EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME

ON KNOWLEDGE REGARDING ANOREXIA NERVOSA

AMONG ADOLESCENT GIRLS IN A SELECTED
COLLEGE AT SIVAGANGAI

REG. NO: 301331551

A DISSERTATION SUBMITTED TO THETAMILNADUDR.M.G.R.

MEDICALUNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT
OF THE REQUIREMENT FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING
OCTOBER 2015
 CERTIFICATE

This is to certified that the dissertation entitled “EFFECTIVENESS

OFSTRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING

ANOREXIA NERVOSA AMONG ADOLESCENT GIRLS IN SELECTED COLLEGE

AT SIVAGANGAI” is submitted to the faculty of Nursing, The Tamilnadu Dr.

M.G.R Medical University,Chennai by Mrs. I.Flarence Anitha in partial

fulfillment of the requirement for the degree of Master of Science in Nursing. It is the

bonafide work done by her and the conclusions are her own. It is further certified that

this dissertation or any part thereof has not formed the basis for award of any degree,

diploma or any title.

Dr.Prof.S.Rajina Rani M.Sc(N),Ph.D,

Principal,

RASS Academy College of Nursing,

Poovanthi,Sivagangai Dist-630611.

Tamilnadu.
EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME
ON KNOWLEDGE REGARDING ANOREXIA NERVOSA
AMONG ADOLESCENT GIRLS IN A SELECTED
COLLEGE AT SIVAGANGAI

APPROVED BY THE DISSERTATION COMMITTEE ON SEPTEMBER 2014

RESEARCH GUIDE : -------------------------------------------------

Dr.Prof.S.Rajina Rani, M .Sc (N), PhD.
Principal,
RASS Academy College of Nursing
Poovanthi, SivagangaiDist – 630611.

CLINICAL GUIDE : ----------------------------------------------

Prof.Mrs. R. Ruth Rani, M.Sc. (N),
Professor,
HOD of Psychiatric Nursing,
RASS Academy College of Nursing,
Poovanthi, Sivagangai Dist.

MEDICAL GUIDE : ---------------------------------------------

Dr.V.Ramanujam, MBBS, MD, (PSY)
Medical officer,
Srinivasa Hospital,
Madurai.

A DISSERTATION SUBMITTED TO THE TAMILNADU DR.M.G.R. MEDICAL

UNIVERSITY, CHENNAI IN PARTIAL FULFILMENT OF THE

REQUIREMENT FOR THE DEGREE OF

MASTER OF SCIENCE IN NURSING

OCTOBER 2015
 ACKNOWLEDGEMENT
I, the investigator to thank, praise and glorify the Almighty God, with all my
heart, for his constant love, blessings, guidance to make this study in a Successful part
of my requirement.

I would like to extend my sincere thanks to Mr.C.Ravisankar,Chairman,

RASS Academy college of Nursing, Poovanthi for his support and for providing the
required facilities for the successful completion of this study.

I express my heartfelt and sincere thanks to my research guide

Dr.Prof.S.RajinaRani,MSc(N),Ph.D,RASS Academy college of
Nursing,Poovanthi for a deniable work,interest,cheerful approach,always with never
ending willingness to provide expert guidance and suggestion to mould this study to
the present form.

I extend my warmest thanks to Associate Prof.H.Ummul Hapipa, M.Sc (N).,

Vice-Principal, RASS Academy college of Nursing, Poovanthi for her expert
guidance, valuable suggestion to bring this study in successful way

My heartfelt and sincere thanks to my medical guide My deep sense of

gratitude to Dr.V. Ramanujam,M.B.B.S, M.D.,(PSY)for his help, valuable guidance
and encouragement which enabled me to accomplish this task.

My words are inadequate to thank my clinical specialty guide Associate

Prof.Mrs.R. Ruth Rani, M.sc (N), Head of the department of Mental Health
Nursing, RASS AcademyCollege of Nursing, Poovanthi for motivation, advice,
feedback and encouragement.

My deep sense of gratitude to Asso.Prof.M.Uma

Maheshwari,M.Sc(N),HOD of Community Health Nursing Dept, RASS Academy
College Of Nursing, Poovanthi, for her support and valuable suggestions to bring
this study in a success.

I express my warmest thanks to,Associate Prof.J.Vijayalakshmi M.sc (N)

Child health nursing,for her support and valuable suggestions to bring this study in a
success.
 I extend my sincere thanks to Mrs.K.Sangeetha,
M.Sc(N),Reader,Department Of Mental Health Nursing,RASS Academy College
of Nursing, Poovanthi for her support and valuable suggestions to bring this study in a
success.

I extend my sincere thanks to Mrs.P.S.Saranya, MSc(N),Reader,

Department of Obsteristics & Gynaecological Nursing, RASS Academy College
of Nursing for their cheerful approach, as their hands out stretched always with never
ending willingness to provide guidance and suggestions.

I extend my sincere thanks to.Mrs.Paramewari,MSc(N),Lecturer,Obstetrics

and Gynaecology, Mrs.Kartheeswari,MSc(N),Lecturer, Medical Surgical Nursing
Dept, Mrs.Kavitha, M.Sc (N),Lecturer, Medical Surgical Nursing Dept,
Ms.P.Kosalai Ramani M.Sc (N), Lecturer, Child Health Nursing Dept,
Mrs.G.Selvi, B.Sc(N), Ms.J.Kanimozhi, B.Sc(N),RASS Academy College of
Nursing, Poovanthi for them help, valuable to complete this study in a successful
way.

I express my sincere thanks to Mr.T.S.Devadass, Administrative

Officier,Mrs.M.Muthulakshmi, Administrative Assistant,
Mrs.S.Jothimani,Librarian, RASS Academy College Of Nursing for them support to
bring this study in a success.

My Sincere thanks to Dr.Varadharajan,M.Sc.,M.Phil.,M.Ed.,Ph.D(Edn),

Professorof Psychology, RASS Academy College of Nursing, Poovanthi for his help
in the statistical analysis of the data which is core of the study.

I extended my special thanks to adolescent girls who participated in this

study, without them this should not have been a success

I immensely thankful to my beloved husband Mr.A.Stephen Michael for his

support and co-operation, and his help to make this study as a success one.

I extended my special thanks to adolescent girls who participated in this

study, without them this should not have been a success.

I express my sincere thanks to power Xerox Sivagangai, for their artistic and
innovative work to bring out the study into a printed form.

I express my sincere thanks to my lovable Parents Late.Mr.A.Irudhyasamy,

Mrs.A.Jebamalai for their prayer, economical support and encouragement in my
research.

I express my sincere thanks to my lovable in laws Mr.S. Antony, Mrs.A.

Michael Mary for them support and encouragement in my research.

I express my sincere thanks to my beloved Brother Mr.I.Rajesh Antony and

Mrs. Rakhi Rajesh,my dear sister Mrs.I.Anjeline for their blessings, support and
encouragement in my research.

Finally I would like to acknowledge the efforts of my seniors

Mrs.Tamilselvi, Ms.Mahalakshmi and my classmates Mrs.Rosamma
Ms.Kavitha, Ms.Mesiya, Mrs.Devika, Mrs.Jayalakshmi, for their encouragement
and support all through my ups and downs during my study.

I dedicate this study to my beloved husband Mr .A. Stephen Michael and my

lovable kids S.Joel Antony, S.Joanna and my family .
 TABLE OF CONTENTS
CHAPTER TITLE PAGENO
I INTRODUCTION
 Background of the study 1
 Need for the study 5
 Statement of the Problem 7
 Objectives of the Study 7
 Operational definitions 8
 Hypotheses 8
 Assumption 9
 Delimitations 9
 Conceptual Framework 9-12
II REVIEW OF LITERATURE
III METHODOLOGY
 Research Approach 21
 Research Design 21
 Setting of the Study 22
 Study Population 22
 Sample of the Study 22
 Sample Size 22
 Sampling criteria 22
 Sampling technique 22
 Development and description of the tool 23
 Pilot study 23
 Data collection procedure 24
 Plan for data analysis 24
 Protection of human rights 24
IV DATA ANALYSIS AND INTERPRETATION 25-42
V DISCUSSION,SUMMARY, CONCLUSION,
IMPLICATIONS& RECOMMENDATIONS 43-48

REFERENCES 49-51

APPENDICES
 LIST OF TABLES

TABLE PAGE
TITLE
NO NO

1 Diagrammatic representation of research design 21

2 Distribution of adolescent girls according to their

26-27
demographic variables

3 Distribution of adolescent girls according to their pre and post

35
test knowledge score on anorexia nervosa.

4 Comparison of mean pre and post test knowledge level of

37
adolescent girls score on anorexia nervosa.

6 Association of pre test knowledge score with their selected

38-41
demographic variables
 LIST OF FIGURES
FIGURE PAGE
NO FIGURES NO
Conceptual framework based on General System Model of Von
1 12
Ludwig Bertlanffy (1968)

2 Distribution of adolescent girls according to their Age 29

3 Distribution of adolescent girls according to their Religion 29

4 Distribution of adolescent girls according to their Type of Family 30
Distribution of adolescent girls according to their Area of
4 30
Residence
Distribution of adolescent girls according to their Mother’s
5 31
Education
Distribution of adolescent girls according to their Father’s
6 31
Occupation
7
Distribution of adolescent girls according to their Family Income 32

8 Distribution of adolescent girls according to the Food habit 32

9 Distribution of adolescent girls according to the Type of Food
33
Pattern
10 Distribution of adolescent girls according to the Frequency of
33
Meals Pattern
11 Distribution of adolescent girls according to the Source of Previous
34
Information about anorexia nervosa
12
Distribution of adolescent girls according to the Body Mass Index 34

13 Distribution of adolescent girls according to their pre test and post

36
test level of knowledge
14 Comparison of pretest and posttest level of knowledge among the
38
adolescent girls
 LIST OF APPENDICES

APPENDIX
NO TITLE
Demographic Data
I

II Structured Questionnaire to assess the knowledge on anorexia

nervosa- English

Structured Questionnaire to assess the knowledge on anorexia

III
nervosa- Tamil

IV Answer key for knowledge questionnaire

V Lesson Plan on anorexia nervosa- English

VI Lesson Plan on anorexia nervosa- Tamil

VII Copy of letter seeking permission to conduct the study

VIII Copies of Certification of content validity

IX List of experts

X Photographic evidence of data collection and therapy session

 ABSTRACT

The study on “EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING ANOREXIA NERVOSA
AMONG ADOLESCENT GIRLS IN SELECTED COLLEGE AT
SIVAGANGAI” was undertaken by Reg.No: 301331551 during the year 2013-2015
in partial fulfillment of the requirement for the degree of Master of Science in Nursing
at RASS Academy College of Nursing, Poovanthi which is affiliated to the
Tamilnadu, Dr.M.G.R. Medical University, Chennai.

Objectives:To assess the pretest knowledge regarding anorexia nervosa among

adolescent girls. To evaluate the effectiveness of structured teaching programme on
knowledge regarding anorexia nervosa among adolescent girls. To find out the
association between the pretest knowledge regarding anorexia nervosa with their
selected demographic variables.Conceptual frame work: It was based on General
System Theory and Design Pre-experimental one group pre test &post test design was
adopted for this study. Setting: The study was conducted in Madurai Sivakasi
Nadar’s Meenakshi Pioneer Women’s College at Sivagangai district. Sample size:
The sample size was 100 adolescent girls.Sampling technique: The purposive
sampling technique was used. Method of data collection procedure: Data were
collected from the adolescent girls to assess the level of knowledge among the
adolescent girls by using structured questionnaire before and after structured teaching
programme.The collected data were tabulated and analyzed by descriptive and
inferential statistics. Results: Structured teaching programme is effective of
adolescent girls according to level of knowledge before and after the manipulation in
which (80%) of the samples had showed inadequate level of knowledge in the pre-
test. In contrast 96% of the samples experience adequate level of knowledge in the
post test. The mean post-test knowledge score(26.03) was greater than the mean pre-
test level of knowledge score 12.22%. The obtained t- value (44.54) was greater than
table value at 0.05 level of significance. It shows the structured teaching programme
was effective in improving knowledge. Conclusion: This study shown that Structured
Teaching Programme had a significant effect in improving knowledge of adolescent
girls.
 CHAPTER – I
INTRODUCTION
 CHAPTER-1

INTRODUCTION

The human body uses food and water as fuel to sustain itself during
adolescence there are many taking place as a child’s body turns into that of an adult
and their nutritional needs increase.

Gale CJ (2013), Due to paucity of literature regarding parent attitudes towards

adolescent problems, the subject is covered only in limited fashion. Following this is a
discussion of adolescent attitudes forward problem of eating habits. There is a
growing concern that teens need to be aware of interventions available to them. More
research is needed to survey adolescent attitudes toward the various high risk
behaviours, as well as determine how to promote help seeking behaviours and
positive youth development.

Institute of Medicine (US) and National Research Council (2011) Adolescents

are subjected to a barrage of messages and pressures affecting how they view
themselves and how they believe they should look. It is a period when peer pressure
can affect teenage eating behaviour and they may start skipping meals to maintain
body size and shape.

In many cultural and historical periods women have proud to be large, being
fat was a sign of fertility, of prosperity, of the ability to survive. And there was less
concerned dieting, fatness, weight fluctuation is among women. Women being fat
often face hostility and discrimination.

Dannis (1996)“Adolescent refers to the period “from puberty to maturity”.

During which physical, emotional and psychological changes occur in them. Young
people are the future of every society and also a great resource for the nation. During
the transition from childhood to adulthood, adolescents, establish patterns of
behaviour and make lifestyle choice that affect both their current and future health
adolescents and young adults are adversely affected by serious health and safety
issues such as slim beauty maintenance and violence and sexual behaviour etc.

Environmental factors such as family, peer group school, and community

characteristics also contribute to the challenges that adolescents face.
Food is the prime necessity of life. The food we eat is digested and assimilated in the
body and used for its maintenance and growth, during adolescence, physiological age
is a better guide to nutritional needs than chronological age. Energy needs to increases
to meet greater metabolic demands of growth; healthy diet is the diet that is arrived
with the intent of improving or maintaining optimal health. The diet includes all the
nutrients in appropriate amounts from all food groups including an adequate amount
of water.

Normal weight and underweight teenage girls who falsely believe they are
overweight are at greater risk of succumbing to unnecessary and unsafe weight loss
behaviour than girls, who can accurately assess their weight status according to
research by university of Illinois expect in eating disorder and body image perception.
Body image distortion appears to be more discriminating indicators of distress than
body dissatisfaction but it’s not something that’s typing screen by health care
providers.

Adolescence is a period of psychosocial changes that is often perplexing for both

teens and their parents. The rapid physical changes that occur at this time lead
adolescents to become preoccupied with their body image.

The term anorexia nervosa was established in 1873 by sir. William gull, one of
the queen Victoria personal physicians, the term is of Greekorigin, “a prefix denoting
negation and orexis” prefix denoting appetite. This means a lace of desire to eat
people with anorexia have an extreme fear of weight gain and a distorted view of their
body size and shape. As a result, they strive to maintain a very low body weight; some
restrict their food intake by dieting, fasting or excessive. They hardly eat all and often
try to eat as few calories as possible, frequently obsessing over food intake.

Anorexia nervosa is an eating disorder characterized by a fierce quest for

thinness. The DSM-IV and ICD-10, defines patients with anorexia nervosa as having
an intense fear of gaining weight, putting undue influence on body shape or weight
for self-image, having a body weight which is less than 85% of the weight that would
be predicted, and missing at least three consecutive menstrual periods.

Anorexia is an emotional disorder that focused on food. But it is actually an

attempt to deal with perfectionism and a desire to control things by strictly regulating
food and weight people with anorexia often feel that their self-esteem is tied to how
this they are anorexia is increasingly common especially among young women in
industrialized countries where cultural expectations encourage women to be thin,
fuelled by popular fixations with thin and lean bodies.

Laura k. (2013) Anorexia nervosa is an eating disorder. It occurs when a

person’s obsession with dieting and exercise leads to excessive weight loss. People
are generally considered anorexia when they refuse to maintain their body weight at
or above 85% of their ideal body weight anorexia can be fatal.

Toby D,(2013) It is often coupled with distorted self-image which may be

maintained by various cognitive biases that after how the affected individual evaluates
and thinness about her or his body, food and eating persons with anorexia nervosa
continue to feel hunger, but denial themselves to have small quantities of food, the
average calorie intake of person with anorexia nervosa is 600-800 calories per day,
but extreme cases of complete self-starvation are know the is a serious mental illness
with a high incidence of co morbidity.

G. Stanley (2011) Adolescents may become preoccupied with themselves,

uncertain about their appearance, compare their bodies with those of other teens, and
become increasingly interested in sexual anatomy and physiology, anorexia nervosa is
an eating disorder that disproportionately affects adolescents and has its origin, at
least partially, in this preoccupation with body image.

Anorexia often leads to a number of serious medical problems including;

amenorrhea, osteoporosis, cardiac abnormities.

The cause of anorexia nervosa is not known. It appears that hereditary due to
genetics, family and learned behaviour, culture and media and restrictive eating
severe trauma or emotional stress during puberty or pre puberty. Abnormalities in
brain chemistry.A tendency towards perfectionism fear of being humiliated and
family history of anorexia. Approximately 95 percentages of those affected by
anorexia are female, but males can develop the disorder as well. It begins to manifest
itself during later adolescence; it is also seen in young children and adults.

Fairburn (1999) The risk factor of anorexia nervosa are age, gender, dieting,
weight gain, weight loss, low self-esteem, feelings of helplessness, perfectionism, fear
of becoming overweight, familial pressure to be thin families that are overprotective,
rigid under involved, or in conflict, family history of eating disorders, emotional
stress, mood disorders such as depression or generalized anxiety disorder, personality
disorders, susceptibility to social and fashion trends emphasizing or glamorizing
thinness, history of sexual abuse or other traumatic event , experiencing a big life
change, such as moving or going to a new school.

Pryor T. The diagnosis of anorexia is lab tests may include blood tests- to look
for signs of anaemia to check electrolytes, and to check liver and kidney function,
electro cardiogram to look for abnormal heart rhythms, bone density test –to check for
osteoporosis, scoff questionnaire developed in Great Britain.

A “yes” response to at least 2 of the following questions is a strong indicator of

an eating disorder.

S: “do you feel sick because you feel full?”

C: “do you lose control over how much you eat?”

O: “have you lost more than 13 pounds recently?”

F: “do you believe that you are fat when others say that you are thin?”

F: “does food and thoughts of food dominate your life?”

The signs and symptoms of anorexia is severe weight loss. Physical signs
including excusive weight loss, scanty or absent menstrual periods, thinning hair, dry
skin, brittle hails, cord or swollen hands and feet bloated or upset stomach downy hair
covering the body ,low blood pressure fatigue, abnormal heart rhythms, osteoporosis,
psychological and behaviour sighs including distorted self-perception, being
preoccupied with food, refusing to eat, inability to remember things, refusing to
acknowledge the seriousness of the illness, obsessive compulsive behaviour,
depression.

The most effective way to prevent anorexia is to develop healthy eating habits
and a strong body image from an early age. Don’t accept cultural values that place a
premium on thin, perfect bodies. Family and friends should be urged not to focus on
the person’s condition, or on food or weight.
 The most successful treatment is a combination of psychotherapy, family
therapy, and medication. It is important for the person with anorexia to be actively
involved in their treatment. Combination of treatments can give the person the
medical psychological, and practical support they need cognitive behavioural therapy,
along with anti-depressants can be an effective treatment for eating disorders.

NEED FOR THE STUDY

Adolescence is a period separate from both early childhood and adulthood. It

is a transitional period. That requires special attention and protection. Evidence shows
that when adolescence girls and boys are supported and encourage by caring adults,
along with policies and services attentive to their needs and capabilities, they have the
potential to break long standing clueless of potential, discrimination and violence.

According to WHO adolescence is the age of 13-21 years and it comprises

about one-fifth of the world’s population, which is equivalent to 1.2 billion young
person (UNFPA, 2003) the WHO declares the adolescence are the adults of tomorrow
and to ignore their needs is difficult unwise and unjust. It is also called as period of
stress and storm, a period when society sends mixed signals to its youngsters which
results in confusion, frustration, despair and risk taking behaviour.

Researchers have produced a substantial body of work on the biological and

psychological changes that occur during adolescence, as well as the family, peer and
cultural influence that shape adolescents, lives in important ways. Current and future
efforts to promote healthy behaviour and also to prevent risky behaviours that are
prevalent during this stage of development.

Anorexia nervosa has recently become one of common disorder in adolescent

girls. A chronic course related to morbidity with one of the most medical
complication being severe osteopenia.

An, incidence has risen in the USA and Europe to some things like one in
among females of the 15-19 age groups, by now, a phenomenon of ED has assumed a
global spread that includes that affluent cast Asian countries, in south America,
especially Argentina and child. It has spread to china too.
 A most commonly occurs in teenage girls, especially in the pre pubertal age
group. The ratio of girls is approximate 10-20:1, about 2% to3% of young women
have a clinically important variant of the disorder. There has been a consistent
increase in the incidence of an over the past 10 yrs.

In a review of 24 epidemiological studies, reported a prevalence of pure anorexia

nervosa of 0.5% young women in western cultures. Reviewing selective studies of
case registers found that the annual incident ranged from 14.1 cases/100,000 girls and
women aged 10-24 to 43 cases/100,000 girls and women aged 16-24.

Dieting is major risk factor eating disorders. The prevalence of eating

disorders in a culture parallels the prevalence of dieting behaviour. In non-western
cultures, a low prevalence of both eating disorders and dieting exists, although
adolescence of all races who belongs to higher white women in higher socioeconomic
classes diet more and are more concerned about their weight than other sub groups of
women.

Participation in hobbies and occupations, such as modelling and ballet that

promote the ideal of thinners seems to lead to a higher prevalence of eating disorders.

Incidence rates for anorexia nervosa are highest for females aged 15-19 yrs.
They constitute approximately 40 years of all identified cases. In Rochester, MN,
USN, the incidence rate was 74 per 100000 person years for 15-19-year old females.

In Switzerland the incidence rate of cases admitted for anorexia was 20 per
100,000 person years’ females between 12 and 25 yrs. of age during the year 1999. In
western countries one-third of the people who meet stringent criteria for anorexia
nervosa 6%.

An is mainly affects women, 1 in 250 in the UK as opposed 1 in 4000 men

and in fact the female prevalence of AN in some western countries is reported to be as
high as 16.7 percentages. A study reported prevalence rates in women in western
countries ranged from 5.2 percentages to 9.4 percentages. In non-western countries,
the range was 3.4 percentages to 6.3 percentages. But the prevalence in non-western
countries seems to be on the rise.
 The average age of onset anorexia is 17 years. Those over 40 years of age
rarely develop AN. It is developed that 40% of newly identified cases of anorexia are
in girls 15-20 years old.

In south west London, on the prevalence rate of anorexia was found to be 20.2
cases per 10,000 populations. Prevalence in female age 15-20 years was 115.4 cases
per 10,000 populations. In the annual incidence of anorexia was found to be 15.7
cases per 10,000 total populations. In female aged 15-20 years the incidence rate was
19.2 cases /10,000 populations.

A study was conducted in sample consisted mostly of female adolescents from

middle socio economic status towns and villages of north – eastern India. The result
indicated that north eastern states of India with a mean age of 15 to 20 years are more
prone to anorexia nervosa. The mean age of onset of symptoms and duration was 15.2
years and 19.2 years respectively.

Now a day’s more adolescent girls that is age group between 15- 20 years
more concerned towards physical maintenance of the body. Adolescents are highly
influenced by television and internet with super slim models idolizing them. There is
immense emphasis on being thin by the society as well.

STATEMENT OF THE PROBLEM

A study to assess the effectiveness of structured teaching programme on

knowledge regarding anorexia nervosa among the adolescent girls in selected
college at Sivagangai.

OBJECTIVES

• To assess the level of pretest knowledge regarding anorexia nervosa among

the adolescent girls.
• To evaluate the effectiveness of structured teaching programme on knowledge
regarding Anorexia nervosa among the adolescent girls.
• To determine the association between pretest knowledge score with their
selected demographic variables.
OPERATIONAL DEFINITIONS

 Effectiveness:
In this study, it refers to the extent to which the structured teaching program is
helpful in gaining knowledge regarding anorexia nervosa in terms of difference
between pretest and posttest knowledge measured by semi structured questionnaire.

 Structured Teaching Program:

In this study, it is systematically developed programme with teaching aids

(LCD), designed to impart knowledge, regarding anorexia nervosa.

 Knowledge :
In this study, knowledge refers to the adolescents response to questions
related to anorexia nervosa as measured by a semi structured knowledge
questionnaire.
 Adolescent girl :

In this study, adolescent girl refers to girls who are in the age group between
17 – 19 years studying in the selected college.

 Anorexia Nervosa :

It is psychological disorder characterized by a prolonged refusal to eat,

resulting in emaciation, amenorrhea, emotional disturbance concerning body
image and fear of becoming obese.

HYPOTHESES

H1 – There will be significant difference between the mean pre - test and post-
test level of knowledge score among adolescent girls on Anorexia nervosa.

H2 – There is a significant association between the pre-test level of knowledge

scores of adolescents with their selected demographic variables.
ASSUMPTIONS
 Adolescent girls who are studying in colleges have some knowledge regarding
anorexia nervosa.
 Structured teaching programme is an effective method to teach adolescent
girls who are studying in a college.
 Girls are commonly having fear about becoming obese.
DELIMITATIONS
The study is limited to
 Students those who were interested to participate in the study.
 Students available at the time of data collection.
 Study focused only on adolescent girls between 17 – 19 years, not other age
group.

PROJECTED OUTCOME
This study reveals the existing level of knowledge among the adolescent girls
studying in selected A Women’s College at Sivagngai. It also will highlight the
effectiveness of structured teaching programme on anorexia nervosa among
adolescent girls. The result of the study will be strong motivator and will provide
irrigate for psychiatric nurses to initiate structured teaching programme in various
settings, since it requires minimal resources and cost - effective. Findings of this study
will help health professionals to plan structured teaching programme where
management is practical and certainly it will add value to psychiatric nursing.
CONCEPTUAL FRAMEWORK
Conceptual framework is a theoretical approach to the study of the problem
that is scientifically based and emphasizes the selection, arrangement and
classification of its concept. The conceptual framework states functional relationships
between events and is not limited to statistical relationships.
The study was intended to assess the effectiveness of structured teaching
programme regarding anorexia nervosa among adolescent girls in a selected Women’s
college, Sivagangai. The present study was based on general system theory which was
introduced by Ludwig Von Bertalanffy (1968) with input, process, output and
feedback.
 According to system’s theory, a system is a group of elements that interact
with one another in order to achieve the goal. An individual is a system because
he/she receives input from the environment. This input when processed provides an
input. This system is cyclical in nature and continues to be so, as long as the input,
process, output and feedback keep interacting. If there are changes in any of the parts,
there will be changes in all the parts. Feedback from within the systems or from the
environment provides information, which helps the system to determine whether it
meets its goal.

In the present study, these concepts can be explained as follows;

INPUT

The input consists of information material or energy that enters the system.
Adolescent girls studying in the selected Women’s college is a system and has inputs
within the systems itself and acquired from the environment. These input’s include
learner’s background like age, area of residence, type of family, family income,
education status of the parents, occupation of the parents, source of previous
information, influence the knowledge of adolescent girls.

PROCESS

It refers to the action needed to accomplish the derived task to achieve the
desired output, i.e. effectiveness of structured teaching programme regarding anorexia
nervosa.

a. Assessment of knowledge of adolescent girls regarding anorexia

nervosa.

b. Administration of structured teaching programme.

c. Assessment of knowledge using same questionnaire.

OUTPUT

Output is the behavioural response. Output response becomes feed back to the
system and environment. In the present study output is the gain knowledge score. This
system achieved through a comparison between mean pre-test and post- test
knowledge scores of the samples.
FEEDBACK

It is a process by which information is received at each stage of the system

output and its redirection to input. Accordingly the higher knowledge score obtained
by adolescent girls indicate that the structured teaching programme was effective in
increasing the knowledge regarding anorexia nervosa.
 INPUT
PROCESS OUTPUT

ASSESSMENT OF
POST TEST LEVEL
SUPPORTIVE OF KNOWLEDGE
CHARECTERISTICS OF BY STRUCTURED
ASSESSMENT OF
ADOLESCENT GIRLS QUESTIONNAIRE
KNOWLEDGE LEVEL BY
STRUCTURED
AGE
RELIGION QUESTIONNAIRE
AREA OF RESIDENCE
ADMINISTER STRUCTURED
TYPES OF FAMILY
TEACHING PROGRAMME
EDUCATIONAL STATUS OF GAINING KNOWLEDGE
REGARDING ANOREXIA
MOTHER
OCCUPATIONAL STATUS OF NERVOSA.
FATHER
MONTHLY INCOME
FOOD AND EATING HABIT
BODY MASS INDEX
INADEQUATE
SOURCE OF INFORMATION ADEQUATE MODERATE

FEED BACK

FIGURE 1: CONCEPTUAL FRAMEWORK BASED ON GENERAL SYSTEM MODEL OF VON LUDWIG BERTALANFFY (1968)

12
 CHAPTER – II
REVIEW OF LITERATURE
 CHAPTER 11

REVIEW OF LITERATURE

Review of literature is an important step in the development of any research

project. It involves the systemic identification, location, scrutiny, and summary of
written materials that contain information on research problems. It enhances the depth
of knowledge and inspires a clear insight into the crux of the problem. Literature
review throws light on the studies and their findings reported about the problem under
study.

The available literature and studies are organized under the following headings.

 Studies and literature related to anorexia nervosa

 Studies and literature related to impact of anorexia nervosa in

adolescent girls.

 Studies and literature related to risk factors, prevention, management

on anorexia nervosa

Studies and literature related to anorexia nervosa:

Stein glass J, (2015) a study was investigating, inadequate intake and

preference for low- calorie foods are salient behavioral features of Anorexia nervosa
This study aimed to develop a new paradigm for experimentally modeling
maladaptive food choice in AN. Individuals with AN (n=22) and healthy controls
(HC, n=20) participated in a computer based Food Choice Task, adopted for
individuals with eating disorders. Participants first rated 43 food images (including
high- fat & low- fat items) for Healthiness and Tastiness. The result is the anorexia
nervosa group was less likely to choose high fat foods relative to HC, as evidenced
both in multilevel logistic regression (z = 2.59, p = .009) and ANOVA (F (1, 39
anorexia nervosa) = 7.80, p = .008) analyses. Health ratings influenced choice
significantly more in anorexia nervosa relative to HC (z = 2.7, p= .006). The findings
suggest that the experience of tastiness changes overtime and may contribute to
perpetuation of illness. By providing experimental quantitative measure of food
restriction , this task opens the door to new experimental investigations into the

13
cognitive, affective, and neural factors contributing to maladaptive food choices
characteristics of AN.

Stenhausen HC, (2015), a study conducted to investigating how often anorexia

nervosa (AN) and co- morbid disorders occur in affected families compared with
control families. A total of N = 2,370 child and adolescent psychiatric subjects born
between 1951 and 1996 and registered in the Danish Psychiatry Central Research
Register (DPCRR) had any mental disorder before the age of 18 and developed AN at
some point during their life- time. AN occurred significantly more often in control
families. Anorexia nervosa risk factors included having a sibling with AN, affective
disorders in family members, and co- morbid affective, anxiety, obsessive-
compulsive, personality, 0r substance use disorders. Furthermore, female sex, and
ascending year of birth were significantly associated with having AN. Urbanization
was not related to the family load of anorexia nervosa and case relatives did not
develop AN earlier than control relatives.

Tolgyes T, (2014) a study conducted to investigating the prevalence rates of

anorexia nervosa in North America and Western Europe , carried out as a screening
examination and a semi- structured diagnostic interview was conducted. Of the
overall female samples, 3% revealed anorexic disposition, but no actual cause of
anorexia nervosa were detected. 25% of the ballet students corresponded to the
criteria of anorexia. They conclude that Body ideal of thinness in young women has a
significant effect of self- esteem. The prevalence rate of adverse eating behaviors in
Hungary has been found to be similar to the score published in the western countries.

King JA, (2014) a study conducted to assess the serious eating disorder
characterized by self- starvation, extreme weight loss, and alterations in brain
structure. Structural magnetic resonance imaging studies have documented brain
volume reductions in acute AN, but it is unclear. So Structural magnetic resonance
imaging data were acquired from adolescent and young adult female patients with
acute AN (n=40), recovered patients following long term weight restoration (n=34),
and an equal number of age - matched healthy control subjects. result is Vertex- wise
analyses revealed significant thinning of over 85% of the cortical surface in patients
with acute AN and CT normalizations in recovered patients following long term
weight restoration patients, although normal age related trajectories were absent in
14
disorder. This study concludes that Structural brain anomalies in AN as expressed in
CT and sub cortical volume are primarily the consequence of malnutrition and
unlikely to reflect pre morbid trait markers or permanent scars.

Ben-Dor DH, (2012) a study conducted to examining the prevalence on

anorexia nervosa among the relatives. Prevalence is estimated at 1/1000, but with a
high prevalence of the partial syndrome and a mortality rate. This article reviews the
findings of concerning the heritability and the contributing genes of the disorder, a
higher frequency of an anorexia nervosa was found among the relatives . The
heritability rate was estimated at 0.71, similar to twin’s studies, which estimate
0.58-0.76. They conclude, although there is a strong familial component in anorexia
nervosa. As well as sub typing the different types of AN, will bring us closer to
understanding of the heritability of anorexia nervosa and enable the development of
improved means of prevention and treatment Hewitt PL, (2011) a study conducted to
assessing the characteristics of individual who died from anorexia nervosa in the
USA. Data from 10 million death records (all National Center for Health Statistics
registered death in USA) were examined for mention of anorexia nervosa as a primary
contributing cause of death. Only 724 were found which equals an average of 145
annual deaths and ate of 6.73 per 100,000 deaths. The age and sex distribution
suggests 2 fatal forms anorexia nervosa, an early onset form comprising 89% of
women age of 15 -35 yrs. and a later form comprising 24% men. The findings suggest
the mortality risk of anorexia nervosa is confined to young adults and adolescents.

Muro- Sans P, (2011) a study conducted to describing the prevalence of

anorexia nervosa among Spain adolescents. A community sample of 1155
participants, and a risk sample of 93 participants, aged between 10.9 and 17.3 years
old from the city of Barcelona participated in the study. A study involves screening
with a structured clinical interview method. They conclude that a 1.28 % of the total
sample was detected as anorexia nervosa (2.31% of girls and 0.17 % of boys.)
Symptoms of anorexia nervosa were higher among girls than boys. Preoccupation
with maintained low weight, with body image and shape and taking excessive
exercises in order to lose weight, are increasing among Spanish adolescent girls.

Isomaa R, (2011) a study conducted to investigating the prevalence, incidence

and development of eating disorders and subclinical eating pathology. A study was
15
conducted in Western Finland with 595 adolescents. A screening questionnaire
followed by a semi structured interview was used to determine the prevalence,
incidence and development of eating disorders. The lifetime prevalence rates for
females age 18 were 2.6 % for anorexia nervosa (AN), 0.4% for bulimia nervosa (BN)
,7.7% for AN- NOS,1.3% for BN-NOS and 8.5 subclinical eating disorder. No
prevalent case of DSM-IV eating disorders was found among the males. The
incidence rate of eating disorder in adolescents age 15 - 18 was 1641 per 100 000
person per year.

A study was conducted in Tamil Nadu, India about the prevalence and
psychiatric co- morbidity among juvenile with eating disorder 41 cases with ICD 10
diagnosis of eating disorder 25% psychogenic vomiting was the commonest eating
disorder and anorexia nervosa the emerging eating disorder.

Studies and literature related to impact of anorexia nervosa in adolescent girls.

Torres S, (2015) a study conducted to assessing the role of depression of

alexithymia in anorexia nervosa (AN) has been controversy explained and several
variables that mask or increase the presence of emotional difficulties. The Toronto
Alexithymia Scale (TAS- 20) and the Zung- Self Rating Depression Scale were
administered to 160 females.80 participants with anorexia nervosa, 80 Healthy
Controls. Alexithymia is a relevant feature thought the spectrum of AN, and the
patient has a cognitive- affective disturbances in AN.

Frank GK (2015) over the past decade, brain imaging has helped to better
define eating disorder - related to brain circuitry. Brain research on grey matter (GM)
and white matter (WM) volumes had been inconsistent, possibly due to the effect of
acute starvation, exercise, medication, and co morbidity. Brain imaging that targeted
dopamine related brain activity using taste reward conditioning tasks suggested that is
circuitry is hypersensitive in anorexia nervosa, and hypo responsive in bulimia
nervosa and obesity.

Corbetta F, (2015) a study conducted to assessing plasma levels of vitamin

B12 and folates with respect to liver function enzymes considering the liver storage
properties of this vitamin. 70 restrictive type AN adolescents and the severity of
psychological traits was assessed using EDI - 3 Scale. Plasma levels of vitamin B12,
16
folates, transaminases (AST, ALT), gamma - glut amyl Transpeptidase, (GGT),
alkaline phosphate (ALP), and Cholinesterase (CHE) were determined. About 38.5%
of patients displayed vitamin B12 values (H- B12) above the upper range of normal
reference. 4.3% of patients had increased values of folates; 20 and 11.4% of patients
displayed ALT and AST values above reference limits. None had GGT limit values
above normal. These data suggest that plasma levels of vitamin B12 might be an early
marker of liver dysfunction, possibly also related to more severe psychopathological
aspects.

Nacinovich R, (2015) an exploratory study conducted to assessing α β plasma

levels in anorexia nervosa patients. A total 24 adolescent female AN outpatients were
recruited with 12 age comparable healthy controls. For each subject assessed α β 40
and leptin plasma levels, as well as APOE gene type. Plasma α β 40 levels were
similar between patients and controls, while a marked reduction was observed for
leptin (-80%) in anorexia nervosa patients. α β 40 plasma levels failed to correlate
with leptin, while a linear correlation was present with HCY (r = 0.50, p<0.03). This
study shows that a significant role for altered α β production in AN- associated
dysfunctions.

Bomba M, (2014) a study conducted to investigating the deficits in

autobiographical memory in adolescents with anorexia nervosa (AN). An
experimental study for 60 female with anorexia nervosa and 60 Healthy volunteers
with an age range of 11 - 18 years were enrolled. The Autobiographical Memory
Test (AMT), the Eating disorder inventory -3, The Toronto Alexithymia Scale (TAS-
20), for the evaluation of alexithymia and children depression Inventory to evaluate
depressive traits was administered. Girls with anorexia nervosa showed a Massive
over general memory effect. This effect was not related to the presence of depression
or alexithymia but increased with the duration of the disorder rather than with its
severity.

Roux H, (2013) a study was conducted to finding the impact on interpretation

of results on anorexia nervosa. The incidence of female cases is low in general
medicine o specialized consultation in town, from 4.2 and 8.3/100,000 individuals per
year. It is much higher in the general population, ranging from109 to 270/100,000
individuals per year. In fact , the studies reporting variations in the incidence of AN
17
were conducted on samples from clinical population in certain countries (United
States and United Kingdom) On average , 4.7 % of the individuals treated for AN
recovered, 34% improved,21% had chronic eating disorder , and 5 % died.
Mortality rate varies according to the population considered. Rates observed are 6.2 t0
10.6 times greater than the observed in the general population for a follow up duration
ranging respectively 13 to 10 years. Only 3.7 times more frequent than in the general
population for follow - up periods of 20- 40 years. It appears lower for subjects
treated before the age of 20. The main causes of death are eating disorder
complications, suicide and cancer.

J Affect Discord (2010) a study conducted to examining the competing

explanations of the high rate of death by suicide among adolescents with anorexia
nervosa. 9 case reports of adolescents died with anorexia nervosa. The findings
converged with the later hypothesis, as predicted by Joiner’s (Joiner, T, 2006. Why
people die by suicide. Harvard University press, Cambridge, MA) theory of suicide
which suggests adolescent with anorexia nervosa may habituate to the experience of
pain during the course of their illness and accordingly die by suicide methods that are
highly lethal.

Studies and literature related to risk factors, prevention, and management on

anorexia nervosa;

Ciao AC (2015) a study conducted to examining the family functioning in two

treatments for adolescent AN from multiple family members perspectives.120
adolescents with AN ages 12- 18 from a randomized - controlled trail comparing
family based treatment (FBT) to individual adolescent - focused therapy (AFT).
Multiple clinical characteristics were assessed at baseline. Families seeking treatment
for adolescent anorexia nervosa reported some difficulties in family functioning, with
adolescents reporting the greatest impairment.

Hofer M, (2014) a study to examining the complications due to re -feeding of

patients with anorexia nervosa, as well as their mortality rate after the implementation
of guidelines from the European Society of Clinical Nutrition and Metabolism.The
sample consist of 65 inpatients, 14 were admitted more than study period, resulting in
86 analyzed cases. Minor complications with re feeding during the first 10 days were

18
9 cases (10.5%), 4 with transient peri orbital edemas, and 3 with organ dysfunction,
and 2 cases with severe hypo kalemia occurred during observational period 30 days
16 minor complications occurred in 14 cases (16.3%). 6 infectious and 10 non -
infectious complications occurred. The findings indicate guidelines are able to reduce
complications and prevent mortality.

Gale CJ, (2013), a study conducted to examining the father in the development
in child and adolescent psychopathology. Research findings shows that family
influence and the value of family - based interventions, this article reviews the
potential impact of the father- child relationship on the development and
maintenance of Anorexia nervosa in young people.13 studies met inclusion and
exclusion criteria and were critiqued, with 8 being forward for discussion. This 8
studies identified key themes within the relationship of the father - child relationship
particularly daughters, around conflict and communication, parental protection,
psychological control, emotional regulation, self - esteem, and self-perfectionism. All
of these factors appear to influence child's level can impact of maladaptive eating
habits and psychopathology.

Lowe B, (2013) a study conducted to investigating the long term outcome and
prognosis in an anorexic sample 21 yrs. after the initial treatment. A multidimensional
and prospective design was used to assess outcome in 84 patients 9 yrs. after a
previous follow up and 21 yrs.’ after admission. Among the 70 living patients, the
follow up rate was 90%. Causes of death for the deceased patients were obtained
through the attending physician. 51% of patients were found to be fully recovered at
follow up, 21% were partially recovered and 10 % still met diagnostic criteria for
anorexia nervosa, 16% were deceased due to causes related to anorexia nervosa. This
study was concludes that recovery is still possible for anorexia nervosa patients after a
period of 21 yrs.

Wick K, (2011) a study conducted to assessing the real world effectiveness of

a German school based interventions for primary prevention of anorexia nervosa in
pre-adolescent girls. Anorexia nervosa is notoriously difficult to treat, has high
mortality rates and has a prevalence peak in 15- year old girls. Intervention involved 9
guided lessons with special posters and group discussions. A parallel controlled with
pre- post measurements and a three month follow up was conducted in 92 Thuringian
19
schools (n = 1553 girls) in 2007 and 2008. Primary outcomes were conspicuous eating
behavior, body self- esteem, and AN - related knowledge. After the primary
interventions provides an efficient and practical model to increase AN- related
protection factors.

Gordon SM, (2010), a study conducted to assessing the treatment of co-

occurring eating disorders in publicity funded addiction treatment programs in
African- American patients. Data were collected between 2002 and 2004 from face to
face interview with nationally representative sample of 351 addiction treatment
programs. In this 29% admit all persons with eating disorders, and 48% of persons
with eating disorders of low severity. These results highlight the need for education of
addiction treatment professionals in assessment of eating disorders.

20
 CHAPTER – III
RESEARCH METHODOLOGY
 CHAPTER III

METHODOLOGY

This chapter deals with the methodology adapted by the investigator to assess
the effectiveness of structured teaching programme on Anorexia nervosa and among
adolescent girls in selected college at Sivagangai. It deals with research approach,
research design, setting of the study population, criteria of the sample, selection
sample size, sampling technique, development of tool for data collection and plan for
data analysis.

RESEARCH APPROACH:

An evaluatory approach was adopted by the investigator to find the

effectiveness of structured teaching programme Anorexia nervosa.

RESEARCH DESIGN:

The investigator adopted Pre-experimental, one group pretest post- test design
to this study.

Group Pre-test Treatment Post-test

knowledge STP knowledge
100 selected sample
of adolescent girls O1 X O2

O1: Pre assessment level of knowledge

X: Treatment

O2: Post assessment level of knowledge

VARIABLES:

 Independent variable: Structured teaching programme is the independent variables

of this study.
 Dependent variable: In this study dependent variable was knowledge score.
21
SETTING OF THE STUDY:

The study was conducted in Madurai Sivakasi Nadar’s Pioneer Meenakshi

Women’s College, Poovanthi, Sivagangai. Approximately 1000 students are studying
in this college. Among them 250 students are B.sc 1st year students in this college.
The college has adequate facilities like electricity, water and transportation facilities.

STUDY POPULATION:

In this study, study population selected was all the adolescent girls those age
group between 17-19 years in selected college at Sivagangai.

SAMPLE:

The samples selected were 100 adolescent girls from the selected Women’s
College at Sivagangai.

SAMPLE SIZE:

The sample for the present study consisted of adolescent girls, who met the
inclusion criteria.

SAMPLING TECHNIQUE:

The investigator adopted purposive sampling technique to select the samples

for this study.

CRITERIA FOR SAMPLE SELECTION:

The sample was selected based on the following inclusion and exclusion
criteria.

Inclusion criteria:

 Who are willing to participate in this study

 Who are available during the period of data collection
 Study focused only on adolescent girls between 17-19 years, not other
age group.

22
Exclusion criteria:

 Who are studying B.Sc II yr or III yr

 Who are willing to participate in this study.

DEVELOPMENT AND DESCRIPTION OF THE TOOL:

The investigator prepared an assessment tool after reviewing literature to

assess effectiveness of structured teaching programme on Anorexia nervosa and
considering the opinion of medical and nursing subject experts.

The tool consists of two parts.

Part I contains the following sections

 Section A : Demographic variables

 Section B : Structured questionnaire

CONTENT VALIDITY:

Assessment tool was given to five experts in the field of nursing for content
validity. Suggestions were considered and appropriate changes were done.

RELIABILITY:

The data were collected from 10 samples to find out the reliability. The split
half method was used to establish the reliability of the tool. This was done by splitting
the items into odd and even items. Using these values Karl’s Pearson correlation co-
efficient was computed (r = 0.75) of the whole test was then estimated by spearman
Brown Prophecy formula and value obtained was r = 0.75, which indicates that tool is
reliable.

PILOT STUDY:

Pilot study was conducted for the period of one week on 10 adolescent girls in
order to test the feasibility, relevance and practicability of the study. Results showed
that study was feasible to carry out the study in the same setting.

23
DATA COLLECTION PROCEDURE:

A formal prior permission was obtained from the Chairman, Principal of the
college by submitting an application and giving assurance to abide by the rules and
regulation that no personal and professional inconvenience would be created because
of the study similarity Head of the Department of Mental Health Nursing was
explained about the purpose of the study of permission was obtained.

The study was conducted for period of one month. The investigator selected
the sample who are fulfilled the inclusion criteria. The investigator explained the
purpose of the study in a compassionate manner and informed consent was obtained.
The investigator was taken care to look in to their convenience and comfort. Data
were collected from adolescent girls to assess their level to knowledge. Score by using
structured questionnaire before administration of structured teaching programme
adolescents were assessed by their score knowledge level.

PLAN FOR DATA ANALYSIS:

Collected data was analyzed by descriptive and inferential statistics. Student’t’

test was used to compare the effectiveness of structured teaching programme. Chi-
Square test was used to final the association between demographic variables with
level of knowledge regarding Anorexia nervosa.

PROTECTION OF HUMAN RIGHTS:

Research proposal was approved by the dissertation committee, RASS

Academy College of Nursing, Poovanthi. Prior to the study oral consent from each
adolescent girls was obtained before starting the data collection. Assurance was given
to the adolescent girls that confidentiality would be maintained.

24
 CHAPTER- IV
DATA ANALYSIS
 CHAPTER - 1V

ANALYSIS & INTERPRETATION OF DATA

This chapter deals with the analysis and interpretation of data collected from
the samples. Data collected were tabulated, analyzed and presented. It consists of the
following sections.

Section I : It deals with distribution of samples according to the

demographic variables.

Section II : It deals with description of sample according to their pre test

and post test level of knowledge

Section III : It deals with comparison of pretest and posttest knowledge

level among Adolescent girls.

Section IV : It deals with the association of pretest knowledge level and

. Selected Demographic variables

25
 SECTION -I

Distribution of sample according to demographic variables of the

adolescent girls.

Table 1: Distribution of sample according to demographic variables of the

adolescent girls

Item Demographic variables Frequency(f) Percentage (%)

a. Age in years
17 – 18 67 67
18 – 19 33 33
b. Religion
Hindu 91 91%
Christian 4 4%
Muslim 5 5%
c. Type of family
Nuclear 57 57%
Joint 35 35%
Extended 8 8%
d. Area of residence
Rural 64 64%
Urban 27 27%
Slum 9 9%
e. Mother’s education
status 8 8%
Illiterate 44 44%
High school 32 32%
Higher secondary 12 12%
Under graduate 4 4%
Post graduate
f. Occupation
Un employed 0 0%
Self employee 70 70%

26
 Private employee 21 21%
Government employee 9 9%
g. Income of the family
Below Rs 5000 31 31%
Rs.5001 – 10000 50 50%
Rs.10001 – 15000 13 13%
Above Rs. 15000 6 6%
h. Habit of Food pattern
Vegetarian 33 33%
Non – Vegetarian 67 67%
i. Type of food pattern
Fatty meals 24 24%
Junk foods 50 50%
Balanced diet 6 6%
Normal diet 20 20%
j. No of meals pattern per
day
1 time meals/ day 37 37%
2 times meals/ day 32 32%
3 times meals/ day 12 12%
More than 3 times/ day 19 19%
k. Source of information
about anorexia nervosa
Family members 05 05%
Friends 05 05%
Mass media 06 06%
No information 84 84%
l. Body Mass Index
Low weight 25 25%
Normal 65 65%
Over weight 08 08%
Obesity 02 02%

27
 TABLE 1 shows that, with regards to age 67 (67%) were 17- 18 yrs, 33(33%)
were 18- 19 years of age. With regard to religion majority of the samples 91 (91%)
were Hindus, 4 (4%) were Christians and 5 (5%) of them were Muslims. With regard
to the area of residence, majority, 64 (64%) resides in rural area, 27 (27%) reside in
urban area, 9 (9%) reside in slum area. Family system of adolescent girls reveals 57
(57%) were from nuclear family, 35 (35%) were joint family, and 8 (8%) were
extended family. distribution of subjects with reference to educational qualification of
mother reveals majority 44 (44%) were belongs to High school, 32 (32%) were
belongs to higher secondary, 12 (12%) were under graduates and 4 (4%) of them were
post-graduation and 8 (8%) were illiterate. With regard to occupation of father reveals
majority 70 (70%) were self-employees, 21(21%) were private employees, 9(9%) of
them were government employees, and no one in unemployed. With regard to family
income majority of the adolescent girls 50 (50%) belongs to the income level 5000
-10,000 per month, 31 (31%) belongs to below 5000 per month, 13 (13%) were
receiving 10,000- 15,000/%, and 6 (6%) of hem receiving above 15,000/month. With
regard to habit of food pattern of adolescent girls majority 67 (67%) non - vegetarian,
33(33%) of them were belongs to vegetarian. Distributions of subjects with type of
food pattern of adolescent girl’s majority 50 (50%) were having junk foods, normal
diet, 24 (24%) were having fatty meals, 20 (20%) were having normal diet, and 6(6%)
of them were having balanced diet. With regard to number of meals pattern per day of
adolescent girl’s majority 37(37%) of them taking 1 time meals per day, 32(32%) of
them taking 2 times meals per day,12 (12%) of them taking 3 times meals per day,
19(19%) of them taking more than 3 times per day. Distribution of subjects with
reference to previous information regarding anorexia nervosa shows majority 84
(84%) of them not received any information about anorexia nervosa,5(5%) had
received information from family members, 5(5%) had received information from
friends, and 6(6%) of them received information from mass media. With regards to
body mass index of adolescent girls majority 65(65%) of them are having normal
body weight, 25(25%) of them are having low weight 8 (8 %) of them are having over
weight and,2 ( 2%) of them are having obesity.

28
 17 - 18
67%
years
18- 19 years
70%
60%
PERCENTAGE

33%
50%
40%
30%
20%
10%
0%
AGE IN YEARS

Figure 2: Distribution of the adolescent girls according to their age

100% Chrstian
98% 4%
PERCENTAGE

96% Muslim
5%
94%
Hindu
92%
90% 91%

88%
86%

RELIGION

Figure 3: Distribution of the adolescent girls according to their religion.

29
Figure 4: Distribution of the adolescent girls according to the type of family

64% Rural
70%

60% Urban

50% Slum
PERCENTAGE

40%
27%
30%

20%
9%
10%

0%
AREA OF RESIDENCE

Figure 5: Distribution of the adolescent girls according to their area of residence

30
Fig. 6: Distribution of adolescent girls according to their mother’s educational
status.

Figure 7: Distribution of the adolescent girls according to their Father’s

occupation
31
Figure 8: Distribution of the adolescent girls according to their family income

Figure 9: Distribution of the adolescent girls according to their food habit

32
Figure 10: Distribution of the adolescent girls according to their type of food
pattern.

Figure11: Distribution of the adolescent girls according to their Frequency of

meals pattern

33
Figure 12: Distribution of the adolescent girls according to source of previous
information about anorexia nervosa.

Figure 13: Distribution of the adolescent girls according to their Body Mass
Index

34
 SECTION –II

Description of samples according to their pretest and posttest level of

knowledge regarding anorexia nervosa.

Table 2: Distribution of adolescent girls according to the pretest and posttest

level of knowledge.

n = 100

Level of Pre – test Post – test

knowledge
Frequency (f) Percentage Frequency (f) Percentage
(%) (%)

Inadequate 80 80% 0 0%

Moderate 20 20% 4 4%

Adequate 0 0% 96 96%

Table 2 depicts that to assess the pretest and posttest level of knowledge
regarding anorexia nervosa. Majority 80 (80%) of adolescent girls had inadequate
knowledge regarding anorexia nervosa, and 20 (20%) of adolescent girls had
moderate level of knowledge about anorexia and no one had adequate knowledge
about anorexia nervosa in the pretest. Majority 96 (96%) of adolescent girls had
adequate knowledge about anorexia nervosa, 4 (4%) of them had 4 (4%) moderate
level of knowledge about anorexia nervosa, and none of them are had inadequate
knowledge regarding anorexia nervosa in the posttest.

35
Figure 17: Distribution of adolescent girls according to the pretest
and posttest level of knowledge.

36
 SECTION –III

Comparison of pretest and posttest knowledge level of adolescent girls

regarding anorexia nervosa.

Table 3: Comparison of mean pretest and posttest knowledge level of adolescent

girls.

n = 100

S.No Level of Mean Mean SD “t” Value

knowledge difference difference

1. Pretest 12.22 13.81 2.036 44.54

2. Posttest 26.03 2.457

P<0.05

Table 3 predicts that comparison of the mean pretest and post -test level of
knowledge and it also deals with mean difference in pretest and, posttest and “t"
value, thus the effectiveness of the study is found. The pretest mean difference is
(13.81) and posttest mean difference is (26.03). The overall calculated’ value (44.54,
p<0.05) in knowledge aspect was greater than table value (0.75) at 0.05 level of
significance. Hence it is concluded that there is very high significant gain in
knowledge of anorexia nervosa.

H1: There is a significant difference between the mean pre- test and post - test
knowledge of adolescent girls regarding anorexia nervosa.

37
Figure 18: Comparison of mean pretest and posttest knowledge level of
adolescent girls.

38
 SECTION-IV

Association of pre- test level of knowledge of adolescent girls with

selected demographic variables.

Table 4: Association of demographic variables with the pretest knowledge score.

S.I Variables <mean(12) >mean(12) X2 Df Level of

significance

1 Age
17 -18 37 30 0.050 1 P>0.05 #
18 - 19 19 14 NS

2 Religion
Hindu 40 51
Christian 1 3 4.18 2 P>0.05 #
Muslim 0 5 NS

3 Type of family
Nuclear 23 34
Joint 17 18 9.41 2 P>0.05 * S
Extended 1 7
4 Area of
residence
Urban 29 35 P>0.05 #
Rural 10 17 0.836 2 NS
Slum 3 6
5 Mother’s
education status
Illiterate 3 5
High school 25 19 14.48 4 P>0.05 * S
Higher secondary 8 24

39
 Under graduate 2 10
Post graduate 0 4
6 Father’s
Occupation
Unemployed 0 0 3.68 3 P>0.05 #
Self – employee 27 43 NS
Private employee 12 9
Government 2 7
employee
7 Monthly income
Below Rs. 5000 15 16
Rs.5001 – 10000 20 30
Rs.10001 – 15000 3 10 2.56 3 P>0.05 #
Above Rs. 15000 2 4 NS
8 Food pattern
Vegetarian 14 19 0.041 1 P>0.05 #
Non- Vegetarian 19 40 NS
9 Type of food
Fatty meals 11 13
Junk foods 9 11 5.33 3 P>0.05 #
Balanced diet 3 3 NS
Normal diet 12 38
10 No of meals
pattern per day
1 time meal per 15 22
day
2 times meal per 11 21
day 9.01 3 P>0.05 * S
3 times meal per 08 04
day
More than 3 06 13
times/day

40
 11 Source of
previous
information 03 02
Family members 02 03 1.207 3 P>0.05 #
Friends 03 03 NS
Mass media 40 44
No previous
information
12 Body Mass
Index 12 13
Low weight 30 35
Normal weight 05 03 2.614 3 P>0.05 #
Over weight 00 02 NS
Obesity

# (NS) Not significant * (S) Significant

Table 4 data presented reveals that association between pre – test and
demographic variables the calculated Chi- square values as used. The researcher has
mentioned age of adolescent girls obtained chi- square value 0.050 at df 1 was not
significant at 0.05 level. Religion of adolescent girls obtained chi- square value 4.18
at df 2 was not significant at 0.05 level. Type of family of adolescent girls obtained
chi- square value 9.41 at df 2 was significant at 0.05. Area of residence an adolescent
girls obtained chi- square value 0.836 at df 2 was not significant at 0.05 level.
Mother’s education status of an adolescent girls obtained chi- square value 14.48 at df
4 was significant at 0.05 level. Father’s occupation of an adolescent girls obtained
chi- square value 3.68 at df 3 was not significant at 0.05 level. Monthly family income
of an adolescent girls obtained chi- square value 2.56 at df 3 was not significant at
0.05 level. Food pattern of an adolescent girls obtained chi- square value 0.041 at df 1
was not significant at 0.05 level. Type of Food of an adolescent girls obtained chi-
square value 5.33 at df 3 was not significant at 0.05 level. Number of meals pattern of
an adolescent girls obtained chi- square value 9.01 at df 3 was significant at 0.05
41
level. Source of previous information regarding anorexia nervosa among adolescent
girls obtained chi- square value 1.207 at df 3 was not significant at 0.05 level. Body
mass index of an adolescent girls obtained chi- square value 2.614 at df 3 was not
significant at 0.05 level.

42
 CHAPTER- V
DISCUSSION AND CONCLUSION
 CHAPTER - V
DISCUSSION, SUMMARY, CONCLUSIONS, IMPLICATIONS
AND RECOMMENDATIONS
DISCUSSION
The aim of the study was to find out the effectiveness of structured teaching
programme in improving the knowledge of adolescent girls regarding anorexia
nervosa.
Respondent Characteristics are as follows,
The first objective was assess the pretest level of knowledge of adolescent girls
regarding anorexia nervosa and selected demographic under study.

The major finding of this study was the majority 80(80%) of the adolescent
girls had inadequate knowledge regarding anorexia nervosa, 20(20%) of them had
moderate knowledge regarding anorexia nervosa, and 0% no one had adequate
knowledge regarding anorexia nervosa in the pretest. The above findings summaries
that majority of the samples are having inadequate knowledge.
Stein glass J, (2015) a study conducted to investigating, inadequate intake and
preference for low- calorie foods are salient behavioral features of Anorexia nervosa
This study aimed to develop a new paradigm for experimentally modeling
maladaptive food choice in AN. Individuals with AN (n=22) and healthy controls
(HC, n=20) participated in a computer based Food Choice Task, adopted for
individuals with eating disorders. Participants first rated 43 food images (including
high- fat & low- fat items) for Healthiness and Tastiness. The result is the anorexia
nervosa group was less likely to choose high fat foods relative to HC, as evidenced
both in multilevel logistic regression (z = 2.59, p = .009) and ANOVA (F (1, 39
anorexia nervosa) = 7.80, p = .008) analyses. Health ratings influenced choice
significantly more in anorexia nervosa relative to HC (z = 2.7, p= .006). The findings
suggest that the experience of tastiness changes overtime and may contribute to
perpetuation of illness. By providing experimental quantitative measure of food
restriction , this task opens the door to new experimental investigations into the
cognitive, affective, and neural factors contributing to maladaptive food choices
characteristics of AN.

43
The second objective to evaluate the effectiveness of structured teaching
program on knowledge regarding on anorexia nervosa among adolescent girls

In case of post –test level of knowledge 96(96%) out of 100 were acquired
adequate level of knowledge, 4(4%) were having moderate level of knowledge, and
no one had inadequate level of knowledge. The obtained “t” value (44.54) was
significant at 0.05 levels with the degree of freedom 99. This indicates that, there is a
significant difference between pre –test and post-test level of knowledge scores
among adolescent girls regarding anorexia nervosa. Hence H1 was accepted.

Isomaa R, (2011) a study conducted to investigating the prevalence, incidence

and development of eating disorders and subclinical eating pathology. A study was
conducted in Western Finland with 595 adolescents. A screening questionnaire
followed by a semi structured interview was used to determine the prevalence,
incidence and development of eating disorders. The lifetime prevalence rates for
females age 18 were 2.6 % for anorexia nervosa (AN), 0.4% for bulimia nervosa (BN)
,7.7% for AN- NOS,1.3% for BN-NOS and 8.5 subclinical eating disorder. No
prevalent case of DSM-IV eating disorders was found among the males. The
incidence rate of eating disorder in adolescents age 15 - 18 was 1641 per 100 000
person per year.

The third objective was to find the association between the level of the knowledge
scores before structured teaching program and selected demographic variables.

The major findings of this study were showed that there was a significant
association between pre-test knowledge score with the selected demographic variables
such as father’s education status, type of family, mother’s occupation, habit of eating
pattern and course. Hence the calculated Chi-square value was compared with the
table value which was higher than the table value. So, the result proven that there was
an association between pre-test knowledge score with the selected demographic
variables. To prevent the anorexia nervosa among adolescent girls with no slim
beauty conscious and standardized, diversified measures should be adopted so that
outcome of anorexia nervosa prevention work should be assessed more objectively
and effectively.

44
 Wick K, (2011), a study conducted to assessing the real world effectiveness of
a German school based interventions for primary prevention of anorexia nervosa in
pre-adolescent girls. Anorexia nervosa is notoriously difficult to treat, has high
mortality rates and has a prevalence peak in 15- year old girls. Intervention involved 9
guided lessons with special posters and group discussions. A parallel controlled with
pre- post measurements and a three month follow up was conducted in 92 Thuringian
schools (n = 1553 girls) in 2007 and 2008. Primary outcomes were conspicuous eating
behavior, body self- esteem, and AN - related knowledge. After the primary
interventions provides an efficient and practical model to increase AN- related
protection factors.

SUMMARY

This chapter deals with the summary of the study. The main aim of the study
was to find the effectiveness of structured teaching programme regarding anorexia
nervosa among adolescent girls in a selected Women’s college.

The conceptual frame work used for this study was based on general system’s
theory. One group pre – test post – test design (O1 X O2) was adopted for the present
study. Study consisted of 100 adolescent girls. Purposive sampling technique was
used to select the samples in a Women’s college at sivagangai.

Content validity tool was established by giving five experts. The reliability of
the tool was tested by split – half method using Karl Pearson’s correlation co efficient
and it was fond to be reliable.

A pilot study was conducted on 10 adolescent girls in St. Fatima Michael

Engineering College. No further changes were made in the tool after pilot study. The
main study was conducted at Madurai Sivakasi Nadar’s Pioneer Meenakshi Women’s
College at Sivagangai. Data were analyzed by using descriptive and inferential
statistics. The hypotheses had been tested at 0.05 level of significance.

Major findings of the study:

The findings of the study revealed that knowledge of the adolescent girls were
not adequate, majority 80% of them were had inadequate level of knowledge, 20% of
them had moderate level of knowledge, and no one had adequate level of knowledge.
45
After administration of structured teaching programme, the knowledge level has
improved among adolescent girls regarding anorexia nervosa, majority 96% of the
adolescent girls had adequate level of knowledge, 4% of them had moderate level of
knowledge and no one had inadequate level of knowledge in the post-test.

Comparisons of mean pre test and post test level of knowledge shows, the “t”
value (44.54) was significant at 0.05 level with the degree of freedom 99. This
indicates that, there is significant difference between pre test and post test level of
knowledge regarding anorexia nervosa among adolescent girls. Hence H1 was
accepted. Father education status, type of family, mother occupation, habit of eating
pattern and course of the student and in the pre test level of knowledge at 0.05 level.
These demographic variables calculated Chi- square value was 14.45 at df (4), type of
family chi-square value 9.41 at df (2), mother occupation chi-square value 14.45 at df
(3) and habit of eating pattern Chi-square value 9.03 at df (3) and course of the
student chi-square value 16.96 at df (1) respectively and it was significant at 0.05
level, So the H2 was accepted.

The overall experience of conducting this study was satisfying one, as there
was good co-operation from adolescent girls and college authority. The study was a
new learning experience for the investigator. The result of the present study reveals
that structured teaching programme could be used as an effective teaching strategy.

CONCLUSION

The study findings provide the statistical evidence which clearly indicate that
Structured Teaching Programme has significant effect on the level of knowledge in
adolescent girls.

IMPLICATIONS OF THE STUDY

Nursing Practice:

The nurses can play an important role in imparting preventive health care.
Health education conducted by the nursing personnel in the college helps in imparting
knowledge regarding prevention of anorexia nervosa among adolescent girls. Staff
Nurses can also educate the adolescent girls who visit the outpatient department or
inpatient department and also do screening programme regarding anorexia nervosa.
46
This education will help the adolescent girls to understand in – depth about anorexia
nervosa measures. Thereby they can adopt healthy life style practices, which will help
to prevent the disease.

Nursing Research:

Nurses being the major focus in the health care delivery system must take the
initiative in conducting research on significant health care problem among the
vulnerable groups in community, especially adolescent girls. The researcher will help
to prevent mortality and morbidity caused by any preventable illness such as anorexia
nervosa. Nurse researcher can conduct studies to determine the effectiveness of
education in terms of anorexia nervosa. Most researchers can be done on prevention
of innovative methods of teaching preparation of teaching effective teaching
materials, focusing on interest, quality and cost effectiveness.

Nursing Administration:

Nurse administrators are responsible to identify the nature of the problem and
organize programme related to health promotion to the target people. The study
assists the nursing administrative authorities to initiate and carry out health education
programme in health care settings.

Nurse administrator can also take the initiative in imparting health information
through different effective methods. They have to support and encourage the nursing
students to participate in health promotion activities. Individual and group teaching
can be arranged for adolescent girls.

Nursing Education:

Nursing education should prepare effective future nurses. Active participation

of student nurses in conducting educational programmes to provide information
regarding diseases of the reproductive tract and hygienic measures. The nursing
curriculum focuses more on the preventive aspect, the nurse must therefore, be
prepared to identify the areas of knowledge deficit through the assessment of learning
needs of adolescents.

Health information can be impaired through various methods like lecture,

47
incidental teaching, and mass media. Several educational strategies can be used to
disseminate the health information like lecture, demonstration, flip chart, flash cards,
and hand out etc. which would make it interesting and helps to gain adequate
knowledge. Nurses have to involve themselves in the areas of health practices which
help to lead a healthy life.

LIMITATATIONS OF THE STUDY:

1.
The study was conducted only one group of 100 students in a selected
Women’s college at Sivagangai, hence generalization is limited to the
population under study.

2.
The study did not use a control group and there is threat to internal validity as
the investigator had no control over the events that took place between the pre-
test and post- test.

3.
Extraneous variables such as exposure to mass media were beyond
researcher’s control.

RECOMMENDATIONS:

On the basis of the findings of the study, the following recommendations are
made for the future research.

1. A similar study can be replicated on a larger sample with demographic

characteristics.

2.
A similar study can be replicated with broader content area on anorexia
nervosa.

3.
A similar study can be done different setting.

4.
A comparative study can be conducted to determine the knowledge of
different age groups on anorexia nervosa.

5.
A comparative study can be conducted to assess the knowledge of urban
and rural adolescent girls regarding anorexia nervosa.

6.
Same study can be conducted by using different teaching modalities
48
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52
 APPENDIX I

RESEARCH TOOL

SECTION A
SOCIO DEMOGRAPHIC DATA OF ADOLESCENT GIRLS
1) Age in years
a) 17 – 18 ( )
b) 18 – 19 ( )
2) Religion
a) Hindu ( )
b) Christian ( )
c) Muslim ( )
3) Type of family
a) Nuclear family ( )
b) Joint family ( )
c) Extended family ( )
4) Father’s educational qualification
a) Illiterate ( )
b) High school ( )
c) Higher secondary ( )
d) Under Graduate ( )
e) Post Graduate ( )
5) Mother’s educational qualification
a) Illiterate ( )
b) High school ( )
c) Higher secondary ( )
d) Under Graduate ( )
e) Post Graduate ( )
6) Father’s occupation
a) Unemployed ( )
b) Coolie ( )
c) Private employee ( )
d) Government employee ( )
7) Mother’s occupation
a) House wife ( )
b) Self employee ( )
c) Private employee ( )
d) Government employee ( )
8) Socio – Economic status of the family
a) Low class family ( )
b) Middle class family ( )
c) Upper class family ( )
9) Monthly income of the family
a) Below Rs. 5000 ( )
b) Rs .5001-10000 ( )
c) Rs.10001-15000 ( )
d) Above Rs. 15000 ( )
10) Area of residence
a) Rural ( )
b) Urban ( )
c) Slum ( )
11) Habit of food pattern

a) Vegetarian ( )

b) Non- Vegetarian ( )

12) Type of food Pattern

a) Fatty Meals ( )

b) Junk Foods ( )

c) Balanced diet ( )

d) Normal diet ( )
13) No of meals pattern per day
a) 1 time meals per day ( )
b) 2 time meals per day ( )
c) 3 time meals per day ( )
d) 4 time meals per day ( )
14) Previous source of information about Anorexia Nervosa?
a) Through mass media ( )
b) Through friends ( )
c) Family members ( )
d) No ( )
15) Physical measurement

Height in cm ___________

Weight in m2 ___________
 SECTION B
STRUCTURED KNOWLEDGE QUESTIONS ON ANOREXIA NERVOSA
1. Adolescent period refers to
a) 10 – 14 years
b) 15 – 19 years
c) 20 – 30 years
d) 30 years and above
2. Weight and body image are
a) Stable body measures
b) Unstable body measures
c) Dynamic body measures
d) Non variable body measures
3) Unhappy with their body structure and consider themselves to be fat even though their
BMI are below normal in
a) Conduct disorder
b) Bulimia nervosa
c) Anorexia nervosa
d) Mood disorder
4) Which one is the high risk in eating disorder?
a) Anorexia nervosa
b) Bulimia nervosa
c) Pica eating
d) None of the above
5. What is anorexia nervosa?
a) Stuffing oneself with food
b) Refusal of eating due to fear of over weight
c) Trying to vomit to lose weight
d) Feeling of Emptiness in the stomach
6. Who are affected with Anorexia Nervosa more frequently?
a) Toddlers
b) Adolescents
c) Middle age groups
d) Old age group
7. Anorexia nervosa is highly affected in
a) Male
b) Female
c) Both
d) None of the above
8. Westernization, Industrialization, Modernization are the causes for
a) Developing anorexia nervosa
b) Developing bulimia nervosa
c) Developing self confidence
d) Developing personality
9. The causes which leads the adolescent girls to be a victim of anorexia nervosa
a) Family pressure among adolescent girls to be slim
b) Media and advertising images promoting thinner as ideal
c) Tendency in women’s media to push weight loss program
d) All the above
10. Strict dieting increases the risk of developing
a) Conduct disorder
b) Tic disorder
c) Anorexia nervosa
d) Sexual disorder
11. Warning sign of Anorexia nervosa?
a) Rapid weight loss or frequent changes in weight
b) Frequent changes in height
c) Frequent changes in taste
d) Rapid weight gain
12. What are all the primary symptoms for Anorexia nervosa?
a) Resistance to maintaining body weight
b) Fear of weight gain
c) Irregular menstruation
d) All the above
13. Anorexic person consume
a) Less protein
b) Less calories
c) Less fat
 d) Less vitamins
14. People with anorexia nervosa have a self esteem that is highly dependent on
a) Their character and attitude
b) Their body sizes and shape
c) Their willpower and ability
d) Their knowledge and personality
15. Distorted perception of self, being pre- occupied with food, refusing to eat, inability to
remember things are
a) Psychological signs of bulimia nervosa
b) Psychological signs of anorexia nervosa
c) Psychological signs of pica eating
d) Psychological signs of binge eating
16. Two diagnostic tests that are often used in anorexia nervosa are
a) Eating attitude test and eating disorder
b) Personality test and aptitude test
b) Blood glucose test and urine test
d) Intelligence test and attitude test
17. BMI means
a) Body Mass Index
b) Body Measurement Index
c) Body Mass Identity
d) Body Movement Index
18. A person’s BMI is a measurement that represents the relationship between
a) Weight and their Height
b) Height and their age
c) Weight and their age
d) Weight and their Image
19. The normal value of BMI is
a) Less than 18.5
b) 18.5 – 24.9
c) 25 – 30
d) More than 30
20. Which of the following is a risky eating behavior in an adolescent?
a) Eating junk foods all the time
b) Eating 3 times a day
 c) Drinking plenty of water
d) Having a cup of milk a day
21. What is the optional choice therapy for anorexia nervosa?
a) Psycho therapy
b) Music therapy with dance
c) Aroma therapy
d) Occupational therapy
22. What is the drug of choice for Anorexia nervosa?
a) Anti depressants
b) Anti manic drugs
c) Anti epileptics
d) None of the above
23. To foster a healthy relationship with food, one has to
a) Try to label food as good or bad
b) Avoid using food as bribes or punishment
c) Do severe fasting
d) Do heavy exercises
24. Adolescent girls feel good about their body images when we
a) Demonstrate healthy eating and sensible exercises
b) Show an acceptance of different body shape and size
c) Do criticize or comment on them about their appearance
d) Answer a and b
25. Adolescent girls encourage to
a) Adapt healthy food habits

b) Skip the meals

c) Do exercises
d) Induce vomiting
26. What is behavior modification in Anorexia nervosa?
a) Efforts to change the psychological problems.
b) Efforts to change the physical problems
c) Efforts to change the maladaptive eating behaviors
d) Efforts to change the attitude of a person
27. The following is the complications of anorexia nervosa except
a) Malnutrition
 b) Absence of menstruation
c) Poor concentration
d) Obesity
28. Which are all the system affected by anorexia nervosa?
a) Cardio Vascular system
b) Central nervous system
c) Gastrointestinal system
d) All the above
29. What is the aim of prevention of Anorexia nervosa?
a) Rule out medical complications of Anorexia nervosa
b) Treatment of Asthma
c) Supporting people with eating disorder
d) Treatment of eye disease
30. Why, the early detection of Anorexia nervosa not possible for most of the cases?
a) Maintaining body image
b) Interest to follow the mass media influence
c) Activity related impression
d) Societal attraction
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 APPENDIX - IV

ANSWER KEY
Answer key and score for the structured teaching knowledge questionnaire to assess
the knowledge regarding anorexia nervosa.

SL.NO ANSWER SCORE

KEY
1 b 1
2 a 1
3 c 1
4 a 1
5 b 1
6 b 1
7 b 1
8 a 1
9 d 1
10 c 1
11 a 1
12 d 1
13 b 1
14 b 1
15 b 1
16 a 1
17 a 1
18 a 1
19 b 1
20 a 1
21 a 1
22 a 1
23 a 1
24 d 1
25 a 1
26 c 1
27 d 1
28 d 1
29 a 1
30 d 1
 APPENDIX - V

LESSON PLAN

ON

ANOREXIA NERVOSA

Regno : 301331551
II YrM.Sc (N)
RASS ACADEMY COLLEGE OF NURSING, POOVANTHI

As a part of dissertation submitted to

THE TAMILNADU DR. M.G.R MEDICAL UNIVERSITY, CHENNAI.
TOPIC : ANOREXIA NERVOSA

GROUP : ADOLESCENT GIRLS

PLACE : SELECTED COLLEGE

DURATION 45 MINUTES

METHOD OF TEACHING LECTURE CUM DISCUSSION

PREVIOUS KNOWLEDGE : BASIC KNOWLEDGE REGARDING ANOREXIA

NERVOSA AMONG ADOLESCENT GIRL’S

TEACHING AIDS : LCD

General Objectives;

At the end of the teaching adolescent girls will acquire adequate knowledge regarding Anorexia nervosa.

Specific objectives:

At the end of the sessions the students will be able to,

 Describe the definition of Anorexia nervosa

 Explain the incidence rate of Anorexia nervosa
 Describe the causes of Anorexia nervosa
 Enumerate the Pathophysiology of Anorexia nervosa
 Point out typical manifestations of Anorexia nervosa
 Explain the treatmentfor Anorexia nervosa
 Explain the complications of anorexia nervosa
 List down the preventive measures of Anorexia nervosa.
TIME SPECIFIC TEACHING AUDIO EVALUATION
OBJECTI LEARNING VISUAL
VES ACTIVITIES AIDS
1mt Introducing INTRODUCTION;
the topic Adolescence is a transitional stage of physical and Teacher LCD
psychological human development generally occurring during introduce the
the period from puberty to teenage (15- 19yrs of age) eating topic
behaviors and they may start skipping meals or possibly under
eating or over eating.
DEFINITION ; Teacher: define Define anorexia
2mts Describe Anorexia nervosa is characterized by refusal to maintain a the anorexia nervosa?
the healthy body weight, a fear of gaining weight and an unrealistic nervosa
definition perception of current body weight. Learner: active
INCIDENCE ; listening.
Anorexia has the highest mortality rate among all
2mts Explain the psychological disorders. Teacher: Explain LCD Explain the incident
incidence  Approximately 90 -95 % of Anorexia nervosa suffers the incident rate rate of anorexia
rate of are girls and women.(American Psychiatric Association of anorexia. nervosa
anorexia , 1994 ) Learner: active
nervosa  Between 0.5 – 1 % American women suffer from listening
Anorexia nervosa.
 Between 5 -20 % of individuals struggling with
 Anorexia will die.
 Mainly seen in adolescent period
 It occurs in the age group of 13 -21 years.
CAUSES :
3 min List out the  Family and social pressure Teacher: LCD List down the causes
causes and  Westernization describe the and risk factors for
risk factors  Modernization causes and risk anorexia nervosa?
for  Industrialization factors for
anorexia  Crash dieting anorexia nervosa
nervosa  Media and advertising images promoting thinner as
ideal. Learner: active

RISK FACTORS: listening

 Strict dieting
 Body dissatisfaction
 Perfectionism
 Family history of eating disorders
 History of physical or sexual abuse
 Low self esteem.
 PATHOPHYSIOLOGY ; Explain the patho
3 min Enumerate Teacher: LCD physiology of
the patho- Enumerate the anorexia nervosa?
physiology pathophysiology
of anorexia
nervosa Learner: active
listening

Signs and symptoms of anorexia

Living with anorexia means you’re constantly hiding your
habits. This makes it hard at first for friends and family to spot List out the signs and
the warning signs. When confronted, you might try to explain symptoms of
5 min Pointing away your disordered eating and wave away concerns. But as Teacher: anorexia nervosa?
out the anorexia progresses, people close to you won’t be able to deny Pointing out the LCD
signs and their instincts that something is wrong—and neither should you. signs and
symptoms symptoms of
As anorexia develops, you become increasingly preoccupied
of anorexia anorexia nervosa
with the number on the scale, how you look in the mirror, and
nervosa Learner: taking
what you can and can’t eat. notes.

Anorexic food behavior signs and symptoms

 Dieting despite being thin – Following a severely

restricted diet. Eating only certain low-calorie foods.
Banning ―bad‖ foods such as carbohydrates and fats.
 Obsession with calories, fat grams, and nutrition –
Reading food labels, measuring and weighing portions,
keeping a food diary, reading diet books.
 Pretending to eat or lying about eating – Hiding,
playing with, or throwing away food to avoid eating.
Making excuses to get out of meals (―I had a huge
lunch‖ or ―My stomach isn’t feeling good.‖).
 Preoccupation with food – Constantly thinking about
food. Cooking for others, collecting recipes, reading
food magazines, or making meal plans while eating very
little.
 Strange or secretive food rituals – Refusing to eat
around others or in public places. Eating in rigid,
ritualistic ways (e.g. cutting food ―just so‖, chewing
food and spitting it out, using a specific plate).
Anorexic appearance and body image signs and symptoms

 Dramatic weight loss – Rapid, drastic weight loss with

no medical cause.
 Feeling fat, despite being underweight – You may feel
overweight in general or just ―too fat‖ in certain places
such as the stomach, hips, or thighs.
 Fixation on body image – Obsessed with weight, body
shape, or clothing size. Frequent weigh-ins and concern
over tiny fluctuations in weight.
 Harshly critical of appearance – Spending a lot of
time in front of the mirror checking for flaws. There’s
always something to criticize. You’re never thin
enough.
 Denial that you’re too thin – You may deny that your
low body weight is a problem, while trying to conceal it
LCD
(drinking a lot of water before being weighed, wearing
baggy or oversized clothes).

Purging signs and symptoms

 Using diet pills, laxatives, or diuretics – Abusing

water pills, herbal appetite suppressants, prescription
 stimulants, ipecac syrup, and other drugs for weight
loss.
 Throwing up after eating – Frequently disappearing
after meals or going to the bathroom. May run the water
to disguise sounds of vomiting or reappear smelling like
mouthwash or mints.
 Compulsive exercising – Following a punishing
exercise regimen aimed at burning calories. Exercising
through injuries, illness, and bad weather. Working out
extra hard after bingeing or eating something ―bad.‖

DIAGNOSTIC GUIDELINES FOR ANOREXIA

NERVOSA ;
As per ICD -10 , F .50 .0
Explain the
2 min Explain the Teacher: explain diagnostic guidelines
 Body weight is maintained at least 15 %below
diagnostic the diagnostic LCD for anorexia nervosa?
that expected body mass index is 18.5 or less.
evaluation evaluation for
Quetelets Body mass index =weight (kg)
for anorexia
height (m )2
anorexia nervosa.
Used for age 16 or above.
nervosa

Two diagnostic tests are often used to identify anorexia

 nervosa.
 Eating attitude test
 Eating disorder inventory

SCOFF questionnaire, developed in Great Britain, is

sometimes used when anorexia nervosa is suspected. A ―yes‖
response to at least two of the following questions is an
amongindicator of an eating disorder.
S: “Do you feel sick because you feel full?‖
C: ―Do you lose control over how much you eat?‖
O: ―Have you lost more than 13 pounds recently?‖
F: ―Do you believe that you are fat when others say that you are
thin?‖
F: ―Does food and thoughts of food dominate your life?‖
TREATMENT MODALITIES FOR ANOREXIA Explain the treatment
NERVOSA ; modalities for
Explain the In this treatment , many type of strategies are there Teacher: explain anorexia nervosa?
4 min treatment 1 ) Effective communication strategies the treatment LCD
modalities 2 ) Milieu Therapy measures for
for 3 ) Cognitive behavior therapy anorexia
anorexia 4 )Behavior and Interpersonal therapies nervosa.
nervosa 5 ) Individual psychotherapy Learner; active
 6 ) Family therapy listening.
7 ) Group therapy
8) Pharmacological treatment.
1 )EFFECTIVE COMMUNICATION STRATEGIES ;
 Develop a rapport with client.
 Create non – threatening and non – punitive
environment.
 Put the client at ease while communicating.
 Maintain professional boundaries.
2 ) MILIEU THERAPY ;
 The client is given a designed amount of time to
complete meals.
 Unit activities closely supervised.
3 )COGNITIVE BEHAVIOR THERAPY ;
 Cognitive behavior approaches, are aimed at
reducing symptoms and restructuring the belief
system that perpetuates the illness.
 To identify at risk periods as well as to self –
monitor eating patterns.
4 )BEHAVIOR AND INTERPERSONAL THERAPIES ;
In addition to cognitive behavior therapy approaches
include behavior therapy and interpersonal therapy.
5 )INDIVIDUAL PSYCHOTHERAPY ;
Individual psychotherapy is generally included
treatment protocols. It is helpful in assisting the client
to establish more realistic thinking process.
 Increase self esteem.
 Establish healthy self control.
 Express emotions and needs more directly.
6 )FAMILY THERAPY ;
Family therapy includes education of each family member
about anorexia nervosa and signs &symptoms, treatment and
preventive measures.
7 )GROUP THERAPY ;
This therapy may helps the client in a more pleasing way as
the client can see others with the same problems. What she is
facing (as in self help groups) and the client feels more liberal
when she is in a group of familiar people.
8 )PHARMACOLOGICAL MANAGEMENT ;
There are no specifically indicated medications for
anorexia nervosa.
Anti -depressants medication may be considered, but
depressive symptoms may be consequences of malnutrition that
will reunite upon weight restoration.
 COMPLICATIONS ;
5 min List down Anorexia nervosa are associated with serious complications, Teacher; list out List out the
the the LCD complications for
complicatio complications of anorexia nervosa?
ns of anorexia
anorexia nervosa.
nervosa Learner; active
listening.

Problems in Cardio vascular system ;

 Poor circulation
 Irregular heart beats
 Hypotension
 Heart valve disease –Mitral valve prolapsed
  Heart failure
 Edema on the leg and face
 ECG abnormalities
 Myocarditis
Problems with bones and muscles ;
 Muscle weakness
 Fragile bones (osteoporosis )
 Problems with physical development in children &
young adults.
Dermatologic problems ;
 Brittle hair and nails
 Hair loss
 Dry skin
 Lanugos
Endocrine Problems ;
 Hypo glycemia
 Cold intolerance
 Amenorrhea
Fluid and electrolyte problems ;
 Dehydration
 Alkalosis (vomiting )
 Acidosis
Sexual problems;
 Irregular menstruation &Infertility in women
 Loss of sexual interest & erectile dysfunction in men.
Problems with Central Nervous system ;
 Seizures
 Difficulties with concentration & memory
 Irritability
Hematologic complications;
 Anemia
 Leucopenia
Gastro intestinal complications;
 Decrease intestinal mobility
 Constipation
 Bloating
Other problems;
 Kidney damage
 Liver damage
Pregnancy Complications;
 Miscarriage
 Premature birth babies
 Low birth weight baby
 Dental problems;
 Enamel erosion
These are the complications for Anorexia
nervosa.
PREVENTIVE MEASURES;
AIM;
 To rule out the medical complications.
 Early identification of changes in body weight.
 Primary reinforcement of taking healthy
3 min Explain the And nutritive foods. Teacher; explain
preventive  Foster a healthy relationship with food the preventive
measures  To label food as good or bad. measures.
 Show an acceptance of different body shape and size. Learner; active Explain the
 Encourage to adopt healthy food habits listening. preventive measures
 Counseling. for anorexia nervosa?
 Allowing the adolescent girls more opportunities for
depth and intimate discussions on issues such as body
image and self esteem.
 Awareness of the disorders and how to prevent them
& how to notice them early and how to seek help
should be done.
 Provide adolescents discussions about school, family,
 nutrition and extracurricular activities & problems.
 Effective communication is also essential in primary
prevention.
PREVENTION AND INTERVENTION AT COLLEGE
LEVEL;
 Create a college environment where all students feel
safe from harassment.
 Focus physical education on skills building and
establishing healthy eating habits, not weight
management.
 Ensure that participation in college or co-curricular
activities is not limited by a student’s body size or
shape.
 Provide general information about information
about Anorexia nervosa and let students know
where they can get help.
CONCLUSION;
At the end of the teaching, adolescent girls gain
adequate knowledge regarding Anorexia nervosa and
also give assurance not to follow such activities of
intake of foods.
 grpapog;G Neha;

(kdg;ghjpg;ghy; grpapd;ik> euk;Gj; jsh;r;rpg; grpapd;ik)

gw;wpa ghl jpl;lk;

gFjp : grpapog;G Neha;

FO : tsh; ,sk; ngz;fs;

,lk; : Njh;T nra;ag;gl;l fy;Y}hp

fhy msT : 45 epkplq;fs;

gapw;Wtpf;Fk; Kiw : ciuahly; kw;Wk; fye;J MNyhrpj;jy;

Kw;ija ghl mwpT : tsh; ,dk; ngz;fspilNa grpapog;G Neha; gw;wpa

mbg;gil mwpT.

gapw;Wtpf;f cjTk;

nghUs;fs; : ePhk
; g; gbf xspj;jpiu (LCD )
nghJthd Fwpf;Nfhs;:

grpapog;G Neha; gw;wpa gapw;Wtpg;gpd; Kbtpy; tsh; ,dk; ngz;fs; me;Nehapidg; gw;wpwa NghJkhd mwptpidg;
ngWjy;.

Kf;fpa Fwpf;Nfhs;fs;:

Grpapog;G Nehapidg; gw;wpa epfo;r;rpapd; Kbtpy; khzth;fs; tpthpf;f Ntz;bait.

 grpapog;G Nehapidg; gw;wpa tpsf;fk;.

 grpapog;G Nehapdhy; Gjpjhfg; ghjpf;fg;gl;lth;fspd; vz;zpf;ifia njhptp;j;jy;.

 grpapog;G Nehapdhy; Vw;gLk; clw; $Wr; nray; khw;wq;fis thpirg;gLj;Jjy;.

 grpapog;G Nehapdhy; Vw;gLk; mwpFwpfis Fwpg;Giuj;jy;.

 grpapog;G Neha;f;fhd rpfpr;ir Kiwfis tpthpj;jy;.

 Grpapog;G Nehapdhy; Vw;gLk; tpisTfis tpthpj;jy;.

 grpapog;G Neha;f;fhd jLg;G Kiwfis thpirg;gLj;Jjy;.

fhyk; Kf;fpa cs;slf;fk; gapw;Weh; gapw;W tpf;f kjpg;gPL
Fwpf;Nfhs;fs; /gapy;Nthh; cgNahfpf;fg;
nray;ghLfs; gLk; nghUs;

Kd;Diu:
1epkp ghl mwpKfk;
lk;; tsh; ,dk; gUtkhdJ cly; kw;Wk; kdepiyfspy; ghl mwpKfk;
tsh;r;rp Vw;gLtJ MFk;. nghJthf g+g;giljypy; ,Ue;J
,sk; taJ tiu Vw;gLk; nghJthd tsh;rpr epiy ( 15-19
taJ tiu) MFk;;. Tsh; ,dk; gUtj;jpdh; vd;gJ 13-18
vd;w taJ epiyapy; cs;sth; Mth;. ,t;taJ
epiyapy;jhd; tsh; ,sk; gUtj;jpdh; Foe;ij vd;w
epiyapypUe;J ,isa tajpdh; vd;w epiyia
milfpd;wdh;. ,t;taJ epiyf;F Vw;wthW tsh;
,sk;gUtj;jpdh; cly; tsh;r;rp> ghypd czh;T kw;Wk; kd
tsh;r;rp milfpd;wdh;. ,t;taJ epiyapy; czt+l;lk;
vd;gJ mth;fSila cly;tsh;r;rp kw;wk; kdtsh;r;rpf;F
Vw;wthW ,Ug;gJ kpfTk; Kf;fpakhdjhff; fUjg;gLfpd;wJ.

tiuaiu
2 tiuaiw gapw;Wdh; ePhk
; g; gbf grpapog;G
tsh; ,sk;gUtj;jpdh; rpy Fwpg;gpl;l fhuzq;fspdhy;
epkplq; tpsf;Fjy; tpsf;Fjy; xspj;jpiu Nehapidg;
czT cz;Zk; fhy Ntisfisj; jtph;jJ Fiw Cl;lk;
fs; gapy;Nthh; gw;wpa
my;yJ kpif czt+l;lk; vd;w epiyf;Fr; nry;fpd;wdh;.
ftdpj;jy; tpsf;Ff
2 grpapog;G ghjpg;gilgth; vz;zpf;if (tpfpjk;):
epkplq; Nehapdhy;
grpapog;G NehahdJ kdepiyf; FiwghLfspy; mjpf
fs; ghjpf;ffg;gl;lth; gapw;Wdh; ePhk
; g; gbf
msT ,wg;G vz;zpf;ifiaf; nfhz;Ls;sJ.
fspd; ghjpf;fg;gl;lt xspj;jpiu grpapog;G
vz;zpf;ifia  rhjhuzkhf 90-95%rpWkpfs; kw;Wk; ngz;fs; grpapog;G h;fspd;
Nehapdhy;
njhptpj;jy; Nehapdhy; ghjpf;fg; gLfpd;wdh;.(mnkhpf;fs; vz;zpf;ifi
ghjpf;fg;gl;lth;
irf;fpahl;bhpf; mNrhrpNard;> 1994). a tpsf;Fjy; fspd;
 5-20 % tprpjh;rrhuj;jpw;F ,ilapy; c;ss jdpegh; gapy;Nthh; vz;zpf;ifia
grpapog;G Nehapdhy; rpukg;gl;L caphpof;fpd;whh;. ftdpj;jy; tpsf;Ff?

 Tsh; ,sk; gUj;jpdhpilNa grpapog;G Nehapdi

Kf;fpakhfg; ghh;f;f Kbfpd;wJ.

 13-21 taJ te;NjhUf;F ,e;Neha; Vw;gLfpd;wJ.

fhuzq;fs;:

grpapog;G Nehapd; grpapog;G Nehapd; fhuzk; kw;Wk; mghaf; fhuzpfis

fhuzq;fs; thpirg; gLj;Jjy;. gapy;Nthh; grpapog;G
kw;Wk; mgha ftdpj;jy; Nehapd;
fhuzpfis  FLk;g kw;Wk; r%f mOj;j epiyik.
fhuzq;fis
thpirg;gLj;Jjy;
thpirg;gLj;Jf
 Nkw;fj;jpaf; fyhr;rhuk;.

 ehfhPfj;jpd; tpisT
  njhopy; Nkk;ghl;bd; tpisT.

 nehWf;Fj; jPdp

 nky;ypa cUt mikg;gpidr; rpwe;jjhf;r rpj;jhpf;Fk;

nra;jp kw;Wk; tpsk;guj;jpd; Njhw;wk;.
grpapog;G
mghaf; fhuzpfs;:
3 Nehapdhy;
epkplq;  fLikahd czTf; fl;Lg;ghL
Vw;gLk; clw; grpapog;G
fs; gapw;Wdh;
 cly; epiwtilahf epiy
$Wr;nray; tpsf;Fjy; Nehapdhy;
khw;wq;fis  g+uzj;Jtk; gapy;Nthh;
ftdpj;jy; Vw;gLk; clw;
thpirg;gLj;Jjy;
 FLk;g cWg;gpdh;fapilNa czt+l;lf; FiwghL.
$Wr;nray;

 jd;idg; gw;wpj; jhNd Fiwj;J kjpg;gpLjy;. khw;wq;fis

thpirg;gLj;Jf
.
 grpapog;G
grpapog;G Nehapdhy; Vw;gLk; clw;$W khw;wq;fs;:
3 Nehapdhy;
epkplq; Vw;gLk;
jhdwpFwpfis gapw;Wdh;:
fs; ePhk
; g; gbf
Fwpg;gpLjy; kd mOj;jk; (jd;idg; gw;wpj; jhNdFiwthf grpapog;G
xspj;jpiu
kjpg;gpLjy;r%fj;jpypUe;J tpyFjy;) Nehapd;
mwpFwpfs;
kw;Wk;
jPtpu czTf; fl;Lg;ghLkw;Wk; mgahfukhd kugZ FwpaPLfisf;
#o;epiyf; Fzhjprak; Fwpg;gpLjy;gap
w;Wedh;:Fwpg;G
vLj;jy;
Nlhgkpd;-ntz;l;us; njsp kjpg;G mikg;gpy; Vw;gLk; khWghL

jhNd gl;bdp fplj;jykw;Wk; Cf;f kjpg;G kw;Wk; Fwpfspy;

$l;Lr;Nrh;e;J ,Uj;jy;

czT cz;zhJ ,Uf;Fk; epiyf;F Ml;gLjy;.

mghafukhd clw;$W khw;wq;fs; Vw;gLjy;.

5 grpapog;G
grpapog;G Nehapdhy; Vw;gLk; mwpFwpfs;:
epkplq; Nehapdhy;
 czTf; Fiwghl;Lg; gof;ftof;fq;fis njhlh;eJ Vw;gLk; FwpaPL
fs;
kiwg;gJ. kw;Wk;
 grpapog;G Nehapw;fhd mghaf; FwpaPLfis ez;gh;fs; mwpFwpfis
kw;Wk; FLk;g cWg;gpdh;fshy; Rl;bf; fhl;l Kbahj thpirg;gLj;Jf
fbdj;ij Vw;gLj;Jfpd;wJ. .
 Mdhy; grpapog;G Neha; njhlUk; gl;rj;jpy;
NehahspNah my;yJ mtUf;F kpfTk;
neUf;fkhzthf;s Nehapdhy; Vw;gLk; tpghPjj;ij
mwpe;J nfhs;s KbAk;.
 grpapog;G Neha; cUthFk; nghOJ> Nehahsp jhd;
vg;gb fz;zhbapy; gpujpgypf;fpd;Nwhk; vd;Wk;> jd;dhy;
vd;d nra;a KbAk; kw;Wk; rhg;gpl Kbahj epiy>
msTNfhypy; cs;s vz;fs; vdg; gythW
Ml;nfhs;sg; gLfpwhu;fs;.

grpapog;G Neha; czTg; gof;f tof;f FwpaPL kw;Wk;

mwpFwpfs;:

cly; nkypjYf;fhd czTg; gof;fk;:

fbdkhd czTf; fl;Lg;ghl;ilf; filg;gpbj;jy;.

Fiwthd fNyhhp czTfis kl;Lk; cl;nfhs;Sjy;.
 khTr;rj;J kw;Wk; nfhOg;G cztpid nfLjy;
czTfshff; fUjp cz;zhky; jil nra;tJ.

fNyhhpfs;> nfhOg;Gr;rj;J kw;Wk; czt+l;lj;jpy; gpbthjk;:

 czTr; rPl;Lfis thrpj;J fNyhhp Fiwthd

cztpid cz;Zjy;>

 cztpidg; gFjpahfg;gphpj;J mse;J> vil Nghl;L

kpfTk; Fiwthf cz;Zjy;>

 czTf; Fwpg;NgLfis itj;Jf; nfhz;L mjd;gb

kl;Lk; czT cz;Zjy;

czT cz;gJ Nghd;W ghtid kw;Wk; czT cz;gjpy;

ngha;ik:

 czT cz;zhikia kiwj;jy;> czit

cz;zhky; tpisahLjy; kw;Wk; czitj;
jtph;g;gjw;fhf cztpid vwpjy; Nghd;wit.

cztpidg; gw;wpa vz;zq;fspy; Ml;gLjy;:

 czitg; gw;wpa njhlh; rpe;jid. kw;wth;fSf;Ffhf czT

grpapog;G rikg;gJ> rikay;Fwpg;Gfsir; Nrfhpj;jy;> czT gw;wpa
Nehapidf; VLfis thrp;jj
; y;> my;yJ jahhpj;J mjd; %yNk czT
 fz;lwpAk; cz;Zk; Kiwiaf; ifahStJ. ePhk
; g;gbf
kjpg;gPl;L gapw;Wdh;: xspj;jpiu
tprpj;jpukhd kw;Wk; ufrpakhd czT gw;wpa rlq;Ffs;:
Kiwfis grpapog;G
tpsf;Fjy;
 nghJ ,lq;fs; kw;Wk; kf;fs; Rw;wpAs;s ,lq;fspy; Nehapidf;
czT cz;gijj; jtph;g;gJ. fz;lwpAk;
kjpg;gPl;L
 Rlq;F Kiwfs;:(v.fh: cztpid tpyf;FtJ
Kiwfis
(cztpd; Kf;fpaj;Jtk; mwpahky; mjid
tpsf;Fjy;.
nghUl;gLj;jhky; tpyf;FtJ> cztpid nkd;W
jpd;W mjidj; Jg;GtJ> czT cz;gjw;F
jdpj;Jtkhd jl;Lfis cgNahfpg;gJ) gapy;Nthh;
2
epkplq; grpapog;G Nehapd; Njhw;wk; kw;Wk; cly; mikg;gpd; FwpaPL ftdpj;jy; grpapog;G
fs; kw;Wk; mwpFwpfs;: Nehapidf;
(jhdwpFwpfs;) fz;lwpAk;
 gfpuq;fkhf vil Fiwjy;: ;. kjpg;gPl;L
 cly; vil kpfTk; Fiwthf ,Uf;Fk;nghOJ kpfTk; Kiwapid
Fz;lhf ,Ug;gJ Nghd;w czh;T: tpsf;Ff.
 cly; Njhw;wj;jpidg; gw;wpa jPh;T:
 cly; vilf; Fiwg;gpy; jtW cs;s gFjpiar;
Nrhjidr; nra;jy;:
 grpapog;G Nehapdhy; gPbf;fg;gl;lth; jhd; nkype;j
cly; mikg;gpid ngw;wij Vw;Wf; nfhs;shik.
 kyk; fopj;jiy Vw;gLj;Jk; FwpaPLfs; kw;Wk; mwpFwpfs;:
czt+l;l khj;jpiufs;> kykpsf;fpfs; kw;Wk; ePhNghf;Fk;
khj;jpiufis cgNahfpj;jy;:
czT cz;lgpd; mjid tPrp vwptJ:
czT cz;lgpd; njhlh;;e;J kiwtJ my;yJ
fopg;giwf;Fr; nry;Yjy;. The;jp vLf;Fk; rj;jj;ij
czuhky; ,Uf;f Fohapy; ePiuj; jpwe;J mjd; rj;jj;ij
mjpfg;gLj;Jjy; kw;Wk; tha;r; Rj;jk; jputk; kw;Wk; Gjpdh
Nghd;w kz%l;Lk; nghUl;fsi cgNahfpj;J the;jpapdhy;
Vw;gLk; Jh;ehw;wj;ij tutplhky; nra;tJ.

grpapog;G Nehapidf; fz;lwpAk; topKiwfs;:

I.rp.b.. 10> vg; 50.0 d; gb.>
cly; vilf;FwpaPL 18.5 my;yJ mjw;Fr; rpwpJ Fiwthd
grpapog;G vilia ngWtjw;Fg; gjpyhf 15 rjtPjj;jpw;Ff; Fiwthd
Nehapw;fhd cly; viliag; ngw;wpUj;jy;
rpfpr;ir Fthl;b gpnsl; cly; vilf; FwpaPL tpfpjk;: gapw;Wdh;:
Kiwfis vil (fpfp) grpapog;G
tpsf;Fjy;. ---------------------------- Nehapw;fhd
cauk; (kP)2 rpfpr;ir
16 taJ (m) mjw;F mjpf tajpdUf;F ,e;j FwpaPl;L Kiwfis
tpfpjj;ijg; gad; gLj;jp cly; vil kjpg;gPL nra;ag; tpsf;Fjy;
gLfpd;wJ.
 grpapog;G Nehapidf; fz;lwpa ,uz;L tpjkhd Nrhjid gapy;Nthh;:
4 Kiw cgNahfg;gLj;jg;gLfpd;wJ. ftdpj;jy;.
epkplq; mitahtd. grpapog;G
fs;  czt+l;l vz;zj;ij mwpAk; ghpNrhjid Nehapw;fhd
 czt+l;l Fiwghl;ilf; fz;lwpAk; fzf;fPL. rpfpr;ir
];fhg; tpdhtpil Kiw: Kiwfis
,k;Kiw fpNul; gphpl;ldpy; cUthf;fg;gl;lJ. Grpapog;G tpsf;Ff.
Nehapd; mwpFwpfis czUk;nghOJ mjidf; fz;lwpa
,t; tpdhtpil Kiw cgNahfg;gLj;jg;gLfpd;wJ. fPNo
tthpf;fg;gl;l tpdhf;fspy; ,uz;L tpdhf;fspd; tpilfs; “
Mk;” vd;w gjpy; miktjhfg; ngwpd; me;egh; grpapog;G
Nehapdhy; gPbf;fg;gl;Ls;s epiyiaf; Fwpf;Fk;.

];fhg; (Scoff):
S- ePq;fs; czT cl;nfhs;sh epiyia mila mjpf
msT ePh; mUe;Jtjhy; ePqf
; s; Neha; gPbf;fg;gl;ljhff;
fUJfpwPh;fsh?
c- ePq;fs; czT mUe;Jtjpy; cs;s fl;Lg; ghl;bid
,oe;J tpl;Bh;fsh?
o- ePq;fs; rkPgfhykhf 13 gTz;l; cly; vilia ,oe;J
cs;sPh;fsh?
f- ePq;fs; kw;wth;fs; cq;fis nkype;j epiyapy; cs;sPh;fs;
vd;W nrhy;Yk; nghOJ ePq;fs; cly; vil $bAs;sjhf
ek;GfpwPh;fsh?
f- czT kw;Wk; czitg; gw;wpa vz;zq;fs; cq;fs;
tho;f;ifapy; Mf;fpukpg;Gr; nra;fpd;wjh?

grpapog;G Nehapw;fhd rpfpr;ir Kiwfs;:

,r;rpfpr;irapy; gytifahd Kiwfs; cs;sd.
Mitahtd
1. rpwg;ghd njhlh;G Kiwfs;
2. kpy;ypa+ rpfpr;ir
.
3. mwpTrhh;e;j gof;f rpfpr;ir
4. gof;f tof;fk; rhh;e;j kw;Wk; cs; kdJ rhh;e;j
rpfpr;ir
5. jdpkdpj (jdpegh;) kdeyr; rpfpr;ir.
6. FLk;g cWg;gpdh;fSld; $ba rpfpr;ir
7. For;rpfpr;ir
8. kUe;jf rpfpr;ir
1. rpwg;ghd njhlh;G Kiwfs;:
 Nehapdhy; ghjpf;fg; gl;lthplk; gpizg;G
Vw;gLj;jy;.
 gakpy;yhj kw;Wk; jz;lidapy;yhj
#o;epiyia cUthf;Fjy;
2. ghJfhg;ghd #o;epiy rpfpr;;ir:
  Nehapdhy; ghjpf;fg; gl;lth; czT cz;L
grpapog;G Kbg;gjw;F xU Fwpg;gpl;l fhy msit
Nehapdhy; eph;zapf;f Ntz;Lk;.
Vw;gLk;  Nehahspapd; FO nray; Kiwfis gapw;Wdh;:
tpisTfis neUf;fkhff; fz;fhzpf;f Ntz;Lk; grpapog;G
thpirg;gLj;jy 3. mwpT rhhe;j gof;f rpfpr;ir: Nehapdhy;
 mwpT rhh;e;j gof;f Kf;fpa Vw;gLk;
rpfpr;irapd;
Nehf;fkhdJ Nehahspapd; Neha; mwpFwpfisf; tpisTfis
Fiw;ggJ kw;Wk; mth;fspd; jd;dk;gpf;if thpirg;gLj;J
mikg;gi kW totk; Vw;gLj;jp Nehapd; jPtpu jy;.
epiyikapidf; fl;Lf;Fs; nfhz;L tUtjhFk;.
5
4. gof;f tof;fk; kw;Wk; cs;kdJ rhh;e;j rpfpr;ir: gapYdh;:
epkplq; grpapog;
 ,r;rpfpr;ir KiwahdJ mwpT rhhe;j gof;f ftdpj;jy;
fs; G Nehapdhy;
tof;f rpfpr;ir KiwAld; Nrh;e;J nra;af;$ba
Vw;gLk;
rpfpr;ir KiwahFk;.
tpisTfis
5. jdpegh; kdeyr;rpfpr;ir:
thpirg;gLj;Jf
 jdpegh; kdeyr;rpfpr;ir rpfpr;ir .
nepwKiwfis cs;slf;fpaJ. ,J Nehahspf;F
cz;ikahd vz;zk; kw;Wk; nray; Kiwfsi
cUthf;f cjtpGhpfpd;wJ. Mitahtd.
 Nehahsp jd;idg; gw;wp cah;thf epidf;Fk;
vz;zj;ij mjpfhpf;fpd;wJ.
 6. FLk;g cWg;gpdh;fSld; $ba rpfpr;ir:
 FLk;g cWg;gpdh;fSld; $ba rpfpr;irahdJ
FLk;g cWg;gpdh;fSf;F grpapog;G Nehapd;
FwpaPLfs;> mwpFwpfs;> rpfpr;ir kw;Wk; jLg;G
Kiwfs; gw;wpa fy;tpia cs;slf;fpaJ.
7. FOr;rpfpr;ir:
,f; FOr; rpfpr;irapy; ,e;Nehapdhy; ghjpf;fg;
gl;lthf;s FOtpy; ,lk; ngWth;. vdNt Nehapdhy;
ghjpf;fg;gl;l xU Nehahsp mNj Nehapdhy;
ghjpf;fg;gl;l kw;w Nehahspiag; ghh;f;Fk; nghOJ
mth;fSila Nehapd; gpur;ridfis Rygkhf
mwpe;J nfhs;s ,f;FOr; rpfpr;ir cjtp nra;fpd;wJ.
8. kUe;Jr; rpfpr;ir:
grpapog;G Neha; rpfpr;irf;F ve;j tpjkhd
rpwg;G kUe;JfSk; fpilahJ.
kdr;Nrhh;T kUe;Jfs; ,e;Nehapdhy; Vw;gLk; kdr; Nrhh;itf;
Fiwf;f Vw;Wf; nfhs;syhk;.
tpisTfs;:
grpapog;G Neha; jPtu tpisTfis cs;slf;fpaJ.
grpapog;G cly; KOtijAk; ghjpf;fpd;wJ.
%is kw;Wk; euk;Gfs;:
rhpahf rpe;jpf;f KbahJ>Vil $btpLK; vd;w gak;>
ftiy> Nrhh;T> vhpr;ry; epiy> Qhgf kwjp> kaf;fk;> %is> ePhk
; g;gbf
 grpapog;G Ntjpg; nghUl;fspd; khw;wk;. xspj;jpiu
Nehapidj; Nuhkk;:
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.
Guided By Prepared By
Mrs. Ruthrani, MSc (N)
HOD of psychiatric department Reg.No. 301331551
RASS Academy college of Nursing
Poovanthi
INTRODUCTION
 Adolescence is a transitional stage of physical &
psychological human development occurring during the
period from puberty to adulthood, due to peer pressure
they avoid eating foods.
DEFINITION
 ANOREXIA NERVOSA;
It’s refers to refusal to maintain a healthy body weight , a
fear of weight gaining, and an unrealistic perception of current
body weight.
INCIDENCE
 90-95% 0f Anorexia nervosa suffers are Girl’s& women
Between 0.5-1% American women suffers Anorexia
nervosa.
It’s the high risk eating disorder cause serious issues.
RISK FACTORS
 Strict dieting
 Body dissatisfaction
 Perfectionism
 Family history of eating
disorders
 History of physical or
sexual abuse
 Low self esteem
CAUSES
 Socio cultural factors
 Biological factor
 Genetic factors
PATHOPHYSIOLOGY
WARNING SIGNS
 Refusal to eat & rapid weight loss.

 Denial of hunger.

 Difficulty in concentration.

 Making excuses for not eating.

 Obsession with body size & shape

PRIMARY SYMPTOMS
 Resistance to maintaining body weight.

 Fear of weight gain or being’ fat’

 Disturbances in body weight & shape.

 Loss of menstruation.
DIAGNOSTIC EVALUATION
 Weight calculation by measuring Body Mass Index
Avoidance of fattening foods
Body image disturbances
Endocrine disorder
TREATMENT
 Participation & support of family members will provide
success treatment .
 On earlier stage anorexia nervosa can be treated easily
 Effective communication strategies

 Cognitive behavior therapy

 Psychotherapies(individual, family, group)

 Antidepressants
MANAGEMENT
 Efforts to change the maladaptive eating behaviors
Seeking medical attention for weight loss
Willingness to accepting the concept of intake
COMPLICATIONS
PREVENTION
 Aim;
 To rule out the medical complications
 Primary Prevention:
 Identify risk groups and educate about nutrition,
 Provide counseling to the Adolescents, family, schools &
college students.
 Effective communication
Secondary prevention;

 Reducing the duration of anorexia nervosa

 Nutrition education,
 Fitness comes in all sizes
 Say no to teasing
 Emotional bites
 Treatment
 APPENDIX - IX

LIST OF EXPERTS

Dr.Prof.S.Rajina Rani M.Sc(N),P.h.D,

Principal,
RASS Academy College of Nursing,
Poovanthi,
Sivagangai District.

Prof.Mrs .R. Ruth Rani, M.Sc (N),

HOD of Psychiatric department,
RASS Academy College of Nursing,
Poovanthi,
Sivagangai District.

Mrs.H.UmmulHapipa, M.Sc (N),

Vice Principal and HOD of Medical Surgical Nursing,
RASS Academy College of Nursing,
Poovanthi,
Sivagangai District.

Dr.V.Ramanujam, MBBS,M.D, (PSY)

Medical officer,
Srinivasa hospital,
Sivagangai.

Mrs.D.Rojaramani, M.sc(N),
Assistant professor,
Matha College of nursing,
Manamadurai.
Sivagangai Dist.
Prof.Mrs.V.JecinthaVedanayagi, M.sc (N),
HOD of Psychiatric Nursing,
Sacred Heart Nursing College,
Madurai.

Mrs.S.Induja, M.Sc (N),

Professor,
Sacred Heart Nursing College,
Madurai.

Mr.P.Selvaraj, MSc (N),

HOD of Psychiatric Nursing,
Shanmuga College of Nursing,
Salem.

Mr.Sam Ebenezer, MSc (N),

HOD of Psychiatric Nursing,
Shri Nithi College of Nursing,
PottaPalayam,
Sivagangai District.

DR.Varadharajan M.sc.,M.phil.,M.Ed.,Ph.D(Edn),
Professor of psychology,
RASS Academy College of nursing,
Sivagangai.
 APPENDIX - X
Photographic evidence of data collection