INTRODUCTION:

Use of alcoholic beverage is very common in many countries. Consumption of alcohol is not reserved only for social affairs for special occasions but has become the part of the lifestyle of many people. Excessive use of alcohol by people leads to a number of social and mental health problems. Many alcoholics having lack of boldness, self-confidence, interest or stand up for rights and vital characteristics of assertiveness life.

Alcohol dependence and its related problems continue to be a major concern of public health and social hazard. It occupies a unique category among the array of psychiatric illnesses. The difficulty which we encounter in the conceptualization of the alcohol abuse is also evident in therapeutic programs. After the detoxification treatment, the hospitalized alcohol dependents get the maximum benefit of the treatment only what they are followed up regularly which is related to a number of psychosocial variables.¹

Alcohol misuse in India is a prominent mode in an interrelated matrix of high risk behavior which has begun to impose an ever growing burden on the social and economic health of the nation, which ultimately did impact on national growth.²

In India, alcohol related statistics (2009) shows that approximately 22.8% per 1000 were dependents in Uttar Pradesh and 10% of them are regular or excessive users. In Tamilnadu, 3 in every 10 men consumed alcohol atleast once in last one year and 2 in every 10 men in last month. The alcohol consumption among females was of course very low.³

Assertiveness is a structured technique and it promotes positive, direct, courteous, and goal-oriented behaviors while maximizing the reinforcement value of social interactions.⁴Thus the present study attempted to examine the assertiveness level of alcoholics. The objective of the study was to assess the effectiveness of Computer assisted instruction on level of knowledge regarding assertiveness among the alcoholic dependent.

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of computer assisted instruction on level of knowledge regarding assertiveness among the alcoholic dependents who admitted in Bharathi de-addiction center, Thiruvarur.

OBJECTIVES:

· To assess the pre test level of knowledge regarding assertiveness among alcoholic dependents

· To find the effectiveness of computer assisted instruction on level of knowledge regarding assertiveness among alcoholic dependents after post test.

· To find the association between the post test level of knowledge regarding assertiveness among alcoholic dependents with selected demographic variables.

RESEARCH HYPOTHESIS:

· H1: There will be a significant difference between pretest and post test level of knowledge regarding assertiveness among alcoholic dependents.

· H2: There will be a significant association between the post test level of knowledge regarding assertiveness among alcoholic dependents with selected demographic variables.

MATERIALS AND METHODS:

Research Approach:

Research approach used for this study was quantitative approach.

Research Design:

Pre experimental one group pre test and post test research design.

Setting:

The Study was conducted in Bharathi De-addiction Center, Thiruvarur.

Population:

Alcoholic dependents who admitted in Bharathi de-addiction center, Thiruvarur.

Sample:

Alcoholic dependent patients.

Sampling Technique:

A Purposive convenient sampling technique was used for the study.

Sample Size:

The sample size consists of 60 alcoholic dependents admitted in Bharathi de-addiction center, Thiruvarur.

Selection Criteria:

I. Inclusion Criteria:

1. Alcoholic dependent patients who meets DSM - IV criteria of alcoholic dependent syndrome and admitted in Bharathi de-addiction center, Thiruvarur.

2. Who are able to read and understand English/Tamil

3. Who are willing to participate in the study

II. Exclusion Criteria:

1. Alcoholic dependents who are suffering from chronic illness.

2. Alcoholic dependents who has the history of substance abuse other than alcohol.

Research Tools and Technique:

Tools were developed by investigator based on his experiences, review of literature and expert opinion. It consists of two parts.

1. Demographic data

2. Questionnaires to assess the level of knowledge on assertiveness.

Description of The Tools and Methods of Scoring:

Section I - Demographic Data:

Demographic profile of the alcoholic dependent patients consists of age, religion, educational qualification, occupational status, family income per month, place of living, type of family, number of children, availability of family support, exposure to Mass media, duration of drinking and presence of any other family drinker.

Section II - Assertiveness scale:

It is multidimensional scale in English developed by investigator. The scale has 35 items in statement form with a five point scale which ranged from most of time, often, sometimes, rarely, almost never. The scale has 13 positively worded items and 22 negatively worded items. The total score is a summation of scores obtained on individual items. The range of the total score is 35 - 175. Based on the score obtained, the samples were arbitrarily divided into 4 categories such as:

CATEGORY	SCORES	%
High knowledge on assertiveness - 141 – 175 (76% - 100%) - 71 - 105 (26%	141 – 175	76% - 100%
Moderate knowledge on assertiveness	106 -140	51% - 75%
Low knowledge on assertiveness	71 - 105	26% - 50%
Completely lack of knowledge on assertiveness	35 – 70	0 - 25%

Validity of the Tool and Content:

Content validity of the Structured interview questions and Assertiveness content was established by sending it to the expert’s from various fields such as psychiatric nursing personnel-3, psychiatrist-2, and clinical psychologist-1. Their opinion and suggestion were taken to modify the tool.

Reliability:

Reliability of the tool was tested by implementing the tool on 6 alcoholic dependents other than the sample. It was done in Vinayaka Missions’s Medical College and Hospital at Karaikal. The reliability was established by test retest method. The ‘r’ value is 0.72.

Pilot study:

Pilot study was conducted with 6 alcoholic dependents from Vinayaka Missions Medical College and Hospital. Samples were selected by conveniently. The alcoholic dependents were co- operative. They were very interested and participated in the Computer Assisted Instruction session. The results of the study was analyzed by using descriptive and inferential statistics.

Data Collection Process:

Formal permission was obtained from hospital authorities for conducting the study The data collection was done for a period of 4 weeks from 9 am to 4 pm. After explaining the purpose of the study, formal consent was obtained from each subject and administered the structured questionnaires separately. Four to six subjects were interviewed per day. During pre test, the researcher administered structured questionnaires for individual subject (15 - 20 minutes). On the same day, computer assisted instruction was given to group wise (4 to 6 subjects for about 45 minutes) regarding knowledge on assertiveness. Post test was done after one week.

RESULT AND DISCUSSION:

Data was analyzed using descriptive and inferential statistics. Standard deviation and t-test was used to determine the effectiveness of the study. Chi- square was used to find out association between the assertiveness with selected demographic variables.

The first objective is to assess the level of knowledge on assertiveness among the alcoholic dependents prior to Computer Assisted Instruction:

Analysis of the pre test level of knowledge on assertiveness shows that maximum 57% of alcoholic dependents were completely lack of knowledge on assertiveness, 31% were having low knowledge on assertiveness and 12% were moderate knowledge on assertiveness and no one is high knowledge on assertiveness.

Shanthi S et.al., (2015) The result revealed that majority (80%) of the samples had average knowledge regarding alcoholism and its effects, 17% of the samples had poor knowledge and 3% of the adolescents had good knowledge regarding alcoholism and its effects and also found that there was a significant association of demographic variables such as religion and past experience of exposure to knowledge regarding alcoholism and its effect with knowledge score at P < 0.005 level of significance.

The Second objective is to assess the effectiveness of Computer Assisted Instruction regarding level of knowledge on assertiveness among the alcoholic dependents after post test:

The analysis of the post test level of knowledge on assertiveness highlights that maximum 55% of alcoholic dependents were moderate knowledge on assertiveness, 40% were high knowledge on assertiveness, 5% were low knowledge on assertiveness. The obtained ‘t’ value is 18.64. (Table value is 3.46, P<0.001). It shows that Computer Assisted Instruction was highly significant & effective in improving the level of knowledge on assertiveness among the alcoholic dependents. There was a significant difference between the pre test and post test level of knowledge on assertiveness among the alcoholic dependents. Hence, the research hypothesis was accepted.

The study findings were support by Ferrell WL, et.al, (2000) study, they conducted a study to find effectiveness on the 3 group of alcoholic patients (n=30, each group having 10 patients) with 3 different form of assertiveness training (rehearsal form, modeling form discussion control group) in an inpatient ward at VA hospital The sample was selected randomly. The training held over a 2-week period. On completion of the assertiveness training result showed that experimental group scored 88% more than control group on the measure of assertiveness.

Devi C G et.al, (2013) Result showed that the comparison of pre and post test counseling level of readiness to change the behaviour, for recognition F = 15.52, for ambivalence – 68.68, taking step F = 3.35 which showed a high statistical significance at p<0.01 level.

The Third objective is to find the association between the post test level of knowledge on assertiveness among the alcoholic dependents:

There is a significant association found between the level of knowledge on assertiveness and the educational status. There was a significant association found between post level of knowledge on assertiveness and educational status (χ2 = 19.84, P<0.001). So, the research hypothesis was accepted.

The same findings were obtained from the Jennifer Gross (2005) study. He conducted a study to assess changes in 5th grade student's refusal skills, assertiveness, level of anxiety and self confidence related to intentions toward alcohol use. Research indicates for the skills of assertiveness, anxiety reduction and self confidence there was a significant relationship with intention towards alcohol use. Those students who scored higher on these three skills had lower intention towards alcohol use. These results indicate the need for an intervention program that strengthens the student's ability to use a variety of refusal skills, increase assertiveness, learn skills to reduce anxiety, and strengthen self confidence to reduce intention toward alcohol use.

Kiran N Hegade1et.al.; (2016). The study findings revealed that the Structured Teaching Programme on ill effects of alcoholism was effective method.

RECOMMENDATIONS:

1. A similar study can be conduct with large number of samples.

2. A study can be conducted by giving assertiveness training.

3. A similar study can be conducted with the post-test after 6 months or 1 year interval with adequate assertive techniques.

4. Periodical reinforcement can be done to find the effectiveness of assertive education by using various types of audio-visual aids.

5. Qualitative studies in identifying the factors responsible for assertive behavior can be conducted.

6. Based on similar concept a comparative study can be conducted in alcoholic and non alcoholics.

CONCLUSION:

From the study it concludes that the given Computer Assisted Instruction regarding assertiveness among alcoholic dependents was effective. There are many ways in which sufferers can be helped, but assertiveness education is the golden tool for alcoholics because it is a definite necessity to succeed in their life. Thus the study reveals that the objective steps should be taken to stem the root of the alcoholics so as to improve their assertiveness, that atmost leads to valid answer to the problem that have been posed.

REFERENCES:

1. Mary C Townsend, (2008); “Psychiatric Mental Health Nursing” V Edition; Jaypee Brothers medIcal Publisher (P) Ltd. New Delhi. Page no 217-227.

2. Burns, Nancy & Susan, K. Grome (2005) “The Practice of Nursing Research”, V Edition, Philadelphia, W.B. Saunders Company. Page no.76-78

3. Carson Robert, C. Butcher James, N “Abnormal Psychology & Modern Life” IX Edition, Harper Colins Publications. Page no. 82-91

4. Debora Anti-otong (2003), “Psychiatric Nursing, Biological & Behavioural Concept”, I Edition, USA. Delmar Thomas Learning.

5. Gail W. Stuart, “Principal and Practice of Psychiatric Nursing”, VIII Edition; published by Elsevier New Delhi. Page no. 453-463.

6. Haber (2000) “Psychiatric Nursing” IV Edition, Mosby publications. Page no. 42-45.

7. Kiran N et al “The Effectiveness of Structured Teaching Programme on Knowledge regarding Ill effects of alcoholism among auto-rickshaw drivers”. Asian Journal of Nursing Education. and Research. 2016; 6(1): 53-60.

8. Devi C G et.al.,(2013) “A Study to Assess the Effect of Psychoeducation on level of Awareness Regarding ill Effects of Alcohol Abuse Among Lorry Drivers at Selected Setting”. Asian Journal of Nursing Education and Research. 2013; 3(4): 224-227.

Received on 11.04.2018 Revised on 13.07.2023

Accepted on 03.10.2024 Published on 20.11.2024

Available online on December 28, 2024

Int. J. of Advances in Nursing Management. 2024;12(4):167-170.

DOI: 10.52711/2454-2652.2024.00036