RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

1 NAME OF THE

CANDIDATE AND

ADDRESS

Mrs. RAINA ANISITA D’SOUZA,

Ist YEAR M.Sc. NURSING STUDENT,

N.D.R.K. COLLEGE OF NURSING,

B.M. ROAD, HASSAN, KARNATAKA.

2 NAME OF THE

INSTITUTION

N.D.R.K. COLLEGE OF NURSING, B.M. ROAD,

HASSAN, KARNATAKA.

3 COURSE OF STUDY

AND SUBJECT

MASTER OF SCIENCE IN NURSING

(COMMUNITY HEALTH NURSING)

4 DATE OF ADMISSION

TO THE COURSE

07/07/2010

5 TITLE OF THE TOPIC “EFFECTIVENESS OF PLANNED TEACHING

PROGRAMME ON KNOWLEDGE OF DIABETES AND

ITS MANAGEMENT AND THE PRACTICE OF

DIABETIC DIET AMONG THE RURAL PEOPLE IN

SELECTED VILLAGES AT HASSAN, KARNATAKA.”

5.

1

STATEMENT OF THE

PROBLEM

“A STUDY TO ASSESS THE EFFECTIVENESS OF

PLANNED TEACHING PROGRAMME ON

KNOWLEDGE OF DIABETES AND ITS MANAGEMENT

AND THE PRACTICE OF DIABETIC DIET AMONG

THE RURAL PEOPLE IN SELECTED VILLAGES AT

HASSAN, KARNATAKA.”

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION:

“If I would have listened, if I would have understood diabetes like I understood music,

may be these things wouldn't have happened.”1

Marvin Isley

“Scientific research consists in seeing what everyone else has seen, but thinking what no

one else has thought”.2

The word diabetes is derived from the Greek word meaning to siphon and refers to the

most obvious sign of the disease – marked loss of water by urination. The word mellitus comes

from the Latin word for sweet or honey and thus differentiates diabetes mellitus (sweet urine

disease) from diabetes insipidus (bland urine disease). 3

Scientific progress in our knowledge of diabetes began in the eighteenth century with the

development of the microscope and Langerhans’s descriptions of the islets in the pancreas that

contain beta cells. The “most celebrated diabetes clinician in the world,” at that time, was

Bouchardat of France (1806-1886). He is perhaps the first to associate the pancreas with diabetes. 3

With the discovery of insulin in 1921, certain complacency settled over the diabetes world

– diabetes was “cured”. After a few years, however, it became evident that insulin treatment was

not the final answer. Insulin extended the life span, but within a few years, people with diabetes

began to go blind and die of vascular disease. Thus, the burden is put on the diabetes specialists to

educate the person who has diabetes, his or her family, the public, and other health care

professionals who care for the patients with diabetes in order to accomplish the goal of

normalizing blood glucose levels as much as safely tolerated. 3

Diabetes is not the patient – the person with diabetes is the patient. Diabetes is a disease

that affects every organ and organ system of the body; moreover, it affects and is affected by the

emotions. This requires a cadre of professionals: a team effort of the individual with diabetes, the

family and significant friends, and the family physician, the diabetes specialist, the acute care

nurse, the nurse educator, the dietitian, the psychologist, counselor, social worker, podiatrist,

physical therapist, or exercise specialists. 3

Diabetes has emerged as a major health care problem in India. According to Diabetes Atlas

published by the International Diabetes Federation (IDF), there were an estimated 40 million 2

persons with Diabetes in India in 2007 and this number is predicted to rise to almost 70 million

people by 2025.4

The countries with the largest number of Diabetic people will be India, China and USA by

2030. It is estimated that every fifth person with Diabetes will be an Indian.4

Due to these sheer numbers, the economic burden due to Diabetes in India is amongst the

highest in the world. The real burden of the disease is however due to their associated

complications which lead to increased morbidity and mortality.4

The goal of diabetes therapy should be to safely achieve normal blood glucose levels

around the clock. This goal may only be achieved with adequate education. The parents and adults

as well as the youth must learn to adjust diabetes medication and food intake to control glucose on

a 24 – hour basis. As the family adjusts to the fact that the one who has DM has a chronic

condition and as the individual adjusts to the same fact, methods must be devised to support

understanding, good judgment, self-discipline, and motivation in order to obtain optimum health. 3

We have always believed that control of diabetes has been and is important in the

prevention of both acute and chronic complications. Data from the Diabetes Control and

Complications Trial study (DCCT, 1993) and studies carried out in other countries have confirmed

this belief. They also have found that education of the person with diabetes is a vital part of the

control program. 3

WHO estimates that mortality from diabetes, heart disease and stroke costs about $210

billion in India in the year 2005. Much of the heart disease and stroke in these estimates was linked

to diabetes. WHO estimates that diabetes, heart disease and stroke together will cost about $ 333.6

billion over the next 10 years in India alone. 4

Therefore let all of us join together in wishing that diabetes may soon be cured and, even

better prevented, so that one day this need will become unnecessary. Until that time, we hope that

our efforts through the care we give will assist those who are afflicted with this chronic problem,

those who care for them professionally, and those they are close to, family and friends alike.

6.2. NEED FOR THE STUDY:

3

Diabetes Mellitus is recognized as an important problem both nationally and worldwide.

Our specific understanding of the spectrum of health effects of DM has increased and numerous

studies are finding important heath complications from DM at levels once considered safe. Youth

and adults are the most susceptible to DM.

As per King (1998) prevalence of Diabetes in India will increase by 195% in 2025 and

majority of sufferers will be young adults.5

Diabetes is growing; prevalence of diabetes in the world is about 170 millions and is

growing rapidly. In fact International Diabetic Federation (IDF) has claimed epidemic status for

diabetes. 6

It is estimated that India has around 40 million diabetic persons at present. It is supposed to

double by 2030. It is true for type 2 diabetes that it is genetically transmitted and also it depends on

diet and lifestyle. 6

It is estimated that 80% of type 2 diabetes can be prevented or postponed for several years.

Exercise, lifestyle management, diet and drugs to some extent prevent type 2 diabetes. There is a

25% risk of getting diabetes if one parent is diabetic. The risk increases, if both parents are diabetic

the risk increases with obesity, and sedentary lifestyle. 6

The disease is affecting at an alarming rate to both rural and urban population in India. 5

The first systematic nation-wide study in India was performed by the Indian Council of

Medical Research Task Force on Diabetes. Population sampling in urban areas was based on

stratified random design and in rural areas on clustered sampling. In large cities in North and

South India (i.e. Chennai, Trivandrum, Mumbai, Delhi, Jaipur and Gauhati), Diabetes prevalence

among adults (more than 20 yrs) had ranged from 8 – 15%.5

The prevalence of Diabetes was more on Southern parts of the country and was least in

Eastern parts. 5

The increased prevalence of Diabetes in India has a lot to do with a switch from the Diet,

Lifestyle patterns and Cultural mix. 5

4

According to Diabetes Atlas of 2007, an estimated 40 million persons were diabetic in

India and this number would touch 70 million by 2025. Yet, India had no institution to tackle all

disorders related to diabetes under one roof, till Karnataka decided to take the first step. 7

The Diabetes Awareness Survey in Hyderabad (DASH) study conducted in twin cities has

recently pointed out that Diabetes Prevalence levels have grown significantly from 16.6% as per

Natural Urban Diabetes Survey (NUDS) of 2001. Exact reason is not yet ascertained. The DASH

study revealed nearly 43% of Hyderabad population was unaware of a condition called Diabetes &

65% did not know that Diabetes could affect the eyes, which could lead to decreased sight. 5

A study was conducted to estimate the Global prevalence of diabetes and the number of

people of all ages with diabetes for years 2000 and 2030. The result showed that the prevalence of

diabetes for all are-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The

total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in

2030. These findings indicate that the “diabetes epidemic” will continue even if levels of obesity

remain constant. 8

The number of people with diabetes is increasing due to population growth, aging,

urbanization, and increasing prevalence of obesity and physical inactivity. Quantifying the

prevalence of diabetes and the number of people affected by diabetes, now and in the future, is

important to allow rational planning and allocation of resources. 8

Exact cause of increased prevalence of diabetes in persons of indian origin is unknown.

Nature and nurture both may have a role. 5

So, I have taken up the nurture aspect for preventing the further increase in the percentage

of diabetes by trying to improve the knowledge and practice of people of hassan who are also a

part of India.

6.3 STATEMENT OF PROBLEM:

5

“A study to assess the effectiveness of Planned Teaching Programme on

Knowledge of Diabetes and its Management and the Practice of Diabetic Diet among the

rural people in selected villages at Hassan, Karnataka.”

6.4 OBJECTIVES OF THE STUDY:

1. To assess the knowledge of Diabetic clients regarding Diabetes & its management before

administration of Planned Teaching Programme among the rural people of Hassan.

2. To assess the Practice pattern of Diabetic diet among the rural Diabetic clients.

3. To develop and administer Planned Teaching Programme regarding Diabetes and its

management (Dietary and Pharmacological).

4. To assess the knowledge of Diabetic clients on Diabetes & its Management after

administration of Planned Teaching Programme among the rural people of Hassan.

5. To evaluate the effectiveness of Planned Teaching Programme on knowledge of Diabetes

and its management among diabetic clients of rural villages at Hassan.

6. To associate the post-test knowledge score of diabetic clients with selected socio-

demographic data.

6.5 HYPOTHESIS:

6

1. NULL HYPOTHESIS:

H1: There will not be a significant difference between the pre-test and post-test

knowledge scores of diabetic clients who have received the Planned Teaching Programme

on Diabetes and its Management.

H2: There will not be a significant difference in the dietary habits after administration of

Planned Teaching Programme on Diabetes and its Management.

2. RESEARCH HYPOTHESIS:

H1: There will be a significant difference between the pre – test and post – test knowledge

scores of diabetic clients who have received the Planned Teaching Programme on Diabetes

and its Management.

H2: There will be significant association between selected socio-demographic variables

and the post – test knowledge of diabetic clients regarding Diabetes and its Management.

6.6 ASSUMPTIONS:

1. The rural people of Hassan have lack of knowledge regarding Diabetes.

2. The rural people of Hassan have lack of knowledge regarding management of Diabetes,

specially the dietary pattern.

3. Lack of knowledge may progress their condition which may give rise to complications.

4. This study will improve the knowledge of diabetic clients regarding Diabetes and its

management (Diet and Pharmacological).

5. The study will improve the knowledge of diabetic clients regarding different aspects of

Diabetes such as definition, etiology, risk factors, signs & symptoms, management and

practice of diabetic diet.

6.7 OPERATIONAL DEFINITIONS:

7

1. EFFECTIVNESS:

It refers to significant increase in the level of knowledge and practice of diabetic clients

regarding Diabetes, its management and diet which is measured from the response of pre-test,

Planned Teaching Programme and post-test.

2. PLANNED TEACHING PROGRAMME:

It refers to systematically organized instructions and discussions of Diabetes and its

Management - Meaning, causes, etiology, clinical manifestation, management (diet, drug and

exercise), complication and follow up.

3. KNOWLEDGE:

It refers to the correct responses from diabetic clients regarding various aspects of Diabetes

Mellitus like - Meaning, causes, etiology, clinical manifestation, management (diet, drug, exercise)

complication and follow up.

4. DIABETES:

Diabetes Mellitus is a syndrome as opposed to a single disease. It is characterized by a

chronic state of hyperglycemia (raised blood glucose levels). This is due either to insufficient

insulin or inadequate action of insulin. The syndrome results in the disorder of the metabolism of

carbohydrates, proteins and fat. The overall long-term effect is degenerative changes in all blood

vessels.22

5. MANAGEMENT:

Refers to various measures of managing Diabetes by dietary modification, drug, exercise,

regular follow up and identification of complications.

6. PRACTICE:

It refers to habits or custom regarding diet mainly of diabetic clients which they are

following; the dietary modifications for Diabetes.

7. DIABETIC DIET:

8

Diabetic diet is the modification of dietary pattern in the Diabetic clients in order to

regulate or control the sugar level.

8. RURAL PEOPLE:

People living in villages mainly depending on agriculture and other allied occupations; and

for the study purpose, the people who have been affected with Diabetes and those who are residing

in the rural area (Boovanahalli, Kanahavalli, Onnenahalli, Dodda Gangiri & Chikka Gangiri)

6.8 CRITERIA FOR SAMPLE SELECTION:

a) Inclusion criteria:

1. Diabetic clients of selected villages at Hassan.

2. Diabetic clients who are present at the time of study.

b) Exclusion criteria:

1. People in villages those who do not have Diabetes.

2. Diabetic clients who are not present at the time of study.

6.9 LIMITATIONS OF THE STUDY:

Study is limited to

Diabetic clients of selected rural areas, Hassan.

A period of 4 -6 weeks.

Sample size is limited to 50 diabetic clients of selected rural areas, Hassan.

6.10 SIGNIFICANCE OF THE STUDY:

9

This study signifies the importance of Planned Teaching Programme on the knowledge of

diabetic clients regarding Diabetes and its Management. And it also paves the way for diabetic

clients to gain knowledge on Diabetic diet as the study implies the practice of the dietary pattern.

“A well planned work is half done,” so if the people are given an education regarding the

Diabetes and its Management, I think they will try to improve their health by dietary modification,

drug intake and by knowing the signs and symptoms and complications in order to lead a healthy

life.

6.11 CONCEPTUAL FRAME WORK:

Conceptual frame work is based on the “Nalo.J, Pender’s health promotion model”.

6.12 REVIEW OF LITERATURE:

Review of literature is a key step in research process. Review of literature refers to an

extensive, exhaustive and systematic examination of publications relevant to the research

project .Before any research can be started whether it is a single study or an extended project,

literature reviews of previous studies and experiences related to proposed investigations should be

done. One of the most satisfying aspects of the literature review is the contribution it makes to the

new knowledge, insight and general scholarship of the researcher.

A study was conducted by Suzanne Bennett Johnson, R. Timothy Pollak of University of

Florida Health Center, Gainesville (Mar 16, 1981) to assess the knowledge among young adults

about insulin-dependent diabetes. RESULT: More than 80% of young adults made significant

errors on urine testing & almost 40% made serious errors in self-injection. A number of other

knowledge deficits were also noted.9

A study was conducted on 20 May 2002, with objective of to assess whether Diabetes

Mellitus knowledge is related to prior attendances at Diabetes education programme, visits to

dieticians or the current use of Self Monitoring Blood Glucose (SMBG) in a community based

subjects with type 2 DM. METHODS: Subjects answered 15 standard MCQ about Diabetes & its 10

management. RESULTS: Attendance at education programme, visits to dieticians & SMBG were

independently associated with greater diabetes knowledge. CONCLUSION: Study concluded that

Diabetes education programme, dietetic advice, SMBG are associated with and may be important

sources of improved Diabetes knowledge in patients with type 2 DM. 10

A study was conducted on 15TH June 2010 by a team of Kasturba Medical College, Manipal

in Coastal Karnataka to estimate the prevalence of diabetes among adults aged 30 yrs and above.

This study suggests that Muslims living in Coastal Karnataka are at a higher risk of developing

diabetes and identified increasing age, Muslims, a skilled or professional job, sedentary lifestyle,

positive family history of diabetes, history of current hypertension, and being overweight or obese

as having significant indicators for being diabetic. This study did not offer any explanation for its

findings. 11

A study was conducted on Clinical Characteristics of Type 2 Diabetes Patients according to

Family History of Diabetes by Department of Internal Medicine, Jeju National University

Hospital, Korea. This study is cross – sectional involving 621 T2DM patients. Among the total 651

patients, 38.4% had a family history of diabetes. The study concluded that in T2DM patients with a

family history of diabetes, the disease tended to develop earlier. 12

A study was conducted on Self Management Education for Adults with Type 2 Diabetes by

Susan L. N, Joseph Lau, S. Jay smith. The objective was to evaluate the efficacy of self –

management education on GHb in adults with Type 2 diabetes. A total of 31 studies of 463

initially identified articles met selection criteria. On average the intervention decrease GHb by

0.76% more than the control group at immediate follow up, by 0.26% at 1 – 3 months follow up,

and by 0.26% at >= 4 months of follow up. GHb deceased more with additional contact time

between participant and educator. The study concluded that self – management education improves

GHb levels at immediate follow – up, and increased contact time increases the effects. 13

A study was conducted on Interventions to Improve the Management of Diabetes in

Primary Care, Outpatient, and Community Settings. Standard search methods of the Cochrane

Effective Practice and Organization of Care Group were used. A total of 41 studies met the

inclusion criteria. Complex professional interventions improved the process of care, regular review

of patients by the organizations showed a favorable effect on process measures, and the enhanced

role of a nurse led to improvements in patient outcomes. 14

11

A study was conducted on 24th Dec 2001 to study factors such as sex, educational status

and place of care, which might influence knowledge and self – management of diabetes, and

glycaemic control in a Pakistani Moslem diabetic population attending primary care general

practices and secondary care clinics at the Manchester Diabetes Center (MDC). Patients took part

in a one–to–one semi–structured interview. 201 patients entered the study, knowledge about

diabetic diet was good (72%), patients claimed to perform regular glucose measurements (66%),

but they were not good at applying their knowledge to problems in daily life. It concluded that

women who can not read in this population are likely to have poorer glycaemic control and may be

finding it more difficult to learn how to apply their knowledge to daily life. 15

As part of the evaluation of diabetes services in Central Manchester, 243 patients attending

the traditional diabetic clinic at the Manchester Royal Infirmary were randomly selected to

complete knowledge questionnaire. 160 patients gave response rate of 63%. The mean knowledge

score in insulin–treated patients was significantly higher than in non insulin–treated patients.

Knowledge of dietary management was generally poor, and half of the patients were unaware of

the link between glycaemic control and long term complications. It was particularly worrying that

32% of insulin–treated patients were unaware that they should continue to take their insulin when

ill. 16

A study was conducted to study the demographic details of diabetes patients and their

knowledge, attitude and practices (KAP) regarding diabetes in Nepal. The KAP of the diabetes

patients visiting the Manipal Teaching Hospital (MTH) during the period from 22nd Aug to 7th Dec

2006 were studied by using the KAP questionnaire developed by the researchers. 182 patients were

enrolled in the study. Knowledge score was 4.90; attitude 2.03 and practice 0.84. The study

concluded that the KAP scores of the patients were low. 17

A study was conducted by Devin .M. Mann, Diego Ponieman, Howard Leventhal,

Ethan .A. Halm to determine diabetic patients' knowledge and beliefs about the disease and

medications that could hinder optimal disease management. A cross-sectional survey of 151 type 2

diabetic patients characterizing diabetes knowledge and beliefs about the disease and medications

was conducted. Over half of the patients (56%) believed that normal glucose is ≤200 mg/dl, 54%

reported being able to feel when blood glucose levels are high, 36% thought that they will not

always have diabetes, 29% thought that their doctor will cure them of diabetes, one in four (23%)

said there is no need to take diabetes medications when glucose levels are normal, and 12% 12

believed they have diabetes only when glucose levels are high. The study concluded that diabetes

knowledge and beliefs inconsistent with a chronic disease model of diabetes were prevalent in this

sample. 18

A study was conducted to explore the relationship among health literacy, patients' readiness

to take health actions, and diabetes knowledge among individuals with type 2 diabetes. Sixty-eight

patients with type 2 diabetes receiving care in an academic general internal medicine clinic were

administered the Rapid Estimate of Adult Literacy in Medicine (REALM) literacy instrument.

After controlling for other covariates of interest, no significant association between DHBM scale

score and REALM literacy level was found (P = .29). However, both DKT score and most recent

hemoglobin A1Clevel were found to be significantly associated with patient literacy (P = .004 and

P = .02, respectively). Low health literacy is a problem faced by many patients that affects their

ability to navigate the health care system and manage their chronic illnesses. The study concluded

that while low health literacy was significantly associated with worse glycemic control and poorer

disease knowledge in patients with type 2 diabetes, there was no significant relationship with their

readiness to take action in disease management. 19

A study was conducted to describe diet and exercise practices from a nationally

representative sample of U.S. adults with type 2 diabetes by Karin M. Nelson, Gayle Reiber and

Edward J. Boyko. They analyzed data from 1,480 adults older than 17 years with a self-reported

diagnosis of type 2 diabetes. Fruit and vegetable consumption was obtained from a food frequency

questionnaire; the percentages of total calories from fat and saturated fat were obtained from a 24-

h food recall. Physical activity was based on self report during the month before the survey. Of

individuals with type 2 diabetes, 31% reported no regular physical activity and another 38%

reported less than recommended levels of physical activity. Sixty-two percent of respondents ate

fewer than five servings of fruits and vegetables per day. Almost two thirds of the respondents

consumed >30% of their daily calories from fat and >10% of total calories from saturated fat. The

study concluded that the majority of individuals with type 2 diabetes were overweight, did not

engage in recommended levels of physical activity, and did not follow dietary guidelines for fat

and fruit and vegetable consumption. Additional measures are needed to encourage regular

physical activity and improve dietary habits in this population. 20

A study was conducted to know whether type 2diabetes can be prevented by interventions

that affect the lifestyles of subjects at high risk for the disease. We randomly assigned 522 middle-

13

aged, overweight subjects (172 men and 350 women; mean age, 55 years; mean body-mass index

[weight in kilograms divided by the square of the height in meters], 31) with impaired glucose

tolerance to either the intervention group or the control group. Each subject in the intervention

group received individualized counseling aimed at reducing weight, total intake of fat, and intake

of saturated fat and increasing intake of fiber and physical activity. The mean (±SD) amount of

weight lost between base line and the end of year 1 was 4.2±5.1 kg in the intervention group and

0.8±3.7 kg in the control group; the net loss by the end of year 2 was 3.5±5.5 kg in the intervention

group and 0.8±4.4 kg in the control group (P<0.001 for both comparisons between the groups).

The cumulative incidence of diabetes after four years was 11 percent (95 percent confidence

interval, 6 to 15 percent) in the intervention group and 23 percent (95 percent confidence interval,

17 to 29 percent) in the control group. During the trial, the risk of diabetes was reduced by 58

percent (P<0.001) in the intervention group. The reduction in the incidence of diabetes was

directly associated with changes in lifestyle. The study concluded that Type 2 diabetes can be

prevented by changes in the lifestyles of high-risk subjects. 21

7. MATERIAL AND METHODS OF STUDY:

7.1 SOURCES OF DATA:

The data will be collected from the diabetic clients from selected villages (Boovanahalli,

Kanahavalli, Onnenahalli, Dodda Gangiri & Chikka gangiri) under Shantigrama P.H.C at Hassan,

Karnataka.

7.2 METHOD OF DATA COLLECTION:

1. Research design: Pre – experimental single group pre-test post-test design is planned for the

research study.

Schematic plan of the study:-

14

Group Pretest Intervention Post-test

A group of 50 diabetic clients of

selected rural areas of Hassan.

O1 X O2

Key:-

O1= Pretest knowledge of diabetic clients regarding Diabetes and its Management.

X = Planned Teaching Programme on Diabetes and its Management.

O2 = Post test knowledge of diabetic clients regarding Diabetes and its Management.

2. Research setting: The setting selected for study is rural areas (Boovanahalli, Kanahavalli,

Onnenahalli, Dodda Gangiri & Chikka gangiri) under Shanthigrama P.H.C of Hassan, Karnataka.

3. Accessible Population: People at rural areas.

4. Target Population: Diabetic clients.

5. Sample: Sample will be screened for Diabetes; or will know cases of Diabetes Mellitus with

records.

6. Sample size: 50 diabetic clients in selected villages at Hassan, Karnataka.

7. Sampling technique: Convenient sampling technique will be used for the study.

8. Collection of data: - Data will be collected by using structured questionnaires regarding the

knowledge of Diabetes and its Management.

8. VARIABLES:

15

Independent variable:

Planned Teaching Programme regarding knowledge of Diabetes and its Management.

Dependent variable:

Knowledge of Diabetic clients on Diabetes and its Management and check list on

practice of Diabetic diet.

9. PLAN FOR DATA ANALYSIS:

Descriptive statistics

Descriptive statistics include percentage, frequency, mean and standard deviation.

Inferential statistics

It include paired ‘t-test’ with chi - square test and “ANOVA” “f” test for the assessment of

knowledge and to associate the socio demographic variable is planned .

10. PILOT STUDY:

10% of sample size is planned for the pilot study.

11. ETHICAL CONSIDERATION:

1. Does the study require any intervention to be conducted on diabetic clients?

Yes

2. Has ethical clearance been obtained from your institution?

16

Yes

3. Has the consent been taken from P.H.C?

Yes

12. LIST OF REFERENCES (VANCOUVER STYLE)

1. www.brainyquote.com/quotes/keywords/d...

2. www.entplaza.com/quotes-poems/research/

3. www.springerpub.com/samples/978082611...

4. www.expresshealthcare.in/200808/diabe...

5.Kamla-Raj, Analava Mitra, B.C. Roy Tech Hospital & Adjunct Faculty, School of Medical

Science and Technology, Indian Institute of Technology,“Anti-diabetic Uses of Some Common

Herbs in Tribal Belts of Midnapur (West) District of Bengal” 2007 Ethno-Med.,1(1): 37-45 (2007)

6 Karnataka Institute of Diabetology, info@kidbangalore.in.

7.Sunitha Rao. R , Karnataka Institute of Diabetology, “Prevelence of diabetes”, Bangalore, Jan

16,2009

8.Wild S, Roglic G, Green A, Sicree R, King H, Public Health Sciences, University of Edinburgh,

Edinburgh, Scotland “Global prevalence of diabetes: estimates for the year 2000 and projections

for 2030” Diabetes Care, 2004 May;27(5):1047-53

9.Suzanne Bennett Johnson, R. Timothy Pollak , Janet H. Silverstein, Arlan L. Rosenbloom ,

Rebecca Spillar , Martha McCallum, Jill Harkavy, Departments of Psychiatry, Pediatrics, and

Clinical Psychology, University of Florida Health Center, Gainesville “Cognitive and Behavioral

17

Knowledge About Insulin-Dependent Diabetes Among Children and Parents”, PEDIATRICS Vol.

69 No. 6 June 1982, pp. 708-713

10. David G Bruce, Wendy A   Davis a b , Carole A   Cull c , Timothy M.E   Davis a , “Diabetes education

and knowledge in patients with type 2 diabetes from the community: The Fremantle Diabetes

Study” (March 2003) Vol 17, Issue 2, Pages 82-89.

11. TCN NEWS, “Study in coastal Karnataka finds Muslims at higher for Diabetes” JUNE-15

2010.

12. Seung Uk Jeong, Dong Gu Kang, Dae Ho Lee, Kang Woo Lee, Dong-Mee Lim, Byung Joon

Kim, et al “Clinical Characteristics of Type 2 Diabetes Patients according to Family History of

Diabetes”, Korean Diabetes, 2010 August; 34(4): 222–228.

13. Susan L. Norris, Joseph Lau, S. Jay Smith, Christopher H. Schmid, and Michael M. Engelgau,

“Self-Management Education for Adults with Type 2 Diabetes A meta-analysis of the effect on

glycemic control” care.diabetesjournals.org/content/25/...

14. Gerlof D. Valk, Simon J. Griffin, Edward H. Wagner, Jacques ThM. Eijk van, Boechorststraat

7, 1081 BT Amsterdam, the Netherlands “Interventions to Improve the Management of Diabetes in

Primary Care, Outpatient, and Community Settings” 29 March 2001

15. K. Hawthorne, S. Tomlinson, “Pakistani moslems with Type 2 diabetes mellitus: effect of sex,

literacy skills, known diabetic complications and place of care on diabetic knowledge, reported

self-monitoring management and glycaemic control” Diabetic Medicine

Volume 16 , Issue 7 , pages 591–597, July 1999

18

16. A MORAN, C HESSETT, J POOLEY, DR A J M BOULTON,

“An assessment of patients’ knowledge of Diabetes, its management and complications” Practical

Diabetes International Volume 6 , Issue 6 , pages 265–267,

17. Dinesh K Upadhyay, Subish Palaian, P Ravi Shankar,

Pranaya Mishra, Departments of Hospital and Clinical Pharmacy and Department

Of Pharmacology, Manipal Teaching Hospital / Manipal College of Medical Sciences

Pokhara, Nepal, “Knowledge, Attitude and Practice about Diabetes

Among Diabetes Patients in Western Nepal” November 26, 2007

18. Devin M. Mann, Diego Ponieman, Howard Leventhal, and Ethan A. Halm, “Misconceptions

about Diabetes and Its Management Among Low-Income Minorities With Diabetes” Diabetes

Care. 2009 April; 32(4): 591–593.

19. Caroline K, Center for Health Disparities Research. Powell, Elizabeth G.Hill, Dawn E.

Clancy, Department of Medicine and the Department of Biostatistics, Bioinformatics and

Epidemiology (Dr Hill), Medical University of South Carolina. “The Relationship between Health

Literacy and Diabetes Knowledge and Readiness to Take Health Actions” The Diabetes Educator

January/February 2007 vol. 33 no.1 144-151.

20. Karin M. Nelson, Gayle Reiber, Edward J. Boyko, “Diet and Exercise Among Adults With

Type 2 Diabetes”Third National Health and Nutrition Examination Survey (NHANES III)

Diabetes Care October 2002 vol. 25 no. 10 1722-1728

21. Jaakko Tuomilehto, Jaana Lindström, Johan G. Eriksson, Timo T.Valle, Helena Hämäläinen,

Pirjo Ilanne-Parikka, et al “Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among

Subjects with Impaired Glucose Tolerance” N Engl J Med 2001; 344:1343-1350May 3, 2001

19

22. Lullian.S.Brunner, Doris.S.Suddarth: Textbook of adult nursing, 1st edition, published by

Chapman & Hall (1992) page no. 620.

13 Signature of the candidate

14 Remarks of the guide

15 Name and designation

15.1 Guide

15.2 Signature

15.3 Co-guide

20

15.4 Signature

15.5 Head of the department

15.6 Signature

16 Remarks of principal

16.1 Signature

21