ࡱ> [ bjbj ΐΐ[% 8'|0d//"QQQ,,, 0 0 0 0 0 0 0$2400E4(,,4(4(00QQu0///4(HQQ 0/4( 0///Q_9 |,\//000/6.6/6/D,8/!z$,,,0000r/@,,,04(4(4(4(6,,,,,,,,, : /A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON THE AWARENESS OF CATARACT AMONG CLIENTS BETWEEN 40-70 YEARS ATTENDING THE EYE DEPARTMENT IN SELECTED HOSPITALS OF BIDAR. PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION MR. MAHESHNATH MEDICAL-SURGICAL NURSING SMT.M.C VASANTHA COLLEGE OF NURSING NAUBAD BIDAR 2013-2014 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION 1) NAME OF THE CANDIDATE:- MR. MAHESHNATH AND ADDRESS SMT.M.C VASANTHA COLLEGE OF NURSING BIDAR 2) NAME OF THE : - SMT.M.C.VASANTHA COLLEGE OF INSTITUTION NURSING BIDAR 3) COURSE OF STUDY : - 1st YEAR M.SC. NURSING AND SUBJECT MEDICAL-SURGICAL NURSING 4) DATE OF ADMISSION : -1.04.2013 TO COURSE 5) TITLE OF THE TOPIC : - A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON THE AWARENESS OF CATARACT AMONG CLIENTS BETWEEN 40-70 YEARS ATTENDING THE EYE DEPARTMENT IN SELECTED HOSPITALS OF BIDAR. 6. BRIEF RESUME OF THE INTENDED WORK:- 6.1 INTRODUCTION:- A cataract is opacity, or clouding, of the lens of the eye. The lens of an eye is normally clear. If the lens becomes cloudy or is pacified, it is called a cataract. Having a cataract removed is one of the most common operations in the UK, with between 250,000 and 300,000 performed each year. Consultant ophthalmologist Mark Wilkins explains what's involved .Cataracts are cloudy patches or areas in the lens inside your eye. They can develop in one or both eyes. One eye can often be more affected than the other. The lensis normally clear. It allows light to pass through to the back of your eye, helping you to see sharp images. If parts of the lens become cloudy (opaque), light cannot pass through the cloudy patches. Over time, these patches usually become bigger, and more of them develop. As less light is able to pass through the lens, your vision may become blurry or cloudy. The cloudier the lens becomes, the more your sight will be affected. A cataract can be described as a clouding that develops in the lens of an eye. It varies in severity from slight to complete opacity. The opacity of the cataract obstructs the passage of light into the eye, thereby affecting the person's vision. Cataracts develop slowly to cause loss of vision, and can render the person completely blind if it is left untreated.1 Cataracts usually affect both eyes, but they will generally develop in one eye before the other. Senile cataracts (cataracts that develop in the elderly due to the ageing process) usually start with initial opacity in the lens, followed by swelling of the lens, and then shrinkage of the lens - resulting in a complete loss of transparency. An untreated cataract can cause theomorphic phacomorphic glaucoma. Cataract is an ocular condition characterized by opacification of crystalline lens in the eye ,which leads to blurring of vision .the neutral lens is a crystalline structure composed of water and protein arranged in precise structure to create a pleasant passage for light to pass through it ,but with aging the lens opaque thus reducing the amount of light reducing the retina. Cataract is a global problem globally cataract is a leading cause of blindness it was estimated to affect 20 million people worldwide and accounted for 47.8% of total blindness in the world 2002 .By the eight of decade half of the population had cataract and by the tenth decade everyone was affected by cataract Taylor et al.estimated that cataract was the most common cause for low vision in Australian population and accounted for 37%of visual impairment in 2004. This study was also demonstrated exponential increase in vision loss with increasing age .It was estimated that 1.67 million Australian aged over 50 years were affected by age related cataract in 2001 and this number projected to increase to 2.74 million by year 2021.2 6.2 NEED FOR THE STUDY:- A cataract is a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light. Early in the development of age-related cataract the power of the lens may be increased, causing near-sightedness (myopia) and the gradual yellowing and opacification of the lens may reduce the perception of blue colours. Cataracts typically progress slowly to cause vision loss and are potentially blinding if untreated. The condition usually affects both the eyes, but almost always one eye is affected earlier than the other. A senile cataract, occurring in the aged, is characterized by an initial opacity in the lens, subsequent swelling of the lens and final shrinkage with complete loss of transparency. Moreover, with time the cataract cortex liquefies to form a milky white fluid in a Morgagnian cataract, which can cause severe inflammation if the lens capsule ruptures and leaks.3 India, a developing country faces many challenges in rendering ophthalmic health needs. Awareness is determined by factors within the health system (e.g., are the services well-known to communities and first-line health workers?) as well as factors such as patient or family education level. It is likely that people who are literate or have access to sophisticated technology (e.g., television or cell phones) are more aware of small decreases in vision than people without these advantages. In Kuper and colleagues' study, the cases were not only poorer than controls; they were significantly less likely to be literate and educated. Could these factors have affected their awareness of cataract and cataract surgery? 4 Cataracts are very common, especially among people age 40 and older. A cataract is a clouding of the eye's clear lens. This prevents the passage of light needed for vision. Cataracts are a significant cause of blindness in some parts of the world; however, technological advances and the availability of new procedures mean that for many people, cataracts don't lead to vision loss. New advances and techniques have made cataract surgery one of the most successful and life-improving surgical procedures. The surgeon will make a tiny incision through which he or she removes the cloudy lens and replaces it with a permanent artificial lens. Lasers are not currently used to remove cataracts. But they are sometimes used after cataract surgery to remove a film that can grow on the lens implant. If you think you may have a cataract, you don't have to live with it. Talk to your eye doctor about your options. There are no medications or exercises that will prevent the formation or progression of cataracts or make a cataract disappear. Nutritional or vitamin supplements have been shown to be beneficial in populations with nutritional deficits, but due to the inconsistent results reported in clinical trials, recommendations cannot be made at this time. Although it is very safe and effective, cataract surgery is surgery and you need to carefully decide if it is right for you. If the cataract does not interfere with your life, you may decide surgery is not warranted. Talk to your eye doctor, if cataracts are interfering with your lifestyle.5 The people who are blind in the world today, 64% are female. There are three main reasons for this: in many countries, women live longer than men and are at greater risk of blindness from causes related to age (such as glaucoma and age-related macular degeneration) some blinding conditions, such as trachoma and cataract, are more likely to affect women than men, whatever their age women and girls do not access eye care services as often as men and boys. There have been efforts in some countries, such as Pakistan5 and Tanzania, which have been effective in increasing the use of services by women. However, most communities, political leaders, and even some eye care workers are not aware of this problem. Ensuring equal access to eye care services for women will require advocacy at all levels: national, district, and community. Although it is beyond the scope of eye care programmes to change gender roles and expectations, gender issues that affect vision 2020 goals need to be addressed.6 India, as one of the biggest developing countries, has a large number of blind requiring sight-restoring cataract surgeries. Despite the increase in service availability and heightened outreach screening efforts, blindness has not decreased and uptake of offered cataract surgery services is suboptimal. Barriers to access cataract surgery services in India have been investigated in several studies, which were reviewed after having been identified through a Medline and Pub med search and summarized by using a model of health care utilization. . Numerous barriers, such as financial reasons, distance, fear, lack of service awareness, lack of support, or other obligations, could be identified but have not been put into the wider context of health care utilization behavior. Financial barriers continue to be a major reason not to take up offered cataract surgery services. More in-depth research of underlying factors is needed to increase self-motivated uptake of offered cataract surgery services. This would free resources currently invested into patient recruitment such as outreach screening. Freed resources could then be invested into treatment and further interventions such as health literacy promotion7. A study was conducted to assess the effectiveness of STRUCTURED TEACHING PROGRAMME on the awareness of cataract among clients between 40-70 years attending the eye department. It is effective to increase knowledge of clients between 40-70 years. During the clinical experience, investigator observed that clients between 40-70 years have lack of knowledge regarding awareness of cataract and their own self-care management. Hence, the investigator felt that the self-instructional module is more effective to improve their awareness and knowledge regarding self-care management and minimize the complications. 6.2 REVIEW OF LITERATURE:- A literature review is a written summary of the state of existing knowledge on the research problem. The task of reviewing research literature involves the identification, selection, critical analysis and written description of the existing information on a topic. A review of related literature gives insight in to various aspect related to the study which in turn develops the link between the precisely existing knowledge and the current study and enables to study various problems encountered during the course of a study by its direction findings ways to increase the effectiveness of data analysis and their interpretation 8. A study was conducted by Aravind Eye Hospital in India on the awareness of cataract disease and treatment to determine the major barriers for patients who need cataract treatment in a rural area of India. A total of 251 cataract patients were selected by means of eye disease screenings throughout Jiangyan County. Questionnaires were administered after the doctor determined that the patient needed cataract surgery. The patient's awareness questionnaire was developed by Fletcher and clinically validated at the Aravind Eye Hospital in India. . A total of 89.6% of patients had been aware of their condition for more than 1 year. Only 49.8% of all patients had known for more than 1 year that their eye disease could be treated. The major barriers for that seeking eye treatment included residual functional vision (49.0%), financial problems (36.7%), no demand for the operation (8.8%), and skepticism about the operation (8.8%). Poor vision function grade and female gender were two significant factors associated with a longer awareness (>3 years) of the existence of cataracts. Patients with a history of eye disease and a longer awareness of eye disease were more likely to have known about the potential treatments for a longer period of time (>1 year). The patients' awareness of the presence of cataract disease and potential treatment were unbalanced. The main treatment barriers were lower demand for vision improvement and financial problems. It is imperative to educate patients on eye health care and to provide low cost, but high quality, cataract surgery to these patients.9 A study was conducted on causes of vision loss among the adults of Hong Kong Chinese population. Patients' knowledge and participation in their care are important in prevention of blindness from cataract; the aim of this study was to measure knowledge of these conditions in the Hong Kong Chinese population. Subjects aged 40 and above in the Shatin district of Hong Kong were randomly selected as part of a larger study of causes of adult visual loss. The subjects received eye examinations in which the primary cause of visual disability was recorded. The respondents were asked by trained interviewers in a standardized fashion about their knowledge of cataract; their answers were rated for accuracy by a senior ophthalmologist. Out of the 2538 eyes examined, 7.0% had visual acuity less than 6/18. Fully 69.6% of the visual disability for those aged 60 or above was caused by cataract, AMD, or glaucoma. Awareness of cataract in particular was high, in that over 90% of respondents had heard of it. However, only 22.9% of them could describe cataract symptoms correctly, and these percentages were even lower in glaucoma (10.2%) and AMD (<1%). Over 40% of subjects did not know that surgery was an appropriate treatment for cataract. Conclusion: This sample of the Hong Kong Chinese population had limited knowledge of common eye diseases. Educational programmes to enhance public awareness may be needed to improve the effectiveness of health promotion and thus prevent unnecessary blindness.10 A study on the prevalence of cataract was carried out in urban and rural field practice areas of the Department of Preventive and Social Medicine, I.G. Medical College Shimla. All the persons aged 60 years and above were included in the survey, which was covered. There were 465 aged persons in the study population, of which only 406 could be examined. Senile cataract was present in 140 persons, thus the prevalence rate was 34.48%. The prevalence was higher in females and in the rural area. Incident nuclear cataract occurred in 13.1%, cortical cataract in 8.0%, and posterior sub capsular cataract in 3.4% of right eyes. The cumulative incidence of nuclear cataract in right eyes increased from 2.9% in persons aged 43 to 54 years at baseline to 40.0% in those aged 75 years or older. For cortical and posterior sub capsular cataract, the corresponding values were 1.9% and 21.8% and 1.4% and 7.3%, respectively. Women were more likely than men to have nuclear cataract even after adjusting for age.11 A survey of Cataract was carried out in a rural population of Pondicherry. Three villages, having a total population of 5430, were randomly selected. 1728 persons in these villages above the age of 30 years were examined for the presence of Senile Cataract. A prevalence rate of 27.7 percent was observed. The prevalence rate was significantly higher as age increased. Males and females were equally affected. Operable cases were 20 percent of the total cases. Rapid assessments for cataract blindness in persons aged 50 years and older can be conducted at district level in India with existing resources and at affordable costs. The results suggest an increase in cataract blindness since the previous survey of 1986. The long-term visual outcome needs improvement. Change in barriers to cataract surgery requires a shift in health education strategy and messages. The large variation in prevalence justifies district-level surveys.12 A study on incidence of cataract carried out in Karnataka in persons 50 years of age and older in 19 districts of Karnataka State, India. Presentation of the results of rapid assessments of bilateral cataract blindness in persons 50 years of age and older in 19 districts of Karnataka State, India. A total of 21,950 persons 50 years of age and older in 19 out of 20 districts were examined. In each district, 15 clusters were randomly selected and in each cluster the visual acuity and lens status were assessed in 90 persons 50 years of age and older. Methods- Systematic Random Cluster Sampling was used. It was found that the prevalence in females was higher than in males. Cataract Surgical Coverage, an indicator for coverage and service utilization, varied from 42% to 68% in different districts. On average, males had a higher coverage than females. Of all aphakic eyes in the sample, 26.4% could not see 6/60. Barriers to cataract surgery are linked to service providers. Conclusions. Rapid assessments for cataract blindness in persons aged 50 years and older can be conducted at district level in India with existing resources and at affordable costs. The results suggest an increase in cataract blindness since the previous survey of 1986. The long-term visual outcome needs improvement. Change in barriers to cataract surgery requires a shift in health education strategy and messages. The large variation in prevalence justifies district-level surveys.13 A study carried out by ophthalmic surgeon of India on cataract. Cataract blindness is a major public health problem worldwide. Unlike other leading causes of blindness, cataract can be treated effectively with surgery. Demographic, social, and economic factors are important determinants of surgical treatment of this disorder in the developing world, resulting in the accumulation of very large numbers of un-operated cases. Because of many factors, the problem is really out of hand. In this paper, we try to raise awareness among optometrists of this major challenge. At the same time, because many individuals do not achieve good vision after surgery and because in most developing countries only one eye is operated upon, we emphasize the use of improved prognostic techniques to make the surgical outcome more predictable, avoiding nonproductive surgery and resultant disappointment on the part of all concerned. We feel optometry can play important roles in diagnosis, visual correction, and management of these patients, hopefully in cooperation with ophthalmic surgeons.14 A study on cataract awareness and management carried out in Maharashtra state. Cataract management was car Blindness due to cataracts presents an enormous problem, not only in terms of human suffering, but also in terms of economic loss and social burden. In the absence of proven measures of primary prevention, secondary prevention in the form of surgical intervention is, currently, the remedy to the problem of blindness due to cataracts. There are various therapeutic approaches in cataract extraction. However, the conventional ICCE/ SPECT and the newer ECCE / IOL are the popular approaches presently adopted on a mass scale. Maharashtra is consistently achieving the quantitative targets for cataract surgery given by the Government of India. However, the qualitative aspects of cataract surgery, the desired outcome of which is sight restoration in those blinded by cataracts, has hitherto not been monitored and assessed. The Kolhapur Circle was selected for this purpose. With the involvement of Ophthalmic Surgeons and PMOAS, the sample of cataract patients operated on in the year 1992-93 was followed. 15 A study is carried out by Kuper and colleagues 0n achieved normal visual acuity after surgery. Once patients with cataract are aware of the problem and possible solutions, the next issue they face is access to services. Success here depends on many factors, including the existence of convenient services, social support to reach them, and, of course, money for transport and service fees. Finally comes the issue of acceptance. Although one might assume that an elderly person with cataract would happily accept surgery if it were provided free and made available, surprisingly often this is not the case. Acceptance is influenced by a wide range of personal and cultural beliefs, including a patient's belief that surgery will restore vision. Unfortunately, in resource-poor settings, cataract surgery is not always successful; for example, only 50%70% of eyes in the populations studied by Kuper and colleagues achieved normal visual acuity after surgery. When we studied Tanzanian patients with cataract who said they were too poor to pay for surgery and interviewed them at their homes, we found there were often multiple reasons why they did not want eye surgery. Only 22% took advantage of offers of fee waivers and transportation. Education, again, is probably involved in the complex issue of acceptance of surgery. For another example of the importance of the social determinants of eye health, consider, cataract another cause of blindness associated with poverty. Studies have shown significant decreases in cataract in communities in the absence of specific trachoma control programs and without any measurable increases in income of the population. Better access to water and perhaps increased understanding of hygiene may have been critical factors.de level of the area. Cataract blindness is a major public health problem worldwide. Unlike other leading causes of blindness, cataract can be treated effectively with surgery. Demographic, social, and economic factors are important determinants of surgical treatment of this disorder in the developing world, resulting in the accumulation of very large numbers of un-operated cases. Because of many factors, the problem is really out of hand. In this paper, we try to raise awareness among optometrists of this major challenge. At the same time, because many individuals do not achieve good vision after surgery and because in most developing countries only one eye is operated upon, we emphasize the use of improved prognostic techniques to make the surgical outcome more predictable, avoiding non-productive surgery and resultant disappointment on the part of all concerned. We feel optometry can play important roles in diagnosis, visual correction, and management of these patients, hopefully in cooperation.4 A study is carried out on awareness Hyderabad in southern India. Awareness of common eye diseases and their treatment can play an important role in encouraging people to seek timely eye care and can therefore help in reducing the burden of visual impairment. Some studies on awareness of eye diseases in the developed world have been carried out but no such information is available for the Indian population. However, awareness of cataract surgery in south India has been reported. We assessed the level of awareness of common eye diseases in the urban population of Hyderabad in southern India in the population-based Andhra Pradesh Eye Disease Study (APEDS). This population has recently been reported also to have a high prevalence of blindness and moderate visual impairment. 16 A study was carried out in Muyuka, a rural district in the South West Province of Cameroon to estimate the prevalence and causes of blindness and visual impairment in the population aged 40 years and over in Muyuka, a rural district in the South West Province of Cameroon. Methods A multistage cluster random sampling methodology was used to select 20 clusters of 100 people each. In each cluster households were randomly selected and all eligible people had their visual acuity (VA) measured by an ophthalmic nurse. Those with VA <6/18 were examined by an ophthalmologist. Results 1787 people were examined (response rate 89.3%). The prevalence of binocular blindness was 1.6% (95% CI: 0.8% to 2.4%), 2.2% (1.% to 3.1%) for binocular severe visual impairment, and 6.4% (5.0% to 7.8%) for binocular visual impairment. Cataract was the main cause of blindness (62.1%), severe visual impairment (65.0%), and visual impairment (40.0%). Refractive error was an important cause of severe visual impairment (15.0%) and visual impairment (22.5%). The cataract surgical coverage for people was 55% at the <3/60 level and 33% at the <6/60 level. 64.3% of eyes operated for cataract had poor visual outcome (presenting VA<6/60).Conclusions Strategies should be developed to make cataract services affordable and accessible to the population in the rural areas. There is an urgent need to improve the outcome of cataract surgery. Refractive error services should be provided at the community level.17 A study on national eye survey was conducted in 1996 to determine the prevalence of blindness and low vision and their major causes among the Malaysian population of all ages. Methods: A stratified two stage cluster sampling design was used to randomly select primary and secondary sampling units. Interviews, visual acuity tests, and eye examinations on all individuals in the sampled households were performed. Estimates were weighted by factors adjusting for selection probability, non-response, and sampling coverage. Results: The overall response rate was 69% (that is, living quarters response rate was 72.8% and household response rate was 95.1%). The age adjusted prevalence of bilateral blindness and low vision was 0.29% (95% CI 0.19 to 0.39%), and 2.44% (95% CI 2.18 to 2.69%) respectively. Females had a higher age adjusted prevalence of low vision compared to males. There was no significant difference in the prevalence of bilateral low vision and blindness among the four ethnic groups, and urban and rural residents. Cataract was the leading cause of blindness (39%) followed by retinal diseases (24%). Uncorrected refractive errors (48%) and cataract (36%) were the major causes of low vision. Conclusion: Malaysia has blindness and visual impairment rates that are comparable with other countries in the South East Asia region. However, cataract and uncorrected refractive errors, though readily treatable, are still the leading causes of blindness, suggesting the need for an evaluation on accessibility and availability of eye care services and barriers to eye care utilization in the country .study on cases of cataract carried out by ICD. There are currently an estimated 180 million visually impaired persons globally. Of these, 45 million are blind, of whom approximately 20 % (i.e., 9 million) have no perception of light. These latter persons require mobility training and other forms of rehabilitation. Out of the total of 171 million which comprises 135 million persons with low vision (ICD-10) and 36 million blind with residual vision, (i.e., with light perception or better but less than 3/60), an estimated 60% can be improved with surgical treatment, mainly for cataract and some for corneal opacity. This accounts for an estimated total of 103 million persons who would benefit from treatment. (Note: Those requiring standard refractive correction would have been already excluded from this group by virtue of the definition in ICD-10). The remaining estimated 68 million persons require low vision care and are likely to benefit from.18 A study was conducted on eye problems in US. Despite being more affected by visual impairment and blindness than any other population group, older people are the group least likely to seek help when faced with eye problems or a deterioration of their vision. Even in the Kilimanjaro region in Tanzania, one of the few regions in Africa to have an excellent community eye care programme, it is estimated that only one in three older people with cataract actually receives an operation. This article looks at some of the most important reasons that older people don't get the eye care they need. Worldwide, particularly in low- and middle-income countries, older people tend to be the poorest members of society. As a result, the cost of eye care services is a major issue, especially when people have to pay for their own health care. There are direct and indirect costs to eye care. In one region in Madagascar, for example, we recently discovered that indirect costs such as transportation and meals for older people and their caretaker(s) can amount to more than three times the price of a cataract operation or ten times the price of presbyopic spectacles. Such indirect, or hidden, costs (which can even include bribes) tend to discourage many older people from seeking treatment. Barriers related to direct cost can be reduced by introducing a tiered pricing system which allows patients to pay according to their ability. One hospital the author worked in had such a system for their consultation fees: US $0 for patients who were too poor to pay, US $1 for regular patients, and US $20 for fast-track patients (who paid extra for special waiting areas and shorter waiting times). Such a system should be clearly formulated and transparent to users and should make provision for people who cannot afford to pay for the services. To help with indirect costs, a fee system could be set up where the fee for treatment includes transportation, meals for the patient and his or her caretaker, medicines, and so on. This eliminates any hidden costs and allows patients and their families to budget sensibly and in advance. Occasionally, patients give 'lack of money' as a reason for refusing an operation when there are deeper, more complex reasons that they may not wish to divulge. Proper counseling and repeat visits by field workers, outreach workers, or community workers can explore these reasons and often help the patient make an informed decision about surgery.19 A study was carried out by American Academy of Ophthalmology in Advances surgical techniques of  HYPERLINK "http://www.empowher.com/condition/cataract" \o "Read more about cataract" \t "_blank" cataract removal surgeries .one of the most successful and life-improving surgical procedures, according to the American Academy of Ophthalmology. More than 1.6 million  HYPERLINK "http://www.empowher.com/condition/cataract" \o "Read more about cataract" \t "_blank" cataract surgeries are performed each year in the U.S., making the procedure one of the most common surgeries in the U.S.  HYPERLINK "http://www.empowher.com/condition/cataract" \o "Read more about Cataract" \t "_blank" Cataract surgery is typically done as an outpatient procedure that requires only local anesthesia. Cataracts happen when the lens of the eye becomes cloudy and hard, leading to vision impairment or blindness. Some people may be genetically prone to develop cataracts, and there are no medications or exercises that can prevent them. Ultraviolet light exposure from the sun is a likely culprit, according to the American Dietetic Association, who recommends a diet high in antioxidants like vitamins C, E and beta-carotene to possibly counter the damage or perhaps delay  HYPERLINK "http://www.empowher.com/condition/cataract" \o "Read more about cataract" \t "_blank" cataract formation. Wearing UV-blocking sunglasses when outside is the best way to protect your eyes. Symptoms of cataracts can include light sensitivity, blurry vision, loss of color vision, difficulty with driving at night or recognizing people, or constantly feeling like you are looking through dirty eyeglasses when they are not.20 6.3 STATEMENT OF THE PROBLEM:- A study to assess the effectiveness of structured teaching programme on the awareness of cataract among clients between 40-70 years attending the eye department in selected hospitals of Bidar. 6.4 OBJECTIVES OF THE STUDY:- 1. To assess the knowledge regarding awareness of cataract among client. 2. To assess the Effectiveness of structured teaching programme module on the knowledge of cataract. 3. To compare mean score of pre-test and post- test. 4. To find association between the knowledge with selected demographic variables. 6.5. OPERATIONAL DEFINITIONS:- 1. Assess: A statistical measurement of knowledge scores of clients regarding cataract and its management. 2. Effectiveness:- It refers to optimum knowledge acquired by the patient regarding awareness of cataract after self instructional module 3. Structured Teaching Programme : Prepared booklet on self care management of patients with cataract to learn at their own pace. 4. Awareness:- Refers to knowledge regarding specific topic for subject. 5. Cataract:- Refers to the formation of the opacity within the lens. 6. Client:- Refers to a person who is receiving the eye services in the hospital. 7. Eye department:- It is a unit where ophthalmic problem patients are coming for eye Problem cure. 6.6 HYPOTHESIS:- There will be significant association between awareness of cataract among Clients with selected demographic variable. 6.7 ASSUMPTIONS:- The clients will have inadequate knowledge regarding awareness of cataract. 7. MATERIALS AND METHODS:- 7.1.1. SOURCE OF DATA:- Research approach : Quasi experimental approach. Research design : One group pre-test and post test design. Setting of study : eye department of selected hospitals at Bidar. Population : 50 subjects. Sampling technique : purposive Sampling technique. Sampling Criteria : Inclusion Criteria : 1) Clients of age group 40-70 years. 2) Clients who are willing to participate. 3) Clients who know either English or Kannada. Exclusion Criteria : 1) Clients those who are not present at the time of study. 2) Clients with blindness. 3) Clients with physical disabilities. 7.2. MEHTODS OF DATA COLLECTION:- A prior formal permission will be obtained from selected hospital. Informed consent will be obtained from client. Tool for data collection:- TOOL-1 : Section A- proforma for collecting demographic Variables. : Section B- Structured questionnaires to assess awareness of Cataract. TOOL-2 : Structured teaching programme on awareness of cataract. Method of data analysis and interpretation:- The investigator will analyze the data Obtained by using descriptive and inferential statistics and will be presented in the form of tables, graphs and diagrams. Duration of the study : - 6 weeks. 7.3. Does the study require any investigator or intervention to be conducted on patients or other humans or animals? If so, please describe briefly. No 7.4 Has ethical clearance been obtained from your institution in case of 7.3? Yes, Ethical clearance has been obtained from the institutions ethical committee. 8. LIST OF REFERENCES:- 1.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=%22Enoch%20JM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract" \t "_blank" Enoch JM,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=%22Barroso%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract" \t "_blank" Barroso L,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=%22Huang%20D%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract" \t "_blank" Huang D., Cataract: a critical problem in the developing world. Optom Vis Sci. 1993 Nov; 70(11):986-9. 2. J Hubley and C Gilbert, Eye health promotion and the prevention of blindness in developing countries: critical issues, Br J Ophthalmol. 2006 March; 90(3): 279284. 3. Lee Teak Tan, Huw Jenkins, John Roberts-Harry, and Michael Austin, should patients set the agenda for informed consent of cataract.11191125 Published online 2008 October. 4. Kuper and colleagues, challenges in rendering ophthalmic health needs. Br J Ophthalmol. 2006 May; 90(5): 538542. 5. Henry Nkumbe, Helping older people get the eye care they need, Community Eye Health. 2008 June; 21(66): 2628. 6. Paul Court right and Susan Lewallen, Improving gender equity in eye care: advocating for the needs of women, Community Eye Health. 2007 December; 20(64): 6869. 7. Rajesh Sinha, Chandrashekhar Kumar, and Jeewan S Titiyal, Etiopathogenesis of cataract: Journal review Indian J Ophthalmol. 2009 MayJun; 57(3): 245249. 8.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=%22Finger%20RP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract" \t "_blank" Finger RP, Cataracts in India: current situation, access, and barriers to services over time. Ophthalmic Epidemiology. 2007 May-Jun;14(3):112- 9. JH Stubbe, W Brouwer, and DMJ Delnoij, Patients experiences with quality of hospital care: the Consumer Quality Index Cataract Questionnaire, BMC Ophthalmol. 2007; 7: 14. Published online 2007 September 19. doi: 10.1186/1471-2415-7-14. 10  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lau%20JT%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract" \t "_blank" Lau JT,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lee%20V%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract" \t "_blank" Lee V,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=%22Fan%20D%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract" \t "_blank" Fan D,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lau%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract" \t "_blank" Lau M,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=%22Michon%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract" \t "_blank" Michon J, Knowledge about cataract glaucoma, and age related macular degeneration in the Hong Kong Chinese population, Br J Ophthalmic. 2002 Oct;86(10):1080-4 11 Rajesh Sinha, Chandrashekhar Kumar, and Jeewan S Titiyal, Etiopathogenesis of cataract: Journal review Indian J Ophthalmol. 2009 MayJun; 57(3): 245249. 12 Soudarssanane MB; Bansal RD. Department of P.S.M. JIPMER, Pondicherry-6, Prevalence of senile cataract in a rural population in Poundicherry, Indian Journal of Community Medicine. 1985 Jul-Dec; 10(3-4): 175 13 Limburg H.;Kumar R,Follow-up study of blindness attributed to cataract in Karnataka State, India  HYPERLINK "http://www.ingentaconnect.com/content/apl/opep;jsessionid=37jqx6mw0qd72.victoria" \o "Ophthalmic Epidemiology" \t "_blank" Ophthalmic Epidemiology, Volume 5,Number 4, December 1998 , pp. 211-223(13) 14 P K Nirmalan, R D Thulasiraj, V Maneksha, R Ramakrishnan, A population based eye survey of older adults in Tirunelveli district of south India: blindness, cataract surgery, and visual outcomes, Br J Ophthalmol. 2002 May; 86(5): 505 15 Laxmikant Mishra Prakash Bhatlawande, Raju Jotkar and Pushkar Bhagoorkar, Review of cataract intervention in Maharashtra State 1996, Vol. 3, No. 1, Pages 3-11. 16 Hans Limburg and Raj Kumar , Follow-up study of blindness attributed to cataract Hyderabad in southern India, 1998, Vol. 5, No. 4, Pages 211-223 17 J E Oye, H Kuper, B Dineen, R Befidi Mengue, and A Foster, Prevalence and causes of blindness and visual impairment in Muyuka: a rural health district in South West Province, Cameroon, Br J Ophthalmol. 2006 May; 90(5): 538542. 18 M Zainal, S M Ismail, A R Ropilah, H Elias, D Alias, etc., Prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey 1996, Br J Ophthalmol. 2002 September; 86(9): 951956. 19 J Hubley and C Gilbert, Eye health promotion and the prevention of blindness in developing countries: critical issues, Br J Ophthalmol. 2006 March; 90(3): 279284 20 American Academy of Ophthalmology, Eye M.D.s, cataracts awareness facts 2006-2009 Dubai Health & News. 9. Signature of the candidate :- 10. Remark of the Guide :- 11. Name of Designation :- 11.1. Guide :- 11.2. Signature :- 11.3. Co-Guide :- 11.4. Signature :- 11.5. Head of the Department :- 11.6. 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