A study to assess the efficacy of audio-visual psychoeducation on level of knowledge and attitude regarding harmful effects of alcohol among alcohol use disorder patients admitted to mental health units of selected hospitals of Western Maharashtra :Seema Madhavan Nair, Punita A Sharma, Radhika Das, Indian Journal of Psychiatric Nursing

ORIGINAL ARTICLE
Year : 2022 | Volume : 19 | Issue : 1 | Page : 54--60

A study to assess the efficacy of audio-visual psychoeducation on level of knowledge and attitude regarding harmful effects of alcohol among alcohol use disorder patients admitted to mental health units of selected hospitals of Western Maharashtra

Seema Madhavan Nair¹, Punita A Sharma², Radhika Das³,
¹ Tutor, College of Nursing, Army Hospital (Research and Referral), Delhi Cantt, India
² Brig MNS, Headquarters South Western Command (Medical), Jaipur, Rajasthan, India
³ Tutor, College of Nursing, Command Hospital (Eastern Command), Kolkata, India

Correspondence Address:
Lt. Col. Seema Madhavan Nair
College of Nursing, Army Hospital (R & R) Delhi Cantt
India

Abstract

Introduction: Alcohol use disorder (AUD) has emerged as a global concern in the world, due to its harmful impact on health, social, economic, and legal aspects. Several established treatment approaches, both pharmacological and nonpharmacological are available but have only modest success. Relapse in alcohol use is noted to be common following treatment, hence efficacy of newer modalities of treatment or therapies is needed. Aim: This study aims to assess the efficacy of audiovisual psychoeducation on the level of knowledge and attitude of harmful effects of alcohol among AUD patients admitted to mental health units of selected hospitals of Western Maharashtra. Materials and Methodology: A quantitative research approach with pretest-posttest control design was adopted in the study. The sample size was estimated to be 70 based on the pilot study and settings were mental health units of selected hospitals in Western Maharashtra. A simple random sampling technique was used with random allocation of subjects into experimental group and control group by lottery method. A structured tool to assess knowledge was developed, validated by experts and reliability was tested. Alcohol Decisional Balance Scale, which is a standardized tool was used for assessing the attitude. Pretest knowledge assessment was done for control and experimental groups. Audiovisual psychoeducation was given to the experimental group. Both the groups were receiving routine care. A posttest assessment was done after 7 days of intervention. Results: Findings revealed that there is statistically significant increase in the level of knowledge from pretest mean score of 9.37 + 3.191–14.06 + 4.179 in posttest of the experimental group by Wilcoxon Z value test at the level of significance P < 0.0001 showing the efficacy of audio-visual psychoeducation in changing the level of knowledge. Similarly, postintervention attitude distribution assessment in the experimental group revealed a statistically significant difference in positive attitude from 6 (17%) in pretest to 12 (34%) in posttest with the McNemar's test at level of significance of P < 0.031. Correlation in level of knowledge with attitude revealed a weak positive correlation with r = 0.17. There was no significant association of pretest knowledge with selected socio-demographic data. Conclusion: Audiovisual psychoeducation is efficient in increasing the level of knowledge and change in attitude toward harmful effects of alcohol.

How to cite this article:
Nair SM, Sharma PA, Das R. A study to assess the efficacy of audio-visual psychoeducation on level of knowledge and attitude regarding harmful effects of alcohol among alcohol use disorder patients admitted to mental health units of selected hospitals of Western Maharashtra.Indian J Psy Nsg 2022;19:54-60

How to cite this URL:
Nair SM, Sharma PA, Das R. A study to assess the efficacy of audio-visual psychoeducation on level of knowledge and attitude regarding harmful effects of alcohol among alcohol use disorder patients admitted to mental health units of selected hospitals of Western Maharashtra. Indian J Psy Nsg [serial online] 2022 [cited 2023 May 28 ];19:54-60
Available from: https://www.ijpn.in/text.asp?2022/19/1/54/349883

Full Text

Introduction

Alcohol use is widely prevalent in Indian society and consequently results in widespread effect in the form of physical, mental, social, and economical losses. Deteriorating physical outcomes such as cirrhosis of liver, heart disease, diabetes, road traffic accidents, mental health issues like depression, anxiety and various behavioral problems, social and economic problems like absenteeism from work, marital disharmony, etc., are known to be the result of alcoholism. A total of 32% of deaths worldwide are caused by alcohol every year and is one of the leading causes of death and disability globally.[1] As per the World Health Organization, one-fourth to one-third of male population in India and neighboring south Asian countries drink alcohol and the use among women is significantly increasing leading to alcohol use disorder (AUD).[1]

Research on treatments for alcoholism seems to be in a transition state. Numerous research reviews conducted to find out the efficacy of various modalities for alcohol addiction treatment reached a definite conclusion that treatment seems better than no treatment for addiction but it is difficult to prove that any one specific treatment is more effective than others.[2]

The outcomes from multiple prospective clinical trials have reinforced the significance of psychoeducation in the management of mentally ill and behavioral disorders. These studies have validated the utilization of psychoeducation as an approach that improves the efficacy of pharmacological approaches.[3]

A study conducted by Mei-Yu Yeh, Tao-Hsin Tung, Fen-Fang Horng, Su-Ching Sung in 2017[4] to assess the effectiveness of a psychoeducational program in enhancing motivation to change alcohol-addictive behavior revealed that the psychoeducational program was effective in reinforcing addicted inpatients' motivation for changing their drinking behavior in the experimental group.

Need for the study

The prevalence of alcohol abuse has increased over the past 10 years and the age of initial alcohol use has decreased gradually. The WHO report-2014[5] states that 38.3% of the world's population and 30% of India's population are reported to consume alcohol regularly. Health effects associated with alcohol intake include an increased risk of malnutrition, chronic pancreatitis, alcoholic liver disease, cancer, etc. Chronic alcoholism is one of the greatest causes for poverty in the country. Alcohol dependence is not only the leading cause of disability but also a prime reason for increase in the incidence of crime and violence.[6]

Hospital statistics from the mental health unit of the selected tertiary care hospital in December 2017 revealed that 26.76% of AUD patients were getting admitted as relapse cases and out of which approximately 10% of patients were also having co-morbidities such as cirrhosis of liver, pancreatitis, road traffic accidents, depression, and psychosis.

Alcoholism and other substance abuse have special relevance in psychiatry. It forms a major chunk of psychiatric disorder. Hence, there is a pressing need to address the issue.

The core treatment of alcoholism involves steps to maximize motivation for abstinence and minimize relapse. This approach helps the person in understanding the reality of the disorder through motivational interviewing techniques, detoxification, and rehabilitation. Psychoeducation is one of the effective methods in imparting knowledge to the client regarding his disease condition, importance of seeking treatment, treatment adherence, and prevention of relapse.[7]

There is a misconception that addictive behavior is associated with low morality and the requirement of structured treatment takes low priority. It is very important for the clients and caretakers to recognize their condition and identify it as a disease. This recognition can eliminate barriers in the process of seeking treatment.[8] Psychoeducation program can be effectively used as a method to mature this recognition into a favorable behavior change leading to abstinence and successful long-term sobriety. Time and again it is a proven fact that audio-visual aids stimulate learning. Hence, the researcher felt a curiosity in exploring the efficacy of audiovisual psychoeducation in changing the level of knowledge regarding harmful effects of alcohol among admitted AUD patients.

Aim

To assess the efficacy of audiovisual psychoeducation on level of knowledge and attitude regarding harmful effects of alcohol among AUD patients admitted to mental health units of selected hospitals in Western Maharashtra.

Objectives of the study

(a) Assess the level of knowledge of harmful effects of alcohol among AUD patients before and after intervention. (b) Assess the change in attitude regarding harmful effects of alcohol. (c) Assess the efficacy of audiovisual psychoeducation by comparing the change in level of knowledge and attitude of harmful effects of alcohol among AUD patients after 1 week of intervention (audio-visual psychoeducation between the experimental and control arm). (d) Associate the selected socio-demographic variables with pretest knowledge

Materials and Methodology

The research design used in this study was true experimental research design with pretest post control group design. Ethical committee clearance and necessary administrative approval for the conduct of the study was obtained. The study was registered under CTRI (Reg no: CTRI/2018/12/016623). The conceptual framework for this study was derived from General Systems Theory developed by Ludwig Von Bertalanffy General Systems model in 1936.

Setting

Mental health units of two selected tertiary care hospitals from Western Maharashtra.

Population and sample

The accessible population was admitted AUD patients and the targeted population was those admitted AUD patients after 1 week of hospitalization. A pilot study was conducted in the same setting in a different period of hospitalization and the feasibility of the study was ensured with required corrections in the methodology. The sample size was calculated to be 70 on the basis of a pilot study. Samples were equally allotted to control and experimental group, i.e., 35 in each arm. Simple random sampling was used for sample selection using computer-generated random numbers and samples were randomly allocated into experimental and control groups using the lottery method.

Inclusion criteria

All cases of AUD patients after 1 week of admission, seeking treatment in the selected mental health units during the period of data collection.

Exclusion criteria

All cases of AUD with alcohol-induced psychosis and severe depression.

Data collection instruments and techniques

[Table 1] shows the description of tool developed for the study. The tool had three parts, sociodemographic data, structured questionnaire to assess the knowledge regarding harmful effects of alcohol and Alcohol Decisional Balance Scale to assess the attitude regarding harmful effects of alcohol.{Table 1}

Audio visual psychoeducation included structured PowerPpoint presentation, video, and handout regarding the contents of harmful effects of alcohol and relapse prevention strategies in English and Hindi languages. The Alcohol Decisional Balance scale is a standardized tool for assessing the attitude and decision regarding the drinking behavior of the client and the Cronbach's alpha scores for Alcohol Decisional Balance scale mentioned in literature is 0.84 for pros of drinking and 0.86 for cons of drinking. The reliability of knowledge assessment questionnaire by split-half method was found to be 0.85. Tool validity was done by experts from fields of psychiatry, psychiatry nursing, psychology, and statistics.

Method of data collection

Pretest was conducted for both experimental and control groups. The experimental group received structured audio-visual psychoeducation (intervention) along with didactic psychoeducation (conventional treatment) and the control group received only the conventional treatment. Both the groups were administered posttest after 07 days.

Data analysis and interpretation

The collected data were organized, analyzed, and interpreted using descriptive and inferential statistics. For the feasibility, the analysis was done in five sections. (i) Distribution of subjects as per socio-demographic variables [Tabel 2] (ii) Assessment of level of knowledge regarding harmful effects of alcohol in experimental and control groups [Table 3] and [Table 4]. (iii) Assessment of the distribution of pretest and posttest attitude in experimental and control groups. (iv) Comparison in change in level of knowledge and attitude of harmful effects of alcohol among AUD patients alcohol [Table 5] and [Table 8]. (v) Association of selected socio-demographic variables with pretest knowledge.{Table 2}{Table 3}{Table 4}{Table 5}{Table 6}{Table 7}{Table 8}

No statistically significant difference of any of the socio-demographic variables among experimental and control groups [Table 2] shows the distribution of samples as per sociodemographic variables.

[Table 3] shows a statistically significant increase in the mean knowledge score between pretest and posttest in the experimental group from 9.37 ± 3.191 to 14.06 ± 4.179 at level of significance of P < 0.0001 showing the efficacy of audio-visual psychoeducation in changing the level of knowledge.

[Table 4] shows a statistically significant increase in the mean knowledge score between pretest and posttest in the control group from 10.29 ± 1.964 to 11.69 ± 2.643 at level of significance of P < 0.008.

[Table 5] shows that there is no statistically significant difference between the mean score of knowledge between experimental and control groups in the pretest score whereas there is significant statistic difference between the posttest score of experimental and control arm at level of significance of P < 0.001, showing the high efficacy of audio-visual psychoeducation in changing the level of knowledge regarding harmful effects of alcohol.

[Table 6] shows the comparison of pre and posttest distribution of attitude toward harmful effects of alcohol in experiment. Statitstical analysis of the data with Mc Nemer test has given a calculated p value of 0.031. Since the p value calculated by McNemer test is less than 0.05, there is statistically significant difference in attitude between pre test and post test in experimental group at level of significance of P <0.031.

[Table 7] shows the pre and post test distribution of attitude towards harmful effects of alcohol in control group. Since the p value calculated by Mc Nemer test is greater than 0.05, there is no statistically significant difference in attitude between pre test and post test in control group at level of significance of P <0.05.

[Table 8] shows the comparison of pre and post test attitude towards harmful effects in alcohol in experimental group. In the pre test, since the calculated χ2 value is less than the table value of 3.84 with a degree of freedom 1, there is no statistically significant difference found between experimental and control group at a level of significance P <0.05. Similarly in the post test findings, analysis with χ2 value revealed that the calculated value (0.61) is less than the table value of 3.84, with a degree of freedom 1, the findings are not statistically significant at a level of significance P <0.05.

[Table 9] shows Karl Pearson Correlation Coefficient Test with knowledge and attitude score shows that there is a weak positive correlation existing between knowledge and attitude r = 0.11 in pretest and r = 0.17 in posttest, but the change in attitude is not statistically significant to change in knowledge at level of significance at P < 0.05. Findings also revealed no significant association of selected socio-demographic variables with pretest knowledge.{Table 9}

Discussion

Alcohol has possibly been one of the oldest psychoactive substances used by humans. Excessive review of literature based on studies and articles related to alcohol and its harmful use has brought out the effect of psychoeducation and its outcome in the prevention of relapse. This understanding helped the researcher to identify the need for innovative psychoeducative module and thus a study was undertaken to assess the efficacy of audio-visual psychoeducation on level of knowledge and attitude of harmful effects of alcohol among AUD patients admitted to mental health units of selected hospitals of Western Maharashtra.

A comparison of pre and posttest knowledge score in experimental group shows an increase in the mean knowledge score between pretest and posttest in the experimental group from 9.37 ± 3.191 to 14.06 + 4.179. Analysis has shown a statistically significant difference at level of significance of P < 0.0001 which shows the efficacy of audiovisual psychoeducation in changing the level of knowledge regarding harmful effects of alcohol.

Pretest distribution of attitude in the experimental group shows that 29 (83.0%) of subjects in the experimental group were having a negative attitude to harmful effects of alcohol and 6 (17.0%) were having a positive attitude. Post intervention attitude frequency distribution depicts an almost 50%, i.e., from 6 (17%) to 12 (34.3%) increase in the distribution of positive attitude toward harmful effects of alcohol in experimental group. This change in attitude distribution has proven to be statistically significant with McNemar's test at a level of significance of P < 0.031 and proves the efficacy of audiovisual psychoeducation in bringing favorable attitude toward harmful effects of alcohol.

Findings of the comparison of pretest and posttest knowledge and attitude of experimental group reveals statistically significant difference at level of significance P < 0.05, hence null hypothesis is rejected and research hypothesis stating that there is change in level of knowledge and attitude among AUD patients after attending the audio-visual psychoeducation on harmful effects of alcohol is accepted at level of 5% significance.

Similar to the findings of the present study which proved the efficacy of audiovisual psychoeducation, the study conducted by Srinivasagam, Raja Shankar from Annamalai university in December 2013[9] to assess the effect of psychoeducation on level of awareness regarding ill effects of alcohol abuse among lorry drivers at selected setting also shown an increase from the pretest mean score (173 ± S.D 22.9 to the post mean score was (228 ± S. D was 44.3) which is highly significant at P < 0.001 level.

Finding of the study conducted by R Snehalatha, M Bhagyalakshmi and S Hemalatha in 2017[10] to assess the effectiveness of structured teaching program on knowledge regarding alcohol use and its harmful effects among high school children Tirupati is also in harmonious with the present study that there was a significant increase in the pretest mean knowledge sore from 5.40 ± 2.499 to 24.08 ± 2.499 in the posttest mean knowledge score which is significant at P < 0.01.

This finding is also supported by the study conducted by Calder B and Shulze S in 2015[11] using psychoeducational program in South Africa with the aim of preventing substance abuse in adolescent children that after the educational programs, the students improved their knowledge related to psychoactive substance and substance-related issues.

Analyzing the socio-demographic data [Table 1] of the present study, it was seen that majority of subjects were in the age group of 30–39; 49% in experimental arm and 40% in control arm The findings of the study is incongruent with the study conducted by R Mohanambal in 2007[12] to determine the effectiveness of psychoeducation on the behavior of patients with alcohol dependence syndrome. Majority of the patients were also in the age group of 30–39.

The present study findings are similar to the study conducted by Deshmukh et al. in 2014[13] to understand the socio-demographic and psychosocial aspects of male alcoholics with admission in psychiatry ward in a tertiary care hospital in regard to mode of admission. Most of the patients (96%) were brought by family members and social workers

Implication

The assessment of knowledge and attitude regarding harmful effects of alcohol among AUD patients will help in

analyzing the effectiveness of the care providedin modifying the care if required based on individuals' level of motivationincorporate innovative measures to enhance the efficacy of the care provided.

The psychoeducational program could assist clinical nurses

in helping alcohol-dependent patients to understand the consequences of drinkingincrease participants motivation for abstinence leading to the contemplation of change

Various policies and procedures to enhance awareness regarding harmful effects of alcohol can be developed and implementedInnovations can be made to develop strategies which improve attitude of the AUD patients regarding their drinking habits.

Recommendations and suggestions

Future researches can be undertaken to compare the effectiveness of different interventional strategies like exploration of more audiovisual aids like Role Play, Psychodrama, combined psychosocial therapy, etc., in changing the level of knowledge and attitude regarding harmful effects of alcoholMore research work needs to be done essentially with the aim of developing effective strategies for improving the attitude of AUD patients toward drinking behaviorThe same study can be conducted incorporating the assessment of behavior or practice of abstinence to validate the consistency of change in knowledge and attitude.

Conclusion

The findings of the study supported the efficacy of audiovisual psychoeducation in the management of AUD patients along with pharmacological management. It also emphasizes on the care based on individual's level of motivation and individualized based approach in management. Government has to strictly adhere to the existent policies related to alcohol production, sale, and consumption and adopt various measures to restrict the easy availability of alcohol aiming the reduction in its consumption.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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