• Users Online: 24
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 36-42

A Study to assess the impact of an ongoing capacity building program for nursing staff on augmentation of Knowledge, Attitude and Practice (KAP) of the trainees at Program Study Centre (PSC), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow


1 Department of Hospital Administration, Sanjay Gandhi Post Graduate Institute of Medical Sciences; Medical Superintendent, Super Speciality Cancer Institute and Hospital, Lucknow, Uttar Pradesh, India
2 Department of Hospital Administration, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission29-Nov-2021
Date of Decision22-Dec-2021
Date of Acceptance13-Jan-2022
Date of Web Publication12-Feb-2022

Correspondence Address:
Saima Alvi
529/207 Ka, Near Fatimi Masjid, Khurrum Nagar, Lucknow - 226 022, Uttar Pradesh,
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jigims.jigims_48_21

Rights and Permissions
  Abstract 


Introduction: The Government of India had notified Department of Hospital Administration (DoHA), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) as Program Study Center (PSC) to provide comprehensive training to selected candidates for Bridge Program on Certificate in Community Health Nursing. To fulfill a commitment, to assess the effectiveness of the assigned program, the PSC: DoHA, SGPGIMS endeavored to create a reliable, valid, and accurate assessment of program decisions and outcomes.
Aim: The aim of the study was to assess the impact of an ongoing capacity building program for nursing staff on augmentation of Knowledge, Attitude, and Practice (KAP) of the trainees at PSC, SGPGIMS, Lucknow.
Objectives:

  1. To ascertain the preintervention status of KAP among trainees of an ongoing capacity building program, through appropriately designed tool
  2. To ascertain the postintervention status of KAP among trainees of an ongoing capacity building program, through appropriately designed tool
  3. To recommend evidence-based modifiers, as feed-forward for the subsequent phases of the program, based on the analysis of the data thus obtained.

Methodology: Interventional study.
Results: Preintervention score: Knowledge – 68.5%, Attitude – 75.2%, Practice – 44.65%. Postintervention score: Knowledge – 86.846%, Attitude – 82.4%, and Practice – 51.15%. Increase: Knowledge – 18.346%, Attitude – 7.2%, and Practice-6.5%.
Conclusion: The training program was successful in achieving a significant improvement in trainees' knowledge and awareness regarding delivery of comprehensive primary care services which was reflected as improvement and change in their attitude. The performance was better in the postinterventional phase as compared to preintervention. Therefore, it is of utmost importance to sustain the present and provide occasions for further improvement in the knowledge and skills to health-care providers as a measure for continuous quality improvement.

Keywords: Bridge program on certificate in community health nursing, capacity building program, primary healthcare


How to cite this article:
Harsvardhan R, Alvi S, Arora T, Srivastava A. A Study to assess the impact of an ongoing capacity building program for nursing staff on augmentation of Knowledge, Attitude and Practice (KAP) of the trainees at Program Study Centre (PSC), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow. J Indira Gandhi Inst Med Sci 2022;8:36-42

How to cite this URL:
Harsvardhan R, Alvi S, Arora T, Srivastava A. A Study to assess the impact of an ongoing capacity building program for nursing staff on augmentation of Knowledge, Attitude and Practice (KAP) of the trainees at Program Study Centre (PSC), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow. J Indira Gandhi Inst Med Sci [serial online] 2022 [cited 2022 Nov 26];8:36-42. Available from: http://www.jigims.co.in/text.asp?2022/8/1/36/338366




  Introduction Top


Ayushman Bharat Program (ABP) was announced in India's Union Budget 2018-2019.[1],[2] The ABP with two components intends to provide services with continuum across three levels of care and brings back the attention on delivery of entire range of preventive, promotive, curative, diagnostic, rehabilitative, and palliative care services.

  1. Delivering comprehensive primary health care by establishing 150,000 Health and Wellness Centers (HWCs) by year 2022, and
  2. Providing financial protection for secondary and tertiary level hospitalization as a part of National Health Protection Scheme.


This study attempt to strive for evidence-based efficiency and effectiveness of capacity building component of ABP. Bridge Program on Certificate in Community Health Nursing (BPCCHN) was developed by MoH and FW, GoI in collaboration with Indira Gandhi National Open University (IGNOU) to ensure continuation of Comprehensive Primary Health Care services at HCWs, as prescribed in the New Health Policy, 2017.

In the year 2018, GoI had notified Department of Hospital Administration (DoHA), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, as a Program Study Center (PSC) to provide comprehensive training to selected candidates for BPCCHN. To fulfil a commitment, to assess the effectiveness of the assigned program, the PSC: DoHA, SGPGIMS endeavoured to create a reliable, valid, and accurate assessment of program decisions and outcomes.[3]


  Subjects and Methods Top


Aim

To assess the impact of an ongoing capacity building program (structure and execution) for nursing staff on augmentation of knowledge, attitude, and practice (KAP) of the trainees at Program Study Centre, SGPGIMS, Lucknow.

Objectives

  1. To ascertain the preintervention status of KAP among trainees of an ongoing capacity building program, through appropriately designed tool
  2. To ascertain the postintervention status of KAP among trainees of an ongoing capacity building program, through appropriately designed tool
  3. To recommend evidence-based modifiers, as feed- forward for the subsequent phases of the program, based on the analysis of the data thus obtained.



  Methodology Top


Study setting

Program study center: DoHA, SGPGIMS, Lucknow, India.

Study period

The study period was 12 months (June 2018–May 2019).

Study span, i.e., time line

[Table 1], depicts logical steps in completing this research work.
Table 1: Timeline

Click here to view


Study sample

The study sample consisted of Trainees BPCCHN enrolled at Program Study Centre: DoHA, SGPGIMS, Lucknow, India.

Study method

Step 1

  • An appropriate tool (structured checklist and questionnaire) was developed for all the objective elements under preidentified domains and subdomains, which are reasonably and practically amenable to improvement
  • There were 26 items to ascertain the knowledge, score of 1 was awarded for each correct response (Maximum score = 26). Twenty-four items of attitude were measured on Likert scale (Score: 1–5). Compliance for 25 items of practice was assessed as 0: no compliance, 5: partial compliance, and 10 for full compliance (maximum score = 25 × 10 × 40 = 10000)
  • To collect the evidence of real time practice, photographs were captured
  • Current status of knowledge, attitude, and practices among trainees at Program Study Centre was ascertained through the predesigned tool in preidentified areas
  • Pretraining knowledge, attitude, and practice: 10 days before the capacity building program, questionnaires were distributed to the study sample to know the knowledge and attitude in the preidentified areas. Direct Observation was made along the structured checklist (10 days before capacity building program) in preidentified areas to observe real time practices
  • Following domains were included in the checklist and questionnaire:


  • Public health and epidemiology
  • Nutrition
  • Communicable diseases and management national health program
  • Noncommunicable diseases and management national health program
  • Communication, management, and supervision
  • Management of common conditions and emergency including first aid
  • Maternal health
  • Reproductive health and adolescent health
  • New born and child health care
  • Overview of common surgical conditions.


Step 2

Identified the deficit/s if any, present in preidentified areas as observed along the predesigned tool (Structured Checklist and Questionnaire) that need improvement.

Step 3

  • Timeline of teaching and training program is as per [Table 2].
Table 2: Timeline of teaching and training program

Click here to view


Step 4

  • Post Training Knowledge, Attitude and Practice 10 days after the capacity building program, questionnaire was distributed to trainees of the program to measure the improvement in knowledge and attitude posttraining. Direct observation was done along the structured checklist (same as pretraining) postcapacity building program (10 days after capacity building program) in preidentified areas to measure the improvement in practice
  • To collect the evidence of real time practice, photographs were captured.


Step 5

  • Data analysis


    • The data were processed by SPSS software version 21.0
    • Demographic characteristics, overall response rate, response to objective elements, and the composite parameters were determined
    • Values of variables was represented in number and percentage and mean and standard deviation
    • Test of significance used are: Unpaired t-test, Paired t-test, Mec-nemar Chi-square test and P ≤ 0.05 was taken as statistically significant
    • Data were represented with appropriate tables, charts, and diagrams.


  • Results and discussion were submitted at the completion of step 5.



  Observations and Discussion Top


Demographic characteristics of the respondents of the study: Trainees enrolled at program study center (n = 40).

A total of 40 respondents were enrolled in the study. Maximum (n = 18; 45%) were aged 26–29 years followed by those aged 22–25 years (35%) and 30–33 years (20%). Majority were females (55%). There were 18 (45%) males. Male-to-female ratio was 4:5.

Majority of the respondents were General Nursing and Midwifery (GNM) (62.5%) followed by B. Sc. Nursing Graduates (37.5%).

With respect to experience (years) of service, majority (45%) were without any experience in service, for 0–1 year, 12 (30%) had work experience for > 4 years, 8 (20%) for 1–2 years, and 2.5% had work experience of 3–4 years.

Majority of respondents were unemployed (45%). A total of 16 (40%) were employed in private sector and 6 (15%) were from Govt. settings.

Objective 1

To ascertain the preintervention status of KAP among trainees of an ongoing capacity building program, through appropriately designed tool.

To accomplish this objective, knowledge, and attitude (preintervention) of the respondents were assessed through structured questionnaire. Response rate was 100%. Practice was observed through structured checklist.

Descriptive statistics of pre intervention knowledge, attitude and practice assessment

Knowledge status before intervention

Prior to intervention, for different items correct responses ranged from 2.5% to 92.5%. For ten items, the correct response rate was in 50%–92.5% range. For eight items, the correct response rate was in >25%–50% range. For all the other, the correct response rate was <25%. Overall, number of correct response mean was 17.8 + 10.3 out of a maximum of 26.

Attitude status before intervention

The attitudes were studied on Likert scale with scores ranging from 1 to 5 for each item. There were 24 items. Among different items, mean scores ranged from 2.9 + 1.142 to 4.55 + 0.986. Overall, attitude mean score was of 3.668 + 1.116.

Practice status before intervention

Proportion of correct responses for different activities related with practice ranged from 12.5% (Steps of waste disposal) to 68.75% (Method of aspiration of medication from ampoules).

For activities Method of dissolving dry medicine, Method of IV cannulation, Method of urine test for proteins, Urine Test for Sugar/Albumin Using Dipstick, Method of urine test for detection of pregnancy, Equipment and Accessories Needed at New Born Care Corner, Method of assessment of new born: Initial Assessment, proportion of correct responses was in 25% to 50% range.

For the activities method of physical examination, method of head to toe assessment, method of examination for antenatal mother, Method of kangaroo mother care, Steps for waste disposal, the proportion of correct responses was <25%. Overall, practice scores was 25.5% (2450 out of 10000).

Interventions as mentioned in methodology conducted and implemented

Objective 2

To ascertain the postintervention status of KAP among trainees of an ongoing capacity building program, through appropriately designed tool.

To accomplish this objective, knowledge, and attitude (postintervention) of the respondents were assessed through structured questionnaire (same as pre). Practice was observed through the same structured checklist as used for Preintervention Observation. Response rate was 100%.

Descriptive statistics of postintervention knowledge, attitude, and practice assessment

Knowledge status after the intervention

Postintervention, for different items correct responses ranged from 2.5% (Route of administration for Diphtheria, Tetanus and Pertussis) to 100% (vector of Kala-Azar). For fifteen items majority had correct knowledge. For eight items, the correct response rate was in >25%–50% range. For all the other items, the correct response rate was <25%. Overall, number of correct responses ranged from 0 to 26 with a mean of 22.577 ± 11.209 out of a maximum of 26.

Attitude status after the intervention

Postinterventions mean attitude scores ranged from 3 ± 1.396 (Use of Oral Contraceptive Pills may cause weakness in the users) to 4.78 ± 0.423 (The word RICE stands for). For 16 items, mean scores were above 4 out of a maximum possible of 5. For 8 items, mean scores were from 3 to 4 out of a maximum possible of 5. Overall, attitude was with a mean score of 4.122 ± 0.871.

Practice status after intervention

Proportion of correct responses for different activities related with practice after the intervention ranged from 20% (Method of examination for antenatal mother) to 75% (Method of aspiration of medication from ampoules).

For 16 activities, proportion of correct response was above 50%. For seven activities, the proportion of correct responses ranged from 25% to 50%. For two activities, the proportion of correct responses <25%. Overall, practice scores were 51.15% (5115 out of 10000).

Impact of intervention on knowledge, attitude and practices of respondents

Comparison of pre-and postintervention knowledge

For twenty five items, an increase in proportion of correct responses was observed. Minimum change was observed for the item – Chronic constipation can lead to, for which the score showed an increment by 2.5% while maximum increase was observed for the item, In the Demographic cycle, at which stage does India stand, for which the increase in awareness was 55%. For ten items, the increase in awareness was significant statistically.

Overall mean knowledge scores changed from 17.808 ± 10.317 to 22.577 ± 11.209, thus showing a significant change in mean total scores for knowledge (P = 0.05).

Prior to intervention minimum score of an individual was 11.53% and maximum score was 53.85%. Postintervention minimum score of an individual was 42.30% and maximum score was 73.07%. The maximum change in knowledge score, 42.03%, was of in sample no. 3 and minimum change, 7.69%, was in knowledge score of sample no. 40.

Comparison of pre- and postintervention attitude scores

After intervention, a positive increase in mean attitude scores was observed for all the items as well as for overall mean scores (P = 0.05). For different items, increase in mean scores ranged from 0.02 to 1.18. Mean overall attitude scores showed an increase from 3.668 ± 1.116 to 4.121 ± 0.871. Statistically, this change was significant (P = 0.05).

Comparison of pre and postintervention practice responses

Increase in proportion of correct responses ranged from 20% to 75%. For all the items, change from preintervention status was observed. Overall mean scores of individuals (25 × 10 = 250) changed from 178.6 ± 71.261 to 204.6 ± 68.482. Statistically, this change was significant (P < 0.05).

Prior to intervention Knowledge score was 68.5%, Attitude was 75.2% and Practice was 44.65%. Postintervention score was 86.846%, 82.4% and 51.15% for KAP respectively. The change was of 18.346%, 7.2% and 6.5% for KAP respectively as depicted in [Table 3] and [Figure 1].
Table 3: Comparison of before and after total knowledge, attitude and practices scores (percentage of knowledge, attitude and practice scores)

Click here to view
Figure 1: Comparison of before and after KAP scores

Click here to view



  Discussion Top


To the best of our knowledge, this is the first analytical study slated to analyse and document Community Health Officer (CHO) trainees' KAP and provide evidence-based efficiency and effectiveness of capacity building component of ABP and also to dignify the various methods to process and improve the findings.

Monitoring and evaluation of the program or further intervention is vital to determine whether it works efficiently or there is a perceived need to refine program delivery modalities, and to provide evidence for continuing support of this program. Evaluation will not only provide feedback on the effectiveness of a program but also give a panoramic view of single or combination of factors that will help to determine whether the program is appropriate for the target population (TP), whether there are any problems with its implementation and support, and whether there are any ongoing concerns that need to be resolved as the program is implemented. This study tries to address these questions by drawing out conclusions from the experiences of recent evaluation of Capacity Building component of “Ayushman Bharat” for the delivery of Comprehensive Primary Health Care through Health and Wellness Centre.[4]

The present study was conducted in SGPGIMS: IGNOU PSC for BPCCHN.

Knowledge evaluation with demographic correspondence before and after intervention

A total of forty respondents were enrolled in the study. Maximum (n = 18; 45%) were aged 26–29 years followed by those aged 22–25 years (35%), and 30–33 years (20%). Majority were females (55%). There were 18 (45%) males. Male-to-female ratio was 0.8.

Majority of the respondents were GNM (62.5%) followed by B. Sc. Nursing Graduates (37.5%).

With respect to previous experience years of service, majority (45%) were without any experience in service, for 0–1 year, 12 (30%), for >4 years, 8 (20%) for 1–2 years, and 3–4 years 2.5%.

Majority of respondents were unemployed (45%). A total of 16 (40%) were employed in private sector and 6 (15%) were from Govt. settings.

Sample size was 40 and the response rate for the participation came out to be 100%, which strongly implied on the enthusiasm and willingness to learn and improve various skills among the respondents.

Assessment of the TP according to their duration of job revealed that majority (45%) were without any experience in service, followed by 12 (30%) respondents had worked in the hospital for <1 year, 8 (20%) for more than 4 years, for 1–2 years and 3–4 years 2.5%. This shows that more than 50% of respondents were not so experienced. Majority of the respondents were GNM (62.5%) followed by B. Sc. Nursing Graduates (37.5%). This was a plausible reason/shortcoming for an overall low level of awareness among them initially as it was observed that overall knowledge before intervention was found to be around 68.5%. However, although in a smaller population it does create a certain level of expectation that BPCCHN trainees should have better knowledge of preventive, promotive, rehabilitative, and curative care for an expanded range of services as they will be serving as CHO placed at a HWC-SHC.[5]

On implementation of the intervention the knowledge levels of the TP increased that accounted to 86.8%. The change was statistically significant for ten parameters and overall change in knowledge level of the trainees was also statistically significant.

Attitude evaluation before and after intervention

Despite not having sound knowledge, the attitude before intervention was in comparison good. Postimplementation of intervention attitude was more positive and appreciable and the change was statistically significant.

The respondents have an avid interest towards the need and understanding of training; this was observed to have increased with the cooperation and involvement of the academic counsellors.

Practice evaluation before and after intervention

Practice was assessed via activities which were assessed through checklist both before and after the implementation of the intervention.

The correct responses for items related with practice after the implementation of the intervention accounted for an increase with responses. The increase in response of eight parameters was statistically significant and the overall increase in practice also proved to be statistically significant.

The practice increased as and when the knowledge levels increased due to a better understanding of the subject and techniques that were induced in the trainees via the training program. This was indicative of the fact that practices increase with better infusion of knowledge. Strategy of upgrading practices, improve services.

Although there are obstacles and mistakes, hard work of the personnel of DoHA aim to achieve 100% through the process of continuous quality improvement and aiming above the mark to hit the mark.


  Conclusion Top


“It is of no use saying “we are doing our best.” You have to succeed in doing what is necessary.”

-Winston Churchill

This study aimed to assess the impact of an ongoing capacity building program (structure and execution) for nursing staff on augmentation of KAP of the trainees at Program Study Centre, SGPGIMS, Lucknow. It analyzed the efficacy of an educational intervention in capacity building and enhancing trainees' knowledge regarding delivery of an effective health care. Furthermore, the practice purview was taken through classroom teaching and field posting under the supervision of well qualified counselors.

  • In respect to first objective: The preintervention findings of this study suggest that KAP of the trainees with respect to comprehensive primary health care service delivery was low
  • In respect to second objective: This study demonstrated that the training program was successful in achieving a significant improvement in trainees' knowledge and awareness regarding delivery of comprehensive primary care services which was reflected as improvement and change in their attitude. The performance was better in the post interventional phase as compared to preintervention.


Therefore, it is of utmost importance to sustain the present and provide occasions for further improvement in the knowledge and skills to health-care providers at all the levels of health-care delivery system in future as a measure for continuous quality improvement.

“There is something that is much more scarce, something rarer than ability. It is the ability to recognize ability.”

-Robert Half


  Recommendations Top


Based on the results of the present study, the following few notifications are recommended:

  1. Use of technology in nursing education and practice: Introduction to use of Information Technology in clinical practice (e.g., basics of HIS, EHR and Robotics) to accustom students to system early
  2. Skill-focused competency-based curricula: To bridge the industry-academia gap and improve UG students' readiness for practice, there is a need to match Nurse Competency framework for B. Sc. Nursing, to current hospital practices
  3. This program provides 90 days out of 6 months to trainees for self-study, this duration can be reduced in order to give more clinical exposure to trainees, and hence will improve their practice
  4. A similar study can be replicated on a large sample, in order to validate the findings and make generalizations. A comparative study can be conducted between different demographics by involving larger sample
  5. A comparative study can be done involving two or more PSCs, to evaluate the efficiency of the PSC and to provide measures to improve program delivery, based on the performance
  6. A study can be done to assess the level of implementation of recommended evidence based modifiers of this study on the subsequent phases of the program
  7. Continuous assessment: Training programs are essential for all categories of health care providers in order to update and help sustain their knowledge. Development of continuing education programs and in-service education is a necessity.


Other miscellaneous recommendations based on incidental findings

  • Study material to be provided as soon as the program starts to help trainees understand the subject better and hence improving the performance
  • Upgradation of the study material provided to the academic counsellors and to the trainees with the latest information
  • Facility of medical leave to be provided to trainees on pro-rata basis as per Govt. guidelines.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Government of India. India Budget 2018-19 and Budget Speech. Ministry of Finance, New Delhi. Available from: http://www.indiabudget.gov.in. [Last accessed on 2019 Feb 12].  Back to cited text no. 1
    
2.
Lahariya C. Budget India 2008: What is new for health sector. Indian Pediatr 2008;45:399-400.  Back to cited text no. 2
    
3.
Rossi PH, Lipsey MW, Henry GT. Evaluation: A systematic approach. Sage Publications; 2018 Dec 6.  Back to cited text no. 3
    
4.
Das J, Holla A, Das V, Mohanan M, Tabak D, Chan B. In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps. Health Aff (Millwood) 2012;31:2774-84.  Back to cited text no. 4
    
5.
Press Information Bureau. Health and Wellness Centres under Ayushman Bharat. PIB, Government of India. Ministry of Health and Family Welfare. Press Release on 08-February-2019. Available from: https://pib.nic.in/newsite/PrintRelease.aspx?relid=188246. [Last accessed on 2019 Mar 12].  Back to cited text no. 5
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Subjects and Methods
Methodology
Discussion
Conclusion
Recommendations
Observations and...
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed456    
    Printed26    
    Emailed0    
    PDF Downloaded29    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]