A meta-analysis was conducted on cognitive-based … · Web viewRAJIV GANDHI UNIVERSITY OF HEALTH...
Transcript of A meta-analysis was conducted on cognitive-based … · Web viewRAJIV GANDHI UNIVERSITY OF HEALTH...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
Ms MANITA UPADHYAY
1ST Year M. Sc Nursing
Medical Surgical Nursing
Year 2013-2014
PADMASHREE INSTITUTE OF NURSING
KOMMAGATTA
BANGALORE-560060
0
RAJIV GANDHI UNVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1 NAME OF THE CANDIDATE AND ADDRESS
Ms. MANITA UPADHYAY
1st Year M. Sc Nursing,
Padmashree Institute of nursing,
Kommagatta– 560 060.
2 NAME OF THE INSTITUTE Padmashree Institute Of Nursing,
Bangalore.
3 COURSE OF THE STUDY AND SUBJECT
1 year M.Sc Nursing,
Medical Surgical Nursing.
4 DATE OF ADMISSION TO THE COURSE
2013
5 TITLE OF THE STUDY A study to assess the effectiveness of multifaceted intervention on adherence to treatment and knowledge regarding side effect to epileptic drug and prevention of complication of epilepsy among patients with epilepsy in a selected hospital, Bangalore.
1
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
The nervous system is one of the major control systems of the body. As change occurs in
the external and internal environment of the body, the nerve cells receive this and transmit it to
other cells. The nervous system exerts primary control over the body’s muscular and glandular
activities, with the goal of maintaining homeostasis. This system is organized into the Central
Nervous System, which is composed of the brain and spinal cord, and the Peripheral Nervous
System, which consist of nerve fibers that carry information between the Central Nervous
System and other parts of the body. The nervous system is vulnerable to various disorders. One
of which is epilepsy.1
The term “Epilepsy” is derived from the Greek word “Epilamabavian” meaning is “to
seize or to take hold of”. To the Greeks epilepsy was a sacred disease, to Hipocrates it was a
disease of the brain. In later ages it became known as “the falling sickness” and was viewed as a
form of mental illness, with victims being consigned to asylums for the insane. Regardless of the
insights gained into epilepsy, stigma and fear are still associated with this problem. Public
awareness of the true mature of epilepsy is needed to dispel the misconceptions and fears
associated with this health problem.2
Epilepsy is a chronic disorder characterized by recurrent seizures and knows no
geographical, racial or social boundaries. It can begin at any age, but is most frequently
diagnosed in children, adolescents and the elderly. Psychiatric and cognitive disturbances are
relatively common in epilepsy.3
2
Epilepsy has been defined as “a disorder of the brain characterized by an enduring
predisposition to generate epileptic seizures, and by the neurobiological, cognitive, psychological
and social consequences of this condition”. The definition of epilepsy requires the occurrence of
at least one seizure. An epileptic seizure is defined as “a transient occurrence of sign and
symptoms due to abnormal excessive or synchronous neural activity in the brain”.4
The World Health Organization (WHO) estimates that 50 million people of all ages
around the world are affected by the world range from 5 to 10 per 1,000 people. However,
worldwide prevalence rate of epilepsy varies from 2.8 to 19.5 per 1,000 of the general population
and is more prevalent among children. The global burden of epilepsy (including epilepsy and
status epilepticus) is determined by estimating the number of productive life years lost due to
disability or premature death resulting from the disease (known as disability adjusted life years,
or DALYs). The DALYs lost annually due to epilepsy as 6,223,000 worldwide.4
3
Incidence of epilepsy in different countries.
Author with year of study
in parenthesis
Place of study Incidence rate per
1,00,000 population
Remarks
Pond (1960) Uk 70 All seizure
Krohn (1961) Norway 11 All seizure
Zielinsiki(1974) Poland 26 Seizure
excluding FS
Juol- jenson (1983) Denmark 39(men)
28(women)
Seizure excluding FS
Granieri(1983) Italy 31 Seizure excluding
FS,SS,PS
Placencia(1992) Ecuador 190 Excluding FS
Hauser(1993) USA 44 Excluding FS,SS,PS
Mani(1997) India 49.3 Excluding HWE
Ulafsson(2005) Iceland 57 All seizure
SS: Single seizure, FS: Febrile seizure, PS: provoked seizure, HWE: hot water epilepsy.4
4
Distribution of the global burden of epilepsy, by age group and level of economic
development.
0-4 5_14 15-29 30-44 45-59 60-69 70-79 80+ total0%
10%20%30%40%50%60%70%80%90%
100%
4% 7% 11% 17% 22% 26% 31% 37%
12%18%
29%34%
42% 35% 33% 29%26%
32%
78%64%
55%40% 42% 41% 40% 37%
56%
high mortality developing reasonlow mortality developing reason developed reason
Epileptic conditions are multifactorial disorders, and it is useful to discuss three
important factors. The first factor is predisposition, or threshold. Anyone with a functioning
brain is capable of having a seizure. Threshold is a dynamic phenomenon; it varies throughout
the day, it also changes in relation to hormonal influences during the menstrual cycle in women.
The second important factor for epilepsy is the epileptogenic abnormality itself. Epilepsies
attributable to identifiable brain defects are refer to as symptomatic epilepsies. Symptomatic
epilepsies can be caused by a variety of disorders, including brain malformations, infections,
vascular disturbances, neoplasm, scars from trauma, including strokes, and disorders of cerebral
metabolism. The third important factor is precipitating condition, which determines when seizure
occurs. The most common are photosensitive seizures induced by flickering light, but some
patients have very specific reflex epilepsy with seizure precipitated by such stimuli like music,
certain visual patterns, and reading, eating and hot-water baths.
5
The mainstay of epilepsy treatment is medical therapy. The number of available
antiepileptic drugs has more than doubled in recent years, and there is now a large selection of
agents from which to choose, each with its own set of indications and adverse effects. The
common drugs are phenoytoin, carbazepine, valporic acid, phenobarbitol.5
Although epilepsy is a largely treatable brain disorder and relatively cheap medication is
available, between 60% and 98% of individuals with this disorder in developing countries
receive no treatment. People with epilepsy present with health problems, while also having to
cope with a wide range of psychosocial difficulties that affect almost every aspect of their lives.
Many of these difficulties are a consequence of public misconceptions, prejudice and stigma.6
Adherence to medication is the backbone to effectiveness of a therapy. In the absence of
a definitive curative therapy, antiepileptic therapy is a key intervention aimed at pro-longing and
improving the quality of life of epileptic patients suffering from a disease known for its
stigmatization.7
Non-adherent behaviour is traditionally categorized into unintentional and intentional.
Unintentional non-adherence includes behaviours arising from forgetfulness, misunderstanding
and confusion. Intentional non-adherence describes patient choice that deviates from the
prescribed medication regimen. Unintentional and intentional non-adherence is not mutually
exclusive; thus, an amalgam of these behaviours often exists in any one patient. An
understanding of patient behaviour and its underpinning psychology plus the wealth of factors,
both internal and external that may influence medication taking, is crucial to understand how to
change patient behaviour and thus improve medication adherence.8
6
Epilepsy affects the individual on both the physical and the psycho-social levels. Indeed,
there is now general agreement that the incidence of neurobehavioral disorders is higher in
patients with epilepsy than in the general population.9
Epilepsy is usually controlled, but not cured, with medication. Once epilepsy is
diagnosed, it is important to begin treatment as soon as possible. For about 80 percent of those
diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical
techniques. In 1997, the Food and Drug Administration approved the vogues nerve stimulator for
use in people with seizures that are not well-controlled by medication.10
Some of the common side effects of antiepileptic drugs are gingival hyperplasia, coursing
of features, ataxia, hyponatremia, diplopia, Gastrointestinal symptoms, tremor, weight gain, hair
loss, thrombocytopenia, sedation, rash, word finding difficulty, renal stones, weight loss,
insomnia, anxiety, and irritability.11
The vagus nerve stimulator is a small device similar to pacemaker which produces a
weak electrical signals that travel along the vagus nerve to the brain it has shown to be effective
in the treatment of partial seizures, who have not respond well to antiepileptic medicines, and
who are not candidates for epilepsy surgery. Vagus nerve stimulator does not eliminate the need
for the medication, but it can help reduce the risk of complications from sever or repeated
seizures.12
Status epilepticus is the most serious complications of epilepsy and a neurologic
emergency. It is a state of continous seizure activity or a condition in which seizure recur in rapid
succession without return to consciousness between seizures. Potential etiologies of status
epilepticus include acute metabolic disturbances, toxic or infectious insults damage to the brain,
7
and underlying epilepsy. Morbidity from status epilepticus can be high; outcomes depend largely
on etiology and duration. Status epilepticus is a medical emergency, the management of which
centers on stopping the seizure activity and preventing the occurrence of systemic complications.
The other complication includes difficulty learning, permanent brain damage, and aspiration
pneumonia.13
6.2 NEED FOR THE STUDY
Epilepsy is quite a serious problem in India. While 60% of people in urban India consult
a doctor after suffering a seizure, only 10% in rural India would do so. Also, epilepsy treatment
is long term and can take around two years time. Adherence to medications therefore is very
poor with only half adhering to the regimen. Once patients are seizure free for a few days, they
stop medication until they suffer another episode.14
Adherence is defined as ‘the extent to which the patient’s behavior matches agreed
recommendations from the prescriber’. Adherence shifts the balance between professional and
patient to suggest there should be agreement between professional and patient about the
prescriber’s recommendation. Nonadherence is a large problem but it should not be seen as the
patient’s problem. Rather, it represents a limitation in the delivery of healthcare, often due to a
failure to fully agree the prescription in the first place or to identify and provide the support that
patients need later on. Addressing nonadherence is not about getting patients to take more
medicines. It starts with an understanding of patients’ perspectives of medicines and the reasons
why they may not want or are unable to use them. Practitioners have a duty to help patients make
informed decisions about treatment and use appropriately prescribed medicines to best effect. 15
8
Reasons for non-adherence are complex and multilayered. Patients can accidentally fail
to adhere through forgetfulness, misunderstanding, or uncertainty about clinician’s
recommendations, or intentionally due to their own expectations of treatment, side effects, and
lifestyle choice. There are various strategies suggested for managing patient adherence but these
are highly dependent on the reasons why a patient has not followed clinician advice initially.15
Estimates suggest that 30–50% of patients prescribed medications for chronic illnesses do
not adhere to their prescribed medication regimen. This non-adherence has been demonstrated to
diminish treatment effect which can result in prolonged illness, additional investigations and
prescriptions that may otherwise have been unnecessary. A link between poor adherence and an
increased risk of mortality is also well established. Consequently, the World Health Organization
has described non-adherence as ‘a worldwide problem of striking magnitude’ and a priority for
healthcare researchers and policymaker. Despite the magnitude and potential gravity of
suboptimal medication adherence, a gold standard intervention remains elusive; a recent
Cochrane review highlighted the paucity of effective interventions in current practice. Evidence
suggests that complex, multifaceted interventions tailored to meet individual needs are most
likely to be efficacious, which is intuitive given the complex, multistage process that is taking
medication.16
The incidence of adverse effects is an important issue when prescribing antiepileptic
drugs, as some of the most effective medications for seizures are associated with a considerable
degree of toxicity. However, all antiepileptic drugs have the potential to exert detrimental effects
on cognitive function. A thorough appreciation of the negative cognitive effects linked to a
variety of antiepileptic drugs makes a crucial contribution to therapeutic success.17
9
Epilepsy can impair an individual’s functioning within work and educational domains. As
well as adverse cognitive effects, some antiepileptic drugs may have the advantage of improving
cognitive performance. Such beneficial influences may simply occur as a result of seizure
control, or in association with positive effects on mood or psychiatric profile. However, a
number of agents may demonstrate efficacy in enhancing cognitive function in a more direct
way, by improving alertness or cognitive capacity.17
A person with epilepsy can face many challenges and dangers as he or she manages his or
her condition. The seizures themselves can cause injury and, in some cases, death. Even when
not endangered by the seizures, a person with epilepsy must still come to grips personally with
the condition and with the misconceptions surrounding it. Treating epilepsy is also its
drawbacks. Surgery can be dangerous and drug treatments usually involve side effects, as well as
complitations.18
The nurses offer a unique perspective in the early education of patients with epilepsy. As
part of care team, the nurses assume an important role in providing comprehensive epilepsy
education. Epilepsy may occur at any time throughout the life, and age related needs necessitate
ongoing assessment and intervention. The initial approach is ongoing assessment and
intervention. The initial approach is to improve cognitive and behavioral pattern towards
adherence to treatment and to formulate individualized education. The goal of education is to
provide the patient with video-assisted teaching and informational tool needed to enhance their
knowledge of epilepsy regarding side effect of drugs and complication of epilepsy and
recommended treatment plan can lead to a great sense of power and control necessary for self
management and an improve quality of life by creating a foundation of trust with the patient,
10
health care providers can continue to monitor and manage the seizure disorder to attain optimal
patient outcomes.
In view of above the researcher opinions that patient with epilepsy should be well
equipped with knowledge regarding adherence to treatment, knowledge regarding side effect of
epileptic drug and complication of epilepsy and the patient will free from complications. It is
important for the client with epilepsy to live as normal life as possible. Most of the patients are
unaware of the disease condition and adherence to treatment. Hence the researcher felt a need to
give multifaceted intervention to the patient about epilepsy.
11
6.3 STATEMENT OF PROBLEM
A study to assess the effectiveness of multifaceted intervention on adherence to treatment
and knowledge regarding side effects to epileptic drug and prevention of complication of
epilepsy among patients with epilepsy in a selected hospital, Bangalore.
6.4 OBJECTIVES OF THE STUDY
1. To assess the pre-test level of adherence to treatment and knowledge regarding side effect
to epileptic drug and prevention of complication of epilepsy among patients with
epilepsy.
2. To assess the post-test level of adherence to treatment and knowledge regarding side
effect to epileptic drug and prevention of complication of epilepsy among patients with
epilepsy.
3. To assess the effectiveness of multifaceted intervention on adherence to treatment and
knowledge regarding side effect to epileptic drug and prevention of complication of
epilepsy among patients with epilepsy.
4. To correlate between adherence to treatment and knowledge regarding side effect to
epileptic drug and prevention of complication of epilepsy among patients with epilepsy.
5. To associate pretest level of adherence to treatment and knowledge regarding side effect
to epileptic drug and prevention of complication of epilepsy among patients with epilepsy
with their selected demographic variables.
12
6.5 OPERATIONAL DEFINITION
1. Effectiveness
It refers to the extent to which multifaceted intervention has desired effect on
adherence to treatment and knowledge regarding side effect to epileptic drug and
prevention of complication of epilepsy.
2. Multifaceted intervention
In this study multifaceted intervention refers to the systematically developed
cognitive and behavioral approach by the investigator, where the investigator will provide
cognitive approach using calendar method and flash card, and behavioral approach
through motivation and counseling.
3. Adherence to treatment
In this study adherence refers to level of following a recommended drug regimen
measured by morisky medication taking adherence scale-MMAS (4-item).
4. Knowledge
It refers to the understanding of adherence and side effect of epileptic drugs and
prevention of complication of epilepsy among epileptic patient.
5. Side effect of epileptic drug
It refers to an effect that is secondary to the treatment of epilepsy such as tremors,
hair loss, gastrointestinal symptoms, and anxiety.
13
6. Prevention of complication
Refers to the actions directed towards modifying the development of a complication
such as injury, loss of consciousness status epilepticus, life threatening complication such
as sudden unexplained death among epiletic patient .
7. Patients with epilepsy
In this study patients with epilepsy refers to the person who were diagnosed with
epilepsy for past two years.
6.6 ASSUMPTION
1. Patients may have lack of knowledge about epileptic drugs and its side effect and
complication of epilepsy.
2. Multifaceted intervention may enhance the knowledge regarding epileptic drug and
epilepsy.
6.7 RESEARCH HYPOTHESES
H1: There will be significant difference between the mean pre-test and post test score on
level of adherence to treatment and knowledge regarding side effect to epileptic drug and
prevention of complication of epilepsy among patients with epilepsy.
H2: There will be significant correlation between level of adherence to treatment and
knowledge regarding side effect to epileptic drug and prevention of complication of
epilepsy among patients with epilepsy.
14
H3: There will be significant association between pre-test level of adherence to treatment
and knowledge regarding side effect to epileptic drug and prevention of complication of
complication of epilepsy among patients with epilepsy with their demographic variables.
6.8 REVIEW OF LITERATURE
Review of Literature is a key step in research process. Nursing research may be
considered as a continuing process in which knowledge gained from earlier studies is an integral
part of research in general. In review of literature a researcher analyses existing knowledge
before delving into a new study and when making judgement about application of new
knowledge in nursing practice. The literature review is an extensive, systematic, and critical
review of the most important published scholarly literature on a particular topic.19
A house to house survey was done on a prospective incidence of epilepsy in a rural
community of West Bengal, India. A total of 38 cases were detected during the survey period in
a population of 20,966. The age adjusted average annual incidence rate was 42.08 per 100,000
persons per year. This rate was higher than many developed countries, but lower than the
developing countries. Cerebral infection was the most common putative factor observed. An
increasing trend of incidence of epilepsy has been observed over the years during the period of
the study.20
A longitudinal study was conducted to determine the prevalence, incidence,
and mortality rates of epilepsy in the city of Kolkata, India. A total of 52,377 (52.74% men)
individuals were screened by using a simple screening questionnaire, and the detailed follow-up
was done by neurologists, the result showed that, there were 309 prevalent and 66 incident cases
of active epilepsy, and during the 5-year period, 20 cases of active epilepsy died. Study
15
concluded that, the incidence rate of epilepsy is comparable to that observed in developed
countries, but mortality rate is higher.21
A door-to-door survey was conducted to study the prevalence and etiological profile of
active epilepsy in the rural population of Uttarakhand (India). A total of 14,086 populations were
interviewed by using questionnaire. The result showed that, 141 cases of active epilepsy was
detected giving a crude prevalence rate of 1%. After excluding acute and remote symptomatic
cases related to NCC (neurocysticercosis), the prevalence rate of epilepsy was 6.5/1000. Study
concluded that the region-specific prevalence rates of epilepsy in India are partly dependent on
the prevalence of NCC in the given community. To some extent, this may be responsible for
variable rates of epilepsy prevalence reported from different regions of the country. 22
A cross-sectional descriptive study design was conducted on Evaluation of Factors
Influencing Medication Adherence in Patients with Epilepsy. A sample of 272 patient with
epilepsy attending Ahmadu Bello University Teaching Hospital/Jicon Hospital Kaduna, who had
been on antiepileptic drugs (AEDs) for at least one year. The level of knowledge of epilepsy
based on signs and symptoms was high as 57.8% and 25.9% of the patient with epilepsy had
excellent and good knowledge respectively. This study showed that patients with epilepsy had
adequate knowledge of epilepsy and its treatment. Medication adherence was demonstrated to be
low due to forgetfulness, fatigue and being away from home.7
A cross sectional study design was used to determine knowledge, attitude and belief about
epilepsy among adults in a northern Nigerian urban community. The respondents (39.0%)
mention that epilepsy is manifested by convulsion. Other respondent included falling down
(36.0%), rolling of eyes (11.7%), foaming of mouth (10.3%), 25.2% didn’t know the cause of
16
epilepsy , heredity (19.9%), brain injury (19.2%), evil spirits (16.3%) and brain infection
(11.7%). Overall (n=52, 26%) of the respondents had good knowledge of epilepsy whereas
(n=62, 31%) and (n=86, 43%) had fair and poor knowledge of the disease respectively. Majority
of respondents (47.0%) opted for spiritual healing. This was followed by orthodox medical care
(34.0%) and the use of traditional herbal medicines (19.0%).23
A meta-analysis was conducted on cognitive-based behavior change techniques as
interventions to improve medication adherence. 26 studies (5216 participants) were included for
the study. An effect size (95% CI) of 0.34 (0.23 to 0.46) was calculated and was statistically
significant (p < 0.001). Heterogeneity was high with an I2 value of 68%. Adjustment for
publication bias generated a more conservative estimate of summary effect size of 0.21 (0.08 to
0.33). Cognitive based behavior change techniques are effective interventions eliciting
improvements in medication adherence that are likely to be greater than the behavioral and
educational interventions largely used in current practice.17
A study was conducted on Patient’s preferences towards antiepileptic drug therapy following
first attack of seizure in department of neurology, government Stanley medical college and
hospital, Chennai, . Included patients with first attack of unprovoked generalized tonic-clonic
seizure (GTCS) within 30 days of onset, aged between 18-60 years. They were followed up for
one year. In that they found 73 enrolled 54 males and 19 females among that 39 were preferred
to go on anti epileptic therapy (AED). The reasons for preferring AED therapy were; fear of
seizure recurrence54%, risky occupation 36% and fear of injury 10%. The reasons for deferring
were fear of adverse effects of long-term AED therapy 56% and preferring to wait for the second
attack 44%. Following first attack of unprovoked GTCS the decision regarding AED members
after adequate counseling and such decisions have more relevance from their perspective.24
17
A survey was developed to gather information from both patients with epilepsy and
community pharmacists on the issue of antiepileptic drug (AED) formulation switching, which
includes brand to generic, generic to brand, and generic to generic. Data were obtained from 82
patients (or parents of patients) with epilepsy and 112 community pharmacists. More than 92%
of patients and 85% of pharmacists agreed that switching between forms of the same AEDs may
cause an increase in seizures or adverse effects. More than two-thirds of our patient sample
reported having problems with formulation switching; many also reported knowing other
patients with problems. Just more than half (51%) of the pharmacists knew of patients who have
described problems when they have changed AED formulations. Less than 50% of both
populations knew that problems resulting from formulation switching should be reported as
adverse drug events to the FDA. Not many pharmacists and far fewer patients use Med Watch to
report these problems. The study conclude that both patients with epilepsy and pharmacists are
under informed and under involved with reporting adverse drug events.25
A study was carried out by a team of nurses on causes of death among the in-patients and
out-patients in the National Epilepsy Centre, Shizuoka. A total of 171 deaths were recorded
among the 20,000 out-patients, which were not necessarily sudden but unexpected. The
standardized mortality ratio for accident and trauma are higher, suggesting that accident and
trauma are frequent causes of death in epilepsy patients as compared to the general population.
Among the accidents, it has-been found that patients with seizures.26
A study was conducted on effects of educational intervention on changing parental
practices for recurrent convulsions in department of nursing, to evaluate the of educational
interventions on family members practices for recurrent convulsion. Total 326 sample were
selected among them 196 family members received pamphlets, 130 family members were
18
attained the educational program. In that they found family members who received pamphlets
did not shows significant improvements. Family members who attended the educational program
demonstrated significant improvements in the recommended practices, particularly in protecting
convulsive patient.27
7. MATERIAL AND METHODS
7.1 SOURCE OF DATA
The data will be collected from patient with epilepsy in abhaya hospital, Bangalore.
METHODS OF DATA COLLECTION
i. Research design
Pre experimental design- one group pretest and post test design.
PRE TEST(O1) INTERVENTION(X) POST TEST(O2)
19
Assess the pretest level of
adherence to treatment
measured by morisky
medication taking adherence
scale and knowledge
regarding side effect to
epileptic drug and
prevention of complication
of epilepsy using structured
interview schedule.
Investigator will provide
multifaceted intervention
through cognitive approach
using calendar method and
flash card, and behavioral
approach through
motivation and counseling.
Assess the post test level
adherence to treatment
measured by morisky
medication taking
adherence scale and
knowledge regarding side
effect to epileptic drug and
prevention of complication
of epilepsy using structured
interview schedule.
ii. Variables
Independent variables
Multifaceted intervention
Dependent variables
Adherence to treatment
Knowledge regarding side effect to epileptic drug and prevention of complication
of epilepsy among patients with epilepsy.
20
Demographic variables
Age, gender, religion, education status, marital status, occupational status, habits, family
income per month, any disease condition, duration of epileptic drug, previous knowledge,
and source of information.
iii. Setting
The study will be conducted in Abhaya hospital which is 100 bedded
multispecialty hospital located at Wilson Garden, Bangalore.
iv. Population
The population of the study will comprise of all the epileptic patients those who
are visiting OPD and are admitted in Abhaya hospital, Bangalore.
v. Sample
The patient who fulfill the certain inclusion criteria are selected for the study. The sample
size is 60.
vi. Criteria for the sample selection
Inclusion criteria
The study includes:
21
1. Patients who are diagnosed with epilepsy for past two years.
2. Both male and female epileptic patients between age group of 20 – 65 years.
3. Epileptic patients visiting OPD and admitted in abhaya hospital.
4. Epileptic patients who can understand Kannada, Hindi or English.
Exclusion criteria
The study excludes:
1. Epileptic patients those who are critically ill and are not able to comprehend.
2. Patient already with status epilepticus.
vii. Sampling technique
Non probability purposive sampling technique.
viii. Tool for data collection
The tool consists of the following sections
Section A: Demographic data includes age, gender, religion, education status, marital
status, occupational status, habits, and family income per month, any disease condition,
duration of epileptic drug, previous knowledge, and source of information.
Section B:- Morisky medication taking adherence scale will be used to assess the
adherence to treatment among patient with epilepsy.
22
Section C:- structured interview schedule will be used to assess the knowledge regarding
, side effect to epileptic drugs and prevention of complication of epilepsy
INTERVENTION PROTOCOL:
Multifaceted intervention will be given by the investigator through cognitive
approach and behavioral approach on the same day where cognitive approach is given by
calendar method for 15 minutes which consist of name of medication, day, time and dose.
Patients are asked to follow the medication pattern according to the calendar method for 7
days and teaching regarding side effect of epileptic drug and complication of epilepsy
through flash card is done for 20 minutes. The behavioral approach is provided through
motivation by giving intensive and counseling the patient for 25minutes.
ix. METHOD OF DATA COLLECTION
After getting formal administrative approval from concerning authorities and informed consent from
the samples the investigator personally collects the data. The data will be collected in following three
phase:-
PHASE 1: Pre-test will be conducted to assess adherence to treatment and knowledge regarding side
effect to epileptic drug and prevention of complication of epilepsy among patients with epilepsy using
morisky medication taking adherence scale and structured interview schedule.
23
PHASE 2: On the same day multifaceted intervention will be given by the investigator through cognitive
approach and behavioral approach. Where investigator in behavioral approach will provide 30 minute
counseling and motivation and in cognitive approach 20 minute teaching is provided using calendar
method and flash card.
PHASE 3: On 7th day, post test level of adherence to treatment and knowledge regarding side effect to
epileptic drug and prevention of complication of epilepsy among patients with epilepsy will be assessed.
x. Plan for data analysis
The data collected will be analyzed by means of descriptive and inferential statistics.
Descriptive statistics:
Frequency and percentage distribution will be used to assess the demographic
variables level of knowledge of patient with epilepsy.
Range, mean standard deviation and mean score percentage will be used to analysis
the level of knowledge regarding level of adherence to treatment, side effect to
epileptic drugs and prevention of complication of epilepsy among patient with
epilepsy.
Inferential statistics:
Paired‘t’ test will be used to compare the pre-test and post test knowledge regarding level of
adherence to treatment, side effect to epileptic drugs and prevention of complication of epilepsy among
patient with epilepsy.
24
Correlation co-efficient will be used to analyze correlation between the pre test and post test
knowledge regarding level of adherence to treatment, side effect to epileptic drugs and prevention of
complication of epilepsy among patient with epilepsy.
Chi-square test will be used to analyze the association between pretest knowledge on level of
adherence to treatment, side effect to epileptic drugs and prevention of complication of epilepsy among
patient with epilepsy with their selected demographic variables.
xi. Projected outcome
This study will assess the existing knowledge of patient with epilepsy. Administration of
multi faceted intervention will help to improve the patient’s knowledge on adherence to
treatment, side effect to epileptic drugs and prevention of complication of epilepsy among
patient with epilepsy.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTRVENTION TO BE
CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALES?
Yes, multifaceted intervention will be administered as an intervention for patient with
epilepsy.
7.4 HAS ETHICAL CLERANCE BEEN OBTAINED FROM YOUR INSTITUTION?
Yes, permission will be obtained from concerned authority of the hospital. The
informed concent will be obtained from samples. Confidentiality and privacy of data will be
maintained.
25
8. LIST OF REFERENCE
1. Roberta Kaplow, Sonya R. Hardin. Critical care nursing surgery for optimal outcome.
USA: Jones and Bartlett Publishers; 2007.
2. Hubley J. Communicating health–an action guide to health education and health
promotion. 1st edition. England: Macmillan; 2003; 351-353.
26
3. Psychiatric Disorders Associated with Epilepsy updated: Jun 8; 2011. Available from
http://emedicine.medscape.com/article/1186336-overview (access date 12/10/2013).
4. World Health Organization. Neurological Disorders. Switzerland: WHO Press; 2006
5. Frank W. Drislane, Micael Benatar, Bernard Chang, Juan Acosta, Andrew Tarulli, Louis
Caplan. Neurology. 3rd edition. New Delhi: Wolters Kluwer/ Lippincott Williams and
Wilkins.
6. WHO. Epilepsy in WHO Eastern Mediterranean Region. Bridging the gap, WHO library:
2010.
7. Ogboi Sonny Johnbull1, Babajide Farounbi, Ademola O. Adeleye, Olabunmi Ogunrin,
Agu P. Uche. Evaluation of Factors Influencing Medication Adherence in Patients with
Epilepsy in Rural Communities. Neuroscience & Medicine 2011, 2: 299-305.
8. Horne R, Weinman J, Barber N, et al. Concordance, adherence and compliance in
medicine taking. London: National Co-ordinating Centre for NHS Service Delivery and
Organisation Research & Development; 2005
9. Edeh J, Toone B. Relationship between interictal psychopathology and the type of
epilepsy. Results of a survey in general practice. Br J Psychiatry. Jul; 1987; 151:95-101.
10. Cascino GD. "Epilepsy: contemporary perspectives on evaluation and treatment". Mayo
Clinic Proc 69: 1199–1211.
11. Suzanne C. Smeltzer, Brenda G. Bare, Janice L. Hinkle, Kerry H. Cheever. Text book of
medical surgical nursing. 11th edition. Philadelphia: Lippincott publishers; 2007.
12. Staven Ck, Susan CK. Vagus nerve stimulator for epilepsy. Aug; 2011. Available from
www.m.webmd.com (access date on 17/11/2013)
27
13. Lewis. S, Heilkemper M, Birksen S, O Brien P, Bucher L. Lewis Medical surgical
nursing. 1st edition. Elsevier: India; 2011.
14. Kounteya sinha. Around 95% of Indians with epilepsy doesn’t get treatment. The times
of india. New Delhi; 2013. www.timesofindia.com (access date on 17/11/2013)
15. Nunes V, Neilson J, et al. Clinical Guidelines and Evidence Review for Medicines
Adherence: involving patients in decisions about prescribed medicines and supporting
adherence. Royal college of general practioners. London 2009 Jan; 1: 223106.
16. Clare M. Eddy, Hugh E. Rickards, Andrea E. Cavanna The cognitive impact of
antiepileptic drugs Therapeutic Advance Neurological Disorder 2011 Nov; 4(6); 3229254
17. Claire Easthall, Fujian Song, Debi Bhattacharya. A meta-analysis of cognitive-based
behaviour change techniques as interventions to improve medication adherence. British
Medical Journal 2013; 3: 002749.
18. Review Global Burden of Epilepsy updated 2010. Available from
http://www.who.int/mediacentre/factsheets/fs999/en/index.html (access date 9/10/2013).
19. Jennifer Monti. Epilepsy complications.2011 July 20. www.healthline.com (access date
on 16/11/2013).
20. Shankar P Saha, Sushanta Bhattachrys et al. A prospective incidence of epilepsy in a
rural community of West Bengal. Neurology Asia. 2008; 13:41-48.
21. Banjerjee TK, Ray BK, Das SK, Hazra A, Ghosal MK, Chaudhuri A, et al. A longitudinal
study of epilepsy in Kolkata, India. Epilepsy. 2010 Dec; 51(12):2384-91.
22. Deepak Goal, J. S. Dhanai, Alka Agarwl, V. Mehlotra, V. Saxena. Knowledge, Attitude
and Practice of epilepsy in uttarkhand. Annals of Indian academy of neurology. 2011
Apr-Jun; 14(2): 116-119.
28
23. M. Kabir, Z. Iliyasu, I. S. Abubakar, Z. S. Kabir and A. U. Farinyaro. Knowledge,
attitude and beliefs about epilepsy among adults in a northen Nigerian urban community
Neuroscience and Medicine, 2011 Dec; 2:299-305.24039 (epi usually)
24. Chandre moulesswaran V, Dhanaraj M, Rangaraj R, Vengatesan A
Chandramoulesswaran V. Anti epileptic drug therapy following first attack of seizure.
Online available from www.ncbi.nim.govt/ site /pubmed.
25. James W. McAuley, Alyssa Y. Chen, John O. Elliott, Bassel F. Shneker. An assessment
of patient and pharmacist knowledge of and attitudes toward reporting adverse drug
events due to formulation switching in patients with epilepsy. Epilepsy & Behavior 14
(2009) 113–117
26. M.Seino, Comprehensive epilepsy care: contribution from paramedical Professional.
Neural Journal South Asia 2001, 1 – 5.
27. Mei-chih Huange, Karen Thoma Effects of educational intervention on changing parental
practices for recurrent febrile convulsions. epilepsia,
www.interscience.wiley.com/journal. (access date 12/10/2013).
29
9. Signature of the candidate :
10. Remarks of the guide : Research is feasible and in
Nursing
11.1Name and designation of the guide : Mr. Venkatesan. B
Assistant Professor Medical Surgical Nursing
11.2 Signature :
11.3 Co- guide : Mrs. Prasanna. K
11.4 Signature :
11.5 Head of the department : Mrs. Prasanna. K
Medical Surgical Nursing Department
11.6 Signature :
12.1 Remarks of the Principal :30
31