Back ground of the study: Anemia is defined as reduction in the number and quality of circulating in the number and

quality of circulating red blood cell when the hemoglobin content is below the normal age, level for particular age, resulting in decreased oxygen carrying capacity. Hemoglobin level below 11 gm% in children between 6 months to 6 years of old is suggestive of anemia and 13 gm% for man and 12gm% to 14 gm% for female. Iron deficiency occurs when there is a long-term negative iron imbalance and anemia is the most severe stage of this deficiency. In India the adolescent population constitute more than one fifth (23%) of total population . Adolescent are vulnerable to iron deficiency because of increased iron requirement related to rapid growth . The adolescent period is a period of intense growth, iron is one nutrient that is in particularly high demand. That's because a girl needs more iron to compensate for the blood lost during her menstrual periods. Pregnancy can also cause a girl to develop anemia. Objectives of the Study: 1.. To assess the level of knowledge of the adolescent school going girls regarding anemia and its prevention. 2. To prepare and validate an information booklet regarding anemia and its prevention among the adolescent school going girls . 3. To evaluate the effectiveness of the information booklet in terms of gain in post test knowledge score among adolescent school going girls. 4. To find out the association between the pretest knowledge score of the adolescent school going girls with the selected variable like age ,number of sibling ,education , socioeconomic status ,health related information .

Variable of the study were : Independent variable : Independent variable is an information booklet on anemia and it s prevention. Dependent variable : dependent variable is knowledge level of the adolescent school going girls.

Hypotheses of the Study: H1: The mean post test knowledge score is significantly higher than the mean pre test knowledge score of adolescent school going girls regarding anemia and it s prevention.

H2: There is a significant association between pretest knowledge scores of the adolescent school going girls with the selected variable like age of the adolescent school going girls, number of siblings ,education , socio economics status and health related information .

Conceptual framework
The conceptual frame work used in this study was developed based on Rosenstoch s Health Belief Model. Of 1974. Health belief model addresses the relationship between a person s beliefs and behavior . It provides a way of understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapist. The research approach utilized for the study was evaluative research approach with one group pretest and post test design . The study was done among adolescent school going girls of a selected high school urban community at nagaon district ,Assam . Non probability convenience sampling was used to select the sample of 40 adolescent school going girls to identify the knowledge about anaemia and its prevention . Further 40 adolescent school going girls had been evaluated for findings the effectiveness of information booklet in terms of knowledge regarding anaemia and its prevention The tools for the data collection were : Tool 1 : Part I -- Demographic Performa. Part II Modified Srivastava Socio Economic Status scale Part III Health related information 2. Tool 2 : Structured knowledge questionnaire on anemia and its prevention. Based on objectives and hypotheses the data were analyzed and interpreted using both descriptive and inferential statistics in terms of frequencies ,percentage ,mean ,median, standard deviation , t value and chi square . MAJOR FINDINGS OF THE STUDY :  Half of the (50%) of the adolescent school going girls were between 13-15 years of age and 50% of the adolescent school going girls were above 15 years of age .

 Majority (45%) of adolescent school going girls has 1 -3 numbers of sibling .  Half (50% ) adolescent school going girls has the educational status on class ix where as 50 % adolescent school going girls has the educational status of class X .  Majority (55 %) of the adolescent school going girls belonged to moderate socio economic status .  Majority ( 55%) of the adolescent school going girls had moderate knowledge of health related information .  The data showed that the pre test knowledge scores of the adolescent school going girls ranged between 12-24 and post test knowledge scores ranged between 27-29 .  Computation of the data using paired t test showed that the research hypothesis was accepted depicting that the gain in knowledge was not by chance and the adolescent school going girls significantly gained knowledge on anemia and its prevention after administration of information booklet (t=60 p<0.05)  The obtained pretest mean scores was 13.3 where the post test mean score was 25.9 .  Out of seven areas of knowledge ( meaning of anaemia, structure and function of blood, causes of anaemia , clinical features, investigation, home level management, complication, prevention ) the mean percentage of pre test score of the adolescent school going girls was highest ( 59%) in the area of investigation and the lowest (32%) in the area of structure and function of blood . The mean percentage of post test score was highest ( 90%) in the area of complication and the lowest (80%) in the area of clinical feature .  The highest actual gain 58.7% was in the area of prevention and the highest modified gain was in the area of home level management .  The chi square value showed that there was significant between the pretest knowledge level with selected extraneous variable .i.e socio economic status, and health related information The study also has its implication in the field of nursing practice ,nursing administration ,nursing education and nursing Research

ACKNOWLEDGEMENT I extend my deep sense of gratitude to God Almighty for the abiding grace which made it possible for the successful completion of the study At the onset ,I express my sincere gratitude to Mrs Sheuli Sen (Ghosh)Professor Child Health Nursing , B.M.Birla College of Nursing for her valuable guidance and inspiration for the successful completion of the study . Without her direction and motivation it would have been difficult to complete the present study . I express my profound gratitude to Mrs Mumtaz Begum ,Lecturer ,other guide ,B.M Birla college of Nursing for her kind support ,valuable guidance and encouragement . I am highly indebeted to Mrs AsimaChkraborty ,Principal B.M Birla College of Nursing ,Kolkata for her kind support and facilitation for present study . I express my deep gratitude to Dr Aparna Bhaduri , Nursing Research Consultant for her excellent guidance and suggestions offered to me for the successful completion of this study . Gratitude is expressed to the expert who gave their opinion for the content validation of tool and planned teaching programme . Gratitude Acknowlgement is expressed to Head Mistress of Kiranbala Balika Vidyapith , Nagaon district for accordance of permission to conduct the study I extend my sincere gratitude to all the experts who have contributed their suggestions in validating the data collection instruments and the information booklet I owe my sincere thanks to all the faculty members of B.M.Birla College of Nursing ,who gave their valuable opinion during the study , so as to make the study more strong and fruitful. Gratitude acknowledgement is expressed to Headmistress of Behala Banitirtha girls high school for accordance of permission to conduct the pilot study Gratitude is expressed to Headmistress of Behala Girls high school for permission to conduct pretesting and Reliability of the tool I am indebted to all the student who participated in the study . without their cooperation this study would not have materialized . I would like to extend my heartfelt thanks to Mrs Abanti Gopan ,Nursing Consultant service and education for editing my thesis paper.

I would like to thank the library staff of B.M.Birla College of Nursing Kolkata for extending their help in the search of reference material needed for the study . My sincere thanks go to all my teachers ,friends and well wishers for their encouragement ,support and good wishes for the success of this study Words of Acknowledgement remain incomplete if I do not express my sincere and deep sense of indebtedness to my parents for their constant love and encouragement throughout the study

SUMMERY ,FINDINGS, LIMITATION,RECOMMENDATION

CONCLUSION,

IMPLECATION

This chapter dealt with a brief summery of research study discussion of the findings and conclusion drown on the basis of Research findings .The implication of this study for nursing practice ,nursing education, nursing administration, and nursing research. Limitation of the study are identified and Review for further research studies are suggested SUMMERY : The study was conducted to assess the knowledge of anemia and its prevention among adolescent school going girls and to find out the association between pre test knowledge level of adolescent school going girls with the variables like age, educational status, number of siblings, socio economic status, health related information . so as to plan recommendation of specific prevention of anaemia among adolescent school going girls . The objectives 1.To assess the level of knowledge of the adolescent school going girls regarding anemia and its prevention. 2. To prepare and validate an information booklet regarding anemia and its prevention among the adolescent school going girls . 3. To evaluate the effectiveness of the information booklet in terms of gain in post test knowledge score among adolescent school going girls. 4. To find out the association between the pretest knowledge score of the adolescent school going girls with the selected variable like age ,number of sibling ,education , socioeconomic status ,health related information Hypotheses H1: The mean post test knowledge score is significantly higher than the mean pre test knowledge score of adolescent school going girls regarding anemia and it s prevention. H2: There is a significant association between pretest knowledge scores of the adolescent school going girls with the selected variable like age of the adolescent school going girls, number of siblings ,education , socio economics status and health related information Variable :

Independent variable : Independent variable is an information booklet on anemia and it s prevention. Dependent variable : dependent variable is knowledge level of the adolescent school going girls. The study was under taken with following assumptions  Adolescent school going girls believe to be give free and frank information.  Anemia is a preventable and curable disease condition.  An information booklet is one of the best method of imparting knowledge to the adolescent school going girls regarding anemia and its prevention.  Adolescent school going girls has preliminary knowledge regarding dietary deficiency diseases. The study was based on Rosenstock s health belief model . The Research approach was evaluative approach and Research design was one group pretest post test design . The study comprised of adolescent school going girls and who could understand and follow assumes . Non probability convenient sampling technique was employed by using to select the adolescent school going girls . An information booklet was used to assess the knowledge level of adolescent school going girls .The steps involved in the development of tool were preparing ,blue print, developing items, content validation, translation, pretesting, and establishing reliability. The pre testing was done among 5 adolescent school going gils in behala banitirtha girls high school at Kolkata . the reliability of the tool was established among 20 adolescent school going girls in behala banitirtha girls high school . The reliability for the structured knowledge questions was calculated using KR-20 formulated and the reliability co-efficient was 0.84 An information booklet was developed on anaemia based on extensive review of literature ,objectives of the study, and consultation with experts .the content of information booklet was developed under following heading ---- meaning of anaemia, structure and function

of blood, causes of anaemia , clinical features, investigation, complication, prevention.

home level management,

Pilot study was conducted on to assess the feasibility of the study and also to plan for analysis of the data from 17.09.11 to 23.09.11 . Pilot study is conducted on (05) subjects .The subjects were selected by non-probability convenience sampling method. A group of 5 (five) adolescent school going girls were selected for the study. The final data was collected in the month of oct 2011 from a sample of 40 adolescent school going girls .Further 40 adolescent school going girls were evaluated for the effectiveness of information booklet on anaemia and its prevention The analysis was done by using both descriptive as well as inferential statistics . MAJOR FINDINGS : SECTION I : findings related to the description of adolescent school going girls according to their demographic characteristics are distributed in frequency and percentage .  Half (50% ) of the adolescent school going girls were in the age group of between 13-15 years of age and 50% of the adolescent school going girls were above 15 years of age .  Majority (45%) of adolescent school going girls has 1 -3 numbers of sibling .  Half (50% ) adolescent school going girls has the educational status on class ix where as 50 % adolescent school going girls has the educational status of class X .  Majority (55 %) of the adolescent school going girls belonged to moderate socio economic status .  Majority ( 55%) of the adolescent school going girls had moderate knowledge of health related information . SECTION II : Findings related to pre test knowledge and post test knowledge scores of adolescent regarding anaemia and its prevention . y Range of obtained scores mean, median, and standard deviation of pre test and post test knowledge scores. y T value to determine the significance of difference between the means of pretest and post test knowledge scores .  The mean ,median, standard deviation, of pre test knowledge scores were 13.3, 13 , 8.16 .

 The mean ,median, standard deviation, of post test knowledge scores were 25.92,26.1, and 6.69 respectively .  The mean post test knowledge scores ( 25.92 ) is significantly higher than the mean pre test knowledge scores (13.35) with a t value of 60 at df 39 significant at o.o5 level for the adolescent school going girls . SECTION III Findings related to the association between pre test knowledge level of adolescent school going girls with the variable like socio economic status , health related information ,age, number of sibling , educational status .  There is an association between pre test knowledge level of adolescent school going girls with the variable i.e socio economic status ,health related information. Chi square computed between pre test knowledge of adolescent school going girls with the variable i.e socio economic status, health related information was 7.263 and 7.263 respectively at df (2) significant at 0.05 level. SECTION IV Effectiveness of information booklet  The data shows that pre test knowledge scores of the adolescent school going girls ranged between 12-14 and the post test knowledge scores ranged form 27-29 .  The obtained pre test mean scores was 13.3 where as the post test mean scores was 25.92 .  In seven areas the mean percentage pre test scores of the adolescent school going girls was highest ( 60.67%) in the area of meaning of anaemia and lowest in the area of prevention . The mean percentage of post test score was highest (100%) in the area home level management and lowest ( 84) in the area of meaning of anaemia .  The highest actual gain percentage score (58.7 %)is in the area of prevention .The highest modified gain is in the area of home level management .  The mean post test knowledge score was higher mean 13.3 than the mean pre test knowledge score mean 25.92 . This indicated that the administration of information booklet was effective in increasing the knowledge of adolescent school going girls .

DISCUSSION The meaning of Research in a simple language is to explore or discover new things and concepts .People do research in the same issue again and again to find more number of facts in wider to compare and discuss their results with the previous findings to see whether these findings are supporting the present findings . By doing this it helps to make the base of the research stronger and stronger. So the present study findings are also discussed related to the objectives and conceptual framework and also compared with other findings . 1. To assess the knowledge about anemia The findings of the present study indicated that the mean pre test knowledge score was 13.3 % on anaemia and it prevention .this findings were supported by the study done by

2. Effectiveness of intervention programmes in the terms of gain in scores . The mean percentage of pretest knowledge scores of the adolescent school going girls regarding anemia was found to 60.67, 32,47.5,35,59,46.75,57.5,28.75 % respectively where as the post test mean % score in these above mentioned seven areas were 84%,84.4%,88.5%,80%,87.33%,100%,90%,87.5% respectively . indicating that the

information booklet was effective in terms of gain knowledge .These findings are supported by the study done by 3. Conceptual Framework : The present study was based on Rosenstocks health belief mode (1974) .The model postulates that health seeking behavior is influenced by a persons perception of threat posed by health problems and the value associated with action aimed at reducing the threat . According to Rosenstocks health belief model there are three factors Individual factors, Modifying factors, and likelihood of taking action .The adolescent school going girls will be able to perceive their susceptibility to anemia if they do not follow the preventive measures like dietary intake, regular health check up, personal hygiene . . Perceived threat of anaemia is influenced by the adolescent perception ,modifying factor and cues to action and ultimately lead to likelihood of taking action. Likelihood of taking action will depend upon the perceived benefits that is after gaining knowledge on

anaemia it will help the adolescent school going girls to prevent the occurrence of anaemia and also avoid further complication . This findings are supported by

IMPLICATION The present study emphasize the effectiveness of an information booklet regarding anemia and its prevention among adolescent school going girls to find out the association between pre test knowledge level Anemia with selected variable like socio economic status , health related information , education , number of siblings. The study has got implication in nursing education , nursing practice , nursing admission and Nursing Research . IMPLICATION FOR NURSING EDUCATION The present study has implication on Nursing Education . The findings of the study in terms of its effectiveness may encourage the teachers as personal to impart education in a effective way . The nurse should be equipped with updated knowledge of Awareness ,so as to impart knowledge to Adolescent school girls . Nursing education should emphasize to prepare student with adequate skill to provide health care from the A perspectives to guide them positively for a better attitude towards anemia . Skill communication is required to deal with adolescent group. Nurses play an important role to meet the needs of adolescent . In this study the information booklet proved its effectiveness in improving knowledge on anemia and it prevention . Hence the effectiveness of the information booklet is well established ,this may be used for the benefit of student as well as parents . IMPLICATION FOR NURSING ADMINISRATION The increasing incidence of anemia among adolescent demands professionals to render more attention to this vulnerable group. The concept of extends and expand role of nurse offers many opportunity for the nurse administrator to help the adolescent to cope during this period and to have proper knowledge of anemia ,the nurse administrator coordinates the work of her subordinates in preventive ,promotive and rehabilitative care . Nurse need to involve more actively in the preventive programme on anemia The nurse administrator should be able to motivate and initiate the health personnel in organizing ,conducting and participating in various educational programme that would contributes to better health care delivery system . There is a need for the health personnel especially the school health nurses about the health message to be communicated regarding anemia and its prevention . Nurse administrator should teach nursing personnel how these delicate message should be put accordance in the content of local , cultural ,traditional belief and custom . Nurse administrator can plan for continuing nursing education programme .i.e refresher courses and workshop for the expanded role of nurses and update this knowledge . She may emphasize that the nurse educator plays an important role in education to all patient admitted in the adolescent age group.

IMPLICATION FOR NURSING RESEARCH There is a need for the nurse to conduct research programme for the prevention of unhealthy behavior and promotion of healthy behavior . On the basis of this need there is an increased demand for research studies to find out the effectiveness of various teaching strategies to educate Adolescent . the nursing researcher should find out the knowledge level of adolescent and make use of newer method of teaching ,focusing on interest and cost effectiveness .Nurse researcher can also take necessary steps to implement the findings of the study to promote the knowledge . Research also can done on prevention of anemia . CONCLUSION The following conclusion were down on the basis of the study .  Half (50% ) of the adolescent school going girls were in the age group of between 13-15 years of age and 50% of the adolescent school going girls were above 15 years of age .  Majority (45%) of adolescent school going girls has 1 -3 numbers of sibling .  Half (50% ) adolescent school going girls has the educational status on class ix where as 50 % adolescent school going girls has the educational status of class X .  Majority (55 %) of the adolescent school going girls belonged to moderate socio economic status .  Majority ( 55%) of the adolescent school going girls had moderate knowledge of health related information  Majority 13.3 % of the adolescent girls have moderate level of knowledge regarding anemia . Thus the result indicate the need for the awareness programme to improve the knowledge of the adolescent school going girls .  From the findings of the study ,it can be concluded that the pre test knowledge level is depend on socio-economic status and knowledge about health related information .  The information booklet was found to be an effective strategy for improving the knowledge of adolescent school going girls on anaemia and its prevention . LIMITATION The following were the limitation of the study : 1. The present study was limited to 40 adolescent school going girls who had been selected from kiranbala balika vidyapith high school urban community at nagaon district ,Assam . thus poising restriction to make broader generalization . 2. Information booklet was administered once. 3. The study was limited to only 9th and 10th standard of girls of selected high school . 4. The sampling technique used was convenience sampling which limits the generalization to larger population with similar characteristics .

5. Only one group pre test ,post test assessment was made. 6. The questionnaire was structured .Hence responses were limited . RECOMMENDATION On the basis of the findings of the study it is recommended that : A similar study may be conducted over a large population for better generalization of the findings using probability sampling  Comparative studies can be done between rural and urban adolescent on a large sample  A similar study may be replicated on a larger sample with a control group .  A survey to assess the knowledge, beliefs , perceptions, of adolescent in the community regarding anemia and its prevention

SUMMARY:
This chapter dealt with the summery of the study .Conclusion, discussion, and implication of the study on nursing field, limitation, and recommendation of the study .

CHAPTER IV DRAFT 20

SUBMITTED TO PROFESSOR SHEULI SEN GHOSH PROFESSOR IN CHILD HEALTH NURSING B.M.BIRLA.COLLEGE OF NURSING

SUBMITTED BY BHAGYA DEVI DAS M.Sc NURSING 2ND YEAR B.M .BIRLA COLLEGE OF NURSING

A study to evaluate the effectiveness of an information booklet on anemia and its prevention among adolescent school going girls in a selected high school urban community at Nagaon district, Assam

BY Bhagya devi Das Dissertation submitted to The west Bengal University Of health Sciences ,Kolkata In partial fulfillment For the degree of Master in Nursing April 2012