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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 1  |  Page : 22-27

Effect of information, education, and communication activity on health literacy of obesity and physical activity among school-going adolescents in Delhi


Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Date of Submission05-Mar-2019
Date of Acceptance16-May-2019
Date of Web Publication5-Jun-2020

Correspondence Address:
Srishti Yadav
C/O Kishan Gupta, F - 130/A, 4th Floor, Gautam Nagar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_21_19

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  Abstract 


Introduction: Awareness about risk factors of lifestyle diseases such as obesity and lack of physical activity is present among adolescents but to some extent only. Furthermore, younger ones tend to maintain the unhealthy habits as they age. Thus, intervention should start at an early age.
Aim: This study was conducted to assess the health literacy of school-going adolescents regarding obesity and lack of physical activity as risk factors for lifestyle diseases and assess the improvement in their knowledge after different information, education and communication (IEC) activities in two schools.
Settings and Design: It was a school-based interventional study conducted in two schools.
Material and Methods: Pretested questionnaire for baseline and post-IEC activity assessment of health literacy of risk factors like obesity and physical inactivity in lifestyle diseases was administered among students of Class 6, 7, and 8. Postintervention data were collected at 2 weeks after the first intervention and 3 months after the last intervention. Responses were scored and categorized as satisfactory and unsatisfactory.
Statistical Analysis: Chi square test was applied to compare the proportion of scores (satisfactory and unsatisfactory) at baseline, 2 weeks and 3 months.
Results: About 64% students in school 1 and 69% students in school 2 knew what obesity was. Moreover, about 79% of students in school 1 and 69% students in school 2 knew the minimum duration of physical activity required to prevent lifestyle diseases. There were a higher proportion of students with a satisfactory level of knowledge in both the schools after 2 weeks and 3 months of IEC activity, and the differences were statistically significant (P < 0.05).
Conclusion: The proportion of students having satisfactory knowledge satisfactory knowledge of obesity and physical activity increased after educational interventions among school-going adolescents of both the schools.

Keywords: Health literacy, information education and communication, obesity, physical activity, school adolescents


How to cite this article:
Yadav S, Khokhar A. Effect of information, education, and communication activity on health literacy of obesity and physical activity among school-going adolescents in Delhi. Indian J Community Fam Med 2020;6:22-7

How to cite this URL:
Yadav S, Khokhar A. Effect of information, education, and communication activity on health literacy of obesity and physical activity among school-going adolescents in Delhi. Indian J Community Fam Med [serial online] 2020 [cited 2020 Sep 25];6:22-7. Available from: http://www.ijcfm.org/text.asp?2020/6/1/22/286020




  Introduction Top


Globally, noncommunicable diseases (NCDs) account for approximately 63% of all deaths in a year which includes cardiovascular diseases, cancers, chronic respiratory diseases and diabetes.[1] Risk factors such as obesity and lack of physical activity contributing to the development of lifestyle diseases were more prevalent in the developed countries earlier but millions of productive years of life were lost due to NCDs in India too which are expected to increase in future.[2]

Many healthy (or unhealthy) lifelong practices begin in adolescence. Younger ones having unhealthy eating habits tend to maintain these habits as they age.[3] In addition, NCDs in adults have been related to the prevalence of risk factors present during the childhood.[4] Thus, preventive interventions should start at an early age as it takes time for healthy practices to blend into behavior.

Health literacy is defined as the ability to obtain, read, understand, and use health-care information to make appropriate health decisions for one's own health and family and community health and follow instructions for treatment.[5] An adequately health literate individual can communicate with health professionals, understand and use health materials (in a variety of formats) that they need to stay healthy, apply health-related knowledge to health care and decision-making so that they are able to make healthy choices and have more control over the things that make them healthy.[6] For that, a school is a key location for educating children about health and for putting in place the interventions to promote the health of children.[7]

Although many studies have been conducted in our country to assess the awareness of NCDs and their risk factors such as obesity and lack of physical activity among school-going adolescents, but there is a paucity of research on assessing the effect of information, education, and communication (IEC) activity on health literacy of lifestyle disease among them. This study was done with the objective of assessing the health literacy of risk factors of NCDs such as obesity and lack of physical activity among school-going adolescents, conducting intervention by IEC activity among school-going adolescents and assessing the effect of the different IEC activities among them.


  Material and Methods Top


It was a school-based interventional study conducted in 2016 in Najafgarh (New Delhi). Prior permission to conduct the study in schools was taken from Deputy Directorate of Education, South-West Delhi, and the Institutional Ethics Committee. From the total of 13 schools in Najafgarh area, the two schools were selected by simple random sampling, and the principals of these schools were consented, and the permission was taken from them to conduct the study. Students of Class 6, 7, and 8 from both the schools were included in the study.

The sample size was calculated based on the study conducted by George et al., in 2014, in two government and one private school in Central Delhi in which they found that among the various risk factors listed in the study 34.6% (P1) students (the least) had the knowledge that by exercising for at least 1 h a day cardiovascular diseases can be prevented.[8] In the present study, the knowledge was expected to increase up to 60% (P2) after the intervention among the school students. Taking an alpha error (α) and beta error (β) of 5% and 20%, respectively, the sample size was calculated using the formula as below:





P1 =0.34, P2 =0.60, Pm=P1+ P2/2 = 47.3% (0.473).

n = 51

Considering design effect = 2, loss to follow-up or nonresponse of up to 10%.

N = n*2

51*2 = 102

Considering loss to follow up = 10%. Thus

102+10.2= 112.2 (rounded off to 120)

Thus, a total of 120 students from Class 6th, 7th, and 8th in each school were taken.

A pretested, semi-structured, self-administered questionnaire based on the materials to be used for intervention was used for baseline and postintervention data. The questions were based on the IEC material adapted from the World Health Organization (WHO) and the Central Health Education Bureau (CHEB). The response options were yes/no/do not know. Some questions were open-ended also. Each right answer was awarded score one and wrong answer as zero. No response was considered as incorrect response and scored 0. The responses were scored and categorized as unsatisfactory (<50%) and satisfactory (>50%) knowledge. The maximum scores of obesity and physical activity questions was 12 for each, and the minimum score was 0. The intervention was given in the form of IEC on obesity and physical activity with the help of posters and pamphlets taken from the WHO office and CHEB for school 1 and lecture from the same reference material was prepared in PowerPoint presentation for school 2.

After the baseline evaluation in June in both the schools, the intervention was done on the next visit in July by giving the pamphlets to the students and displaying posters in their classes and common areas. The postintervention data were obtained after 2 weeks from both the schools by administering the same questionnaire. After that, respective interventions were repeated two more times monthly among the students of both the schools in August and September for reinforcing knowledge. Thus, interventions were given a total of 3 times in the span of 3 months, and postintervention data were also obtained at 3 months from the last intervention, i.e., in January. Thus, postintervention data were obtained two times – first at 2 weeks after the first intervention and the other after 3 months from the last intervention.

There was a loss to follow-up in both the schools during interventions. At 2 weeks, there was attrition rate of 7.5% in school 1 and 4% in school 2 and at 3 months' follow-up; there was attrition of 21% in both the schools.

Data analysis was done using Statistical Package for Social Sciences (SPSS) for Windows version 17.0, Released 2008 (SPSS Inc., Chicago, IL) software. All the values were analyzed using descriptive statistics to calculate frequencies, mean, range, and standard deviation. Chi-square test was applied to compare the proportion of scores (satisfactory and unsatisfactory) at baseline, 2 weeks and 3 months, and P < 0.05 was considered to be statistically significant.


  Results Top


The distribution of general awareness of obesity and physical activity among students of both the schools is shown in [Table 1].
Table 1: Distribution of study participants according to general awareness of obesity and physical activity at baseline

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The effect on musculoskeletal and digestive system was the maximally known harmful effect of obesity in school 1 and school 2, respectively. Stroke and irregular menses due to obesity were the least known harmful effects of obesity in school 1 and school 2, respectively. Obesity was the most known effect of lack of physical activity in both schools whereas the least known effects of lack of physical activity were diabetes and hypertension in school 1 and school 2, respectively, as shown in [Table 2].
Table 2: Distribution of study participants according to awareness of harmful effects due to obesity and lack of physical activity at baseline

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“Taking balanced diet” was the maximally known measure to avoid obesity in both the schools. Avoiding spicy food and avoiding eating when not hungry were the least known measures to avoid obesity in school 1 and school 2, respectively, as shown in [Table 3].
Table 3: Distribution of study participants according to awareness of measures to control obesity at baseline

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“Decreased weight” and “decreased blood sugar” were the maximally known benefits of physical exercise in school 1 and school 2, respectively, and the least known benefits were “decreased blood pressure and body fat” in school 1 and “decreased stress” in school 2 as shown in [Table 4].
Table 4: Distribution of study participants according to awareness of benefits of physical activity at baseline

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There were a higher proportion of students with a satisfactory level of knowledge of obesity after 2 weeks of intervention in both the schools, and this difference was statistically significant. There were a higher proportion of students with satisfactory level of knowledge of physical activity after 2 weeks of intervention in both the schools but the difference was found to be significant only in school 2 as shown in [Table 5].
Table 5: Comparison of the level of knowledge of obesity and physical activity at baseline and 2 weeks after intervention in school 1 and 2

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There were a higher proportion of students with a satisfactory level of knowledge of obesity and physical activity after 3 months of intervention in both the schools and the difference was statistically significant, as shown in [Table 6].
Table 6: Comparison of level of knowledge of obesity and physical activity at baseline and 3 months after intervention in school 1 and 2

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  Discussion Top


There were many studies conducted to assess the awareness of obesity and physical activity among school-going adolescents in different parts of the country. The present study revealed 100% of students had heard of obesity. In a study conducted by Mangalathil et al. in Sikar, they found 63% of students had heard of obesity.[9] According to another study conducted by Chaudhari et al. in Patan, 34.5% of students had heard of obesity.[10] The difference in knowledge level may be due to the setting of the present study where awareness programs are quite common.

In the present study, 64.2% of students in school 1 and 69.2% of students in school 2 knew what is obesity. In a study conducted by Samudre and Kulkarni among students of Class 8th–10th in a private school, they found 82.21% students correctly responded to the items regarding the meaning of obesity.[11] A higher level of awareness in the latter study may be because of higher grade of students of private school were included in the study. In the present study, 10% of students in school 1 and 35% students in school 2 had heard of body mass index (BMI). In a study conducted by Ramya and Batra, they found that none of the students had heard of BMI.[12] This difference may be due to the different setting of the study. In the present study, 6.3% students in school 1 and 5% students in school 2 knew that BMI is one of the indicators of obesity. In a study conducted by Shivalli et al. in Varanasi, they found that 18.2% of the students knew BMI as an indicator of obesity.[13] The higher level of awareness in the latter study may be because of higher grade of students who were included in the study.

In the present study, the effect on musculoskeletal and digestive system was the maximally known effects of obesity whereas stroke and irregular menses were the least known effects of obesity. In a study conducted by Shivalli et al., they found that the maximally known complication of obesity was joint pain followed by diabetes, hypertension, and heart attack whereas the least known complication of obesity was cancer.[13] In another study conducted by Chaudhari et al. they found heart attack was the most commonly known hazard of obesity, and the least known was cancer.[10] In the present study, taking balanced diet was the maximally known measure to avoid obesity while avoiding spicy food and avoiding food when not hungry was the least known measure to avoid obesity. In the present study, 25% of students in school 1 and 30% of students in school 2 had satisfactory knowledge (> 50%) of obesity. In a study conducted by Mangalathil et al. they found only 6% of students had average knowledge (50%–60%).[9] The higher level of knowledge in the present study may be due to the different setting of the study, i.e., in Delhi where such awareness programs are quite common. In the present study, there were a significantly higher proportion of students with a satisfactory level of knowledge of obesity after 2 weeks and 3 months of intervention in both the schools.

In another study conducted by Vijayapushpam et al., there was a similar improvement in the level of knowledge of obesity after 2 weeks of intervention in the form of lectures, charts, and folder.[14] In another study conducted by Chaudhari et al. among high school students, baseline knowledge of the students regarding the hazards of obesity increased significantly after intervention.[10] The study conducted by Shah et al. in North India (New Delhi, Jaipur, and Agra) also shows a significant increase in the level of knowledge of obesity from baseline to 6 months after Medical education for children/adolescents for Realistic prevention of obesity and Diabetes and healthy aGeing (MARG) intervention.[15]

In the study conducted by Vijayapushpam et al. conducted in Andhra Pradesh, they observed a significant improvement in the knowledge levels related to obesity 2 weeks after the intervention and knowledge on outcomes of obesity also increased significantly from 6.9% to 80.3% after 2 weeks of the intervention in the form of lectures, showing charts, and distributing folders.[14]

In the present study, 66.4% of students in school 1 and 57.5% students in school 2 knew the minimum duration of physical activity to prevent NCDs. In another study conducted by George et al. in both government and private schools, 34.6% of students in government school knew exercising <1 h/day can prevent from getting heart diseases.[8] Reason for low awareness level in the latter study may be due to different schools; both government and private included in their study. In the present study, the maximally known harm of lack of physical activity was obesity while the least known effect was diabetes and hypertension. In a study conducted by Shivalli et al. in Varanasi, 10.4% students knew lack of exercise could cause diabetes.[13] Low level of awareness in the latter study is due to different study settings. In the present study, there was a statistically significant (P < 0.05) improvement in scores of obesity and physical activity from baseline to 2 weeks and 3 months in both the schools after the intervention given in the form of posters and handouts and didactic lectures. The study conducted by Shah et al. in 2010 in North India (New Delhi, Jaipur, and Agra) also reveals similar improvement knowledge levels of physical activity after 6 months of MARG intervention.[15] In a study conducted by Saraf et al., knowledge about physical activity increased significantly in the intervention group as compared to the control school.[16]


  Conclusion Top


There was a statistically significant improvement in the satisfactory level of knowledge of risk factors – obesity and physical activity among students of both the schools studied both at 2 weeks and 3 months after after IEC activities like poster display and pamphlets distribution and didactic lectures. Hence, IEC activity in various forms may be used as one of the tools to improve health literacy regarding NCDs among school-going adolescents.

Acknowledgment

Authors would like to deeply acknowledge the institutional ethics committee for approving the topic and school teachers and the students who participated in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Bloom DE, Cafero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, Fathima S, et al. The Global Economic Burden of Non-communicable Diseases. Geneva: World Economic Forum; 2011.  Back to cited text no. 1
    
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World Health Organization. Health for the World's Adolescents. Geneva, Switzerland: World Health Organization; 2014.  Back to cited text no. 6
    
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Centre for Disease Control and Prevention. Guidelines for School Health Programs to Promote Lifelong Healthy Eating. Morbidity and Mortality Weekly Report 45(RR-9); 1996. p. 1-33.  Back to cited text no. 7
    
8.
George GM, Sharma KK, Ramakrishnan S, Gupta SK. A study of cardiovascular risk factors and its knowledge among school children of Delhi. Indian Heart J 2014;66:263-71.  Back to cited text no. 8
    
9.
Mangalathil TX, Kumar P, Choudhary V. Knowledge and attitude regarding obesity among adolescent students of Sikar, Rajasthan. J Nurs Health Sci 2014;3:44-8.  Back to cited text no. 9
    
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Chaudhari AK, Rami K, Thakor N. Assessment of knowledge regarding noncommunicable diseases and their risk factors among students of higher secondary school: An interventional study. Int J Med Sci Public Health 2016;5:115-8.  Back to cited text no. 10
    
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Samudre M, Kulkarni SM. Knowledge of prevention of obesity among the students from selected high schools. Int J Sci Res 2013;5:682-7.  Back to cited text no. 11
    
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Ramya KR, Batra K. Perception and knowledge of coronary heart disease among adolescents of Kerala. Asian J Nurs Educ Res 2015;3:327-30.  Back to cited text no. 12
    
13.
Shivalli S, Gupta MK, Mohapatra A, Srivastva RK. Awareness of noncommunicable diseases and their risk factors among rural school children. Indian J Community Health 2012;24:332-5.  Back to cited text no. 13
    
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Vijayapushpam T, Antony GM, Rao GM, Rao DR. Nutrition and health education intervention for student volunteers: Topic-wise assessment of impact using a non-parametric test. Public Health Nutr 2010;13:131-6.  Back to cited text no. 14
    
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Shah P, Misra A, Gupta N, Hazra DK, Gupta R, Seth P, et al. Improvement in nutrition-related knowledge and behaviour of urban Asian Indian school children: Findings from the 'medical education for children/Adolescents for realistic prevention of obesity and diabetes and for healthy aGeing' (MARG) intervention study. Br J Nutr 2010;104:427-36.  Back to cited text no. 15
    
16.
Saraf DS, Gupta SK, Pandav CS, Nongkinrih B, Kapoor SK, Pradhan SK, et al. Effectiveness of a school based intervention for prevention of non-communicable diseases in middle school children of rural North India: A randomized controlled trial. Indian J Pediatr 2015;82:354-62.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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