? of emotions over the years. They often struggle with:
- Guilt: Guilt can harm the parent’s emotional health if it is not dealt
125
with.
- One or both parents may feel as though they somehow caused the child
to be disabled.
- Some struggle with why and experience a spiritual crisis or blame the
other parent.
- Most parents experience severe disappointment. These parents must

deal with the death of the perfect child who existed in their minds and
learn to love and accept the child they have. Occasionally, parent feels
embarrassed or ashamed that their child is mentally disabled.
PARENTS’REACTION:
According to Rosen : There are five stages
1. Awareness of a problem:
As mental disability in the child is revealed totally by the beginning
of school. Awareness among parents occurs late and this leads to
a. Denial
b. Anger Listeners Demonstr What is the
2. Recognition of the basic problem: listens ation usual parental
reaction to the
The second stage helps the parents gain insight and find the cause. birth of an
M.R child?
3. Search for cause:
Third stage in the parents’ reaction.
a. Self blaming/guilt
b. Poor adjustment
c Misplaced hostility
d Anger
e Self
126
4. Searching for cure:
Fourth stage is the search for cure and can lead to family
destruction. Parents reaction’s are
a. Despair
b. Grief
5. Acceptance of the problem:
Final stage occurs in a later part of the years. Parents react by
a. Adapting to child needs.
b. Overcoming their Challenges.
c. Involving in various programme related to caring for these
children.
d. Interacting with such groups.
9. 3 How to Listener Flip card How to manage

mins manage FINANCIAL NEEDS: listens to financial
financial lecture needs?
areas? Raising a child with a mental retardation may be more expensive than
raising a typical child. These expenses can arise from:
• Medical equipment and supplies

• Medical care
• Care giving expenses
• Private education, tutoring
• Adaptive learning equipment
127
• Specialized transportation.
The care of the child may last a lifetime instead of 18 years. Parents may
have to set aside money. They can think of forming a trust fund for the
child's care when they pass away.
Special programs like :
-Special Olympics Association for Retarded Citizen.
-Intermediate Care Facilities for the Mentally Retarded (ICFs/MR)

provides optional Medicaid benefit and even caters for the links to
applicable laws and regulations. These are some programs organized by
the government for the upliftment and financial gains for the mentally
10. 5 What are DISCIPLINING AND BEHAVIOUR: Listener Demonstr What are the
mins the ways • Encourage the child to do things independently. listens ation ways to
to • Attend psychological counseling for the child and yourself. discipline and
discipline • Attend outings and social functions with the child to teach him behavior a
and the social skills. M.R child?
behavior a • Learn as much as you can about the child's diagnosis to
M.R understand what behaviors you may encounter.
child? • Incorporate skills from school teaching into home life.
• Maintain good communication between yourself and the mentally
challenged child’s primary care physician
• Introduce behavioral interventions: Likely
- Behavior-accelerating procedure such as: Conditional
reward for specific behavior.
- Behavior-declaratory techniques: Rewarding for specified
period of time.
- Reinforcement of the problem behavior.
128
Client listens Flip card How to
11. 5 How to PREVENTION: prevent
mins prevent Prevention refers to a set of approaches that reduce or eliminate the risk further
further of mental retardation in the community disability?
disability? 1. Secondary Prevention:
Refers to interventions soon after the medical or psychosocial
problem has been detected.
• Screening for treatable disorders like lead poisoning.
• Early recognition and intervention for developmental delay.
• Intervention with “at risk” cases.
2. Tertiary Prevention:
Refers to Preventing complications and maximization of functions. They
can be achieved by
• Stimulation, training, education and vocational opportunities
• Occupational therapy, physical therapy etc are introduced to Client listens Flip card What are the
decrease the risk of further disabilitating conditions. types of
• Encourage daily routines in a monotonous pattern to increase prevention
confidence and skill. methods?
• Support for families
• Parental self-help groups
12. 2 CONCLUSION
mins So far we have discussed about the definition, cause, signs and symptom,
classification, home care, daily living skills, emotional concerns,
financial needs, discipline and behavior and prevention of further
disability among the mentally challenged children.
Hope you understood regarding the familial concerns in regard to the
care of children with mental retardants has to deal and how to take care
and manage such children in a home setting. If you feel that you need
further clarifications and need more discussions in this regard, I shall be
glad to initiate and continue our dialogue further.
129
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A QUASI EXPERIMENTAL STUDY TO EVALUATE THE

EFFECTIVENESS OF THE STRUCTURED TEACHING PROGRAMME

Under the guidance of

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled “A QUASI EXPERIMENTAL

STUDY TO EVALUATE THE EFFECTIVENESS OF THE STRUCTURED TEACHING

PROGRAMME ON THE FAMILIAL CONCERNS AMONG THE MOTHERS OF THE

MENTALLY CHALLENGED CHILDREN IN THE SELECTED SPECIAL SCHOOLS

IN BANGALORE, KARNATAKA” is a bonafide and genuine research work carried out by

me under the guidance of Mrs.Kanakaratnam M.Sc (N), Professor, Department of

Community Health Nursing, New Sri Shanthini College of Nursing, Bangalore.

This is to certify that the dissertation entitled “A QUASI EXPERIMENTAL STUDY TO

EVALUATE THE EFFECTIVENESS OF THE STRUCTURED TEACHING

PROGRAMME ON THE FAMILIAL CONCERNS AMONG THE MOTHERS OF THE

MENTALLY CHALLENGED CHILDREN IN THE SELECTED SPECIAL SCHOOLS

IN BANGALORE, KARNATAKA” is a bonafide research work done by Mrs. Deepa Jacob,

This is to certify that the dissertation entitled “A QUASI EXPERIMENTAL STUDY

TO EVALUATE THE EFFECTIVENESS OF THE STRUCTURED TEACHING

PROGRAMME ON THE FAMILIAL CONCERNS AMONG THE MOTHERS OF THE

MENTALLY CHALLENGED CHILDREN IN THE SELECTED SPECIAL SCHOOLS

IN BANGALORE, KARNATAKA” is a bonafide research work done by Mrs. Deepa Jacob

under the guidance of Mrs,Kanakaratnam M.Sc(N) Professor, Department of Community

Health Nursing, New Sri Shanthini College of Nursing, Bangalore.

Signature and Seal of HOD Mrs. Vahitha Khanam

Declaration by the Candidate

or electronic format for academic / research purpose.

© Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

unconditional love showered on me throughout the study.

extending their help in completing my study.

It is my pleasure to express my sincere gratefulness and genuine thanks to my guide

Mrs.Kanakaratnam M.Sc(N) HOD, Community Health Nursing, of New Sri Shanthini

inspirations on me for the completion of this dissertation.

successful completion of this dissertation.

and cooperated in the study to make it a success.

strength and inspiration for the completion of my dissertation.

whose blessing and dream was to see me in greatest heights.

their timely financial and physical help and prayers.

wishes at all time to complete this study.

Date: Mrs. Deepa Jacob

3. P value : Probable value

4. < : Less than

5. > : Greater than

7. STP : Structured Teaching Programme

9. M.R : Mentally Retarded

10. I.D : Intellectual Disability

11. IQ : Intelligence Quotient

13. n : Sample Size

14. r : Correlation Coefficient

Background of the Study

the mentally challenged children in the selected special schools in Bangalore.

2. To develop planned structured teaching programme regarding the familial concerns

3. To assess the effectiveness of structured teaching programme by conducting post-test.

demographic variables of mothers of the mentally challenged children.

samples of 60 mothers of the mentally challenged children in selected special schools in

objectives of the study by using descriptive and inferential statistics.

monthly income of Rs 4001 to 6000.Most 44 (73.33%) were from unconsangious marriage.

significance at 5% level (t=31.14).

scores as revealed by paired “t”-test.

mentally challenged children.