Effectiveness of a Structured Instructional Module Regarding the Prevention of Oral Cancer among Adolescents in Urban Colleges.

BACKGROUND: Oral cancer is a preventable disease that can be controlled by tobacco cessation and health education. For development of a healthy nation, a healthy society is desirable that is dependent on physically and mentally strong adolescents and adults.
OBJECTIVES: The present study was conducted to assess the effectiveness and utilization of a structured instructional module on knowledge, attitude, and practice regarding the prevention of oral cancer among adolescents.
MATERIALS AND METHODS: The study was conducted on 500 preuniversity urban college students, divided into two groups: experimental and control groups (n = 250 each). A structured instructional module was developed and knowledge, attitude, and practice of students were analyzed. Pre and post values for all parameters were taken and subjected to statistical analysis using SPSS software version 20.0.
RESULTS: The data were collected and compared for sociodemographic variables and knowledge, attitude, and practice of students for prevention of oral cancers. A statistically significant correlation was observed between all the parameters for both the groups. In the experimental group, a significant correlation (P ≤ 0.05) was observed between pre- and posttest values for knowledge, attitude, and practices for prevention of oral cancers.
CONCLUSION: It has been observed that there are several implications of the structured instructional module in the field of education, practice, administration, and research. Copyright:

INTRODUCTION

Around 21% of the world population consists of adolescents (aged 10–19 years) and young adults (20–24 years). During the psychological development of adolescents and young adults, various kinds of behavioral patterns are established.[1] UNICEF database (2019)[2] revealed that around 1.2 billion people under 20 years of age are at a high risk of developing habits like smoking and tobacco chewing that can lead to various problems like oral cancers in their early and late years of life. Thus, it is necessary to educate them regarding the risk of harmful habits and their consequences like the development of oral cancers.

Cancer is a noncommunicable, second most common global disease that can affect any individual, irrespective of his gender, race, culture, or socioeconomic status. It is considered to be one of the most fearful diseases, with a high incidence of pain, disfigurement, and death of the patient. It can involve any cell, or tissue of the human body, and occurs with wide morphological and clinical variations throughout the world.[3] The common sites of occurrence of oral carcinomas are labial or buccal mucosa, alveolar bone, tongue, gingivolabial sulcus, etc.[3] Around 90% of oral cancers are of squamous cell origin.[4]

According to the data obtained by International Agency for Research on Cancer in 2007, India is at high risk for oral cancer due to the high prevalence of tobacco chewing, bidi smoking, and alcohol consumption.[6] The primary cause was found to be tobacco chewing in 90% of cases. It accounts for one-third of all cancers and 50% of cancers affecting males.[7]

The present study was conducted to assess the effectiveness and utilization of structured instructional module on knowledge, attitude, and practice regarding prevention and control of morbidity and mortality rate of oral cancer among adolescents. The study also aimed at using the module to teach the staff nurses and peripheral health workers, which in turn can educate general public regarding causes and prevention of oral cancer by community personnel.

MATERIALS AND METHODS

The study design adopted was quasi-experimental design. The study was conducted on 500 preuniversity urban college students using a stratified random sampling technique. The study subjects were divided into two groups: experimental and control groups (n = 250 each) after obtaining informed consent. Both male and female English medium students aged 15–19 years (adolescents), who were available and willing to participate in the study, were included in the study.

A self-administered structured questionnaire was used to evaluate the effectiveness of structured instructional module on prevention of oral cancer among adolescents. The structured knowledge questionnaire (30 items), 5-point Likert's Attitude Scale (14 items with 7 positive and 7 negative statements), and self-reported practice checklist (15 items) were developed based on prevention of cancer.

For knowledge assessment, each correct answer carries 1 mark, with a total of 30 marks. The scores were distributed as follows: inadequate knowledge: ≤50, moderately adequate knowledge: 51%–75%, and adequate knowledge: >75%. Similarly, attitude items were scored as unfavorable: ≤50%, moderate favorable: 51%–75%, and favorable attitude: >75% score. Practice items were interpreted as low practice ≤50%, moderate 51%–75%, and high practice level >75% score.

Pretest was conducted for an average 50 min time to complete the tool and followed by administration of the structured instructional module for the experimental group. Posttest was conducted with the same tool after a period of 1 week. The same procedure was followed for the control group without administering the structured instructional module. The data collected was analyzed using descriptive and inferential statistics using statistical software SPSS 21.0 Armonk (2012).

RESULTS

Various demographic characteristics (11 items) were recorded. The overall mean knowledge scores of respondents on prevention of oral cancer on pre- and posttest in experimental and control group are depicted in Table 1. A comparison between pre- and post-test practice scores of the experimental and control group on prevention of oral concern is shown in Table 2. The results of the present study were analyzed using Pearson's correlation statistical analysis to find the correlations between knowledge, attitude, and practice in both experimental and control groups. For posttest attitude, all demographic variables except source of information, place of residence, father's occupation, mother's occupation, and family monthly income showed a positive association in the experimental group [Table 3].

Table 1

Overall mean knowledge scores of respondents on the prevention of oral cancer on pre- and posttest in experimental and control groups

Aspects	Experimental Group (n1=250)						Control group (n2=250)
	Max. Score	Respondents Scores				Paired t-test	Maximum. Score	Respondents Scores				Paired t- test
		Mean	SD	Mean (%)	SD (%)			Mean	SD	Mean (%)	SD (%)
Pretest	30	15.65	2.9	52.2	9.5	44.24*	30	14.95	3.3	49.8	10.9	1.37 (NS)
Posttest	30	23.95	3.1	79.8	10.3		30	15.03	3.2	50.1	10.8
Difference	30	8.30	3.0	27.7	9.9		30	0.08	0.6	0.2	2.3

*Significant at 5% level, t (0.05, 249 df)=1.96, t (0.05, 249 df)=1.96. NS: Nonsignificant, SD: Standard deviation

Table 2

Comparison between pre- and posttest practice scores of experimental and control group on prevention of oral concern=500

Aspects	Maximum score	Experimental group (n1=250)				Paired „t‟ test	Control group (n2=250)				Paired „t‟ test
		Mean	SD	Mean (%)	SD (%)		Mean	SD	Mean, n (%)	SD (%)
Pretest	15	7.80	1.7	52.0	11.5	41.14*	7.80	1.7	52.03	11.5	1.90 (NS)
Posttest	15	12.21	1.5	81.4	29.4		7.84	1.7	52.27	11.4
Difference	15	4.42	1.7	29.4	11.3		0.04	0.3	0.24	2.0

Significant at 5% level, t (0.05, 249 df)=1.96. NS: Nonsignificant, SD: Standard deviation

Table 3

Association between demographic variables and post-est attitude level on prevention of oral cancer - experimental group. (n1=250)

Demographic variables	Category	Sample	Attitude level		χ 2	P
			Moderate, n (%)	Favorable, n (%)
Age group (years)	15-16	146	71 (48.6)	75 (51.4)	9.20*	P<0.05
	17-18	86	40 (46.5)	46 (53.5)		Df=2
	19-20	18	2 (11.1)	16 (88.9)
Gender	Male	182	75 (41.2)	107 (58.8)	4.30*	P<0.05
	Female	68	38 (55.9)	30 (44.1)		Df=1
Class Studying	1st PUC	115	60 (52.2)	55 (47.8)	4.18*	P<0.05
	2nd PUC	135	53 (39.3)	82 (60.7)		Df=2
Combination in PUC	Arts	86	37 (43.0)	49 (57.0)	0.40 (NS)	P>0.05
	Commerce	101	48 (47.5)	53 (52.5)		Df=2
	Science	63	28 (44.4)	35 (55.6)
Number of siblings	No	145	62 (42.8)	83 (57.2)	1.44 (NS)	P>0.05
	One	81	38 (46.9)	43 (53.1)
	Two	21	11 (52.4)	10 (47.6)
	Three	3	2 (66.7)	1 (33.3)
Source of information	Electronic media	89	39 (43.8)	50 (56.2)	4.84 (NS)	P>0.05
	Print media	34	13 (38.2)	21 (61.8)		Df=4
	Health Professional	73	39 (53.4)	34 (46.6)
	Family members	35	12 (34.3)	23 (65.7)
	Friends/neighbors	19	10 (52.6)	9 (47.4)
Place of residence	Urban	130	60 (46.2)	70 (53.8)	0.45 (NS)	P>0.05
	Semi urban	92	42 (45.7)	50 (54.3)		Df=2
	Rural	28	11 (39.3)	17 (60.7)
Religion	Hindu	155	61 (39.4)	94 (60.6)	6.58*	P<0.05
	Muslim	50	25 (50.0)	25 (50.0)		df-2
	Christian	45	27 (60.0)	18 (40.0)
Type of family	Nuclear	172	74 (43.0)	98 (57.0)	1.16 (NS)	P>0.05
	Joint	67	34 (50.8)	33 (49.2)		Df=2
	Extended	11	5 (45.5)	6 (54.5)
Occupation of father	Government	40	18 (45.0)	22 (55.0)	0.61 (NS)	P>0.05
	Private	88	40 (45.5)	48 (54.5)
	Self employed	97	42 (43.3)	55 (56.7)
	Agriculture	25	13 (52.0)	12 (48.0)
Occupation of mother	Government	29	16 (55.2)	13 (44.8)	3.53 (NS)	P>0.05
	Private	82	31 (37.8)	51 (62.2
	Coolie	30	13 (43.3)	17 (56.7)
	Housewife	109	53 (48.6)	56 (51.4)
Family income/month	<Rs.5000	23	12 (52.2)	11 (47.8)	0.69 (NS)	P>0.05
	Rs.5001- 10,000	35	15 (42.9)	20 (57.1)
	Rs.10,001- 15,000	93	43 (46.2)	50 (53.8)
	>Rs.15,000	99	43 (43.4)	56 (56.6)
Combined		250	113 (45.2)	137 (54.8)

*Significant at 5% Level. NS: Nonsignificant

DISCUSSION

It was observed that the majority of subjects were in the age group of 15–16 years in both the groups. Similar findings have been observed in the study conducted by Makwana et al.[3] In our study, male subjects were more than females. In demographic data, we also asked for a number of siblings and type of family, as in a study by Peter and Sequeriea,[4] it was observed that among adolescent students, the use of tobacco is significantly associated with a brother/sister smoke. The present study emphasized on relationship of various sociodemographic characteristics on different aspects of oral cancers which was similar to the study conducted by Ganesh et al.[5]

In relation to the source of health information, majority of the subjects got information from electronic media. It has been observed by various researchers that rapid social changes in the world are taking place due to the expansion of mass media.[6] The knowledge, attitude, and practice of adolescents on the prevention of oral cancer were also significantly correlated with various sociodemographic parameters. Similar findings were also observed in studies conducted by Cruz et al.[7] and Orlando et al.[8]

It has been observed that there was a significant change in knowledge regarding the prevention of oral cancers, similar findings have been observed in studies conducted by Tomar and Logan[9] and Torabi et al.[10] A significant change was observed in attitude regarding the prevention of oral cancers after instructional module. The results of our study were in accordance with a study by Smyth et al.[11] We observed a positive correlation between knowledge, attitude, and practice of adolescents on the prevention of oral cancer. Thus, the results of various studies supported the findings of the present study.[12131415]

Various teaching programs and journal presentations could be organized by administrators for community health nurses to enhance their knowledge and keep them aware of the causes for oral cancer and its prevention. Findings of the present study suggest that educators and administrators should encourage nurses to read, discuss, and conduct research studies to enable the nurse to make data-based decision rather than intuitive decisions.

CONCLUSION

The present study revealed that structured instructional module has enhanced the knowledge, attitude, and practice of adolescents, which is essential in preventing oral cancer in tfuture. It can be used to educate different sections of the population in different settings. The study can be replicated on larger samples in different settings. Thus, further studies should be conducted considering large population involving both rural and urban areas.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.