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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 4  |  Page : 370-377

Effectiveness of video-assisted teaching program on toilet training of toddlers among parents in a selected rural area in Shimla, Himachal Pradesh, India


Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Kingdom of Saudi Arabia

Date of Submission04-Oct-2018
Date of Decision28-Jul-2019
Date of Acceptance20-Nov-2019
Date of Web Publication16-Jul-2020

Correspondence Address:
Dr. Jinu Rajan
Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_83_18

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  Abstract 


Introduction: Family is the central focus in the life of toddlers. A toddler in turn exerts considerable influence on all the other family members, regardless of the size and form of the family unit. As toddlers begin to interact with others outside the family, the parents help the child to conform to the expectations of the society. The most important societal demand made on the child during this period is the control of elimination. Materials and Methods: In order to achieve the objectives of the study, a preexperimental study approach was adopted for the study. The conceptual framework used for the study was based on General System Theory. A close-ended questionnaire was used to assess the knowledge of parents on toilet training. A pilot study was conducted in an anganwadi, situated in Shimla, Himachal Pradesh, India, and there were no major problems encountered while conducting the study. Purposive sampling technique was used to select the sample. The sample consisted of forty parents of toddlers. The main study was conducted in an anganwadi, situated in Shimla area. The data collected were systematically tabulated to facilitate the data analysis. The collected data were analyzed by using descriptive and inferential statistics. Results: The analysis of the demographic variables revealed that majority (40%) of the participants are in the age group of 26–30 years. Among the participants, most (52.5%) of them completed high school education. The highest percentages (90%) of the samples were females. Majority of the participants (80%) are Hindus and 20% are Muslims. Most of them (57.5%) were having two children and 67.5% of them have their second child as toddler. A majority (77.5%) are homemakers. Most of them (67.5%) are living in joint families. Majority (37.5%) of the participants' monthly income is between 4001 and 6000. All the participants received information regarding toilet training, and among them, 40% got information from elders, relatives, or friends. The assessment of the knowledge among parents on toilet training revealed that majority (60%) of the parents had moderate knowledge, 35% had poor knowledge, and 5% had good knowledge. None of the participants had very good knowledge. The overall mean knowledge score was 14.03 ± 2.665, with a mean percentage of 46.75%, revealing that the overall knowledge of the parents regarding toilet training is moderate. Area-wise analysis of knowledge score revealed that the parents had the highest knowledge in the area of meaning of toilet training and its readiness with a mean percentage of 57% and least in the area of steps of toilet training with a mean percentage of 41.43%. The assessment of the effectiveness of video-assisted teaching program on toilet training revealed that the total mean knowledge score is increased by 25.83% with a mean ± standard deviation (SD) of 7.75 ± 2.55 after the administration of video-assisted teaching program. The pretest mean was 14.03 with that of SD ± 2.665 and posttest mean was 21.78 with that of SD ± 2.616. The pretest knowledge level was average in 60%, poor in 35%, and good in 2% and posttest knowledge level was very good in 12.5%, good in 70.5%, and average in 12.5% of the parents. The cumulative frequency distribution of pre- and post-test knowledge scores shown in the Ogives shows a significant difference between the pre- and post-test scores. The knowledge pretest median was 13.50, whereas the posttest median score was 21.50. It shows a difference of 9 in knowledge. Association between pretest knowledge with demographic variables revealed that there was a significant association between the preexisting knowledge with these demographic variables on toilet training. Conclusion: Experts suggest that it is easier to train a child on toileting skills when he/she is at least 18 months old, and for boys, it is better to wait even longer because they usually lack the necessary language and fine motor skills. This time frame is much easier to use because of the child wanting to please his/her parents.

Keywords: Effectiveness, toddler, toilet training, video-assisted program


How to cite this article:
Rajan J. Effectiveness of video-assisted teaching program on toilet training of toddlers among parents in a selected rural area in Shimla, Himachal Pradesh, India. J Datta Meghe Inst Med Sci Univ 2019;14:370-7

How to cite this URL:
Rajan J. Effectiveness of video-assisted teaching program on toilet training of toddlers among parents in a selected rural area in Shimla, Himachal Pradesh, India. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Aug 14];14:370-7. Available from: http://www.journaldmims.com/text.asp?2019/14/4/370/289863




  Introduction Top


Today's society is complex and ever changing. Growing up emotionally is complicated and difficult under any circumstances.[1] Children are blooming buds. They are an important asset of any nation. As children grow, they must learn not only to care with the current demands but also to prepare for the many unexpected events they will face in their tomorrows and changes brought by new techniques and technologies. Children are expected to grow and learn to their fullest potential. Parents serve as advocates for children in order to meet the needs of all children for access to education and health-care process.[1]

All the stages in human life are exposed to challenges, difficulties, and success as a gain. One of such stages is the toddler period. It is the magical time of childhood. It is a different exciting and interesting period of life. The fundamental learning process develops in the child as the child begins to seek autonomy and explores the world. It learns how to tolerate, express desires, and develop relationships.[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15]


  Materials And Methods Top


The objectives of the study were to (a) determine the existing knowledge of parents regarding toilet training using a structured knowledge questionnaire, (b) find the effectiveness of video-assisted teaching program on toilet training among parents using the same structured knowledge questionnaire, and (c) find the association between pretest knowledge scores of parents on toilet training with selected demographic variables.

In view of the nature of the problem under study and to accomplish the objectives of the study, an evaluative approach was found to be appropriate to describe the effectiveness of video-assisted teaching program on toilet training among parents of toddlers.

Preexperimental, i.e., one group pre- and post-test design was adopted for the study. Here, only one group was observed twice, before and after introducing the independent variable. The effect of treatment would be equal to the level of the phenomenon after the treatment minus the level of phenomenon before treatment. In this study, the video-assisted teaching program on toilet training was the independent variable. The dependent variable is the effect of action of the independent variable and cannot exist by itself. In this study, dependent variable was knowledge of parents. The demographic variables in this study were age, gender, education, religion, number of children, birth order of the toddler, occupation, type of family, family income, and any previous information regarding toilet training. The study was conducted at an anganwadi in Shimla which is a rural area under Surathkal primary health center. The samples were selected using purposive sampling method. The population and the sample selected for the study comprised of forty parents of toddlers staying in Shimla's rural area at Himachal Pradesh.

Ethical clearance

Ethical clearance was obtained from the Institutional Ethical Committee of Majmaah University, Al Majmaah, Kingdom of Saudi Arabia on 8th March 2018. With ethical clearance no MAJUNI/Eth/2018-19/41.


  Results Top


Part I: Description of demographic characteristics of the parents of toddlers

Data presented in [Table 1] show that majority (40%) of the participants are in the age group of 26–30 years. Among the participants, most (52.5%) of them completed high school education. The highest (90%) proportion of the samples were females. Majority of the participants (80%) are Hindus and 20% are Muslims. Most of them (57.5%) were having two children and 67.5% of them have their second child as toddler. The highest percentages (77.5%) are homemakers. Most of them (67.5%) are living in joint families. Majority (37.5%) of the participants' monthly income is between 4001 and 6000. All the participants received information regarding toilet training, and among them, 40% got information from elders, relatives, or friends.
Table 1: Frequency and percentage distribution of samples according to demographic characteristics (n=40)

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Part II: Knowledge of parents regarding toilet training

Data in [Table 2] and [Figure 1] show that majority (60%) of the parents had moderate knowledge, 35% had poor knowledge, and 5% had good knowledge. Nobody had very good knowledge.
Table 2: Percentage and distribution of level of knowledge of parents regarding toilet training

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Figure 1: The cylinder diagram shows percentage distribution of parents according to the level of knowledge

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Section B: Area-wise analysis of the knowledge scores

This part deals with area-wise mean, standard deviation (SD), and mean percentage of pretest knowledge scores of parents regarding toilet training.

Data in [Table 3] and [Figure 2] reveal that parents had the highest knowledge in the Area I, that is, meaning of toilet training and its readiness with a mean percentage of 57% followed by Area II which is dos and donts of toilet training and guidelines for nighttime control with a mean percentage of 42.50%, and then the Area III, that is, the effects of faulty toilet training practice with a mean percentage of 41.67%, and least in the Area IV, that is, in the steps of toilet training with a mean percentage of 41.43%. The mean knowledge score was 14.03 ± 2.665, with a mean percentage of 46.75%, revealing that the overall knowledge of the parents regarding toilet training is moderate.
Table 3: Area-wise mean, standard deviation, and mean percentage of pretest knowledge scores of parents regarding toilet training

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Figure 2: The bar diagram shows area-wise percentage distribution of parents' knowledge

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Part III: Effectiveness of video-assisted teaching program on toilet training

Section A: Area-wise mean, standard deviation, and mean percentages of pre- and post-test knowledge scores

This part deals with area-wise mean, SD, and mean percentages of pre- and post-test knowledge scores.

The data presented in [Table 4] show that the total mean knowledge score was increased by 25.83%, with a mean ± SD of 7.75 ± 2.55 after the administration of video-assisted teaching program.
Table 4: Mean, standard deviation, and mean difference of pre- and post-test knowledge scores

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Comparison of the area-wise mean ± SD of the knowledge scores showed that the effectiveness of video-assisted teaching program in the area of “meaning of toilet training and its readiness” had 24.75% increase in the mean percentage knowledge scores, with the mean ± SD of 2.48 ± 2.30, with that of 57% in pre- and 81.75% in the post–test knowledge scores. In the area of “steps of toilet training,” there was 24.29% increase in the mean percentage knowledge scores, with the mean ± SD of 3.40 ± 1.39, with that of 41.43% in pre- and 65.71% in post-test knowledge scores. In the area of “effects of faulty toilet training practice,” there was 28.33% increase in the mean percentage knowledge scores, with the mean ± SD of 0.85 ± 0.66, with that of 41.67% in pre- and 70% in the post-test knowledge scores. In the area of “dos and donts of toilet training and guidelines for nighttime control,” there was 34.17% increase in the mean percentage knowledge scores, with the mean ± SD of 1.03 ± 0.86, with that of 42.50% in pre- and 76.67% in post-test knowledge scores. The results reveal that the overall knowledge was high compared to that of the pretest knowledge score as the posttest knowledge score come under good knowledge level which was average in the pretest assessment.

Section B: Comparison of level of knowledge pretest and posttest and effectiveness of the study

This part compares the level of knowledge and mean of pre- and post-test knowledge scores; it also deals with mean difference in pre- and post-test knowledge scores, and “t” value thus finds the effectiveness of the study. To evaluate the effectiveness of video-assisted teaching program, a null hypothesis was formulated. A paired t-test was used to find the effectiveness. The value of “t” was calculated to analyze the difference in the knowledge score of parents pre- and post-test.

H01: There will be no significant difference between pre- and post-test mean knowledge of parents on toilet training.

The data presented in [Table 5] and [Figure 3] show that the pretest knowledge level o was moderate in 60%, poor in 35%, and good in 2%, and posttest knowledge level was very good in 12.5%, good in 70.5%, and moderate in 12.5% of the patients.
Table 5: Comparison of level of knowledge and effectiveness pretest with posttest and effectiveness of the study

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Figure 3: The cylinder diagram compares pre- and post-test knowledge scores of parents regarding toilet training

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The findings in [Table 5] revealed that the mean posttest score was significantly higher than the mean pretest score. The calculated “t” value (19.23, P < 0.05) in knowledge aspect was greater than the table value (1.83) at 0.05 level of significance. Therefore, the null hypothesis was rejected, and the research hypothesis was accepted indicating that the gain in knowledge was not by chance. Hence, it is concluded that there is very highly significant gain in the knowledge of parents on toilet training.

The cumulative frequency distribution of pre- and post-test knowledge scores is shown in the Ogives. The data presented in the Ogives show a significant difference between the pre- and post-test scores. The knowledge pretest median was 13.50, whereas the posttest median score was 21.50. It shows a difference of 9 in knowledge. The Ogives plotted shows that the first quartile score of posttest is higher than the third quartile score of pretest. This indicates that there is a significant increase in the knowledge of parents regarding toilet training.

Part IV: Association between pretest knowledge scores of parents on toilet training with selected demographic variables

Chi-square test was computed to test the association between the knowledge of the parents and selected demographic variables; the following null hypothesis was formulated.

H02– There will be no significant association between knowledge score with selected demographic variables.

Data presented in [Table 6] reveal that the calculated Chi-square value of source of information (5.014) is greater than that of table value (3.84) at 0.05 level of significance; hence, the null hypothesis can be rejected and concluded that there was a significant association between the preexisting knowledge with these demographic variables on toilet training.
Table 6: Association between pretest knowledge with demographic variables (n=50)

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  Discussion Top


Level of knowledge of parents regarding toilet training

Majority (60%) of the parents had moderate knowledge regarding toilet training. Only 5% had good knowledge. None of the participants had very good knowledge. The findings of this study were supported by a study conducted on toilet training status of Korean toddlers and their mother's knowledge of toilet training. The researchers selected 315 toddlers aged between 12 and 29 months and their mothers for the study. The data were collected using a questionnaire. The result showed that 68% of mothers were unaware of proper toilet training techniques. There was a significant correlation between toilet training and mother's level of knowledge on toilet training.[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40]

Area-wise analysis of the knowledge scores

The area-wise analysis revealed that the parents scored highest in the area of meaning of toilet training and its readiness (mean percentage 57%). The area-wise analysis revealed that the parents scored lowest in the area of steps of toilet training (mean percentage 41.43%). The overall mean knowledge score was 14.03 ± 2.665, with a mean percentage of 46.75%.

The study findings were supported by a descriptive study conducted on the knowledge and practices regarding toilet training among mothers of preschoolchildren in a selected urban community at Bengaluru city. The samples were sixty mothers having preschoolchildren at Mahalakshmipuram, Bengaluru. The data were collected using a structured questionnaire. The results showed that only 59.7% of mothers were knowledgeable about toilet training and among them, only 52.2% of mothers were giving toilet training to their children. The highest mean knowledge (78.3%) was found in the aspect of physiological readiness followed by psychological readiness (67.1%). The researcher summarized that there exists inadequate knowledge and practice among parents [Figure 4].[16],[17]
Figure 4: Ogives of the pre- and post-test knowledge scores of parents regarding toilet training

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Effectiveness of video-assisted teaching program on toilet training

The results show that the total mean knowledge score was increased by 25.83%, with a mean SD of 7.75 ± 2.55 after the administration of video-assisted teaching program.

Comparison of the area-wise mean ± SD of the knowledge scores showed that the effectiveness of video-assisted teaching program in the area of “meaning of toilet training and its readiness” was 24.75% increase in the mean percentage knowledge scores, with the mean ± SD of 2.48 ± 2.30, with that of 57% in pre- and 81.75% in the post-test knowledge scores.

The area of “steps of toilet training” had 24.29% increases in the mean percentage knowledge scores, with the mean ± SD of 3.40 ± 1.39, with that of 41.43% in pre- and 65.71% in post-test knowledge scores.

In the area of “effects of faulty toilet training practice,” there was 28.33% increase in the mean percentage knowledge scores, with the mean ± SD of 0.85 ± 0.66, with that of 41.67% in pre- and 70% in the post-test knowledge scores. In the area of “dos and donts of toilet training and guidelines for nighttime control,” there was 34.17% increase in the mean percentage knowledge scores, with the mean ± SD of 1.03 ± 0.86, with that of 42.50% in pre- and 76.67% in post–test knowledge scores.

The calculated value (19.23, P < 0.05) in knowledge aspect was greater than the table value (1.83) at 0.05. Therefore, the null hypothesis was rejected, and the research hypothesis was accepted, indicating that the gain in knowledge was not by chance.

Hence, it was concluded that there is very highly significant gain in the knowledge of parents on toilet training after the video-assisted teaching program. The findings revealed that the mean posttest score was significantly higher than their mean pretest score. The study findings were supported by a preexperimental study on the effectiveness of a planned teaching program on toilet training to mothers of children between 1 and 3 years of age in selected day-care centers at Mangalore. The samples were sixty mothers having children between 1 and 3 years of age at Mangalore. The data were collected using structured questionnaire. The results show that 95% of mothers had good knowledge score that is 70%–100% in the posttest as compared to average knowledge score that is 50%–69% obtained among 73.33% of samples in the pretest. The researcher concludes that a planned teaching program helps to improve the knowledge of mothers regarding toilet training.[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29]

Quartile distribution of pre- and post-test knowledge scores of parents regarding toilet training

The plotted “o” gives shows a significant difference between the pre- and post-test knowledge scores. The knowledge pretest median of knowledge was 13.50 whereas the posttest median score was 21.50. It shows a difference of 9 in knowledge and this indicates that there is a significant increase in the knowledge of parents regarding toilet training after the video-assisted teaching program.

Hence, it was concluded that there is very highly significant gain in knowledge of parents on toilet training after the video-assisted teaching program.

Association between pretest knowledge scores of parents on toilet training with selected demographic variables

There was a significant association between the knowledge and the demographic variables.

The null hypotheses were rejected. The study findings were supported by a cross-sectional study which was done to determine the association of toilet training with child and environmental factors in the USA. The samples were a total of 496 children aged 24–42 months attending a pediatric clinic. The method of data collection was observation method. The results showed that the ages at which 50% of children were predicted to be toilet trained were 36 and 39 months for girls and boys, respectively. Significant factors predicting toilet training completion were older age, non-Caucasian race, female gender, and single parenthood.[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53],[54],[55],[56],[57],[58],[59],[60],[61],[62]


  Conclusion Top


Learning to use toilet is a big event in a young child's life – a sure sign of growing up. Most of the children are eager about learning how to use the “potty” and are quite proud of their achievement. Toilet teaching is easiest when children are physically and emotionally ready, which happens between the ages of 2 and 3 years. The process of toilet training can be a very challenging time for parents. The secret to success is patience and timing. This area of pediatric care presents a critical opportunity for anticipatory guidance. The parents need guidance in recognizing the signs of readiness, in helping their child achieve the necessary skills, and in addressing the problems when they occur. Proper toilet training will help make a well-disciplined hygienic generation.[63],[64]

Acknowledgments

I am grateful to the Almighty God for the abundant blessings showered on me to complete this work successfully.

Accomplishment of this study owes to the encouragement and guidance given by many individuals. It is a pleasure to thank many people who made this thesis possible.

I express my sincere acknowledgment to Dr. Rema Devi C, Vice Principal, Anathapuri College of Nursing, Thiruvananthapuram, and to the management for giving me the support and encouragement.

I express my sincere gratitude to my parents and my family for their stimulating suggestions, constant encouragement, and motivation in all the time of the research and for writing this research work.

This research work would never have taken shape without the inspiration and support of my colleagues. Hence, I express my gratitude and love toward them. Thanks to one and all for their kind-hearted support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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