Effectiveness of Information Booklet on Immunosuppressant Therapy after Organ Transplantation among Students.

 

Anju Philip¹*. T, Shintu Shiju², Sreelakshmi M.S³, Sruthy Varghese³, Silu Mathew Thomas³

¹Assistant Professor, Amrita College of Nursing, AMRITA Vishwa Vidyapeetham,  AMRITA university ,Health Sciences Campus, Amrita Institute of Medical Science And Research Center, Kochi-41.

²Fourth Year BSc., Amrita College of Nursing, AMRITA Vishwa Vidyapeetham,  AMRITA university ,Health Sciences Campus, Amrita Institute of Medical Science And Research Center, Kochi-41.

³Nursing Students, Amrita College of Nursing, AMRITA Vishwa Vidyapeetham,  AMRITA university ,Health Sciences Campus, Amrita Institute of Medical Science And Research Center, Kochi-41.

 

ABSTRACT:

Organ transplantation is the moving of an organ from one body to another¹. Immunosuppressive drugs reduce the strength of the body’s Immune system, but they do not eliminate the Immune system. The combination of medications and smaller dosage are used to develop a balance between providing enough Immune suppression to avoid rejection and to minimize the side effects. The purpose of the study is to assess the Effectiveness of information booklet on immunosuppressant therapy after organ transplantation among students of health science campus, Kochi. Objectives of the study: 1) Compare the level of knowledge regarding immunosuppressant therapy before and after intervention among students. 2) To find out the association between pre-test level of knowledge regarding immunosuppressant therapy and demographic variables. Methodology: Quantitative approach with experimental research design was adopted for the study. Probability sampling was used to select 80 samples from health sciences campus at Aims, Kochi. The tools used where semi-structured questionnaire to assess the effectiveness of information booklet on Immunosuppressant therapy after organ transplantation. Data were analyzed using both descriptive and inferential statistics. Major findings: Majority of the students 37(92.5%) in experimental group belongs to the age group of 18-20 years and 34(85%) are females. Half of the students 20(50%) are taken from both Nursing and Pharmacy. Most of the students 21(52.5%) have no previous knowledge in experimental group. The major information regarding immunosuppressant therapy obtained from books 13(32.5%). Most of the students in experimental group 29(72.5%) have average knowledge in pre-test; while in post-test 36(90%) have good knowledge. The mean score on level of knowledge in experimental group was 11.98 in pre-test and 22.45 in post-test, the estimated t-value was 18.194 which is significant at p<0.05. The mean score on post-test level of knowledge between experimental group and control group was 12.68, the calculated t-value was 15.859 which is significant at p<0.001.The association of pre-test level of knowledge with selected demographic variable shows that level of knowledge is significantly associated with gender and professional qualification. Conclusion: Immunosuppressant therapy is essential and effective for the survival of patients after organ transplantation.  Those who are dealing with the patients need more and adequate knowledge regarding immunosuppressant therapy. So for improving knowledge on immunosuppressant therapy information booklet is effective.

 

 

 

INTRODUCTION:

Organ transplantation is a lifesaving procedure in patients with end stage organ disease. The transplanted graft contains numerous antigens that are recognized as foreign by the host’s Immune-system. So a wide variety of drugs are used to prevent and treat solid organ rejection. Immunosuppressant drugs are of drugs that suppress or reduce the strength of the body’s Immune-system. One of the primary uses of immunosuppressant drug is to lower the body’s ability to reject a transplanted organ such as liver, heart and kidney.²

 

BACKGROUND OF THE STUDY:

Transplant rejection occurs when a patient’s body does not recognize the new organ and attacks it. Patient undergone transplantation must take drugs to prevent rejection. In organ transplantation, Immunosuppressant are used to prevent the body from rejection .

 

In 2015, thirty thousand nine hundred and seventy three organ transplants performed. Among that 15,064 peoples are donors for transplantation and on average 21 people die each day while waiting for a life saving kidney transplant.³

 

In 2014 four thousand two hundred and seventy patients died while waiting for a kidney transplant and another three thousand six hundred and seventeen people become too sick to receive a kidney transplant .Next most commonly transplanted organ is the liver with more than 6,000 surgeries in 2010.Around 4,000 kidney and 8,500 liver live donation are being carried out by relatives to their patients only annually in various hospitals.⁴

 

A study was conducted by Dictinson-Herbst, Diane, Saldanha, Akinyedeo, Mckoy N A, Robbinson (in 2001) on Immunosuppressive drug therapy for preventing rejection following lung transplantation in cystic fibrosis, in this study found that Immunosuppressive therapy is need to prevent episode of graft rejection and subsequently reduce morbidity and mortality of the population. ⁵

 

A prospective study conducted by Elisa J Gordan and Thomas Prochaska (2007) on adherence to Immunosuppression. Immunosuppression adherence among kidney transplant recipients is essential for graft survival. 

 

The research for each occurrence of non-adherence of 20 (51%) patients who completed the diarys, 11 (55%) reported at least one form of non-adherence. The study result shows that a total of 20 (51.3%) diary were completed, there were significant demographic differences by gender (p<0.05,x² =4.74 ) and race (p<0.05,x²=5.07) most respondent were female (55%). This study concluded that Immunosuppression is essential for graft survival.⁶

 

STATEMENT OF THE PROBLEM:

Effectiveness of information booklet on level of knowledge regarding immunosuppressant therapy after organ transplantation among students of health sciences campus, AIMS, Kochi.

 

OBJECTIVES OF THE STUDY:

1     Compare the level of knowledge regarding immunosuppressant therapy before and after intervention among students.

2     Find out association between pre-test level of knowledge and demographic variables like age, professional qualifications.

 

HYPOTHESIS:

1.        H₁-There is a significant difference between the mean pre-test and post-test score on knowledge regarding Immunosuppressant therapy after organ transplantation among students.

2.        H₂- There is a significant association between the mean pre-test score on knowledge regarding Immunosuppressant therapy after organ transplantation and selected demographic variables.

 

VARIABLES:

a)   Independent Variables: Information booklet on Immuno suppressant therapy after organ transplantation.

b)   Dependent Variables: Level of knowledge regarding Immunosuppressant therapy after organ transplantation.

c)    Extraneous variables: Age, gender, professional qualification, previous knowledge and source of information

 

RESEARCH METHODOLOGY:

Research Approach: Quantitative research approach.

 

Research Design: True Experimental pre-test post-test design.

Fig 1; Schematic Design of the study.

Group	1st day (pretest)	8th day (post-test)
Experimental	O1      X	O2
Control	O1	O2

 

Key:

O1- Preset knowledge regarding Immune-suppressant therapy

X- Administration of information booklet regarding Immune-suppressant therapy.

O2- Post-test knowledge regarding Immune-suppressant therapy.

 

Research Setting:

The study conducted in 3^rd year B.Sc. Nursing classroom that located in College of Nursing and 3^rd year B.Pharm classroom that located in ground floor of school of Pharmacy, at health sciences campus, Kochi.

 

Population:

Target Population:

All students of health science campus Kochi

 

Accessible Population:

3^rd year students from both the B.Sc. Nursing and B.Pharm of health science   campus Kochi.

 

Sampling technique:

Lottery method –probability sampling

 

Sample:

Size: Sample size for the present study is 80. (40samples in experimental and 40 samples in control group).

 

Criteria for the selection of Samples:

Inclusion Criteria:

1.    Students studying in health science campus Kochi.

2.    Students who are available at the time of study.

 

Exclusion Criteria:

1.    Students who were not present at the time of data collection

2.    Students who are not interested to participate in this study.

 

Data collection Instruments and Technique:

Tool 1:

Semi-structured knowledge questionnaire to determine the knowledge regarding Immunosuppressant therapy after organ transplantation among students.

·      Section A: Socio-demographic data

·      Section B: Semi structured knowledge questionnaire on knowledge regarding Immunosuppressant therapy after organ transplantation. The questionnaire includes 21 items from areas of Classification, Dosage, and Mechanism of action, Indications, Contra-Indications, Side-Effects and Instructions of Immunosuppressant agents. And the knowledge level was graded into:<10 marks =Poor knowledge ,  10-20 marks = Average,   ≥ 21 =Good

 

 

Information Booklet:

The intervention was information booklet on Immunosuppressant therapy after organ transplantation. The information booklet was provided to the subjects of experimental group after conducting pre-test and subjects of control group after post-test. It includes importance, classification, indications, contra-indications and side effects of immunosuppressant therapy.

 

Content Validity:

The prepared tool was given to 5 experts, 2 experts from pharmacology departments, 2 from medical surgical nursing, 1 from transplantation unit (GI surgery). Content validity index was calculated and which was 0.9.

 

Ethical Consideration:

Research proposal was presented before the research committee of AIMS, Kochi. .The permission was obtained from the respective head of the departments to conduct the study. Informed consent was obtained from subjects before data collection.

 

Pilot Study:

Pilot study was conducted on 28/09/2015 among 10 samples in selected nursing students to test feasibility and practicability of the tool and the methodology. No other difficulties were encountered during the pilot study in terms of probability and feasibility.

 

Data Collection Procedure:

The data collected from 9^th November 2015 to 22^nd November 2015 after getting ethical clearance from the thesis review committee of AIMS and getting permission from principals of Amrita college of Nursing and Amrita school of Pharmacy.  We informed the coordinators of each batch and took appointment for data collection. The samples were selected randomly using lottery method and divided them to experimental and control group. Individual’s consent was also taken and thereafter the pre-test was conducted in control group. On 8^th day post-test conducted on control group and at same time pre-test to experimental group. Then provided information booklet to all. In the same manner post-test conducted to experimental group.

 

Analysis and interpretation:

Section I: Socio demographic data:

This section deals with demographic details which includes age, gender, previous knowledge and source of information.

 

 

 

 

 

Table 1: Distribution of samples based on demographic variables.

Sl.No	Demographic variables	Experimental group (n=40)		Control group (n=40)
		F	%	F	%
1	Age in years a)       18-20 yrs.	37	92.5	37	92.5
	b)       21-23 yrs.	3	7.5	3	7.5
2	Gender a)         Male	6	15	7	17.5
	b)        Female	34	85	33	82.5
3	Professional qualification a)        B-Pharm	20	50	20	50
	b)        Nursing	20	50	20	50
4	Previous knowledge a)             Yes	19	47.5	32	80
	b)               No	21	52.5	8	20
5	Source of information a)        Books	13	32.5	26	65
	b)        Media	2	5	0	0
	c)         Health Professional	4	10	6	15

 

Section II: Knowledge regarding Immunosuppressant therapy after organ transplantation: 

i)Distribution of students based on their level of knowledge regarding immunosuppressant therapy after organ transplantation.

ii)       Comparison of mean pre-test score and mean post test score on level of knowledge regarding Immunosuppressant therapy after organ transplantation among Students.

 

 

 

Figure: 2 Multiple Bar diagram showing distribution of level of knowledge among students

 

 

 

Table 2 : Comparison of mean pre-test score and mean post test score on level of knowledge regarding immunosuppressant therapy after organ transplantation within experimental and control group

Group		Mean	Standard deviation	Mean difference	df	t-value
1	Experimental (n=40)
	Pre test	11.98	3.142	10.475	39	18.144*
	Post test	22.45	2.717
2	Control (n=40)
	Pre test	10.08	2.759	2.6	39	4.035NS
	Post test	12.68	2.795

*Significant at P<0.05  level of significance t₃₉=1.68

Table 3 :Comparison of mean pre-test score and mean post test score on level of knowledge regarding immunosuppressant therapy after organ transplantation between experimental and control group

Sl.No	Group	Mean	Standard deviation	Mean difference	df	t-value
1	Experimental (n=40)	22.45	2.795	9.775	78	15.859*
2	Control  (n=40)	12.68	2.717

*Significant at P<0.001 level of significance                 t_{78 = 0.357}

 

Section III: Association between pre-test levels of knowledge regarding immunosuppressant therapy and selected demographic variables.

 

Table 4 : Association between pretest level of knowledge regarding immunosuppressant therapy and  variables like age, gender and professional qualifications

Variables	Category	Knowledge		X2	p-value
		Poor	Average
Age	18-20yrs	22(29.7)	52(70.3)	1.061	0.567
	21-23yrs	3(50.0)	3(50.0)
Gender	Male	9(69.21)	4(30.8)	10.422*	0.004
	Female	16(23.9)	51(76.1)
Professional qualification	Nursing	5(12.5)	35(87.5)	13.091*	0.001
	Pharmacy	20(50)	20(50)

*Significant at P<0.05  level of significance                          

 

DISCUSSION:

Objectives	Present study	Review study	Remarks
First objective of the study is to compare the level of knowledge regarding immunosuppressant therapy before and after intervention among students	·          Mean score on level of knowledge in control group was 10.08 in pretest and 12.68 in posttest, the estimated paired t-value is 18.144 ,which is slightly significant at p<0.05. ·          Mean score on posttest level of knowledge in experimental group was 22.45 and in control group it was 12.68, the estimated t-value was 15.859 which is significant at p<0.001.	Whisenant, Debra Pettit, conducted a study in Ann Arber on improving Nursing students knowledge andCompare the level of knowledge regarding immunosuppressant therapy before and after intervention among students .101 subjects in experimental groups and 83 subjects in controlled groups were used as sample for the study. the randomized controlled trial were used for the selection of sample the study proved that 97.99 point (40%) the overall increase in knowledge  after exposure to educational interventions.7	Congruent with review
Second objective of the study was to find out association between pre- test level of knowledge and demographic variables like age, professional qualifications.	The pre-test level of knowledge is significantly associated with demographic variables like gender(x2=10.422), professional qualification (x2=13.091) and knowledge, which is not associated with age.	A study conducted by Changi, in general hospital Singapore,  The main aim of the study is to assess the knowledge of the nurse in the administration  of the immunosuppressant therapy to kidney transplant recipients and the same time they assess whether an annual kidney transplant nurse education programme had any beneficiary effects. The study results shows that only 46% of participants passed the test, the proportion of nurse who passed was not significantly difficult with respect to years of nursing experience, professional rank, post-graduate nursing qualifications. Nurse's understanding and knowledge of immunosuppressant therapy is insufficient and they need to update their knowledge on immunosuppressant therapy.8	Congruent with review

 

 

REFERENCE:

1.     Johns Hopkins Medicine. Organ transplantation.  [Online]. 2011 June 24 [cited 2013 April 17]; Available from: URL: https://en.wikipedia.org/wiki/organ-transplantation.

2.     Nadm Mahmud, Dusk Klipa, Nasimul Ashan. Antibody immunosuppressive therapy in solid organ transplant. [Online]. 2010 Mar-April (2):148-156: Available from: URL: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2840233/.

3.     Yosuke Shimazono- World Health Organization. Public Health Reviews the state of international organ trade. [Online]. December 2007. 85 (12); Available from: URL:www.who.int>volumes>06.039370.pdf

4.     National kidney foundation. Organ Donation and transplantation statistics. [Online]. 2006; Available from: URL: https://www.kidney.org/newsroom/factssheets/organ-donation-and-transplantation-status.

5.     Dickinson-Herbest, Diane, Saldanha, Akinyedeo, Mckoy et.al. Cystic fibrosis and lung transplantation. Ethical concern. Pediatric nursing. 2001 January 27; 87-9. Available from:  URL:https://search.proquest.com/health/docview/199522443/D5B3745A21104969PQ/44?accountid=34231.

6.     Elisa J. Gordon, Thomas Drohaska, Mary Gallant, Ashwini R, Sehgal et.al. Adherence to immunosuppression. A prospective Diary study. Transplant procedure. [Online]. 2007 Dec (10:3081-3085).Available fromURL:http://www.ncbi.nlm.nih.gov/pmc/ articles/pmc2361155  

7.     Whisenant, Debra pettit .Improving nursing student’s knowledge towards organ donation and transplantation. A randomized intervention: 2007. Available from :URL:https://search. proquest.com/health/docview/304775491/C41200C3704EAC58PQ/27?accuntid=34231.

8.     Changi ,general hospital Singapore .Br.J.Nurs.2012 Jul.12-25: 21(B): 795-805.Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/22874779.

 

 

Received on 04.06.2016                Modified on 02.07.2016

Accepted on 15.07.2016                © A&V Publication all right reserved