INTRODUCTION:

Cataract is the cloudiness of the eye or it's a medical condition in which the lens of the eye becomes progressively opaque, resulting in blurred vision¹. The ability to see the world clearly can easily be taken for granted, the eye is an invaluable sensory organ that is responsible for gathering visual stimuli to assist individuals in communicating with the world around them². Blindness due to cataract, presents an enormous problem in India not only in terms of human morbidity but also in terms of economic loss and social burden. Cataract is the second commonest cause of blindness after refractive error. Most of the cases are well treated by surgery, which leads to good visual outcome. The basic aim of this study is to assess the awareness and knowledge of patients about post cataract surgical care and complications. Insufficient or inadequate knowledge of patient who underwent for surgery can result numerous complications.³

The WHO/ NPCB (National Programme for Control of Blindness) survey has shown that there is a backlog of over 22 million blind eyes (12 million blind people) in India, and 80.1% of these are blind due to cataract. The annual incidence of cataract blindness is about 3.8 million. Prevalence of cataract increased from 23.87 to 43.88 per 10,000 populations.³

BACKGROUND OF THE PROBLEM:

Cataract is the leading cause of visual impairment worldwide, with approximately 37 million people affected according for 48% of global blindness. It is estimated that there are about 12 million blind people due to cataract in India alone. In India cataract operations has increased from 1.2 million in 1989 to 2.7 million operations in 1996⁴. However impressive this increase may be, the figure does not indicate the extent to which the problem of cataract blindness has been reduced. Treatable blindness, particularly that associated with cataract and refractive error, remains a significant problem among older adults in south Indian population especially in females, the illiterate and those living in rural areas⁵. Refractive errors (33.8%) and Cataract (21.4%) account for more than half of the OPD attendance at a military hospital in Ladakh, North India⁶.

A study was conducted to assess the knowledge of patients regarding post cataract surgical care and complications. The descriptive approach was used to assess the knowledge regarding post-surgical complications and eye care among the patients who are attending in OPD, A.V. College hospital, Coimbatore, Tamilnadu. The sample size was sixty. Patients were included Male and female, aged between 40 to 70 years, surgery done for uniocular or binocular cataract, has undergone any types of cataract surgery like ICCS, SICS, Paco-emulsification with short duration and long. Patients were excluded patients who are mentally ill, aged above 80 years. The study reveals that majority 27 (45%) subjects had poor knowledge, 22(36.6%) subjects had moderately knowledge and 11(18%) subjects had adequate knowledge. Thus, must take action by educating patients continuously to update knowledge on regular follow-up after cataract surgery for preventing further complications and blindness⁷.

A global initiative for the elimination of avoidable blindness under the title “VISION 2020: The Right to Sight” was launched in 1999 by the World Health Organization in collaboration with a number of international nongovernmental organization. The objectives of this initiative is to facilitate reduction of blindness worldwide by bringing together the resources needed to do so. The major steps addressed to eliminate avoidable blindness is to be achieve;⁸

(i) Improvement in the quality of cataract surgery and increase in the number of surgeries on persons blind in both eyes,

(ii) Effective screening to detect refractive error blindness and provision of spectacle and

(iii)Initiation of long-term strategies to prevent corneal and glaucoma blindness.⁸

NEED AND SIGNIFICANCE:

Vision gets cloudy because you have a cataract, your doctor may suggest a surgery to remove the lens of your eye and replace it with an artificial one. It’s a common and safe procedure and when it's done you will be able to see better. If you have a cataract, that doesn't always mean you need surgery. You may not even notice any change in your vision. Some people who have this condition see just fine if they wear prescription glasses, use a magnifying lens, or rely on brighter lighting. If proper care is not given after surgery it may lead to further worsening of visual perception.⁹

A study was conducted to assess the effectiveness of structured teaching programme regarding early detection and prevention of visual impairment among older adults. An evaluative research approach was adopted under the study. The study was conducted in selected rural areas in Meerut district. Purposive sampling technique was used to select the older people under both experimental and control groups. The sample comprised of 100 older people, 50 each in experimental and control group. The study concluded that Structured Teaching Programme (STP) is an effective strategy in improving knowledge and attitude of older people regarding early detection and prevention of visual impairment. More educational strategies can be undertaken to mobilize the older people towards eye care services and prevention of visual impairment.¹⁰

A study was conducted to assess the effectiveness of structured teaching programme regarding informed consent for cataract surgery. To determine patients' understanding and opinions about the usefulness of the informed consent (IC) document for cataract surgery and evaluate the deterioration in the effectiveness of verbal and written IC over time. Academic tertiary care centre. Multiple-choice questionnaires addressing specific information about cataract surgery were distributed to patients. The questionnaires covered topics such as treatment, risk, and outcome probabilities (assessed preoperatively and postoperatively); terminology commonly used in IC; and patients’ opinions about IC. Scores were calculated and compared using paired and unpaired t tests. Twenty-six patients thought that their legal autonomy would be waived by signing a consent form. Patients who took part in a standardized discussion of IC before testing scored 73.4% versus 23.4% in a control group who received no IC counseling. Patient recall of outcome probabilities significantly decreased between preoperative and postoperative testing (61.2% to 44.0%) when IC was given verbally but improved to 75.0% when patients were given written information to take home. Patients about to consent to cataract surgery had a reasonable grasp of basic terminology. A standardized IC discussion was effective in educating patient.¹¹

With the reference of the above evidence and details be find that knowledge regarding home care management of elderly undergoing cataract surgery is poor. For improving knowledge of regarding the homecare management of elderly undergoing cataract surgery thrust to take over the problem after study

OBJECTIVES:

1. To access the pre-test level of knowledge regarding home care management among elderly patients undergoing cataract surgery.

2. To evaluate the effect of structured teaching programme on knowledge regarding home care management among elderly patients undergoing cataract surgery.

3. To determine association between mean pre-test score on knowledge regarding home care management among elderly patients with selected demographic variables.

HYPOTHESES:

H1: There is a significant difference between the pre-test and post-test knowledge regarding home care management among elderly patients undergoing cataract surgery.

H2: There is a significant association between pretest level of knowledge score regarding home care management among elderly patients undergoing cataract surgery.

MATERIAL AND METHODS:

Research Approach:

In this study, a quantitative research approach was used for assessing the effect of structured teaching programme on knowledge regarding home care management of cataract among elderly patients at selected Hospitals of Kattanam, Kerala.

Research Design:

For assessing the effect of structured teaching programme on knowledge regarding home care management among elderly patients undergoing cataract surgery at selected Hospitals of Kattanam, Kerala. The Research design used in the study was quasi experimental non-equivalent one group pre-test post-test design.

Variables:

Variables are qualitative property and characteristics of personal thing or situation that changes or vary.

Independent Variable:

In this study independent variable is the structured teaching programme.

Dependent Variable:

In this study the dependent variable is knowledge.

Demographic Variable:

In this study the demographic variables are age in years, gender, religion, educational status, occupation, marital status, social habits.

Setting of the Study:

The study was conducted in adults above 65 years in age who underwent cataract surgery in selected hospital of Kattanam, Kerala.

Population:

The entire set of individuals or objects having some common characteristic selected for a research study. In this study selected population is people who underwent cataract surgery in selected hospital of Kattanam, Kerala.

Sample and Sampling Technique:

Sample:

Elderly patients undergoing cataract surgery in selected hospital of kattanam, Kerala.

Sample Size:

In this study the sample consist of 40 elderly patients who underwent cataract surgery.

Sampling Technique:

The sample for the study was selected by using convenient sampling technique. The samples were selected based on the inclusion and exclusion criteria.

The inclusion criteria in this study were:

· Adults who are willing to participate on the study.

· Age group 65 and above

· Available during the data collection

Exclusion Criteria:

The sampling criteria that can cause a person or element to be excluded from the target population. In this study the exclusion criteria were:

· Adults who are deaf

· Adults who are not willing to participate.

Description of Tool /Instrument:

A tool is a device used to measure the concept of interest in a research project that a researcher used to collect. The following tool was used for the present study.

Section A:

The section A was developed after extensive review of literature and based on expert opinion. It includes baseline performance is a structured interview schedule to collect information regarding the sample. It includes data like age in years, gender, religion, educational status, occupation, marital status, social habits.

Section B:

The section B was developed after extensive review of literature and based on expert opinions. The researcher was prepared the knowledge questionnaire regarding home care management among patients patients aged 65 and above. It consists of 25 questions. Each correct answer carries one mark and wrong answer carries zero marks.

Data Collection Process:

It is precise, systematic gathering of information relevant to researchers’ purpose or objectives or hypothesis of the study.

Phase 1:

After getting approval from concern authority for the study, demographic data, questionnaire and lesson plan for such as teaching are designed and prepared.

Phase 2:

The study was conducted adults who are 65 and above years of age who underwent surgery for cataract. 40 Samples were selected according to the non-probability convenient sampling techniques in this phase researcher explain about study and its purpose to sample and obtain informed consent for their participation. Before data collection the investigator introduced himself and about the purpose of the study. After assuring the confidentiality the subject was requested to participate to study. The tool was administered to the group. The average time taken to conduct pre-test was 15minutes and Structured teaching programme was 45 minutes with the help of Audio-visual Aids like charts, slides. The participants and management cooperated well for conducting studies. They provided positive feedback to planned teaching programme.

Phase 3:

Post-test was done to assess the knowledge regarding home care management of elderly patients undergoing cataract surgery after 7 days.

ORGANIZATION OF FINDINGS:

Data was analysed and presented under the following headings.

SECTION A:

Distribution of demographic variables.

SECTION B:

To assess the pre-test and post-test knowledge regarding home care management among elderly patients undergoing cataract surgery at selected hospital of Kattanam, Kerala.

SECTION C:

To determine association between mean pre-test score on knowledge regarding home care management among elderly patients undergoing cataract surgery at selected hospital of Kattanam, Kerala, with selected demographic variable.

SECTION A:

Distribution of demographic variables.

Fig 1: Shows that majority of the respondents are in the age 65-69 (45%) and the least respondents are from the age group of 80 years and above that is 10%.

Fig 2: Shows that majority of the participants were males and are 55% and the rest 45% were females.

Fig 3: Shows that out of the total sample majority was Christians and composed of 45% and the Muslims were least and are 20%. The Hindu’s contribute to 35% of the sample.

Fig 4: Shows that majority of the sample were given secondary education, that is 32.5% and 20% primary education, and another 20% graduate or above education. 27.5% of the sample had higher secondary education but none was illiterate.

Fig 5: Shows that majority of the sample were unemployed that is 50%, 17.5% were retired from their job, 2.5% were working in the private sector and 17.5% were retired from their job and none were government employee.

Fig 6: Shows that majority of the sample who had participated were married and consisted of 82.5% and 10% were widowed and 7.5% were divorced. None of the participants were unmarried.

Fig 7: Shows that out of the total sample 82.5% were people with no bad habits and 12.5% were alcoholic and 2.5% were smokers and the rest 2.5% were both alcoholics and smokers.

SECTION B:

To evaluate the effect of structured teaching programme on knowledge regarding home care management among elderly patients undergoing cataract surgery at selected hospital of Kattanam, Kerala.

SECTION-C

Table 4: Association of pretest knowledge score with selected demographic variables. The table show Chi square test showing the association of pretest knowledge score with selected demographic variables.

Demographic variables	Pre-test knowledge			Chi square table value	Df	Chi square value	Inference
Demographic variables	Poor	Average	Good	Chi square table value	Df	Chi square value	Inference
Age in Years
a) 65-69 years	6	12	0
b) 70-74 years	8	4	0	0.981	6	1.09	Not signficant
c) 75-79 years	2	4	0
d) 80 years and above	4	0	0
Total = 40
Gender
e) Male	12	6	0	0.162	2	3.63	Not significant
f) Female	8	14	0
Total = 40
Religion
Hindu	12	2	0
Muslim	7	1	0	<.0001	4	-0.110	Significant
Christian	1	17	0
Total = 40
Occupation
Unemployed	15	5	0
Government employee	0	0	0
Private employee	0	1	0		8	-0.172	Significant
Retired	2	5	0	<.0001
Others	3	9	0
Total = 40
Marittal status
Married	15	18	0
Unmarried	0	0	0
Widow	3	1	0	0.990	6	-0.871	Not significant
Divorced	2	1	0
Total = 40

Level of Knowledge	Range of Score	Pretest		Posttest
		Frequency	Percentage	Frequency	Percentage
Poor	1-10	20	50%	1	2.5%
Average	11-20	20	50%	28	70%
Good	21-25	0	0%	11	27.5%

	Mean	Median	Standard Deviation
Pretest	10.92	10	3.304
Post test	18.12	19	4.256

	Mean	Standard Deviation	Mean Diff	df (n-1)	t-Value	p-Value
Pretest	10.92	3.304	7.2	39	10.1	0.05
Post test	18.12	4.256	7.2	39	10.1	0.05