Prevalence of Mentally Challenged Children in Selected Urban Area: Study of Mental Retardation in Children

Statement of the problem

A study to assess the prevalence of mentally challenged children and evaluate the effectiveness of information booklet on knowledge regarding stress management among parents of mentally challenged children in selected urban areas of Jabalpur

Objectives

Prevalence of mentally challenged children in selected urban area
pre-test knowledge score parents of mentally challenged children
post-test knowledge score parents of mentally challenged children
Effectiveness of information booklet on knowledge regarding stress management among parents of mentally challenged children
Determine the association between the pretest knowledge score with selected demographic variable

Operational definitions

Assess In this study, assess refers to check the prevalence of mentally challenged children & knowledge regarding stress management among parents of mentally challenged children.
Prevalence in this study the prevalence is a statistical concept referring to the no. Of cases of mentally challenged children that are present in a particular population at a given time.
Effectiveness-In this study effectiveness is the extent to which an information booklet producing a result or improving the knowledge of parents regarding stress management.
Knowledge In this study, it refers to the responses of subjects on questionnaires on stress management.
Information booklet – Information booklet refers to the written material. In this study, the information booklet will be used as independent variable by the researcher.
It provides information about-

Introduction of stress
Sign of stress (physical & mental)
Nature of stress
Stress management techniques
Short & long-term stress reduction techniques

Stress management -Stress management is a wide spectrum of techniques aimed at controlling a persons level of stress, usually for the purpose of improving everyday functioning.
Mentally challenged children- It is characterized by below-average intelligence or mental ability & lack of skill necessary for day-to-day living.

Assumption

Parents of mentally challenged children will express their knowledge regarding stress management techniques
·Information booklet increases knowledge regarding stress management among parents

Research Hypothesis

H1- significant difference in the mean pre-test & post-test knowledge score regarding stress management among parents
H2 There will be significant association between pre-test knowledge scores with demographic variables.

Delimitation

Limited time available for data collection
60 parents of mentally challenged children
Samples belong to selected urban areas
Samples willing to participate

Review of literature related to prevalence of mentally challenged children.

Ghising R., Shakya S., and Rizyal A (2013) conducted a study on Prevalence of refractive error in mentally retarded students of Kathmandu Valley according to the researcher A specific cause is identifiable in only about 25% of people who are mentally retarded, and of these only 10% have the potential for cure. In the remaining 75%, predisposing factors, such as deficient prenatal care, inadequate nutrition, poor social environment, and poor child-rearing practices, contribute significantly to mental retardation. Mental retardation has no cure but we can prevent before it develop or we can best manage with proper care.

Tizard and Grand (2008) conducted survey and made a comparative study of 150 families whose mentally retarded children were institutionalized and 10 families having retarded children at home. There was disturbed family functioning curtailment of social contact in 15% and 1/3 of another health problem in those families who had retarded at home.

Review of literature related to knowledge and attitude of parents regarding care of child with mentally challenged children.

Margalit M (2015) studied ethnic differences in expression of shame feeling by mothers of severely handicapped children. Shame on the part of parents of mentally handicapped children. Has pronounced effects on child-rearing practices. The aim of this study was to compare expressions of shame of different ethnic groups in Israel. The attitudes of 23 western mothers and 26 eastern mothers towards their moderately and severely retarded children were studied. Significant differences (P less than 0.05 P less than 0.01) were found, suggesting that the eastern mothers strongly expressed their shame where as the western mothers felt ashamed to express it at all. The western mothers felt that the social norms that reject feelings at shame and their own personal feelings of embarrassment were in conflict.

Levy Shift (2010). conducted a survey was done in Hyderabad to assess knowledge of people about causes and treatment of mental retardation in children. In society, there is a stigma about mental illness as well as mental retardation. People believe that mental retardation is due to black magic, god’s disgrace, or the sins of ancestors. Even educated people believe that no treatment for mental disorder. Half of the population seek required treatment from traditional healers and religious institutions irrespective of the nature of the illness; 20% of the people seek medical treatment as well as religious care for mental illness, and Only 10% of the people go to mental hospital. People believe that going to mental hospital will reduce family dignity and have to face religious stress. The postnatal mother will keep semi-starve for 3 months it cause nutritional deficiency intern leads to mental retardation. Consanguineous marriage is most prominent cause for mental retardation in South India.

Review of literature related to stress & its management among parents of mentally challenged children.

Mita Majumdar, Yvonne Da Silva Pereira, and John Fernandes (2018) conducted a study was on Stress and anxiety in parents of mentally retarded children Background: Studies comparing the stress perceived by parents of mentally retarded and normal children are limited. Aim: (i) To find whether there exists a difference in the perceived stress between both the parents of mentally retarded children, (ii) to study whether these stresses occur more frequently in parents of mentally retarded children compared with those of normal children, and (iii) to find any correlation between the severity of perceived stressors and the anxiety state of these parents. Methods: This study was conducted in the Child Guidance Clinic of a tertiary care psychiatry hospital. The study sample, comprising 180 subjects, was categorized as group A (60 parents of profound to moderately mentally retarded children), group B (60 parents of mild to borderline mentally retarded children), and group C (60 parents of children with normal intelligence), which served as the control group. Each parent was evaluated using the Family Interview for Stress and Coping (FISC) in Mental Retardation, and the Hamilton Anxiety Rating Scale (HARS). Results: Parents in group A had a significantly higher frequency of stressors and level of anxiety as compared to those in groups B and C. A positive correlation was found between the level of anxiety and stressors.

Ntswane AM, Van Rhyn L. (2017) conducted a qualitative, exploratory, descriptive, and contextual design was followed to investigate mothers experiences of caring mentally retarded children at home. Phenomenological interviews were conducted with a 12 purposefully selected samples of mothers. Findings indicated various challenges experienced by mothers during the care in terms of feelings of shock, despondency, and sadness in the early young stages. During later years, as the children grown, mothers felt shame, fear, frustration, anger, disappointment, and worry but they accepted. Suggestions were on improvement of health care services and education of the mothers and their families.

Pradeep Rao (2017) conducted a study on psychopathology and coping in parents of chronically ill children in Mumbai, North India. 30 parents whose children who had thalassemia were randomly selected from the thalassemia daycare centre of a teaching general hospital. The parents were interviewed on a semi-structured Performa and rated on stress and mechanisms of coping scales. Chronic illness in children affects the psychological health of the parents. Active coping strategies are associated with fewer distress indices and thus if inculcated may improve the ability to bear the burden of the illness without becoming themselves affected by psychiatric illness.

Ehiemere E, (2017) conducted a study to assess the effectiveness of health teaching approach incorporating use of puppetry with respect to BCG immunization by purohith JJ in 1984. The data was collected from 49 mothers and 33 health personnel using interview schedule, compliance checklist, and questionnaire. The data was analyzed using descriptive and interferential statistics. Study results indicated that health teaching incorporating puppetry increased the knowledge related to and compliance with BCG immunization. The group accepted puppetry as a method of health teaching.

Raj Kumari Gupta and Harpreet Kaur (2017) conducted a study on stress among parents of children with intellectual disability. The study examines stress among parents of children with intellectual disability. 102 parents formed the sample of this study, 30 of whom had children without disability. A stress assessment test with internal validity of 0.608 was utilized. This test has two parts: physical and mental, former with 19 items and latter with 21 items. T-test was applied to check differences in stress, gender differences, and differences in mental and physical stress. Results show that most parents of children with intellectual disability experience stress, physical and mental stress are significantly correlated, gender differences in stress experienced occur only in the mental area, and parents have higher mental stress scores as compared to physical stress.

Douma JC, Dekkar MC, and Koot Tim (2016) conducted an Exploratory study with a sample of 745 youths (aged 10-24 years) with moderate to borderline ID, 289 parents perceived emotional and/or behavioral problems in their child. Inference done was most parents (88.2%) needed some support (friendly ear, respite care, child mental health care, and information) & those who perceived both emotional and behavioral problems in their child needed support the most & those whos children with moderate ID or physical problems needed ‘relief care’, that is, respite care, activities for the child and practical/material help & these needs were met through parental counseling.

Methodology

Research Approach survey with evaluative research

Research Design

Phase I Descriptive with non-experimental with cross-sectional
Phase II Pre-experimental One group pre-test & post-test research
The setting of the study urban areas (Tilwara & Adhartal)
Sample 3-15 years mentally challenged children & their parents
Sample size 60 parents
Sampling Technique Non-probability convenient sampling
Population mentally challenged children & their parents
Target Population: mentally challenged children aged 3 to 15 years & their Parents
Accessible Population: mentally challenged children aged 3 to 15 years & their parents

Research Variables

Independent variables: Information booklet regarding stress management.
Dependent variables: Knowledge of parents of mentally challenged
Demographic variables: Age, Educational status, Types of family, Occupational status, Family income, previous knowledge regarding stress management

Sample selection criteria

Inclusion criteria

Mentally challenged children.
Parents who are willing to participate in the study & present during time of data collection.

Exclusive criteria

Parents who are not available at the time of data collection.
Development & description of the tool
Preparation of the blueprint

Blue Print of the Content

S.
No.
Content areas
Question
No.
Total No. of Question
Weightage
(%)

1 Knowledge

1,3,6,7,14,15,16,17,20,28,29.
11
36.67%

2 Understanding

2,5,8,10,12,19,21,23,25,30.
10
33.33%

3 Skill

4,9,11,13,18,22,24,26,30.
9
30%

TOTAL

30
100%

Description of the tool

Section A:

Socio-demographic data age, educational status of parents, types of family, occupational status, income & any previous information obtained about stress management.

Section B:

IQ TEST -Draw a man test (Mrs. Pramila pathak)

Section C:

A self-structured questionnaire effectiveness information booklet on stress management

Reliability of the Tool

Split half method (Karl Pearsons correlation coefficient formula r = 0.87,

Pilot study

Ranjhi, 1st March to 20th March 2019., 10 samples, non probability convenient sampling technique., Post test conducted after 20 days.

Procedures for data collection

Permission obtain BMO, 60 samples, urban area (Tilwara & Adhartal)

The actual data was collected in 1/4/19 to 15/4/19 & 1/5/19 to 15/5/19. subject provided information booklet regarding stress management.

Planning for data collection

Knowledge regarding stress management among their parents

DRAW A MAN TEST (MRS. PRAMILA PATHAK)

Directions: I want you to make a picture of a person. Make the very best picture that you can. Take your time and work very carefully. Try very hard and see what a good picture you can make.

Time: No time limit. Usually, 10 minutes will suffice with young children.

This test is to be used primarily as a screening device. The drawings of bright children more than 10 years old or those who have had drawing lessons will result in an invalid evaluation of the childs intellectual potential.

Scoring

Class A Preliminary Stage in which the drawing cannot be recognized as a human figure:

Aimless uncontrolled scribbling score 0.
Lines somewhat controlled approaches crude geometrical form score 1.

Class B All drawings that can be recognized as attempts to represent the human figure. Each point is scored plus or minus. One credit for each point scored plus and no half credits given.

Gross detail

Head present
Legs present.
Arms present
Trunk present
Length of trunk greater than breadth.
Shoulders are indicated (abrupt broadening of trunk below neck)

Attachments

Both arms and legs attached to trunk.
Arms and legs attached to trunk at correct points.
Neck present.
Outline of neck continuous with that of head, trunk, or both.

Head detail

Eyes present (one or two)
Nose present
Mouth present
Nose and mouth in two dimensions, two lips shown.
Nostril shown
Hair shown
Hair on more than circumference of head and non-transparent better than a scribble.

Clothing

Clothing present (any clear representation of clothing)
Two articles of clothing non transparent (ex. Hat, trousers)
Entire drawing free from transparencies sleeves and trousers must be shown.
Four articles of clothing definitely indicated. *should include 4 hat, shoes, coat, shirt, necktie, belt, trousers*
Costume complete with incongruities *business suit, soldiers costume and hat, sleeves trousers and shoes must be shown*

Hand detail

Fingers present (any indication)
Correct number of fingers shown
Fingers in two dimensions length greater than breadth, angle subtended not greater than 180 degrees
Opposition of thumb clearly defined
Hand shown distinct from fingers and arm

Joints

Arm joint shown elbow, shoulder, or both
leg joint shown knee, hip, or both

Proportion

Head not more than ½ or less than 1/10 of trunk
Arms equal to trunk but not reaching knee
Legs not less than trunk not more than twice trunk size
Feet in 2 dimensions not more than 1/3 or less than 1/10 of leg
Both arms and lens in two dimensions

Motor coordination

Lines firm without marked tendency to cross, gap, or overlap.
All lines firm with correct joining.
Outline of head without obvious irregularities. Develop beyond first crude circle. Conscious control apparent.
Trunk outline. Score same as #3.
Arms and legs without irregularities. 2 dimensions and no tendency to narrow at point of junction with trunk.
Features symmetrical (more likely to credit in profile drawings)

Fine head detail

Ears present (2 in full face, 1 in profile)
Ears present in correct position and proportion.
Eye details brow or lashes shown.
Eye detail pupil shown.
Eye detail proportion. Length greater than width.
Eye detail glance only plus in profile.
Chin and forehead shown.

Profile

Projection of chin shown usually + in profile.
heel clearly shown
Body profile head, trunk, and feet without error.
Figure shown in true profile without error or transparency.

Table of mental age equivalents of scores

Score
Ma
Score
Ma
Score
Ma
Score
Ma

3-3
14
6-6
27
9-9
40
13-0

3-6
15
6-9
28
10-0
41
13-3

3-9
16
7-0
29
10-3
42
13-6

4-0
17
7-3
30
10-6
43
13-9

4-3
18
7-6
31
10-9
44
14-0

4-6
19
7-9
32
11-0
45
14-3

4-9
20
8-0
33
11-3
46
14-6

5-
21
8-3
34
11-6
47
14-9

5-3
22
8-6
35
11-9
48
15-0

5-6
23
8-9
36
12-0
49
15-3

5-9
24
9-0
37
12-3
50
15-6

6-0
25
9-3
38
12-6
51
15-9

6-3
26
9-6
39
12-9

In finding the IQ of retarded children who are more than 13 years old, the chronological age should be treated as 13 only, and the IQ recorded as or below.

It is not wise to attempt to use this test with bright children of more than 15 years of age.

Plan for data analysis

Descriptive

Frequency and percentage distribution to analyze demographic variables.
Mean, Mean percentage and standard deviation

Inferential statistics:

t-test to compare pre and post test score of knowledge regarding stress management after information booklet
Chi square to measure association between pre test knowledge score with socio-demographic variables.

Ethical consideration

Presented before the committee.

No subjects were harm

Informed consent from the parents of samples.

Analysis and interpretation of data

Organization of findings

Section I: Prevalence of mentally challenged children
Section II: distribution of parents of mentally challenged children according demographic variables.
Section III (A): pre-test Knowledge score
Section III (B): post test Knowledge score
Section IV: effectiveness of information booklet on stress management
Section V: association between pre-test knowledge scores with selected demographic variables

Prevalence of mentally challenged children

S. No.
Area
Population

(Age 3- 15 years)

No. of Mentally challenged children found
Prevalence
(%)

1. Adhartal

2357
72
3.05%

2. Tilwara

747
17
2.27%

population (age group 3-15 years) of Adhartal is 2357 & in Tiwara 747. 72 children in Adhartal & 17 children in Tiwara, found mentally challenged so the prevalence rate is 3.05% in Adhartal & 2.27% in Tiwara.

Frequency & percentage distribution of mentally challenged children according to their IQ level

N=89
S.N.
IQ level
Frequency (n)
Percentage (%)

1. Borderline (71-90)

8
8.99%

2. Mild (50-70)

9
10.11%

3. Moderate (35-50)

66
74.16%

4. Severe (20-35)

4
4.49%

5. Profound (below 20)

2
2.25%

Distribution of mentally challenged children through IQ test

8 (8.99%) children had borderline IQ, 9(10.11%) children had mild IQ, 66(74.16%) children had moderate IQ, 4(4.49%) children had sever IQ, 2(2.25%) child had profound IQ.

SECTION-II: Distribution of subjects according to their selected demographic variables.

Age
Educational status
Types of Family
Occupational status of the Subjects
Family Income
Previous Information Related to stress management

SECTION III(A): pretest knowledge score

pre-test knowledge score regarding stress management

SECTION III(B): post-test knowledge score.

post-test knowledge score regarding stress management

SECTION IV: effectiveness of information booklet on stress management among parents of mentally challenged children.

Comparison between pre-test and post-test Knowledge score subjects

SECTION V: Association between pre-test knowledge score with selected demographic variables

S.No
Variables
Poor
Average
Good
Total
df
Chi-
value
P-
value

Inference

1. Age (in years)

6
7.539
NS
a
25-30 yrs
8
4
12
b
31-35yrs
5
13
18
12.59
c
36-40yrs
7
15
1
23
d
Above 40 yrs
3
4
7

2. Educational status

8
7.659
NS
a
No formal education
3
3
6
b
Primary school
8
5
13
15.51
c
Middle school
4
7
11
d
Higher school
4
10
14
e
Graduate
4
11
1
16

3. Type of family

4
1.541
NS
a
Joint
13
19
32
9.49
b
Nuclear
9
15
1
25
c
Extended
1
2
3

4. Occupational status

6
30.83
S
a
Non working
6
4
10
b
Self employed
12
16
28
12.59
c
Private job
4
14
18
d
Government job
1
2
1
4

5. Family income

2
2.48
NS
a
Below ¹ 10000 / –
17
26
43
5.99
b
Above ¹ 10000 / –
6
10
1
17

6. Previous source of knowledge regarding stress management

6
5.24
NS
a
Mass media
2
6
8
12.59
b
Health personnel
2
8
1
11
c
No information
18
19
37
d
Family & relatives
1
3
4

Significant- Occupational status

Not significant- Age, educational status, family types, family income & previous source of knowledge regarding stress management

Implication

Nursing practice:

parents of mentally challenged children had always under pressure like stress related to care of their child.
As a health professional, the nurses who are in hospitals have a responsibility in providing information regarding various stress management strategies. Nurses work in psychiatric hospitals they adopt the program & implement it for better outcome of the parents of mentally challenged children.

Nursing Administration

Nursing administrator can make use of the facilities or educate with the existing hospital setting together with the nurses to utilize the stress management techniques for public.
Administrators should take provision for in service education program regarding stress management for staff to update their knowledge.
Nurse administrator should implement outreach program to make public aware about stress management.

Nursing Education

Nurse educators need to be equipped with adequate knowledge regarding complimentary & alternative therapy for stress management.
Nursing students should be made aware to evaluate the physical and psychological causes of the stress and about the various nursing interventions.

Nursing Research

Disseminate the findings of research through seminar, workshop & publishing nursing journals.
Nurses should be encouraged for conducting further research such as relaxation, teaching, counselling management of stress complementary health practices etc.

Recommendations

A similar study may be replicated on a larger sample.
A similar study could be done on their psychiatric conditions, depression etc.
A similar study can be undertaken at different setting.
A study may conduct to assess the knowledge and practice of staff nurses regarding stress management.

Limitations

The study was confined to a specific geographical area which imposes limits on generalization.

Long term effect of the intervention was not assessed due to lack of time.
Responses of the subjects were restricted to self structured questionnaire.
The study is time consuming.
The study tool is difficult to use on severe mentally challenged children.

Conclusion

Study aimed to assess the prevalence of mentally challenged children and evaluate the effectiveness of information booklet on knowledge regarding stress management among parents of mentally challenged children.

concluded undoubtedly that the administration of information booklet on stress management among parents of mentally challenged children increase the knowledge about stress management techniques.

Research approach (survey with evaluative approach)
Research design (descriptive with non experimental with cross sectional design & one group pre test & post test research design)
Target population (mentally challenged children & their parents in selected urban areas of jabalpur city)
Accessible population (mentally challenged children & their parents presented at the time of data collection)
Sampling technique (non probability convenient sampling technique)
Sample size ( 60 sample)

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