The study assessed the effectiveness of an educational intervention on knowledge of hepatitis B among secondary school students in Nepal. It found that: 1) Students had low baseline knowledge of hepatitis B transmission, symptoms, treatment and prevention as assessed by a pre-test. 2) After receiving an educational session using prepared teaching materials, students' knowledge significantly improved based on post-test scores. Correct responses increased by 38-100% across different knowledge areas. 3) The educational intervention was effective in improving students' knowledge of hepatitis B definitions, transmission, signs/symptoms, diagnostic tests, treatment, complications and prevention.

1. Effectiveness of Education Intervention
on Knowledge Regarding Hepatitis-B
among Secondary Level Students of
Carmel Secondary School in Dharan
Municipality
Investigator Guide
Asmita Lama Syangtan Mr. Ram Sharan Mehta
B.Sc Nursing 4th year Additional Professor
Batch 2007 Department of medical- surgical
Roll no.-4166 nursing
College of nursing,BPKIHS

2. Background of the study
Hepatitis-B is an infectious illness caused by hepatitis
B virus (HBV) which infects the liver and causes an
inflammation called hepatitis. Transmission of HBV
results from exposure to infectious blood or body
fluids.
About a third of the world's population, more than 2
billion people, have been infected with the hepatitis
B virus.

3. The disease has caused epidemics in parts of Asia
and Africa, and it is endemic in China.
In Nepal, there are about 315,000 people infected
with chronic Hepatitis-B.
HBV is about 100 times more infectious than HIV.

4. Need of the study
A study conducted by Liver Foundation Nepal shows
that drug abuse and hepatitis B and C start together
among children in our schools.
The problem continues to smolder inside without the
knowledge of the infected persons or the
community. And in 20 years time when it will
explode, it will add to a costly and tragic condition
with a large number of patients with cirrhosis and
liver cancer.

5. Contd...
The first step in this direction is the spread of
awareness about drug abuse and hepatitis among
school children as it is the problem of our youth.
The best way to beat it is being aware of it and by
sharing concern with people.

6. Significance of the study
• This study had assessed the effectiveness of education
intervention on knowledge regarding Hepatitis-B among
the secondary level students of Carmel Secondary
School. The school can use the findings of this study to
uplift the knowledge of the students regarding Hepatitis-
B and take preventive measures to prevent from
Hepatitis-B.

7. Objectives
To assess the knowledge regarding Hepatitis-B among
the Secondary level students of Carmel Secondary School
in Dharan Municipality.
To prepare the teaching module and provide education
intervention regarding Hepatitis-B.
To evaluate the effectiveness of planned educational
intervention regarding knowledge of Hepatitis-B.

8. Null Hypothesis
• There will be no difference on knowledge
regarding Hepatitis-B before and after
educational intervention among the students.

9. Operational Definitions
• EFFECTIVENESS: The outcome of the educational
intervention that causes differences in the knowledge of
Hepatitis B among the secondary level students of
Carmel Secondary school in Dharan, measured by pre-
test and post-test questionnaire.
• KNOWLEDGE: It refers to the students ability to recall the
facts and information regarding Hepatitis-B, its causes,
signs and symptoms , management ,preventive measures
and Hepatitis-B vaccination, according to the given tool.

10. Contd...
• EDUCATION INTERVENTION: It is a structured teaching
program which is designed to provide information
regarding Hepatitis-B among the students based on
educational package developed.
• EDUCATIONAL PACKAGE: A set of educational materials
which consists of information regarding Hepatitis B which
includes:
Definition,
Causes ,

11. Contd...
Signs and symptoms
Management
Preventive measures
Hepatitis B vaccination
• SECONDARY LEVEL STUDENTS: It refers to the
students studying in class 8,9 and 10 of Carmel
Secondary school in Dharan.

12. Study variables
Dependent Variables:
Knowledge on Hepatitis B.
Independent Variables:
Educational intervention.

13. INPUT THROUGHPUT OUTPUT
Level of students
Education
intervention Affect on
on Hepatitis-
knowledge
B
Other source of
information
Fig I. Conceptual framework based on General system theory approach.

14. Research methodology
1.RESEARCH DESIGN:
Pre-experimental, one group pre-test and
post-test research design was used to conduct the
study.
2.RESEARCH SETTING:
The study was conducted in Carmel
Secondary School in Dharan Municipality, ward no.
18.

15. 3. STUDY POPULATION:
All the students studying in secondary level (class 8, 9 and
10) of Carmel Secondary School constituted the study population
(N=156).
4. SAMPLE:
The students meeting the eligibility criteria was study
sample.
5. SAMPLE SIZE:
The sample size of the study was 39 (25% of the target
population).

16. SAMPLE TECHNIQUE:
Population proportionate stratified simple random
technique was adopted.

17. Table 1
Details of Sampling Technique
Description Class 8 Class 9 Class 10 Total
Total no. of 60 52 44 156
students
Percentage 38.5% 33.3% 28.2% 100%
of the
students
taken
No. of the 15 13 11 39
students
taken

18. Eligibility Criteria
Inclusion criteria
• Only the students from class 8, 9 and 10 of Carmel
Secondary School and who were willing to participate
were included in this study.
Exclusion criteria
• Students who were not able to participate due to
absenteeism or other problems were excluded from
this study.

19. RESEARCH INSTRUMENTS
Data was collected using a semi-structured
questionnaire based on the objective of the
study which consist of 2 parts:
1. Socio-demographic data.
2. Knowledge of Hepatitis-B.

20. Validity of the tool
• The content validity was established by review
of literature, consulting with the research
guide and experts on the subject, faculties of
nursing college and modification was done
accordingly.

21. Pre-testing of the tool
• Pretesting was done by taking 10% of the
sample size (n=39) with similar characteristics
but not in the same setting i.e in Depot Higher
Secondary School. Four students were taken, 2
students from class 8, 1 student from class 9
and 1 student from class 10.

22. Procedures of data collection
• Permission obtained: concerned all
• Pre-Test (25th of Jan, 2011)
• Education intervention
• Post-test (8th of Feb, 2011)
• Analysis of data

23. Ethical consideration
• Permission was taken from the concerned
authority i.e. from college of nursing, principle of
the Carmel Secondary School where the students
were studying and informed verbal consent was
taken from each student prior to data collection.
• Confidentiality and anonymity of the students
was maintained. The purpose of the study was
revealed to the students prior to the data
collection.

24. Results
RESULTS

25. Table 2
Socio-demographic Characteristics of the Students
n=39
S.N Characteristics Categories Frequency Percentage
(%)
1. Age groups 13-14 20 51.3
( In years)
15-16 19 48.7
Mean =14.41
S.D =1.16
Range =13-16

26. Table 2 (contd...)
S.N Characteristics Categories Frequency Percentage
(%)
2. Sex Male 21 53.8
Female 18 46.2
3. Permanent Address Sunsari 37 94.9
Others 2 5.1
4. Religion Hindu 15 38.5
Buddhist 9 23.1
Christian 3 7.7
Kirat 12 30.8

27. 80
69.2
70
60
50
percentage (%)
40
30
20
10.3 10.3
10 5.1 5.1
0
Mongol Brahmin Newar Chhetri Others
Fig II: Ethnic group of the students
n=39

28. Table 3
Income and Main Occupation of the Family of the Students
n=39
S.N Characteristics Categories Frequency Percentage
(%)
1. Family income per 20000-29000 14 35.9
month 30000-39000 13 33.3
40000-49000 6 15.4
≥50000 6 15.5
Mean =34358.97
S.D =15984.35
Range =20000-80000
2. Main occupation of Abroad 12 30.8
the family Business 11 28.2
Service 10 25.6
Army 6 15.4

29. Table 4
Source of Information for the Students
n=39
Characteristics Categories Frequency Percentage
(%)
Source of Teachers/Books/Class 25 64.1
Information
(Multiple response)
TV/Radio 20 51.3
Parents 11 28.2
Friends 7 17.9

30. Table 5
Student’s Pre-test and Post-test Knowledge Regarding
Definition of Hepatitis-B
n=39
Knowledge Correct response % p-value
regarding difference
definition of
Hepatitis-B Pre-test Post-test
No. % No. %
16 41.0 39 100.0 59.0 <0.001*
* Binomial test

31. Table 6
Student’s Pre-test and Post-test Knowledge Regarding Incubation
period and Transmission of Hepatitis-B
n=39
S. Knowledge regarding Correct response % p-
N transmission of Hepatitis-B difference value*
Pre-test Post-test
No. % No. %
1. With infected needle syringe 31 79.5 39 100.0 20.5 0.008
2. Shaking hands^ 32 82.1 39 100.0 17.9 0.016
3. Unprotected sexual contact 25 64.1 39 100.0 35.9 <0.001
4. A mother to her infant at birth 28 71.8 39 100.0 28.2 0.001
5. Sneezing and coughing^ 17 43.6 39 100.0 56.4 <0.001
6. Transfusion of blood 34 87.2 39 100.0 12.8 0.63
7. Sharing contaminated towels and 4 10.3 36 92.3 82.0 <0.001
toothbrushes
8. Sharing needle for body piercing 17 43.6 35 89.7 46.1 <0.001

32. Table 6 (Contd....)
Knowledge Correct response % p-value
regarding difference
incubation
period of Pre-test Post-test
Hepatitis-B
No. % No. %
7 17.9 39 100.0 82.1 <0.001*
*Binomial test Median score (IQR) : 5(4-6) and 9(9-9)
^ Negatively correct

33. Table 7
Student’s Pre-test and Post-test Knowledge Regarding Signs and
Symptoms of Hepatitis-B
n=39
S. Knowledge regarding Correct response % p-value*
N signs and symptoms of difference
Hepatitis-B Pre-test Post-test
No. % No. %
1. Abdominal pain 24 61.5 39 100.0 38.5 <0.001
2. Low body temperature^ 7 17.9 36 92.3 74.4 <0.001
3. Jaundice 19 48.7 37 94.9 46.2 <0.001
4. Feeling of more appetite^ 10 25.6 35 89.7 64.1 <0.001
5. Diarrhoea 4 10.3 34 87.2 76.9 <0.001
6. No nausea and vomiting^ 11 282 35 89.7 61.5 <0.001
7. Pale stool 12 30.8 35 89.7 58.9 <0.001
*Binomial test Median score (IQR): 2(0-4) and 7(6-7)
^Negatively correct

34. Table 8
Student’s Pre-test and Post-test Knowledge Regarding
Diagnostic tests for Hepatitis-B
n=39
Knowledge Correct response % p-
regarding difference value*
diagnostic
tests for Pre-test Post-test
Hepatitis-B
No. % No. %
13 33.3 35 89.7 56.4 <0.001
* Binomial test

35. Table 9
Student’s Pre-test and Post-test Knowledge Regarding
Treatment of Hepatitis-B
n=39
Knowledge Correct response % p-
regarding difference value*
treatment of
Chronic Pre-test Post-test
Hepatitis-B
No. % No. %
12 30.8 39 100.0 69.2 <0.001
Knowledge 13 33.3 36 92.3 59.0 <0.001
regarding
cure of
Hepatitis-B
* Binomial test Median score (IQR): 0(0-1) and 2(2-2)

36. Table 10
Student’s Pre-test and Post-test Knowledge Regarding
Complications of Hepatitis-B
n=39
Knowledge Correct response % p-
regarding difference value*
complications
of Hepatitis-B Pre-test Post-test
No. % No. %
16 41.0 37 94.9 53.9 <0.001
* Binomial test

37. Table 11
Student’s Pre-test and Post-test Knowledge Regarding Prevention of
Hepatitis-B
n=39
Knowledge regarding Correct response % p-value
prevention of Hepatitis-B difference
Pre-test Post-test
No. % No. %
Use sterile syringes and needle 24 61.5 39 100.0 38.5 <0.001
Do not sit next to infected person^ 25 64.1 39 100.0 35.9 <0.001
Practising safer sex 19 48.7 39 100.0 51.3 <0.001
Do not hug with infected person^ 28 71.8 39 100.0 28.2 0.001
Take vaccination 39 100.0 39 100.0 0.0 -
Avoid kissing 1 2.6 37 100.0 92.9 <0.001
Vaccination available for 23 59.0 39 92.3 41.0 <0.001
prevention of Hepatitis-B
Regular doses of Hepatitis-B 23 59.0 39 89.7 41.0 <0.001
*Binomial test Median score (IQR): 5(3-6) and 8(8-8)
^ Negatively correct

38. 120
100.0 98.0 96.2 98.4
100 94.9
89.7
83.5
percentage(%)
80
55.6 58.3
60
41.0 41.0
40 31.5 33.3 32.1
20
0
Fig III: Overall Differences in Knowledge on Hepatitis-B
before and after Education Intervention
pre per post per

39. Table 12
Student’s Overall Pre-test and Post-test knowledge Regarding
on Hepatitis-B
n=39
Knowledge Total score Pre-test Post-test p-value*
regarding
Hepatitis-B
Median Median
with IQR with IQR
29 15 (11-18) 28 (28-29) <0.001
*Wilcoxon Signed Ranked test

40. CONCLUSION
The findings of the study showed that the post-test
median score on knowledge regarding Hepatitis-B was
increased than the pre-test median score.
Thus, the findings revealed that there was a significant
increment on knowledge of the students on Hepatitis-B
in the post-test after the education intervention.

41. RECOMMENDATIONS
The study can be conducted in the larger sample size to
generalize the results.
Regular health education program can be conducted in
the school to update the knowledge of both students and
teachers.
Similar study can be done using control group.

42. LIMITATIONS
This study was conducted in one setting i.e Carmel Secondary
School, hence findings of the study cannot be generalized to
other settings.
There was no control group in this study, to compare the
results.
The study was conducted among the secondary level students
only. The other levels students were not included.
Time was limited for data collection.

43. IMPLICATIONS
This study had positive impact in enhancing knowledge
among the students and making aware about Hepatitis-B.
The findings also emphasize on the increasing need of
awareness program on Hepatitis-B.
The educational package can be used to prepare educational
material like booklets, pamphlets etc on Hepatitis-B.
Regular health education program on Hepatitis-B can be
provided so that students and the teachers will be updated
with adequate knowledge.

44. THANK YOU