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1294
" Effectiveness of Health Education Contact Program in Improving Nurses' Knowledge about Promoting Health and Preventing of Communicable Diseases at Primary Health Care Centers in Al -Amara
City-Iraq"
Tahssein Ali Hussein AL-Hraishawi 1 , Raad Kareem Fraaj 2
1 MSc. lecturer, Academic Nursing Specialist, Higher Health Institute/Maysan Health Directorate, Maysan, Iraq.
2 Assistant Prof., Community Health Nursing Department - College of Nursing/ University of Baghdad.
ABSTRACT
Background: Promoting and satisfying Nurses knowledge in health centers to promoting health and preventing of communicable diseases that help nurses develop health trends, build healthy behavior and enable people to understand their families' health messages on how to prevent the spread of transmitted communicable diseases.
Objective: The aim of this study is to evaluate the knowledge of the nurse in primary health care centers about the promoting health and preventing of communicable disease and to develop an educational program.
Methodology: Began their quasi-experimental design between 17 November 2019 and 28 December 2020 at (19) Primary Health Care Centers. Selected purposive samples of 50 nurses are divided into 2 groups equally; the study group were exposed to the nursing education program and the control group. The investigator has built the study instrument.
Questionnaire comprised (56) questions on the promoting health and preventing of communicable disorders to evaluate knowledge among nurses. The validity of the tool is determined by the 15 expert panels while reliability of instrument is determined using test and retest approach. Data analysis using description statistics (frequency, percentage, arithmetic mean and standard deviations) and inferential statistical (ANOVA, t-test and chi- square test).
Results: The study shows that the majority of nurses have poor of knowledge in their pre- test evaluation when the control group has moderate knowledge of the promoting health and preventing of communicable in health promotion and immunization unit.
Conclusion: Study showed that the two groups with their knowledge did not differ substantially at pretest. During the after test and before test their knowledge of promoting
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1295 health and preventing of communicable disease has clearly improved and the study and control groups have confirmed high significant differences.
Keyword : Effectiveness; Health Promotion Program; Nurse; Knowledge; Preventing transmission of Communicable disease; Health Promotion and Immunization Unit.
Introduction
Communicable diseases in the world today consider that they represent an important threat to public health; mobile groups (groups of people, animals, and objects) transmit these globally through increasing urbanization and global travel. (1).A microorganism that causes disease is a pathogen. The conditions characterized as communicable diseases (CD) are the consequences of the presence of a microorganism in/on the body (2). Communicable diseases (CDs), for instance viruses, bacteria, fungi, and parasites can be caused by pathogenic microorganisms (causative agents). Transmissible diseases (CDs) may be transferred by vector exposure of causative agents or environment from one person to another, direct or indirectly (3) (4). The rapid spreading of communicable diseases like Severe Acute Respiratory Syndrome (SARS) coronavirus in South China, first detected in Guangdong in November 2002, resulting in over (8,000) people infected, and (774) deaths in (37) countries, in years 2012 the Middle East Respiratory Syndrome (MERS-CoV), that emerged in Saudi Arabia and was responsible (2494) lab.-confirmed MERS cases were recorded and related deaths occurred (858) (5). In December 2019 a coronavirus, namely SARS-CoV-2, was identified as the cause of the viral pneumonia disease outbreak that first occupy a particular location in China in Wuhan, Hubei, which was currently called COVID- 19. (6). Incidence of tuberculosis (TB) the mentioned mortality rate was estimated at (0.7) per (100 000) people in 2013 (7). In addition, Incidence of Mumps Cases in 2017, in Columbia in the U.S. revealed mumps infections was estimated at 4667 people(8). Information estimated about (35000000) Health Care Workers (HCWs) included nurses worldwide, and about (3000000) exposures to blood borne viruses each year (2000000 HBV; 900,000 HCV and 300,000 HIV)(9). According to the estimates by the Centers for Disease Control & Prevention (CDC) and (37,000) deaths in Europe, and health care related infections reported deaths (99,000) deaths in American health care setting (10) (11). Despite the focus on communicable diseases, in particular in the developing world, health promotion strategies for preventive and disease control are equally valid (12) Importance of the Study: The importance of communicable diseases to highlight the limited capacity and resources available to ensure the
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1296 greatest impact on health and socio-economic development is a vital health strategy (13). Knowledge of nurses is supported through education and healthcare protection for uninfected persons, important and effective measures for community members to avoid diseases through the understanding of the fundamental concepts for control (CD's) and the many issues surrounding them (1). Objective of the study: The main objective of the study is to determine the efficacy of the Health Promotion program for nursing knowledge of the promoting health and preventing of communicable conditions in primary health centers in Al-Amara city as well as to evaluate the knowledge of nurses on promoting health and preventing of communicable disease (age , gender, level of education, years of experience in nursing field, and training courses ).
Methodology
To do this study, the preliminary, pre-test and post-test approach for the study and control groups was used as a quasi-experimental design. This study was carried out from 17, November 2019 to 28, December 2020 in AL Amara City (19) Primary Health Centers. There were (50) nurses in a A purposive sample. The sample has been randomly divided into two categories. Each consisted of (25) nurses, since the study group had been exposed to the educational program. The program consisted of six sessions and have implemented in eight day and time each session was one hour. Constructed the study instrument by researcher.
Questionnaire consisted of (56) questions to evaluate the nurses' knowledge about promoting health and preventing of Communicable Diseases., it consisted of three parts: First part. Self- administered questionnaire sheet regarding demographic characteristics of the nurses consisted of (5) variables (age, gender, level of education, years of experience in nursing, and training sessions). Second part: Questionnaire Nurses' knowledge about Common Communicable Diseases, it was composed of (35) questions in four domains (General information about Communicable disease consisted of (5) items, nurses' knowledge relative to their information about Coronaviruses consisted of (4) items, nurses' knowledge relative to their information about Tuberculosis TB consisted of (4) items, nurses' knowledge relative to their information about (Measles Mumps Rubella) consisted of (9) item nurses' knowledge relative to their information about H1N1 consisted (4) item nurses' knowledge relative to their information about Viral hepatitis A and B (5).and nurses' knowledge relative to their information about Scabies consisted of (4) items). Third Part: Nurses' knowledge about Health Promotion Approaches it was composed of (16) questions in four domains (nurses'
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1297 knowledge relative to general information of the health promotion program consisted of (4) items, nurses' knowledge relative to their information about Health Protection consisted (4) item, nurses' knowledge relative to their information about Disease prevention consisted (4) item, and nurses' knowledge relative to their information about Health education on communicable diseases consisted (4) item. Each question comprised of (4) alternatives for multiple choice. The questions were scored as correct (1) point and incorrect (0) point. Scores of response are categorized according to the following : Poor knowledge = (> 0.33): 1;
Moderate knowledge = (0.33-0.66):2; Good knowledge = (0.67-1.00):3.
The panel of 15 experts determines validity of the Program content and the study instruments. Reliability of instrument via use of Alpha Cronbachs’ reliability, it is a high acceptance level (0.80). Analyze data through a statistical approach (frequency, percentage, Mean of score and standard deviation and an inferential statistical approach (T- test, Chi- Square & ANOVA test).
Results and Finding:
Table (1): Overall evaluation of nurses' knowledge to promoting health and preventing communicable disease in pre- and post-test study and control groups
Test Period Levels of Evaluation Pre-Test Post- Test
Freq. % Freq. %
Study Group
Poor ( 0 - 0.33 ) : 1 16 64.0 0 0.0 Moderate (0.34 – 0.67) :
2 9 36.0 5 20.0
Good (0.68 – 1.00) : 3 0 0.0 20 80.0
Total 25 100.0 25 100.0
𝐱 ∓ 𝐒𝐭𝐝. 𝐃𝐞𝐯.
0.39 ∓ 𝟎. 𝟏𝟎𝟐 0.81 ∓ 0.114
Control Group
Poor ( 0 - 0.33 ) : 1 10 40.0 10 40.0 Moderate (0.34 – 0.67) :
2 15 60.0 15 60.0
Good (0.68 – 1.00) : 3 0 0.0 0.0 0.0
Total 25 100.0 25 100.0
𝐱 ∓ 𝐒𝐭𝐝. 𝐃𝐞𝐯. 0.41 ∓ 0.085 0.43 ∓ 0.092
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1298 𝐱 ∓ 𝐒. 𝐃.=Arithmetic Mean (𝐱 ) and Std. Dev. (S.D.) .
Table -1- shows a poor evaluation knowledge for two-thirds of study group 16 participants 16(64%) , and a moderate level of knowledge for control group 15 (60% ).This table also shows a significant improvement in the study group at a good level of 20 (80%) after testing. Although the majority of control group at the same evaluation level in post-tests 15 (60%). This shows the efficacy of a nurses' knowledge educational program in the study group after testing..
1299 Table (2): Distribution of nurses responses and significant comparisons between (pre-test and post-test) for Study and control groups with respect to knowledge on preventing communicable disease transmission
Domains of knowledge Concerning Preventing transmission of
communicable disease *
Groups
Responses
Study Group Control Group C.S.
Pre-Test Post- Test
C.S.
P-value
Pre-Test Post-Test
C.S.
P-value
Post-C x Post-S
(C X S)
F % Mea
n F % Mea
n F % Mea
n F % Mea
n 1. General information
about Communicable disease
Correct 58 46.
4 0.46 M
10
9 87.2 0.87
G
P=0.00 0 HS
70 56.
0 0.56 M
61 48.8 0.49
M
0.129 NS
P=0.000 Incorrect 67 53. HS
6 16 12.8 55 44.
0 64 51.2
2. The most common Communicable disease
2.1. Corona viruses
Correct 39 39.0 0.39
M
79 79.0 0.79
G
P=0.00 0 HS
37 37.
0 0.3 7 M
42 42.0 0.42
M
0.401 NS
P=0.000 Incorrect 61 61. HS
0 21 21.0 63 63.
0 58 58.0
2.2 Tuberculosis TB Correct 34 34.
0 0.34 M
84 84.0 0.84
G
P=0.00 0 HS
35 35.
0 0.35 M
48 48.0 0.48
M
P=0.03 7 NS
P=0.000 Incorrect 66 66. HS
0 16 16.0 65 65.
0 52 52.0
1300 2.3 Mumps
Correct 48 38.
4 0.38 M
92 73.6 074
G
P=0.00 0 HS
53 42.
4 0.42 M
51 40.8 0.41
M
P=0.77 4 NS
P=0.000 Incorrect 77 61. HS
6 33 26.4 72 57.
6 74 59.2
2.4 Measles and Rubella
Correct 43 43.
0 0.43 M
83 83.0 0.83
G
P=0.00 0 HS
39 39.
0 0.39 M
42 42.0 0.42
M
P=0.63 3 NS
P=0.000 Incorrect 57 57. HS
0 17 17.0 61 61.
0 58 58.0
2.5 H1 N1
Correct 38 38.
0 0.34 M
76 76.0 0.76
G
P=0.00 0 HS
45 45.
0 0.45 M
50 50.0 0.50
M
P=0.43 8 NS
P=0.000 Incorrect 62 62. HS
0 24 24.0 55 55.
0 50 50.0
2.6 Viral hepatitis A and B
Correct 45 36.
0 0.36 M
10
6 84.8 0.85
G
P=0.00 0 HS
45 36.
0 0.36 M
49 39.2 0.39
M
P=0.61 3 NS
P=0.000 Incorrect 80 64. HS
0 19 15.2 80 64.
0 76 60.8
2.7 Scabies
Correct 38 38.
0 0.38 M
84 84.0 0.84
G
P=0.00 0 HS
39 39.
0 0.39 M
40 40.0 0.40
M
P=0.88 5 NS
P=0.000 Incorrect 62 62. HS
0 16 16.0 61 61.
0 60 60.0
Part three: Health promotion approach to preventing
1301 transitional of Communicable
diseases
3.1 General information about the health promotion program
Correct 31 31.
0 0.31 P
74 74.0 0.74
G
P=0.00 0 HS
43 43.
0 0.43 M
43 43.0 0.43
M
P=0.89 2 NS
P=0.000 Incorrect 69 69. HS
0 26 26.0 57 57.
0 57 57.0
3.2 Preventive measures in health promotion program include:
3.2.1 Health Protection from infectious diseases
Correct 42 42.
0 0.42 M
80 80.0 0.80
G
P=0.00 0 HS
39 39.
0 0.39 M
43 43.0 0.43
M
P=0.56 6 NS
P=0.000 Incorrect 58 58. HS
0 20 20.0 61 61.
0 57 57.0
3.2.2 Disease prevention
Correct 40 40.
0 0.40 M
74 74.0 0.74
G
P=0.00 0 HS
39 39.
0 0.39 M
45 45.0 0.45
M
P=0.39 9 NS
P=0.000 Incorrect 60 60. HS
0 26 26.0 61 61.
0 55 55.0
3.2.3 Health education on communicable diseases
Correct 36 36.
0 0.36 M
87 87.0 0.87
G
P=0.00 0 HS
44 44.
0 0.44 M
38 38.0 0.38
M
P=0.39 8 NS
P=0.000 Incorrect 64 64. HS
0 13 13.0 56 56.
0 62 62.0
1302 F: Frequencies, %: Percent; C.S.: Comparison Significant; C X S: Testing coincidence between Control and Study groups; Level of Evaluation: P= poor (0 - 0.33 ) : 1; M= Moderate ( 0.34 – 0.67 ) : 2; G= Good (0.68 – 1.00) : 3; N.S: Non-Significant at ( P> 0.05); HS: High Significant at ( P< 0.01).
The results of this table show that, depending on the correct response of the nurses, there was a moderate evaluation of nurses' knowledge concerning the whole domain of pretest communicable diseases for the control group. Although after delivery of the training program, the knowledge evaluation of Nurses in the post-test study group is improved, it is raised to a good level. When analyzed by independent sample t- test
Nurses' Knowledge
Variables
Pre- Test Post –Test
ANOVA d.f p-value Sig. ANOVA d.f p-value Sig.
Age 0.999 21 0.413 NS 1.782 21 0.181 NS
Experiences Years in
Nursing Field 1.043 21 0.394 NS 4.765 21 0.011 S
Participation in Training
Courses 0.899 22 0.421 NS 0.072 22 0.931 NS
Pre- Test Post -test 2
t-test d.f p-value Sig. t-test d.f p-value Sig.
1303 Table (3): Association of the knowledge of nurses with their demographic variables
d.f = degree of freedom, P = probability value, Sig.= Significant, S= Significant at( P< 0.05), HS= High Significant at ( P< 0.01), NS= Non Significant at (P > 0.05).
Table -3- shows that there is no statistically significant association between nurses' knowledge and their demographic variables at ( pretest, post-test), except (Gender and Experiences Years in Nursing Field) in post-test are showed highly significant differences in relationships
to nurses' knowledge were found.
Gender 1.537 23 0.138 NS 3.327 23 0.003 HS
Level of Education 1.380 23 0.181 NS 1.000 23 0.328 NS
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1304 Discussion:
Part I: Discussion Effectiveness of Health Education Contact Program in Improving Nurses' Knowledge about Promoting Health and Preventing of Communicable Diseases at Primary Health Care Centers in Al -Amara City at (Pre-Post Tests)
Table -1- Demonstrated that 16 (64 %) of the two-thirds of the study group participants had poor evaluation knowledge and that 15 (60%) had a moderate control. The table furthermore showed a high level of knowledge improvement in the post-testing 20 (80%). Most control group at the same evaluation level in post-tests at 15 (60%). This shows the effectiveness of a post-test study group education program
The results of the present study show that nurses have poor knowledge before program application but have had a positive impact on a high level of knowledge among nurses about the promoting health and preventing communicable diseases following education program.
(14).
Table 2 statistically indicates a high level of significant difference in all domain of knowledge of the nurses in relation to the promoting health and preventing of communicable diseases (between pre- and post-testing of the study group as well as post-testing between the study and control group). In all of the above items there were statistically significant difference in the P value (<0.01) between the two groups (<0.01). (15)
Part II: Discussion of the relationship between Nurses' Knowledge with demographical characteristics for study group at (Pre Test, Post Test)
Table -3- shows that the statistically significant association between knowledge of nurses and the demographic variables (pre-test, after-test) does not exist, with the exception of (gender and Experiences Years in Nursing Field) in the after-testing .This study has demonstrated that the relationship between the knowledge of the nurses and age has not been significant (16). This totally agrees with a study published by (15) it shows that a significant relationship between nurses' knowledge and their gender post-test (at P=0.024). This result has been supported by a recent study, which revealed that the statistical difference between knowledge, score among nurses and their educational level is significant. (17). The study revealed a significant statistical relationship between years of experience and the full post-testing knowledge, they don’t update their knowledge and may have no time for searching and increasing their knowledge, therefore nurses carryout certain aspects of care without knowledge. This result support by (15) show that the knowledge and experiences years in
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1305 nursing field of the Nurses knowledge have been significantly relationship. Training course in the health promotion and immunization units in particular can improve the science of nurses whose work leads to the dream of comprehensive care that can therefore be given, and does not show statistical differences between knowledge and training courses for nurses at (p value 0.072)(18) .
Conclusions.
1. Not every nurse within the PHCCs approved by the Iraqi Ministry of the Health in health promotion and immunization were properly trained in health promotion with the objective of promoting health and preventing of communicable diseases.
2. The results of this study demonstrate that the knowledge of the nurses shows that two thirds (64%) of study group participants had a pre-test knowledge poor while the control group, was moderately 15 (60%) aware of PHCC in Al-Amara City.
3. After implementing an education program to promoting health and preventing of communicable diseases, the Nurses' knowledge scores are increased.
Financial disclosure
There is no financial disclosure.
Conflict of interest None to declare.
Ethical Clearance
The College of Nursing has approved all experimental protocols and all experiments have been conducted in conformity with approving guidelines.
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