CHAPTER-III METHODOLOGY “Methods are tools. Use them; don’t let them use you.” Methodology is the framework for concluding a study. It indicates the general pattern for recognizing the procedure to gather valid and reliable data for an investigation, This chapter gives a description of the research approach, Research design, Variables under the study, setting of the study, Population, Sampling and Sampling technique, Schematic representation of the study design. The present study is aimed at assessing the knowledge of cardiac patients regarding the lifestyle modification and to find the association between the knowledge score with selected demographic variables with a view to develop an self instructional module to enhance the knowledge of cardiac patients regarding the lifestyle ification for maintaining healthy heart. Research approach Research approach indicates the procedure for conducting the study. In order to accomplish the objectives of the study. a evaluative approach has been adopted. Research design Evaluation Research studies are an applied form of research design which involve the judgment about how well a specific programme, practice, Procedure or policy is working.Nee cunn? test t Aiea) measure associatio eas nea Secer Tha COnICaey |: Independent variables DV: Dependent variables SIM: Self Instructional Module Fig. 2 Schematic Representation of the Study DesignVARIABLES A variable is a measu Ie isa measurable component of an object or event that may fluctuate in quantity or quality from one i f quantity or quality from one individual, objects or event to another individual of the some general class. Dependent Variables The dependent varia i ¢ dependent variable is that phenomenon in the hypothesis, is not manipulated by the investigator but accepted as it occurs. It also called the effect, the response, the criterion measure. behavior or outcome that is researcher wishes to predict, study and explain. In this study the dependent variable was knowledge on lifestyle modification for maintaining healthy heart which will be tested before and after conducting self instructional module among cardiac patients. Independent Variables The independent variable is that phenomenon in the hypothesis that, in the s not manipulated by the investigator. non-experimental study, to test the hypothesis, It is also called the cause, stimulus, non-experimental variable that is manipulated by the researcher in order to study the effect upon the dependent variable. In this study the independent variable was Age, Educational status, income And health teaching, Setting of the study: The setting is the location where the study is conducted. For the present study the setting was in Government Dharmapuri medical college and hospital . This setting was selected because of theavailability of the sample, ‘sibility of conducting the study of the investigator with the setting, Pop Polit anc! Hungler (2004), referred population as the entire set of individuals or subjects having ca a i "NB common characteristics, sometimes referred to as universe Population may be of wo types. target population and accessible population. In this study two populations were described, Sample mple refers to subset of a population that is selected to participate in a study. It 8 a portion of a population that represents the entire population. In this study, sample consists of 60 patients of Government Dharmapuri Medical college and hospital. Sampling Technique Sampling defines the process of selecting a group of other elements with which to conduct a study. In this study non — probability random sampling technique was adopted. Random sampling involves selection of sample on basis of probability. Each of the population has an equal chance of being selected, Criteria for sampling a) Inclusion criteria 1. The patients with the CAD who are admitted in Government Dharmapuri Medical College and hospital nts with the CAD who are able to read and understand Tamil OR 2. The pat English. 3. Patients who are willing to participate in the study 4. Patients who are available during the period of collecting datab) Exclusion criteria 1. The patients with the C. © Patients with the CAD admitted in Government Dharmapuri Medical college and hospital and who ae not willing to participate in the study 2. The patients with th Ne Patients with the CAD who are not able to read and understand Tamil or English DEVELOPMENT OF THE TOOL, The most important aspect of any investigation is the collection of appropriate information. which will provide necessary data to answer the question raised in the study. A Self Instructional Module was selected based on the objectives of the study, as it was considered to be the most appropriate instrument to elicit the responses from the participants. An interview schedule demographic Performa was prepared to identify the demographic variables. self administered questionnaire was prepared to assess the knowledge of the patients those who are affected by Cardiovascular Disease. Knowledge questionnaire consisted of 34 questions each of it carried a score of | The tool was developed. «After reviewing the related literature. the related studies from journals and periodicals. «Based on the experience of the investigator and © Based on the contact and consultation of the subject experts All these helped in the ultimate development of the tool.DESCRIPTION OF THE TOOL Based on the objectives of the study, the followin tool was developed to generate the data The tool consists of following sections, Seetion As It consist of demographic data of the patients with CAD Section B: Self administered questionnaire to assess the knowledge regarding the Life Style Modification for maintaining Healthy He art among eardiae patients, SECTION A: N consists of demographic data which gives base line information of the patients with the CAD such as. 1) Age 2) Sex 3) Religion 4) Education 3) Occupation 6) Family income 7) Marital status 8) Type of family 9) Type of diet 10) Personal habits 11) Duration of illness 12) Medical diagnosis 13) Number of admissions in one year 14) Number of visit for follow-up eteSECTION B: It consists of self-adn inistered questionnaire to assess the knowledge regarding the Life Style Modification for maintaining healthy heart among cardiac patients in Government DharmapuriMedical College and hospital In mainly consists of five parts: Part I : General knowledge related to heart disease Tl: General information about Life Style Modification Part III: Knowledge related to dietary modification & weight loss Part Knowledge related to exercise & stress management Part V : Knowledge related to habits All the five parts of questionnaire consists of 34 multiple choice questions, each having more than 4 options from which the correct option was to be chosen: Each correct item was scored 1 mark. The subject who. got a score of <50% were considered as inadequate knowledge. scores of 50-75% were considered as moderately adequate knowledge. scores of 75% were considered as well adequate knowledge . CONTENT VALIDITY OF THE TOOL Validity refers to whether a measuring instrument accurately measures what it is supposed to measure, The content validity of the tool and self instructional module was ascertained in consultation with experts in the field of Medical & Surgical Nursing. Validation checklist was sent and was completed by the experts for content validation. The experts were requested to give their opinion regarding relevance, appropriateness anddegree of agreemen In cach ite "mM in the tool, §; ol. Suggesti io by the experts ns and recommendations given Suggestion clicits from experts On knowledge questionnaire: One of the experts suggested adding ding the general knowledge regarding, cardiac problems and avoiding unnece: ssa “TY Questions about anatomy and physiology of heart and neglecting adding more all electing of, the above in the answer options. The items were included and answei id answer options were changed. On demographic data:- One of the experts su este: gested modify the data type questions. Accepted the suggestion and the items were changed Criteria rating scale for validation of tool was developed Part ~ |, comprised of demographic data and Part - Il, comprised of self administered questionnaire on Life Style Modification for cardiac patients Check list for the tool had relevant, need modification, not relevant options and remarks of experts. TAMIL TRANSLATION The tool was translated by the language experts into Tamil and it was translated to English by another expert to determine its content validity. ETHICAL CONSIDERATION: ce was obtained from the Government An ethical clearan' Dharmapuri Medical college and hospital. + Consent was taken from all the participants.RELIABILITY OF THE TOOL, Reliability of research instru _ trument is defined as the extent to which the instrument yields the san Same result on respected measure. It is then concemed with consistency, accuracy, it % Precision, stability, equivalence and homogeneity. The final tool w; was i tested for reliability. The self administered questionnaire was administered to | O patients. The reliability of the tool was established by testing the stability and i ternal consistency, The stabilit is 'y of the tool is assessed by test retest method (Karl Pearson Coefficient f it formula) and the stability of the tool is 0.7 which indicate that tool is ia Th i stable. The internal consistency of the tool is assessed by split half method and the internal consistency of the tool is 0.91.1t indicates that the tool was reliable PILOT STUDY A Pilot study is a small scale version or trial run, done in preparation for the major study. It is designed to acquaint the researcher with the problems to be encountered in preparation for the larger project. It also provides the researcher to try out the procedure for collecting the data. The function of pilot study is to obtain information for improving the project or assessing its feasibility. The subject selected for the pilot study possessed the same characteristics of the major study in order to maintain homogeneity. The consent was taken by explaining the purpose of the study. Pilot study was conducted in to assess the effectiveness of self instructional module regarding lifestyle modification among cardiac patients in Government dharmapuri Medical College and hospital.After that § i ‘that Self Instructional Module was administered. After 3 days gap post- was done to the same ubjects by using the same questionnaire. Statistical ay lysis done with the help of paired ‘t’ test to observe the icant difference the knowledg ¢ r Knowledge scores of subjects before and after the self instructional module. The sample taken fi 'e sample taken for pilot study was not considered in the main study. The Purpose of pilot study was To find out the feasibility on conducting the final study. > Refine the tool. > To determine the method of data analysis. After conducting the pilot study, it was found that the study was feasible , authentic and clients was cooperative, the questionnaire and the teaching plan were relevant and time and cost of the study were within the limits Tool to validate the effectiveness of Self Instructional Module: The same structured questionnaire which was used for pre-test used to assess the effectiveness of the Self Instructional Module on Life Style Modification among Cardiac patients in Government dharmapuri Medical College and hospital. Prior to the actual data collection, written permission was obtained from the s from hospitals and concern from the cardiac patients to conduct higher authoriti n three phases on the basis of inclusion interview. Data collection was carried out i criteria,PHASE 1: Pre-test will be conducted to as the knowledge regarding the Life Style Modification for healthy heart among cardiae patients using self administered questionnaire, Duration: 2 days PHASE 2: Self Instructional module regay le Modification for Ir H garding the Life Sty! toatl maintaining healthy heart among cardiac patients was administered after phasel PHASE 3: After 3 days post-test was administered to assess the level of knowledge regarding the Life Style Modification for maintaining healthy heart among cardiac patients to the same subjects with the help of same questionnaire duration of the study: 8-10 days DESCRIPTION OF THE INTERVENTION The samples were drawn from the patients those who have been admitted in Government dharmapuri medical college and hospital. The investigator was contacted around 60 patients and explained the objectives and need of the study and administers the Self instructional Module. ‘The score were given such as lesser the score: reflect inadequate knowledge. Based on the scores, the self instructional module were planned and prepared by the investigator and it send to the experts for the tools validity. Based on the suggestion given by the experts and guide the tool was modified for final data collection. The total sample consisted of 60 cardiac patients for self instructional module were administered.‘The pre — test and post — tests knowledge level on life style modification to maintain healthy heart were evaluated to find out the effectiveness of self instructional module, PLAN FOR DATA ANALYSIS The collected data will be planned and analyzed in the form of descriptive and inferential statistics. The analyzed was presented in the form of tables and figures by using mean, median, mode, percentage, standard deviation, chi-square test HUMAN RIGHTS PROTECTION: The study was conducted after getting the approval from the ethical Committee. Permission was obtained from authority of particular Hospital. The purpose and other details of the study were explained to the study subjects and oral consent was obtained from them.