INTRODUCTION:

In the current scenario, India is undergoing an epidemiologic, demographic, and health transition. The expectancy of life has increased, with the consequent rise in degenerative diseases and lifestyles. Nevertheless, communicable diseases are still dominant and constitute major public health issues.¹According to the report, two-thirds of the world population has been infected at one point in their lives, including 240 million to 350 million who have chronic infections. Among them, over 750,000 people die of hepatitis B each year. The disease is now only common in East Asia and sub-Saharan Africa where between 5 and 10% of adults have a chronic disease. Rates in Europe and North America are less than 1%.²

Among all communicable diseases, Hepatitis B is a highly contagious disease affecting the liver. It spreads through contact with infected blood, saliva, and other bodily fluids.³Hepatitis B is a viral infection of the liver that is transmitted from one infected person to another through direct blood-to-blood contact, Semen or, vaginal fluid. Although the mode of transmission is the same as that of the HIV virus (Human Immunodeficiency Virus), the virus is 100 times more infectious and can survive outside the body for und a week. During this time, the virus can infect a person.⁴

People born in hepatitis B-endemic regions have a higher rate of hepatitis B infection than in the general population. These regions include Africa, the Middle East, and the Mediterranean region. People from the Mediterranean region (predominantly Italy, Greece, and Malta) constituted 16% of a Melbourne liver clinic population with chronic hepatitis B. Martin and Maknote the proportion of African migrants accessing the Migrant Health Unit in Western Australia rose from 43% in 2002 to 79% in 2003 and 2004, and higher chronic hepatitis B infection rates in people from the African sub-Sahara (6.4%); Southeast Asia (6.5%) and North Africa (6.8%).43 This geographical variation in chronic hepatitis B prevalence is reflected among African refugees in Melbourne with higher rates among people from western rather than eastern Africa.⁵

According to the study report, India has over 40 million HBV carriers and accounts for 15% of the entire pool of HBV carriers in the world and it is estimated that over 1 million run the lifetime risk of developing chronic HBV infection. Every year over 100,000 Indians die due to illnesses related to HBV infection. There are varying reports of the overall rate of HB positivity ranging between 2-4.7%. While horizontal transmission is a major route of transmission, the role of vertical transmission is probably underestimated. Blood transfusion and unsafe therapeutic injections continue to be important modes of transmission of HBV. There is a need for large-scale field studies to better understand HBV epidemiology and identify high prevalence areas, and public health measures to prevent disease transmission and decrease the burden of the disease.⁶ Therefore this study aimed to assess the effectiveness of the educational packages on awareness and influencing lifestyle factors regarding hepatitis B among non-medical students in Bengaluru.

OBJECTIVES:

1. To explore the existing awareness and influencing lifestyle factors regarding hepatitis B among non-medical students.

2. To assess the posttest awareness regarding hepatitis B among non-medical students.

3. To evaluate the effectiveness of the educational package on awareness regarding hepatitis B among non-medical students.

4. To find out the association between pretest level of awareness and influencing lifestyle factors regarding hepatitis B among non-medical students with their selected demographic variables.

MATERIAL AND METHODS:

A quasy-experimental one group pre-test and post-test design with a quantitative approach were used. A total of 60 non-medical students between the age group of 20 to 25 years were randomly selected using probability simple random sampling technique who were willing to participate in the study. The data collection instrument was developed by the investigator. The validity and reliability of the tool were done with the help of nursing experts and bio-statistician. The awareness part included the questions on general information regarding hepatitis B, causes and transmissions, clinical manifestation and diagnosis, management and prevention, and complication. 9 statements were included regarding lifestyle-related factors regarding hepatitis B and response included (Yes/No). To complete the data a master data sheet was prepared by the investigator. Demographic data containing sample characteristics were analyzed using frequency and percentage. The aspect of awareness score was analyzed in terms of frequency, percentage, mean and standard deviation. A chi-square test was computed to find out the association between awareness and influencing lifestyle factors regarding hepatitis B among non-medical students and their selected demographic variables. Institutional research committee approval was taken. Formal approval was also obtained from the principals of the selected arts and science colleges. The investigator introduced the self to the participants, written consent was obtained from the participants and the purpose of the study was explained to ensure better cooperation during the data collection period.

RESULTS:

Table 1: Description of socio demographic variables of non-medical students in selected management and arts college Bengaluru (n = 60).

Sl No.	Demographic variables	No. of students	(%)
1	Age in years
	a. Below 20	14	23.3
	b. 21-25 years	45	75.0
	c. Above 25	1	1.7
2	Gender
	a. Male	38	63.3
	b. Female	22	36.7
3	Religion
	a. Hindu	42	70.0
	b. Christian	8	13.3
	c. Muslim	6	10.0
	d. Others	4	6.7
4	Course of study
	a. Under graduate	19	31.7
	b. Post graduate	41	68.3
5	Father’s Occupation
	a. Agriculture/ business/ self- employee	38	63.3
	b. Gov. employee	8	13.3
	c. Private employee	7	11.7
	d. Daily wages	7	11.7
6	Family income (Rs./month)
	a.≤10,000	23	38.3
	b. 10,001-15,000	18	30.0
	c.15,001-20,000	10	16.7
	d. Above 20,000	9	15.0
7	Place of residence
	a. Urban	25	41.7
	b. Semi urban	5	8.3
	c. Rural	30	50.0
8	Have you heard about hepatitis B?
	a. Yes	35	58.3
	b. No	25	41.7
9.	If yes, specify the source of information(n=35)
	a. Magazine	10	28.6
	b. Health care professional	17	48.6
	c. Friends	8	22.9

Table 1 depicts the frequency and percentage distribution of the demographic variables of the non-medical students, and the majority of them (75%) are in the age group of 20-25 years, and many of them are males (63.3%). The majority of them are Hindus (70%) and doing post-graduation (68.3%) and their father’s occupations, are agriculture sector, business, and self-employee. With regards to the family income, the majority of them (38.3%) earn with an income of <10000rs/months and they reside in the rural areas (50%). In addition, the study participants heard about hepatitis B (58.3%) and most of their source of information (48.6%) was from health care professionals.

Table 2: Frequency and percentage distribution of pre and posttest awareness on hepatitis B among non- medical students in selected management and arts college Bengaluru. N=60

Sl. No

Level of awareness

Pre-test

Post test

Frequency

Inadequate awareness (<50%)

83.3

Moderate awareness (50-75%)

16.7

28.3

Adequate awareness (>75%)

71.7

Overall

100

Table 2 depicts the pre-test and post-test level of awareness towards Hepatitis B among non-medical students which was assessed by general information regarding hepatitis B, causes and transmissions, clinical manifestation and diagnosis, management and prevention, and complication regarding hepatitis B. According to the total score obtained by subjects, awareness was classified into adequate awareness (>75%), moderate awareness (50–75%), and inadequate awareness (>50%). Our study indicates that 50(83.3%) study participants had inadequate awareness, 10(6.7%) had moderate awareness and none of the study participants were having adequate awareness. Whereas after the intervention majority 43(71.7%) had adequate awareness, 17(28.3%) had moderate and none of the study participants had inadequate awareness of hepatitis B. During the pre-test, the overall mean awareness score of the study participants was 14.00, with a standard deviation of 2.55, mean score percentage was 41.2. furthermore, after post-test the overall awareness regarding hepatitis B, out of a maximum score of 34, the range was 21-31, the mean score was 26.35, with a standard deviation of 3.23, and the mean score percentage was 77.5.

Figure 1: Percentage distribution of students according to the level of awareness on hepatitis.

Table 3: Frequency and Percentage distribution of influencing lifestyle factors regarding hepatitis B among non-medical students in selected management and arts college Bengaluru. N = 60

Sl. No	Characteristics of influencing life style factor of hepatitis B	YES		NO
Sl. No		No.	(%)	No.	(%)
1	Have you ever exposed to any hepatitis B infected person?	13	21.7	47	78.3
2	Are you often attend late night parties?	27	45.0	33	55.0
3	Do you consume alcohol?	24	40.0	36	60.0
4	Do you have the habit of smoking and tobacco use?	19	31.7	41	68.3
5	Are you indulged in injectable drug abuse?	1	1.7	59	98.3
6	Do you have habit of sharing needles and razors?	5	8.3	55	91.7
7	Do you often travel various places?	44	73.3	16	26.7
8	Have you ever had unsafe exual contact?	8	13.3	52	86.7
9	Do you have habit of tattooing in your body?	18	30.0	42	70.0

Table 4: Association between level of awareness on hepatitis B and selected demographic variables (n = 60).

Sl. No.	Demographic variables	Sample (n=60)		Awareness				Chi- Square Value	p-value
		Sample (n=60)		≤median		>Median
		F	%	F	%	F	%
1	Age in years
	a. Below 20	14	23.3	7	20.0	7	28.0	2.080, df=2, NS	p>0.05
	b. 21-25 years	45	75.0	28	80.0	17	68.0
	c. Above 25	1	1.7	0	0	1	4.0
2	Gender
	a. Male	38	63.3	22	62.9	16	64.0	0.008, df=1, NS	p>0.05
	b. Female	22	36.7	13	37.1	9	36.0	0.008, df=1, NS	p>0.05
3	Religion
	a. Hindu	42	70.0	24	68.6	18	72.0	4.482, df=3, NS	p>0.05
	b. Christian	8	13.3	3	8.6	5	20.0
	c. Muslim	6	10.0	4	11.4	2	8.0
	d. Others	4	6.7	4	11.4	0	0.0
4	Course of study
	a. Under graduate	19	31.7	11	31.4	8	32.0	0.002, df=1, NS	p>0.05
	b. Post graduate	41	68.3	24	68.6	17	68.0	0.002, df=1, NS	p>0.05
5	Father’s Occupation
	a. Agriculture/ business/ self-employee	38	63.3	26	74.3	12	48.0	*8.41, df=3, S**	p<0.05
	b. Gov. employee	8	13.3	4	11.4	4	16.0
	c. Private employee	7	11.7	1	2.9	6	24.0
	d. Daily wages	7	11.7	4	11.4	3	12.0
6	Family income (Rs./month)
	a. <10.000	23	38.3	17	48.6	6	24.0	4.954, df=3 NS	p>0.05
	b. 10,001-15,000	18	30.0	10	28.6	8	32.0
	c. 15,001-20,000	10	16.7	5	14.3	5	20.0
	d. > 20,000	9	15.0	3	8.6	6	24.0
7	Place of residence
	a. Urban	25	41.7	9	25.7	16	64.0	*9.285, df=2, S**	p<0.05
	b. Semi urban	5	8.3	3	8.6	2	8.0
	c. Rural	30	50.0	23	65.7	7	28.0
8	Have you heard about hepatitis B?
	a. Yes	35	58.3	15	42.8	20	80.0	*4.29, df=1, S**	p<0.05
	b. No	25	41.7	20	57.2	5	20.0	*4.29, df=1, S**	p<0.05
9.	If yes, specify the source of information(n=35)
	a. Magazine	10	28.6	4	23.5	6	33.3	0.931, df=2, NS	p<0.05
	b. Health care professional	17	48.6	8	47.1	9	50.0
	d. Friends	8	22.9	5	29.4	3	16.7

Note: S-significant at (p<0.05); NS-Not significant at (p>0.05).

Table -5: Association between influencing lifestyle factors of hepatitis B with demographic variables (n = 60).

Sl. no.	Demographic variables	Sample (n=60)				Life style factors								Chi- Square Value		p-value
						≤median				>Median
		F		%		F		%		F		%
1	Age in years
	a. Below 20	14		23.3		8		25.8		6		20.7		1.248, df=2, NS		p>0.05
	b. 21-25 years	45		75.0		23		74.2		22		75.9
	c. Above 25	1		1.7		0		0		1		3.4
2	Gender
	a. Male	38		63.3		16		51.6		22		75.9		*3.894, df=1, S**		p<0.05
	b. Female	22		36.7		15		48.4		7		24.1
3	Religion
	a.Hindu	42		70.0		21		67.7		21		72.4		6.107, df=3, NS		p>0.05
	b.Christian	8		13.3		7		22.6		1		3.4
	c.Muslim	6		10.0		2		6.5		4		13.8
	d.Others	4		6.7		1		3.2		3		10.3
4	Course of study
	a. Under graduate	19		31.7		6		19.4		13		44.8		*4.493, df=1, S**		p<0.05
	b. Post graduate	41		68.3		25		80.6		16		55.2
5	Father’s Occupation
	a. Agriculture/ business/ self- employee		38		63.3		17		54.8		21		72.4		*9.508, df=3, S**		p<0.05
	b. Gov.-employee		8		13.3		2		6.5		6		20.7
	c. Private-employee		7		11.7		6		19.4		1		3.4
	d. Daily wages		7		11.7		6		19.4		1		3.4
6	Family income (Rs/month)
	a. <10.000		23		38.3		15		48.4		8		27.6		3.468, df=3, NS		p>0.05
	b. 10,001- 15,000		18		30.0		7		22.6		11		37.9
	c. 15,001- 20,000		10		16.7		4		12.9		6		20.7
	d. >20,000		9		15.0		5		16.1		4		13.8
7	Place of residence
	a. Urban		25		41.7		12		38.7		13		44.8		0.707, df=2, NS		p>0.05
	b. Semi urban		5		8.3		2		6.5		3		10.3
	c. Rural		30		50.0		17		54.8		13		44.8
8	Have you heard about hepatitis B?
	a.Yes		35		58.3		17		54.8		18		62.1		0.322, df=1, NS		p>0.05
	b.No		25		41.7		14		45.2		11		37.9
8.A	If yes, specify the source of information(n=35)
	a. Magazine		10		28.6		5		29.4		5		27.8		0.030, df=2, NS		p>0.05
	b. Health care professional		17		48.6		8		47.1		9		50.0
	d. Friends		8		22.9		4		23.5		4		22.2

Note: S-significant (p<0.05); NS-Not significant (p>0.05)

Table 5 depicts the Association between influencing lifestyle factors of hepatitis B with demographic variables. The finding shows that the majority of the participants 38(63.3%) are male with the age group between 21-25 years 45(75%). Regarding religion majority of them are Hindu 42(70%) and completed post-graduation 41(68.3). Most of the responder’s fathers 38(63.3) are in agriculture, business, and self-employed and have an income of 23(<10.000) and they reside in rural areas 30(50%). Further 35(58.3%) of the responders have heard about hepatitis B before and the main source of information was from healthcare professionals 17(48.6%). The result of the study shows that the association between Gender, Course of study, and father occupation was found statistically significant whereas Age, religion, family income, place of residence, have you heard about hepatitis B, and source of information was found statistically non-significant.

DISCUSSION:

In the pre-test, the majority half (83.3%) of the students had inadequate awareness about hepatitis B and 16.5% of non-medical students had Moderate level and there are no students found at an adequate level of awareness on hepatitis B. whereas after the implementation of educational package our study shows that (71.7%) of the respondents had adequate awareness, (28.3%) of the respondents have moderate awareness about hepatitis B and none of them had inadequate awareness in the post-test on hepatitis hence, the non-medical students level of awareness regarding hepatitis B were enhanced after the post-test intervention. The first objective of the study was to assess the existing awareness and influencing lifestyle factors regarding hepatitis B among non-medical students. With regard to the level of pre-test awareness regarding hepatitis B, the results show the pre-test level of awareness on hepatitis B among non-medical students, in which 50(83.3%) subjects had inadequate awareness, 10(16.7%) subjects had moderate awareness and none of the subjects had the adequate awareness before the administration of educational package. The finding of the study was supported by a cross-sectional study to assess the knowledge and awareness of HBV among pregnant women in the Kintampo Municipality of Ghana. The result shows 41% of the 504 women were aware of hepatitis B viral infection, 33.5% of the women were able to correctly mention the transmission routes of Hepatitis B. The ratio was the most (42%) mentioned source of information on HBV. The study concludes that there is a low level of knowledge and awareness of HBV among pregnant women in this municipality. This could potentially hamper effective HBV prevention and control in Ghana. Education on hepatitis B needs to be included in health promotion activities⁷.

Posttest level of awareness on hepatitis B among non-medical students, evident that 43(71.7%) subjects had adequate awareness, 17(28.3%) subjects had moderate awareness and none of the subjects had the inadequate awareness regarding hepatitis B after the administration of educational package. Findings are supported by an interventional study done to assess the effectiveness of the Structured Teaching Programme on Knowledge regarding Hepatitis-B among nursing students In Selected Schools of Nursing Moga, Punjab. A quasi-experimental approach was used for the study by taking 60 Nursing students. A self-structured and self-reported questionnaire on knowledge assessment regarding Hepatitis B was used. After post-test Data was analyzed through descriptive and inferential statistics. The study finding revealed that the pre-test knowledge score of nursing students was inadequate which get increased after imparting the STP. In this study, the post-test mean knowledge score of the experimental group was higher than the post-test mean knowledge score of the control group at p<0.05level. This indicates that STP was effective. It was concluded that continuing education program is essential for nursing staff to reduce the morbidity and mortality due to Hepatitis B.⁸Our study shows that the outcome of paired t-test value evident the high statistical significance in the educational package on awareness regarding hepatitis B among non-medical students. The t-test value was found to be 24.36 which was found as a high significant difference at p<0.001 level ford f-59. The findings of the study were supported by a study conducted among government high school students, Dharan regarding awareness on the transmission of the Hepatitis B virus. Three government schools were selected using the lottery method. An equal number of students (45) from each class was selected by simple random sampling technique and interviewed by using a semi-structured questionnaire. Data were analyzed in frequency and percentage by using Two Population Proportion Test. Results show there was a significant increase (p<0.005) in the level of awareness of students in Post interventional test. A significant number of students 71.1% (p<0.005) came to know about all types of Hepatitis virus after the intervention. The study concludes that there was a significant increase in the level of awareness of Hepatitis B among government high school students of Dharan after the educational intervention.⁹ With reference to the association between influencing lifestyle factors and demographic characteristics there was a significant association of influencing lifestyle factor score with gender, course of study, and father’s occupation. The findings were supported by a cross-sectional study done among international students of University Putra Malaysia, to ascertain their levels of knowledge, attitude, and practices regarding hepatitis B, and C and its associated factors. 662 international students participated in this study. A cluster sampling method was employed and data was generated using a self-administered questionnaire. Their response rate was 71.49%. Of these, 50.3% of the respondents had better knowledge of hepatitis B, 52.7% had better knowledge of hepatitis C, 54.8 % had a positive attitude towards hepatitis B and C, and 77.6% had safer practices towards hepatitis B and C. Some of the socio-demographic variables and history of hepatitis such as the study level, faculty, age, nationality, marital status, and gender of the respondents were significantly associated with their levels of knowledge, attitude, and practices towards the disease. These findings imply that there is a need for hepatitis health promotion among the international students of UPM and possibly other international students across the globe.¹⁰

CONCLUSION AND RECOMMENDATION:

In India, around 250,000 infants get infected every year by hepatitis B and 90% of them develop chronic infection. There are wide variations in social, economic, and health factors in different regions of India, which may explain the difference in HBV carrier rates, reported by investigators in different parts of the country. Professional blood donors constitute the major high-risk group for HBV infections in India, with a hepatitis B surface antigen positivity rate of 14%. The finding of the present study show the overall awareness and influencing lifestyle factors among non-medical students. The level of awareness was significantly associated with the father’s occupation, place of residence, and previous knowledge of hepatitis B, and lifestyle influencing modification was significantly associated with Gender, Couse of study, and Fathers occupation. Therefore proper health education, dissemination of information, community conversation, and proper guidelines regarding hepatitis B is required to create an adequate awareness, and lifestyle medication behavior towards the prevention of hepatitis B in the country. A similar study can be conducted by using a survey, cross-sectional, and comparative study design to compare the factors between urban and rural areas by using different teaching strategies like interactive learning sessions and video-assisted teaching, etc.

ETHICAL APPROVAL:

Ethical clearance and permission were obtained from the institutional research review board committee. Permission was secured from each Arts and science college authority through formal letter and the authority was briefed on the relevance, and objectives of the study. The purpose of the study was explained to the participants and written informed consent was obtained from each participants.

CONFLICT OF INTEREST:

The authors of this research declare that there is no conflict of interest of this research.

ACKNOWLEDGEMENTS:

The authors would like to thank all the study participants and concerned departments for their kind support to carry out this study.

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Received on 14.09.2021 Modified on 11.03.2022

Int. J. of Advances in Nur. Management. 2022; 10(3):285-291.

DOI: 10.52711/2454-2652.2022.00065