A STUDY TO EVALUATE THE IMPACT OF AN EDUCATIONAL PACKAGE UPON THE KNOWLEDGE AND ATTITUDE OF INFANT’S MOTHERS REGARDING WEANING

INTRODUCTION

"Small opportunities are often the beginning of great enterprises."
Demosthenes

Breastfeeding and weaning practices are important determinants of growth and development not only in infancy but also later in life. Appropriate nutrition during infancy is essential for optimal growth and development, and when solid food is introduced is recognized as important. Guidelines recommend that infants start weaning from six months. Weaning is the process of gradually introducing a mammal infant, either human or animal, to what will be its adult diet and withdrawing the supply of its mother's milk. The process takes place only in mammals, as only mammals produce milk. The infant is considered to be fully weaned once it no longer receives any breast milk (or bottled substitute). Solid food is gradually introduced to a baby's diet, alongside its previous diet of breast or formula milk, at around six months (though this varies slightly from child to child). Before this, a child's digestive system and kidneys are still developing and are not yet ready to deal with solid food. Soft, runny food such as mashed fruit or vegetables are introduced to babies in the early stages of weaning, as they do not have teeth and are unable to chew.¹

Malcolm Knowles says that “in an era of knowledge explosion and accelerating social change, people who do not continue to learn become obsolete and obsolete human beings are a drain on our resources. Thus learning is a continuous process and in today’s world no one can complete education. ²

Teaching is a deliberate intervention that involves the planning and implementation of instructional activities and experiences to meet intended learner outcomes according to a teaching plan. Teaching is also a highly versatile strategy that can be applied in preventing, promoting maintaining and modifying a wide variety of behavior in a learner who is receptive, motivated, and adequately informed³.

            Growth faltering and malnutrition are highly prevalent in most South Asian countries. Among the serious consequences of malnutrition are increased risks of morbidity and mortality in children as well as deficits in physical stature and lowered cognitive measures. Childhood malnutrition in poor households has been well documented in India. . Countrywide National Family Health Survey II (NFHS II) data show mean underweight prevalence increases from 11.9% among infants fewer than six months of age to 58.4% at 12-23 months of age. and  with the highest rates observed in those aged 12-23 months. ⁴

            The weaning process varies widely among different cultures as to when the practice is initiated and terminated; in the variety, quality, and  quantity of the weaning foods; and in the manner in which the endogenous food is provided. The variations in practices range from providing a food source even before the first breast-feeding to feeding nothing but breast milk for as long as 9 to 12 months, and include feeding from a cupped hand to use of a modern feeding bottle.  However, among some poor traditional societies and in deprived environments, this food may be limited and monotonous in flavor and texture. The  serious malnutrition prevalent in the 1 to 3 year olds in many deprived environments have its antecedent etiology in the complementary feeding practices established in the first year of life. Effective interventions to reverse growth faltering of infants reared in deprived environments where breast-feeding is prolonged may require increased attention to providing variety  in the weaning diet from at least 6 months onward. ⁵

            Infants are at increased risk of infection during weaning when caregivers begin giving foods other than breast milk to 4-6 month old infants. Since the gradual withdrawal of breast milk reduces its benefits, infants are more exposed  to food-borne microorganisms. Thus, it is especially important to practice safe food preparation and storage during weaning. Infants mothers  should  find ways to reduce the risk of diarrhea from contaminated food. ⁶

The world health organization has given definition of weaning as “Weaning is the process by which an infant gradually becomes accustomed to an adult diet WHO (2003) An other historical definition “To replace mothers milk with other nourishment” The American Academy of Pediatrics (AAP) recommends feeding babies only breast milk for the first 6 months of life. After that, the AAP recommends that a combination of solid foods and breast milk be given until a baby is at least 1 year old.

Weaning is a difficult period in infant’s life because, the food supplements or substitutes or not adequate in quantity and quality the child becomes malnourished. Millions of children around the world in underdeveloped tropical and subtropical areas are suffering from malnutrition as a result of poverty, unavailability of suitable foods, lack of knowledge and superstitions on weaning practices. The key to successful weaning and infant feeding practices is correct diagnosis of their problems , attitude towards these feeding practices ant the most important is the education about the same . dissemination of healthy information is one of the ways of increasing knowledge on weaning and feeding practices. Moreover, each individual has self care potential in assuming this responsibility. ⁷

Need for study.

When we are no longer able to change a situation, we are challenged to change ourselves.  ~Victor Frankl

               Complementary feeding, also known as weaning, mixed feeding or introduction of solid foods, should begin for infants by six months of age (26 weeks) but not before 17 weeks. Breast milk or infant formula should continue during the complementary feeding period with amounts gradually reduced as the variety of foods increases. As all infants' needs are different, health care professionals have to be aware of key nutrients and foods needed at the same time as monitoring growth and understanding the needs of parents and the resources available to them.⁸

               The WHO 2001 global recommendation is a one size fits all approach to weaning, an approach which may not take sufficient account of the special needs of some infants and fails to allow for the different problems encountered in the industrialised nations compared with economically developing countries. For the healthy normal birth weight full term infant born in an industrialised country, current research supports the benefit of exclusive breast milk feeding until 4-6 months and after that with proper weaning practices and other complementary foods. So infants should be managed individually according to their needs. ⁹

               A survey  study was conducted in Rajasthan, India to explain the infant feeding and weaning practices in the rural communities from 328 rural mothers.  The study shown that  Mean age at weaning (27.1 months) again not only affects the health status of mothers and their children but also leads to the undernutrition among both. The study concluded that there is an urgent need  to evolve an exhaustive educative programme dealing with various aspects of infant feeding and weaning practices, keeping in view their traditions, so that the useful practices can be encouraged and harmful ones be prohibited. ¹⁰

               A study was conducted in Baroda to assess the Knowledge and practices regarding breast feeding and weaning using pretested questionnaires. Results indicated that  mainly commercial baby foods were used for weaning. Most mothers avoided 'dals' for the child because these were believed to be difficult to digest and produced gas in the child's stomach. Fifty percent of the mothers were not in favour of feeding the sick child with small frequent meals. The study revealed that there was an urgent need of proper education on these mothers regarding the right breast feeding techniques and weaning practices. ¹¹

               A comparative study was conducted in Varanasi, India to describe  infant and child feeding practices in the urban, urban  slum, and rural areas.  784 mothers were  interviewed from which the results    shows that 66.67% of children in the urban group were weaned before 6 months, as compared to 40.14% and 33.63% in the slums  and in the rural group; weaning was markedly delayed in those last 2 groups; 5-9% of children in rural areas were not weaned at all. The study concluded that traditional and customary child rearing practices are still prevalent in urban slums and rural areas, and certainly not to the advantage of the growth and development of children. Only education on infant health and nutrition imparted to young mothers would correct such age-old infant  feeding practices. ¹²

               A longitudinal study was conducted in India to evaluate the role of weaning in determining the nutritional status of infants as well as to identify the sociocultural factors affecting weaning practices in the rural area. . 98% had poor knowledge about nutritional requirements of infants, other than that breast milk  is the natural food of infants. Most mothers practiced poor hygiene. Nutritional status declined with age, reflecting the unhygienic weaning practices in the area. At the end of  12 months, 6.8% suffered from severe grades of malnutrition. . These findings show that inadequate knowledge about proper weaning, not lack of food, is the limiting factor in infant nutrition. Education about the importance of proper weaning and  weaning foods imparted by grass-root level workers is needed. ¹³

               A survey study was conducted in Srinagar,  India to determine whether maternal knowledge and practice were associated with the nutritional status of the infants. health workers interviewed 123 mothers of infants attending the child health clinic  28 children were considered to be well nourished, while the remaining 95 children were determined to be in various degrees of malnutrition. The findings show a decreasing trend between awareness and practice of breast feeding/infant weaning, suggesting that further improvement of health education is needed to reduce the lag between weaning  awareness and practice. ¹⁴

               A survey was conducted in Maharashtra to assess the  prevalence of malnutrition and its relation with feeding practices was studied in 605 tribal underfive children. There was a significant relation of nutritional status of preschool children to feeding practices. So the information revealed that Health education messages should stress on importance of timely weaning with introduction of solid foods by 6 to 9 months of age; to address the widespread problem of malnutrition in under five children. ¹⁵

Review Of Literature.

Review of literature is a systematic identification, location, scrutiny and summary of written materials that contain information on research problems. ¹⁸

This chapter deals with selected studies, which are related to the objectives of the proposed study, which helped the investigator to develop a deeper insight into the problem and gain information on what has been done in the past.

The review of related literature was done through medline, internet, journals and text books and is organised under the following headings.

1. Literatures related to prevalent weaning practices.

2. Literatures related to teaching as an effective interventional strategy .

3. Literatures related to knowledge and attitude of mothers on weaning practices.

Literatures related to prevalent weaning practices.

        A study based news was published in South Africa which dealt with the guidelines proposed for the age group 6-12 months regarding the introduction of complementary foods in the infant's diet. The studies shown that  most of South African infants receive solid foods at the age of 4 months or earlier while only a small percentage are breastfed exclusively until 6 months.

The untimely and inappropriate introduction of complementary foods have been shown to be risk factors for both under- and over-nutrition with resultant under- or overweight, stunting and micronutrient deficiencies. The studies concluded that . timely introduction of appropriate complementary foods is necessary  for the immediate and long-term health of the infant.¹⁹

            A descriptive cross sectional study was conducted in Ethiopia to assess the  mothers' knowledge and practice related to weaning in 1,543 mother-child pair. 40% of the weaned children were reported to have been started on weaning food at the age of 4-6  months. Of the children who were reported to be exclusively breast feeding, 34% were beyond the age of 7 months. The majority of the mothers used "swallow or suffocate" method in feeding their children. The study concluded that there is an urgent need of appropriate intervention to avoid the inappropriate weaning practice in the area.²⁰

            A cohort study was conducted in rural Malawian community to compare growth, morbidity incidence and risk factors for under nutrition between infants receiving complementary feeding early, before 3 months of age, with those receiving complementary foods after 3 months. Infants with early complementary feeding had lower weight for age, increased risk for respiratory infection (P<0.05),marginally increased risk for eye infection and episodes of malaria. While later complementary feeding was associated with reduced infant morbidity and improved growth. The study concluded that greater emphasis is required to promote  breast-feeding  programmes and to improve complementary feeding practices. ²¹

               A cross-sectional study was conducted in Pakisthan to assess the current weaning practices in infants. Among 150 infants who were selected for this study 60% infants were

receiving semi-solids foods in addition to milk. The recommended age (between 4 to 6 months) was noted in 25% cases, while early weaning was  present in 6% cases and delayed weaning in 29 % cases. The study concluded that the identification and analysis of weaning practices prevalent can lead to remedial strategies for improving the nutrition status of infants and, thereby, help reduce infant and morbidity rate.²²

               A study was conducted in Bombay suburb, India covering a total population of 4879. One hundred and fifty-three mothers having children below two years were interviewed. Only 48% of infants were fed weaning foods between the ages of 6 and 10 months. From that 23% of mothers used bottle for administration of supplementary food or water. Only 15.7% of mothers used commercial milk formula and 8.5% used commercial weaning food. The study concluded that the weaning practices followed by the infant’s mothers were not up to the level of expectation. ²³

            A cross-sectional study  was carried out in 57 lactating mothers in a  rural community of West Bengal, India to investigate  the breast feeding and weaning practices.  52.6% of infants were offered sweet water and only 24.6% were offered breast milk as first feed, all 57 were put on breast milk within 24 hours of delivery. The introduction of artificial milk to young infants was practiced in 35 cases. 77.2% received such milk before reaching 6 months of age The study concluded that early and prolonged breast feeding was an universal practise, but timely weaning was neglected and offered to 54.5% of infants only. ²⁴

               A study was conducted in Agra, India to assess  the prevailing complementary feeding practices. The results showed that 30.9 percent infants were not receiving complementary foods, 21.9 % mothers initiated complementary feeding at the right age and it was fed mostly  (88.6%) in  semi-solid consistency, 66.7 % practiced demand feeding and the  practice of cleaning hands before feeding was very poor with only 17.1%. the study concluded that complementary feeding practices were not satisfactory and need to be improved. ²⁵

Literatures related to teaching as an effective interventional strategy .

               A prospective study was conducted in  Sewagram, India to examine weaning and food supplementation practices  and to conduct health educations on the importance of exclusive breast feeding, followed by the introduction of semisolid foods. The results showed that only 1% began weaning before 4 months of age. Between 4 and 6 months, 38% mothers initiated weaning and after 6 months  61%.  The study concluded that health education campaigns improved the situations existed. ²⁶

               A survey study was conducted in Baharin to assess out the current practices of infant feeding in Bahrain and the impact of health educational to the mothers on these practices. A total sample of 200 Bahraini mothers of children less than 2 years were interviewed in the health centers.  The study revealed that introduction of foods during the first 3 days of the infant's life as well as the practising of breastfeeding on schedule increased after giving health education to the  mothers. ²⁷

               A cohort study was conducted in Sub-Saharan Africa to facilitate optimal growth of newborns by introducing feeding recommendations. The results showed that most babies were given water or other supplemental foods soon after birth, the exclusive breastfeeding rates were only 19%, 8%, 2% and 0% at ages 1, 2, 3 and 4 month, respectively. Complementary foods and family foods were introduced at median ages of 2.5 and 6.3 mo, i.e. much earlier than recommended. The study revealed that education and family planning improves adherence to infant feeding recommendations and reduce the incidence of early childhood malnutrition.²⁸

               A longitudinal study was conducted to compare infant feeding practices among  217 low-income, urban, African-American women. They were divided into two groups and one group was enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children( WIC) and the other was not. A structured questionnaire was given to both and the results showed that by 7 to 10 days postpartum, approximately a third of infants were receiving some nonmilk liquids or solids; this escalated to 77% by 8 weeks and 93% by 16 weeks postpartum. The study concluded that WIC nutrition program was a very powerful and innovative educational tool to motivate and help mothers for weaning. ²⁹

Sunita (2004)³¹ conducted a study on the effect of structured teaching programme on knowledge and practises related to hand washing technique among food handlers in the mess of Christain Medical College and Hospital Ludhiana (Punjab) A descriptive co- relational approach was adapted to assess knowledge and observe the hand washing practises of food handlers before and after structured teaching programme by using purposive sampling technique among 23 food handlers had poor knowledge and hand washing practises and structured teaching had been significantly effective in increasing their knowledge and practices scores. ³⁰

Pratima (2002)³¹ conducted a study to assess the effectiveness of planned teaching programme on the knowledge of G.N.M. students regarding breast cancer and breast self examination (BSE) and the ability to perform (BSE) in a selected school of nursing in West Bengal. Simple random sampling technique was used among 30 second year GNM students. A structured questionnaire and observational checklist were found to be suitable for the study to assess the knowledge of a group of G.N.M. students about breast cancer and breast self examination (BSE). The findings of this study indicate that the planned teaching programme enhanced the knowledge and developed the ability of the G.N.M students to perform (BSE). The PTP is a suitable method of instruction for educating G.N.M. students for disseminating health information.

Manju (2000)³², conducted a study on a teaching programme to the caregivers of bedridden neurological patients on prevention of pressure sores. A pre experimental research approach was used for the study. The investigator concluded that a planned teaching programme on prevention of pressure sores to the caregivers of bedridden neurological patient was effective in terms of preventing pressure sores in their patients.

Philip (1999)³³ conducted a comparative study to determine the effectiveness of PTP of breast care during postnatal period in Karnataka. Forty primigravida mothers were selected using non-probability purposive sampling. Structured interview schedule and observations checklist was used for data collection. Finding of the study revealed that the PTP was highly effective for both primigravida and primiparous women and there was no difference in gain in knowledge scores between those who were exposed to PTP in the antenatal period and those who were exposed to PTP in the post natal period.

Literatures related to knowledge and attitude of mothers on weaning practices.

            A prospective study was conducted in Hong Kong to describe the knowledge on  breastfeeding and weaning practices of mothers over the infant's life and to determine the factors associated with early cessation of breast feeding. The  study used descriptive statistics in 1417 mother-infant pairs and the results showed that at 1 month, 3 months, 6 months and 12 months only 63%, 37.3%, 26.9%, and 12.5% of the infants respectively, were still receiving any breast milk; approximately one-half of breastfeeding mothers were exclusively breastfeeding. The study concluded that breastfeeding promotion programs have been successful in achieving high rates of  breastfeeding and weaning initiation. ³⁴

               A study was conducted in Egypt to assess the the effect of teaching about weaning in  50 mothers aged 15-40. The mothers were interviewed at baseline on their weaning knowledge and practice, then re-interviewed after having been taught relevant information by community nursing students. Mothers' weaning-related knowledge, attitude, and practice were significantly improved by the nutrition education intervention. The study revealed that mothers' level of education was found to be an important  factor affecting knowledge, attitude, and practice.³⁵

            A longitudinal  survey study was conducted in Australia to describe women's views about aspects of infants' diets around the time of weaning. Among  505 women joined in the study majority of women(84%) viewed fruit juice was suitable, 14% cow’s milk and  77% considered that additives in food could cause health problems. There is considerable diversity in the views women express about aspects of infant feeding that have been the subject of guidelines. The  study concluded that health promotion efforts are needed to achieve greater consistency with recommendations and to address other concerns women have. ³⁶

               A study was conducted in China to study the effects of existing different modes of health education on mothers knowledge in feeding babies and young children. 414 mothers with their babies aged 0 to 18 months were interviewed with an ad hoc questionnaire. The  results

revealed that the best source of mothers' nutritional knowledge was derived from a comprehensive mode of health education, the others from mass media and medical care professionals. The study  suggested that  comprehensive education channel, training course for pregnant women, baby-friend hospitals, and so on, all are major means of nutritional education for baby feeding. ³⁷

            A  longitudinal study was conducted in Lahore, Pakisthan to assess the  beliefs and practices related to the feeding in 52 infants through quantitative and qualitative data during their first year of life. The results showed that  98% mothers started breast feeding within the first week,  prelacteal feeds were  given to 94% infants, 55.4% cases considered Water was essential from the very first day and 48% babies were put on supplemental bottle feeding during the first week and by five  months of age 97% were bottle fed. The study concluded that health education interventions are needed to promote use of colostrum, exclusive breast feeding and appropriate

complementary feeding practices as it depends on the attitude and knowledge of the mothers  to do so.³⁸

            A study was conducted in Bangladesh to assess their knowledge and attitude regarding breastfeeding and weaning using pretested questionnaires.  The results showed that 83.5% mothers knew that colostrum is good for the child, majority among them   did not have the correct knowledge about the appropriate time for introduction of weaning foods; and only 3% of them knew how to prepare proper weaning foods. The  mean score of knowledge of the mothers was only 4 +/- 1.7 out of 10. The study concluded that there is an urgent need for nutrition education among mothers so as to increase their knowledge and attitude towards breast feeding and weaning practices. ³⁹

               A study was conducted in Nigeria to examine the knowledge, attitude and practice of weaning in 516 mothers. The study results shows that 44.2% of selected mothers  had commenced weaning by 3 months of age while 83.9% had done so by 6 months and  36.2% indicated the reason of weaning by  crying after a feed or demanding more frequent feeds. 55.8% reported diarrhea, associated with bottle feeding or cow-pea diet, as the major cause of  morbidity during weaning. The study suggested the  ways of improving child health during the weaning period. ⁴⁰

A survey study was conducted in Jabalpur, India to assess the attitude concerning breast feeding, top milk initiation, feeding technique, and weaning practices. 80 mother substitutes were interviewed. The results of the study shows that 50% believed in initiating breast feeding from the 2nd day onward, the majority of substitutes thought proper weaning age to be after 6 months, 50%, aged 21-40 years, believed in adding solid food from below 6 months, 90% of the young mother substitutes were against solids being introduced by the age of 4 months and the majority of the substitutes suggested weaning foods such as dal, rice, roti, and biscuits with a few considering tinned cereals as proper weaning foods. The study revealed the reason for protein and energy deficiency which can be observed around weaning age in many infants throughout the 3rd world. ⁴¹

               A cross sectional  study was conducted in U.K. to examine   the mothers' perceptions of desirable nutritional practices in infant feeding. A total of 1004 mother-infant pairs were taken for the study. The results showed the misconceptions of mothers' attitudes to healthy eating for infants; 83% felt that a high fibre intake was important  while 20% considered that plenty of calories was not important and  87% that a low fat intake was important. The  study  concluded that mothers considered a wide variety  of foods, plenty to drink and a low sugar and salt intake to be important. ⁴²

A cross sectional community based study was conducted in Andhra Pradesh, India to assess Knowledge, Attitude & Practices of mothers regarding Breast Feeding and weaning and to Eliminate Harmful Breast Feeding Practices, by Intensive Health Education to mothers. 9% preferred Bottle Feeding majority of the subjects (62%) knew that weaning should be initiated by 4-6 months of age but only 35% mother initiated it by the correct age of 6 months. Only 18% knew about the harmful effects of delayed weaning. 81% mothers preferred liquid foods for weaning and a statistically significant difference was found among illiterates & educated (x2 = 4.747, P <0.05). The study concluded that all mothers should be educated about Basic principles of Breast Feeding & weaning during antenatal period.⁴³

A study was conducted in India to assess the knowledge and practice of mothers regarding infant feeding. The results showed that about two-third of the under-five children from the respondents is malnourished. Among them, 5-8% are severely malnourished while rest fall in the group of mild or moderate malnutrition. The study concluded that every time an innocent child suffers the curse of malnutrition; the responsibility goes to the mother, the family and to the community due to their faulty or no knowledge regarding the harmful effects of prelacteal feeding, benefits of exclusive breast feeding and initiation of proper weaning at the correct time.⁴⁴

               A study was conducted in Karnataka, South India to assess the knowledge and attitude towards infant feeding. 300 mothers whose babies' ages from 3 days to 17 months was randomly selected for the study. The results showed that 71% of the mothers considered 3 to 5 months to be the optimum duration of exclusive breast-feeding.  90% felt that cow's milk was an ideal supplement. 78.3% subscribed to the view that breast-feeding should continue beyond one year. A sizeable proportion expressed the need to discontinue breastfeeds during babies' or maternal illness, particularly diarrhea. The study concluded with a need of future health education program. ⁴⁵

            A study was conducted in Ludhiana to assess the attitudes of 2500 urban college girls towards infant feeding.the results of the study revealed that the overall attitudes of the whole group towards infant feeding were negative. Science students had better attitude scores on most of the themes tested (p < 0.05) and most of the girls were desirous of studying the concepts of infant feeding in their college curriculum. The study concluded with strongly recommending to put efforts to incorporate these concepts in the formal educational curriculum so that girls grow up with positive attitude towards infant feeding. ⁴⁶

METHODOLOGY.

Research methodology is a way of systematically solving the research problem it explains the various steps that are generally adopted by a researcher in studying the research problem along with the logic behind it.

This chapter deals with the methodology of the study to evaluate the effectiveness of the educational package on infant’s mother upon weaning practices.

Methodology of research indicates the general pattern to gather valid and reliable data for the problem under investigation.

RESEARCH APPROACH.

Descriptive and evaluative survey approach was used in the study. Descriptive approach was used to assess the knowledge and attitude of infant’s mother on weaning practices. Evaluative approach was used to test the effectiveness of the planned teaching program regarding weaning practices.

According to Polit and Hungler (1999) descriptive studies are undertaken to describe what exists in terms of frequency of occurrence (or its presence versus absence) rather than to describe the relationship between variables.⁴⁷

Polit and Hungler (1999) describe evaluation research as an applied form of research that involves finding out how well a program, practice, procedure or policy is working.

Objectives of the study:

Objectives provide the investigator with some clear criteria against which, the proposed research method can be assessed. For the present study, review of literature, discussion with experts, and personal experience of the investigator gave a basis for selection of the problem.

Statement of the problem:

A study to evaluate the impact of an educational package upon the knowledge and attitude of infant’s mothers regarding weaning in selected community, Gulbarga.

The objectives of the study are

1. To assess the knowledge and attitude of mothers of the infants regarding weaning.

2. To prepare an educational package on weaning.

3. To evaluate the impact of educational package in terms of knowledge and attitude among infant’s mothers on weaning.

4. To determine the association of mean pre-test knowledge scores of mothers of infants with selected socio demographic variables.

To determine the association of mean pre-test attitude scores of mothers of infants with selected socio-demographic variables.

Operational definitions:

1.         Evaluation:

         The final stage of nursing process in which the effects of nursing intervention are compared with the goal or objective is set in the care plan.

2. Educational Package

It is a package of instructions which enable the mothers to practice weaning. In my study a planned teaching program is done with providing an information booklet to all my samples which has a description of the content of the teaching for their reference.

3.         Impact:

In this study impact refers to effect or influence of the educational package regarding weaning.

4. Knowledge:

In this study it refers to the understanding ability to answer on weaning by mothers of infants.

5. Attitude:

It refers to the opinions values, feeling expressed by mothers of infants.

6.          Weaning:

It is the process of gradual and progressive transfer of the baby from the breast milk to the solid foods.

7. Infant Mother :

Mothers of the infants who fulfills all the inclusion criteria of this study.

Assumptions

1. Mother of infants will have some knowledge regarding weaning to some extent.

2. The educational package is an accepted teaching strategy to improve the knowledge level.

3. Mother of infants will have a positive attitude regarding weaning.

Hypotheses:

All hypotheses will be tested at 0.001 level of significance.

H₁: The mean post test knowledge scores of the mother of infants regarding weaning will be significantly higher than the mean pre test knowledge scores

H_2: The mean post test attitude scores of the mother of infants regarding weaning will be significantly higher than the mean pre test attitude scores.

H_3:There will be significant association of knowledge scores with selected demographic variables.

H4: There will be significant association of attitude scores with selected demographic variables.

DELIMITATION

1. Mothers of infants who are residents of Nandur community in Gulbarga.

2. Mothers of infants who are able to communicate in English and Kannada.

3. Mothers of infants who are willing to participate in the study.

4. Mothers of infants who are present at the time of the study

SAMPLING CRITERIA

INCLUSION CRITERIA

- Infant’s mother in the age group of 15-35 years in Nandoor community, Gulbarga.

- Infant’s mothers who are able to communicate in English and Kannada.

- Infant’s mothers who are willing to participate in the study.

- Infant’s mothers who are present at the time of the study.

EXCLUSIVE CRITERIA

- Infant’s mothers among which their babies are below 6 months of age.

- Infant’s mothers who are not able to communicate in English and Kannada.

- Infant’s mothers who are not willing to participate in the study.

- Infant’s mothers who are not present at the time of the study.

CONCEPTUAL FRAMEWORK

Conceptual framework is defined as a theoretical approach to the study of problems that are scientifically based, which emphasizes the selection, arrangement and classification of its concept.⁸ A conceptual framework states the functional relationships between the events and is not limited to statistical relationship. ¹⁶

Christensen J. Paula⁹ defines ‘theory’ as “a set of concepts, definitions and propositions that project a systematic view of phenomena by designing specific inter-relationships among concepts for the purpose of describing, explaining, predicting, controlling or prescribing the phenomena”. ¹⁷

The present study aimed at evaluating the effectiveness of an educational package upon the knowledge and attitude of infant’s mother regarding weaning in Nandoor at Gulbarga.

The conceptual framework of this study was based on the general system theory developed by Ludwig Von Bertalanffy with input, process, output and feedback in 1968.

According to systems theory a system is a group of elements, which are considered to be individuals and their environment. An individual is capable of taking energy and information as input from the environment and release it to the environment. This input, when processed, provides an output and continues to be so, as long as these four parts keep interacting. If there are changes in any of the parts, there will be changes in all the parts. This system is cyclical in nature that interacts with one another in order to achieve the goal. Feedback from within the system or from the environment provides information, which helps the system to determine whether it meets its goal.

In this study, these concepts can be explained as follows.

Input: It refers to the process by which the system receives energy and information from the environment. These inputs include ‘learners’ background, level of knowledge and interest.

In this study input refers to the mother of infants. The influencing demographic variables are age, educational qualification, marital status, type of family, religion, family income and source of information.

Process: It refers to the actions needed to accomplish the desired task, i.e. energy and information for the maintenance of homeostasis of the system. Through dynamic interaction with the environment, the system changes information in different forms such as verbal and behavioral communication.

In this study, process refers to knowledge of the infant mothers which will be assessed using a structured knowledge questionnaire; educational package will be developed and administered. Following this, knowledge will be assessed again by using the same structured questionnaire to know the gain.

Output: Output refers to the product of the process. After processing the input, the system releases the energy and information to the environment as output.

In the present study, output refers to the evaluation of the effectiveness of an educational package on infant’s mother regarding weaning practices that may also be regarded as the product of the process.

Feedback: Feedback refers to the process by which information is received at each stage of the system and the feedback as input to guide/direct in its evaluation.

It is the process that provides information about the systemic output. Accordingly, the higher knowledge scores obtained by the infant mothers in the post test indicate that the educational package was effective in increasing the knowledge and attitude of the infant mothers on the weaning practices. Lower scores indicate educational package was not effective in increasing the knowledge. Hence, alternative measures should be taken to improve the knowledge.

Environment: The individual’s environment is the fixed constraints that may influence the effectiveness of educational package. It include mother’s interest and participation in educational programmes regarding weaning, their social responsibilities, role of mass media, attitude of the mothers, learning resources and their readiness to learn. In the present study, the environment is considered as Nandoor community in Gulbarga.

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