Prevention of Non-communicable Diseases

KAP on Prevention of Non-communicable Diseases

Knowledge, Attitude and Practice on Prevention of Non-communicable Diseases Among

People Living in Borama, Somaliland

Ahmed M. Abdo

Amoud University

A Proposal Submitted in Partial Fulfilment of the Requirement for the Master’s Degree in

Public Health Epidemiology

January, 2024
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DECLARATION AND APPROVAL

Declaration by the Student

I declare that this proposal on KAP on prevention of non-communicable diseases among

people living in Borama District, Somaliland is my original work. It has not been submitted to

any university or institution for academic or any other award.

______________________ Date___________________________

Ahmed M. Abdo

MEPI/01/3123/2024/BR

Approval by the Supervisor

This proposal titled KAP on prevention of non-communicable diseases among people living in

Borama District, Somaliland will prepare under my supervision and has been submitted for

examination by my approval as candidate’s supervisor.

______________________ Date_____________________________

Dr Vitalis Okoth

School of Postgraduate Studies and Research,

Amoud University, Somaliland

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DEDICATION

In dedicating this research endeavor, I extend my heartfelt gratitude to my unwavering support

system. To my family, Mohamed A. Omer and Madino O. Elmi, whose encouragement and

understanding have been the bedrock of my journey, I am profoundly thankful. Your constant

belief in my capabilities has fueled my determination. I dedicate this work to my mentors and

educators whose guidance has been instrumental in shaping my intellectual pursuits. Your

unending prayers and encouragements continue to play a pivotal role in my education and

general life. I dedicate this study to you and may Allah grant you a peaceful and long life.
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ACKNOWLEDGMENTS

I would like to thank the Almighty God for giving me the strength, determination and wisdom to

undertake this project. In a special way I extend my sincere and heartfelt gratitude to my

supervisors, Dr. Vitalis Okoth (PhD) for their invaluable time, guidance, comments and

suggestions that have led to the completion of this project; to them I will forever be indebted.

Thank you for accepting to serve on my committee, DR. Josiah A. Osiri (PHD) and Dr.

Mirium N. Mutuku (PHD). I also thank to the staff of Amoud School of Postgraduate Studies

and Research, Dr. Abdisalan H. Muse (Dean), Mrs. Saida Sh. Abdirahman Omar (Associate

Dean), and others (Mohamed and Khadar) and the rest of the group who had directly or

indirectly involved in the completion of this proposal.

 Prevention of non-communicable diseases

TABLE OF CONTENTS

TITLE .............................................................................................................................................. I

DECLARATION AND APPROVAL .............................................................................................. II

DEDICATION .............................................................................................................................. III

ACKNOWLEDGMENTS ............................................................................................................ IV

TABLE OF CONTENTS ............................................................................................................... V

LIST OF FIGURES ................................................................................................................... VIII

LIST OF ABBREVIATIONS AND ACRONYMS ....................................................................... IX

CHAPTER ONE: INTRODUCTION ............................................................................................. 1

1.1 Background of the Study ..................................................................................................... 1

1.2 Statement of the Problem ..................................................................................................... 5

1.3 Research Objectives ............................................................................................................. 7

1.3.1 General Research Objectives ........................................................................................ 7

1.3.2 Specific Research Objectives ....................................................................................... 7

1.4 Research Questions .............................................................................................................. 7

1.4.1 General Research Questions ......................................................................................... 7

1.4.2 Specific Research Questions ........................................................................................ 7

1.5 Scope of the study ................................................................................................................ 8

1.6 Significance of the Study ..................................................................................................... 8

1.7 Conceptual Framework ........................................................................................................ 9

CHAPTER TWO: LITERATURE REVIEW ................................................................................11

2.1 Introduction .........................................................................................................................11

2.2 Knowledge of People on Prevention of NCDs ...................................................................11

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2.3 Attitude of People on Prevention of NCDs........................................................................ 12

2.4 Practice of People on Prevention of NCDs ........................................................................ 13

2.5 Summary ............................................................................................................................ 14

2.6 Conclusion ......................................................................................................................... 14

2.7 Theoretical Review ............................................................................................................ 15

CHAPTER THREE: RESEARCH METHODOLOGY ............................................................... 16

3.1 Introduction ........................................................................................................................ 16

3.2 Research Area ................................................................................................................. 16

3.3 Research Design................................................................................................................. 16

3.4 Study Population ................................................................................................................ 17

3.4.1 Target Population ........................................................................................................ 17

3.4.2 Accessible Population .................................................................................................... 17

3.5 Sample and Sampling ........................................................................................................ 17

3.5.1 Sample Size ................................................................................................................ 17

3.5.2 Sampling Technique ................................................................................................... 18

3.6 Data collection ............................................................................................................... 18

3.6.1 Data Collection Methods ............................................................................................ 18

3.6.2 Data Collection Instrument ......................................................................................... 18

3.6.3 Research Procedure ........................................................................................................ 19

3.7 Quality Control .............................................................................................................. 19

3.7.1 Piloting ........................................................................................................................... 19

3.7.2 Validity of Instrument..................................................................................................... 20

3.7.3 Reliability of Instrument ................................................................................................ 20

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3.8 Data Analyzed .................................................................................................................... 20

3.9 Ethical Consideration ......................................................................................................... 21

APPENDIX A ............................................................................................................................... 27

APPENDIX B ............................................................................................................................... 28
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LIST OF FIGURES

Figure 1: Conceptual Framework…………………………………………………………………9

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LIST OF ABBREVIATIONS AND ACRONYMS

NCDs: Non-communicable diseases

KAP: knowledge, attitude and practice

LICs and MICs: low-income and middle-income countries

GBD: Global Burden of Disease

WHO: World Health Organization

DALY: disability-adjusted life-years

IFRC: International Federation of Red Cross and Red Crescent

HH: House Hold

HBM: health believe model

SPSS: statistical package for social science

 Prevention of non-communicable diseases

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Non-communicable diseases (NCDs) are diseases that are not transmissible from one

person to another (Gamage & Jayawardana, 2017). Non-communicable diseases (NCDs) have

emerged as a serious public health burden and the leading cause of death globally (Sitaula et al.,

2022d). Non-communicable diseases (NCDs) are a huge group of illnesses that comprise chronic

respiratory illnesses (asthma, COPD), malignant growth, diabetes, and cardiovascular ailments

(including stroke and respiratory failures). The mortality rate of NCDs is considerably higher in

low-income and middle-income countries (LICs and MICs), which makes NCDs a tremendous

barrier to reducing developing and developed nations' health disparities (Ramesh & Kosalram,

2023).

Extensive research has shown that NCDs are primarily attributed to underlying and

modifiable risk factors that often emerge during these earlier years. It is estimated that

approximately 70% of premature deaths occurring during adulthood are the result of health-related

behaviours that are initiated in childhood and adolescence. Such risk factors, including overweight

and obesity, physical inactivity, substance use and poor nutrition, substantially contribute to

disease development and poor health in later life (Akseer et al., 2020b).

The burden of NCDs is increasing in adolescents and young adults in developed and

developing countries. Estimates from the Global Burden of Disease Study (GBD) 2019 of

European Union member states revealed that NCDs accounted for 38.8% of all deaths in

individuals aged 10 to 24 years. Chronic noncommunicable diseases (NCDs), including

cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases, are responsible for
 Prevention of non-communicable diseases

74% of global mortality, causing 41 million deaths annually. NCDs are associated with high rates

of premature morbidity and mortality, reduced quality of life, loss of productivity, and high

economic costs for countries. The prevalence and impact of these chronic conditions are more

significant in low- and middle-income countries compared to high-income countries (Pedroso et

al., 2023c).

Globally, non-communicable diseases (NCDs) have emerged as a serious public health

burden and the leading cause of death globally. As per WHO NCD country profiles, NCDs

accounted for 71% of the 57 million deaths that occurred glob ally in 2016. Among the NCD

deaths, 78% of total NCD deaths and 85% of premature NCD deaths occurred in low-and middle-

income countries. According to Global Burden of Disease (GBD) 2019, NCDs accounted for 1.62

billion healthy-years lost in 2019, with the rise of Disability Adjusted Life Years (DALYs) from

43.2 percent of total DALYs in 1990 to 63.8 percent in 2019 (Sitaula et al., 2022).

In Africa, Noncommunicable diseases such as cancer, cardiovascular diseases and diabetes

are increasingly becoming the main cause of mortality in sub-Saharan Africa, where the diseases

were responsible for 37% of deaths in 2019, rising from 24% in 2000 largely due to weaknesses

in the implementation of critical control measures including prevention, diagnosis and care. In

Africa, between 50% and 88% of deaths in seven countries, mostly small island nations, are due

to noncommunicable disease, according to the 2022 World Health Organization (WHO)

Noncommunicable Disease Progress Monitor (Deaths from Noncommunicable Diseases on the

Rise in Africa | WHO | Regional Office for Africa, 2023).

In sub-Saharan Africa, because of the demographic transition, the prevalence of NCDs is

highly increasing. The disability-adjusted life-years (DALYs) due to NCDs in the region increased

by 67 % between the years 1990–2017. The age-standardized DALY rate (per 100 000 population)
 Prevention of non-communicable diseases

due to NCDs in 2017 was 21,757.7 DALYs which was almost equivalent to that of communicable,

maternal, neonatal, and nutritional diseases (Legesse et al., 2022).

In Somaliland, according to the Somaliland Health and Demographic Survey 2020, 7

percent of household members had at least one chronic disease. Only 6 percent of household

members had at least one chronic disease diagnosed by a physician. And in Awdal region

Percentage of HH members who have at least one chronic disease is 6.2 and Percentage of HH

members who have at least one chronic diagnosed by physician is 5.4 Percentage of HH Members

who have at least one chronic and get treated is 4.0.

This study is guided a theory of health believe model (HBM) was developed in the 1950's

by social psychologists Hochbaum, Rosenstock and others. Since this time, the Health Belief

Model has evolved to address public health concerns and has been applied to a broad range of

populations and health behaviors (Health Behavior and Health Education | Part Two, Chapter

Three: Main Constructs, n.d.). Key elements of the Health Belief Model focus on individual beliefs

about health conditions, which predict individual health-related behaviors. The model defines the

key factors that influence health behaviors as an individual's perceived threat to sickness or disease

(perceived susceptibility), belief of consequence (perceived severity), potential positive benefits

of action (perceived benefits), perceived barriers to action, exposure to factors that prompt action

(cues to action), and confidence in ability to succeed (self-efficacy).Key elements of the Health

Belief Model focus on individual beliefs about health conditions, which predict individual health-

related behaviors. The model defines the key factors that influence health behaviors as an

individual's perceived threat to sickness or disease (perceived susceptibility), belief of

consequence (perceived severity), potential positive benefits of action (perceived benefits),

perceived barriers to action, exposure to factors that prompt action (cues to action), and confidence
 Prevention of non-communicable diseases

in ability to succeed (self-efficacy) (The Health Belief Model - Rural Health Promotion and

Disease Prevention Toolkit, n.d.). this study is investigating knowledge attitude and practice on

prevention of NCDs among population living in Borama, Somaliland. This is relevant because the

theory will adopt disease prevention strategies for early detection of diseases.

Knowledge is fact or condition of having information or of being learned (“Knowledge,”

2023). Knowledge on prevention of non-communicable diseases is defined knowledge of the risk

factors of NCDs plays a pivotal role in the prevention and control of diseases (Legesse et al.,

2022b). Knowledge on prevention of non-communicable diseases is about knowledge the types of

chronic disease, causes of chronic disease, healthy lifestyle for chronic disease prevention,

concepts of chronic disease prevention. In this study knowledge will operationalize as facts,

information, knowledge of risk factors, and health lifestyle on prevention of non-communicable

diseases among people living in Borama, Somaliland.

an attitude refers to a set of emotions, beliefs, and behaviors toward a particular object,

person, thing, or event (MSEd, 2023). Attitude on prevention of non-communicable diseases is

defined attitude, and personal lifestyle behaviours and their association with NCD-risk perception

and self-efficacy (Yenit et al., 2023). In this study attitude will operationalize as beliefs, behaviors,

and perception about prevention of NCDs among people living in Borama.

According Kassa and Grace (2022) practice is defined as NCD prevention action plans and

their implementation that involve managing and addressing at least one of the four NCDs risk

factors. Practice on prevention of non-communicable diseases is defined appropriate dietary

practices, increased physical activity, weight management, abstinence from tobacco/substance use

and alcohol abuse play an important role in their prevention and management (Passi, 2017). In this
 Prevention of non-communicable diseases

study practice will operationalize dietary practices, physical activity, and weight management of

people living in Borama in order to prevent NCDs.

The term NCDs refers to a group of conditions that are not mainly caused by an acute

infection, result in long-term health consequences and often create a need for long-term treatment

and care (Noncommunicable Diseases | WHO | Regional Office for Africa, 2023b). Non-

communicable diseases are diseases that are not spread through infection or through other people,

but are typically caused by unhealthy behaviours (Non-communicable Diseases | IFRC, n.d.). A

non-communicable disease, or NCD, is a medical condition or disease which by definition is non-

infectious and cannot be passed from person to person (What Is a Non-communicable Disease? |

South African Government, n.d.).

In context, according to Somaliland Demographic Health Survey (2020) 7% of the

population has at least one chronic disease. The most commonly reported chronic diseases are

blood pressure (41%), Diabetes (19%), kidney disease (9%) and heart disease (7%). And in Awdal

region Percentage of house hold (HH) members who have at least one chronic disease is 6.2%,

and Percentage of HH members who have at least one chronic diagnosed by physician is 5.4 %,

and Percentage of HH members who have at least one chronic diagnosed by physician and get

treated is 4%. So, it seems that NCDs are increasing in Borama community.

1.2 Statement of the Problem

Non-communicable diseases (NCDs) cause a large and growing burden of morbidity and

mortality in sub-Saharan Africa. Yet non-communicable diseases can be easily prevented if people

have right knowledge attitude and practice of its prevention.

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The prevalence of NCDs in Somaliland is estimated 7% of the population has at least one

chronic disease. The most commonly reported chronic diseases are blood pressure (41%), Diabetes

(19%), kidney disease (9%) and heart disease (7%). And in Awdal region Percentage of house hold

(HH) members who have at least one chronic disease is 6.2%, and Percentage of HH members

who have at least one chronic diagnosed by physician is 5.4 %, and Percentage of HH members

who have at least one chronic diagnosed by physician and get treated is 4%.

If non-communicable diseases (NCDs) are not effectively addressed in Somaliland, the

region may experience a heightened burden of illness and premature mortality, leading to a

significant reduction in the overall health and well-being of its population. The economic strain on

the healthcare system could escalate, as the costs associated with treating NCDs increase,

potentially hindering the capacity to provide adequate healthcare services. This situation may

exacerbate existing health inequalities, particularly among vulnerable populations, and result in a

decreased quality of life for individuals affected by NCDs. Failure to implement targeted

interventions and health policies could further perpetuate the cycle of chronic diseases, potentially

impacting not only individual health but also the broader social and economic

fabric of Somaliland.

Yet the problem can be quite reduced if people have right knowledge attitude and practice

of NCDs prevention. There is need to determine the knowledge attitude and practice on prevention

of NCDs among people living in Borama, Somaliland as basis for controlling its prevalence.

Without such knowledge attitude and practice people will continue to develop NCDs from habits

that can easily be changed or avoided.

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1.3 Research Objectives

1.3.1 General Research Objectives

The overall objective of this study is to assess status of knowledge attitude and practice on

prevention of non-communicable diseases among people living in Borama, Somaliland.

1.3.2 Specific Research Objectives

This study is guide by three specific objectives. There is to

1. To assess the level of knowledge on prevention of non-communicable diseases among

people living in Borama, Somaliland

2. To Investigate the attitudes of the people towards non-communicable disease prevention.

3. To determine the practices on prevention of NCDs among people living in Borama,

Somaliland.

1.4 Research Questions

1.4.1 General Research Questions

What are the knowledge attitude and practice on prevention of NCDs among people living

in Borama, Somaliland?

1.4.2 Specific Research Questions

1. What is level of knowledge on prevention of NCDs among people living in Borama,

Somaliland?

2. How are the attitudes towards prevention of NCDs among people living in Borama,

Somaliland?
 Prevention of non-communicable diseases

3. What are the practices associated with prevention of NCDs among people living in

Borama, Somaliland?

1.5 Scope of the study

The study will conduct among people living in Borama, Somaliland through cross sectional

study in 2023.

1.6 Significance of the Study

The study provides information on Knowledge attitude and practice on prevention of NCDs

among people living in Borama, Somaliland. The study will inform the Ministry of Health and

other development partners about the factors related to KAP study that negatively impact the

prevention of NCDs. Based on the results of the study, the Ministry of Health of Somaliland and

partners can develop an intervention to improve KAP that can help prevention of NCDs among

people living in Borama. The study also will make recommendations on how to reduce the

prevalence of NCDs in Somaliland. The study therefore will make direct contributions to policies

on Health in Somaliland.
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1.7 Conceptual Framework

KAP On Prevention of NCDs

Knowledge on Prevention of NCDS

Facts

Information

knowledge of risk factors

health lifestyle
On Prevention of NCDs
Attitude on Prevention of NCDs

Believes

Behavior

Perceptions

Practice on Prevention of NCDs

Dietary practices

Physical activity

weight management

Figure 1: Conceptual framework.

Figure 1: Conceptual framework of KAP on Prevention of NCDs

Conceptual framework for KAP on prevention of NCDs among people living in Borama,

Somaliland. In figure 1 is conceptualize as knowledge of people on prevention of NCDs, attitude

of people on prevention of NCDs and practices of people on prevention of NCDs.

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Knowledge will operationalize as facts, information, knowledge of risk factors, and health

lifestyle, attitude will operationalize as beliefs, behaviors, and perception and practice will

operationalize dietary practices, physical activity, and weight management on prevention of NCDs

among people living in Borama, Somaliland.

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CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

This chapter gives review of prior studies, as well as people’s knowledge, attitude and

practice on prevention of NCDs. The goal of the study “knowledge, attitude and practice linked

to prevention of NCDs” is to generate and document evidence of existing prevention knowledge,

attitude and practice among people.

2.2 Knowledge of People on Prevention of NCDs

In this study knowledge is defined and operationalize as facts, information, knowledge of

risk factors, and health lifestyle on prevention of non-communicable diseases among people

living in Borama, Somaliland.

According Ramli, R., el (2021) the research design was a cross sectional study. The study

population was 22,653 adolescents aged 15-19 years, with a sample of 394 adolescents. Data

were obtained using a questionnaire to measure the level of KAP about diabetes mellitus, risk

factors and diabetes mellitus prevention. The highest respondent's knowledge level was in good

category (53.8%), the attitude of the most respondents was in good category (72.6%), while the

prevention practice of T2DM was also in good category (76.4%).

According Ladawan, T. (2020) this is descriptive research studying a relationship

between knowledge, attitude and behavior in preventing non-communicated disease in Air Force

Student Nurses by using KAP model. A sample was 140 Air Force Student Nurses selected by

random sampling. The result found that 100 % of student’s knowledge at good level.
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According to Shubayr, M. A., el (2021) A self-administered questionnaire survey was

done among dental students (n = 274), interns (n = 81), and faculty members (n = 117) in the

College of Dentistry at Jazan University between May 2019 to February 2020. The results shows

that the Most of the participants had poor knowledge (71.9%).

According community based cross sectional study was conducted from March 19-26,

2011G.C in Arada sub-city using quantitative method. Multi stage sampling technique was used.

Result among 807 respondents showed that 87.1% had sufficient knowledge about prevention of

chronic non communicable diseases (Mezgebe, 2011).

2.3 Attitude of People on Prevention of NCDs

In this study attitude is defined and operationalize as beliefs, behaviors, and perception

about prevention of NCDs among people living in Borama.

According to a cross-sectional study among health extension workers (HEWs) working in

three districts of the North Gondar zone from February to April 2022, all available HEWs (n =

225) working in the selected districts were invited to participate in the study, most participants

(81.8%) believed that changing one’s lifestyle could help prevent NCDs (Yenit et al., 2023c).

It was a cross-sectional analytical study that recruited 384 participants through a non-

probable convenient sampling technique from the general population of Peshawar.

Out of 384 participants 244 (64%) were males and 140 (36%) were females.

For the attitudes category 47% scored Good (Nazar, 2023).

Adults aged 18-25 years reside in Malaysia were recruited via convenience sampling.

Sociodemographic characteristics, medical knowledge on hypertension (K1), knowledge (K),

attitude (A), practice (P) and perceived barriers in practicing healthy living to prevent
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hypertension were assessed. A total of 1 218 respondents participated in this survey. the

attitude was 78.2% (Lee et al., 2022).

community based cross sectional study was conducted from March 19-26, 2011G.C in

Arada sub-city using quantitative method. Multi stage sampling technique was used. Result

among 807 respondents showed that 67% of the respondents had good attitude towards risk

reduction behaviors of chronic non communicable diseases (Mezgebe, 2011)

2.4 Practice of People on Prevention of NCDs

In this study practice is defined and operationalize dietary practices, physical activity, and

weight management of people living in Borama in order to prevent NCDs.

The present survey was conducted in April-June 2022. People from the general

population were invited to participate in the study, and the data were collected using a validated

questionnaire. A total of 1207 non-diabetic subjects participated in the study [females

798(66.1%) and males 409(33.9%)], and the response rate was 80% (1207/1500). Two-thirds

(66.86%) of non-diabetic adult community members had 62.14% maintained a healthy lifestyle

to avoid DM (Baig et al., 2023).

An Observational-based analytical, cross-sectional study design s to assess the attitude

and practice of medical students towards the role of physical activity in non- communicable

diseases prevention in Nile University as perceived by students. The study included 81 males

(43.1%) and 107 females (56.9%). Out of total number of students, 51% do not engage in

physical activities (Mohamed et al., 2023c).

A community-based cross-sectional study was conducted among Bahir Dar city residents.

A multistage sampling technique was used to select 845 study participants. A total of 845 study
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participants took part in the study. Nearly 63% of the respondents were females. About 28% of

the study participants had good preventive practice (Bantie et al., 2022).

According community based cross sectional study was conducted from March 19-26,

2011G.C in Arada sub-city using quantitative method. Multi stage sampling technique was used.

Result among 807 respondents showed that only 1.1% of the respondents had good preventive

behavior (Mezgebe, 2011a).

2.5 Summary

In summary, non-communicable diseases (NCDs) are chronic conditions that are not

caused by infectious agents and they typically progress slowly over time. NCDs encompass a

wide range of health conditions, including cardiovascular diseases, cancer, diabetes, chronic

respiratory diseases, and mental health disorders. These diseases are a significant global health

challenge, accounting for the majority of deaths worldwide. As a result of that NCDs is common

problem. In this chapter the researcher is reviewed on knowledge on prevention of NCDs,

attitude on prevention of NCDs and practice on prevention of NCDs. Finally the authors were

agreed that the respondents had poor KAP on prevention of NCDs.

2.6 Conclusion

The purpose of this study is to assess the knowledge, attitude and practice on prevention

of non-communicable diseases among people living in Borama, which could help them to inform

the strategies for prevention and control of non-communicable diseases in Borama.

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2.7 Theoretical Review

This study will be guided the theory of health believe model (HBM) was developed in the

1950's by social psychologists Hochbaum, Rosenstock and others. Since this time, the Health

Belief Model has evolved to address public health concerns and has been applied to a broad

range of populations and health behaviors.

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CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Introduction

This chapter involves the overall methodology that is used to answer research questions. It

explains where the study is going to conduct in terms geographical location, research design,

population, sampling technique as well as sample. It also clarifies what tool will be used to

collected data, type of data to be collected as well as how to check the quality of the data that will

the basis of the study.

3.2 Research Area

This study is conducted in Borama town, the main town in Awdal region, located 120 km

west from Hargeisa, the capital city of Somaliland. The population of Borama is approximately

about 640,000 (Borama Municipal, 2022). Borama town is 3 km to the north of Ethiopian border

and lies at latitude 90 and longitude 230; it also lies at 80N and 110N above the sea level (UNHCR,

2014). Borama is one of the districts with highest cases of NCDs. So as result of that Borama is

the best suitable place for this study to be conducting in.

3.3 Research Design

The study will be conducted using cross-sectional research design. A cross sectional

study is an observational in nature and is known as descriptive research, not causal or relational,

meaning that you can’t use them to determine the cause of something, such as a disease. The

study will help us to record the information that is present in population. This method is

applicable for determining KAP on prevention of NCDs.

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3.4 Study Population

The study will determine knowledge, attitude and practice on prevention of

noncommunicable diseases among people living in Borama. This study will focus on the general

adult population living in Borama households.

3.4.1 Target Population

The target population of this study will be 19869 households (SHABA water company in

Borama, Household register 2023) in Borama. The study is focus KAP on prevention of non-

communicable diseases.

3.4.2 Accessible Population

The accessible population is the same as the target population who are living in Borama

and present in households during data collecting period.

3.5 Sample and Sampling

3.5.1 Sample Size

The sample size will be 375 of households in Borama. The sample size will determine

according to Krejcie and Morgan, (1970), who recommend a sample size of 375 for a house hold

of 19869 (Shaba water company in Borama, Household register 2023) at level of confidence 95%

and 5% margin error, which were also the same margins that were set in this study.
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3.5.2 Sampling Technique

The study employed Cluster and simple random sampling method. Cluster sampling is a

method of probability sampling that is often used to study large populations, particularly those

that are widely geographically dispersed. In cluster sampling, researchers divide a population

into smaller groups known as clusters. They then randomly select among these clusters to form a

sample. A simple random sample is a randomly selected subset of a population. In this sampling

method, each member of the population has an exactly equal chance of being selected (Thomas,

2023).

3.6 Data collection

3.6.1 Data Collection Methods

The study used questionnaire as the main data collection method. The questionnaire will

use to collect data from households. A questionnaire is mostly used in determination of the level

of knowledge on an issue, opinion, attitudes, beliefs, ideas, feelings, experience as well as the

gather general information about the respondents (Oso, 2013). Questionnaire is a collection of

precise pre-formulated written to yield specific information to meet particular needs for research

(Oso, 2016).

3.6.2 Data Collection Instrument

The study will use semi-structured questionnaire and key informant guide interview will

be use as key of data collection tool. A questionnaire is a research instrument consisting of a

series of questions for the purpose of gathering information from respondents (Mcleod, 2023).

Semi-Structure questionnaire is formed from a blend of close-ended items. This provided for
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uniformity of responses and enabled the researcher to collect a large of data in short time. It also

ensures that data analysis was rather simple and faster as the codes were predefined or could

easily determine. It also produced a lot of detailed information in the short time available and

permits fairly simple analysis procedures (Oppenheim, 1992).

3.6.3 Research Procedure

The researcher will develop a proposal under the guides of the supervisor. The proposal

will defend and once approbation, the researcher sought permission from School of Postgraduate

Studies and Research and from head of households in Borama When all necessary permits were

obtained and once the instruments were validated, the researcher proceeded to collect data from

375 households in Borama district using questionnaires.

3.7 Quality Control

3.7.1 Piloting

The data collection instruments will be pilot in among people living in Sh. Ali area

households in Borama city. who shall be excluded in the main data collection. During piloting, the

researcher was seeking validity and reliability coefficients of at least 0.70, which is the lowest

acceptable validity and reliability index (Oso, 2016). Piloting was necessary before embarking to

the main study because it enables the researcher to test the usefulness of questionnaire in proving

relevant information. It was also useful for detected for the major defects in questionnaire design.
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3.7.2 Validity of Instrument

The validity of this study will be using Content validity index method. Validity refers to

how accurately a method measures what it is intended to measure (Middleton, 2023). Content

validity refers to the extent to which a measurement instrument (e.g., a test, questionnaire, or

survey) accurately and adequately measures the specific content or construct it is designed to

assess. In simpler terms, it assesses whether the questions or items included in an assessment are

relevant and representative of the subject matter or concept under investigation (Thompson, 2023).

3.7.3 Reliability of Instrument

Reliability refers to how consistently a method measures something (Middleton, 2023).

The test-re-test method will use to assess reliability. Test-retest reliability is the degree to which

test scores remain unchanged when measuring a stable individual characteristic on different

occasions (Vilagut, 2014). Test-retest reliability measures the consistency of results when you

repeat the same test on the same sample at a different point in time (Middleton, 2023).

3.8 Data Analyzed

The data will be using SPSS (statistical package for social science) version 25.

Descriptive statistics will be select as data analysis method. The data results expressed as

frequencies and percentages. Descriptive statistics provide summarizing information of the

characteristics and distribution of values in one or more datasets (J. Lee, 2020).
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3.9 Ethical Consideration

The researcher will inform all participants of the intention and methods of the study. The

researcher will obtain permission from all relevant authorities to carry out the study. The

researcher will maintain the privacy, confidentiality, and anonymity of the respondents, as well

as observe researchers' responsibility.

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APPENDIX A

RESEARCH BUDGET

No Item Description Unit Cost Estimated

(USD) Amount (USD)

1. Stationary Copy 115 pages $6

2. Total $6

Source: Ahmed M. (2024).

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APPENDIX B

WORK PLAN

No Phase Time Dates Sequence

(Months) 2023-2024
1 Proposal Development 3 Nov-Jan 2023 A

2 Piloting of instruments 1 March 2024 B

3 Data collection 1 April 2024 C

4 Data organization, analysis 1 May 2024 D

and interpretation

5 Typing/Editing/Report 2 June 2024 E

Writing/Submission

Source: Ahmed M. (2024).