Hemşirenin yürüttüğü eğitim ve İzlem programının çocukların güneşten korunma davranışlarına etkisi
Küçük Resim Yok
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Yaşam boyu güneşe maruziyetin yaklaşık %25'i 18 yaş öncesinde oluşmaktadır. Çocukluk döneminde maruz kalınan ultraviyole radyasyon dozu ile erişkinlik döneminde ortaya çıkan deri kanserleri arasındaki anlamlı ilişki, bu dönemde uygulanacak güneşten korunma davranışlarının önemine dikkat çekmektedir. Koruyucu sağlık davranışlarını kazandırmada, okul çağı çocuklar kolay ulaşılabilir bir konumdadır. Araştırmada amaç, hemşirenin yürüttüğü eğitim ve izlem programının çocukların güneşten korunma davranışlarına etkisini incelemektir. Gereç ve Yöntem: Randomize kontrollü prospektif deneysel izlem araştırması, Şubat-Ekim 2014'te gerçekleştirildi. Araştırma, İzmir ili Karşıyaka ilçesindeki 25 okuldan amaca uygun olasılıksız örnekleme yöntemi ile seçilen orta ekonomik düzeydeki ailelerin çocuklarının öğrenim gördüğü iki okulda yürütüldü. Araştırma öncesinde Fitzpatrick sınıflaması ile 260 çocuğa risk değerlendirmesi yapıldı. Riskli bulunan 144 çocuktan ebeveyni ve kendisine ait yazılı izni olanlar; yaş, cinsiyet ve deri fototipine göre randomize edildi. Randomizasyonda; tabakalama ve bloklama kullanılarak, deney (n:40) ve kontrol (n:40) grubuna atama yapıldı. Araştırmada %5 hata ve %80 güvenle etki büyüklüğü 0.73 olarak belirlendi. Teoriler üstü modele dayandırılan çalışmada; veriler tanıtıcı veri formu, güneşten korunma değişim aşamaları, güneşten korunma davranış ölçeği, çocuk ve ebeveyn güneşten korunma değişim aşaması formları, karar dengesi ölçeği, güneşten korunma öz yeterlilik ölçeği ile yüz yüze görüşülerek toplandı. Ölçeklerin, Türkçe geçerlik ve güvenirlik çalışmaları Aygün ve Ergün (2013) tarafından yürütülmüştür. Deney grubuna, güneşten korunma davranışları konusunda altı oturumda eğitim verildi. Eğitim sonrası (15.gün,1.ay,2.ay) hatırlatma eğitimleri düzenlendi. Programın başlangıcında ve sonunda çocukların güneşten korunma davranışları, karar dengesi ve öz yeterlilikleri değerlendirildi. Veriler bağımsız iki örnek t testi ve tek yönlü varyans analizi, Wilcoxon işaretli sıralar testi, Mann Whitney U testi ve ki-kare analizleri ile değerlendirildi. Çocuklar ve velilerinden, okul yönetimlerinden, yerel etik kuruldan ve ölçeklerin sahibinden yazılı onamlar alındı. Bulgular: Çocukların %50'si kız olup, yaş ortalaması 8.27±0.44 idi. Deri fototipleri açısından çocukların %22.5'i tip I, %41.2'si tip II, %36.3'sı tip III olarak değerlendirildi. Deney grubunun, güneşten korunma davranış ölçeği puan ortalaması araştırma öncesi 19.25±5.44 iken, araştırma sonrası dönemde anlamlı düzeyde yükseldi (33.05±4.23, p<.001). Deney grubunun, güneşten korunma öz yeterlilik puan ortalaması araştırma öncesi 20.50±6.68 iken, araştırma sonrası 35.85±4.70 bulundu (p<.001). Deney grubunun, araştırma öncesi güneşten korunma karar dengesi algılanan yarar alt boyutu puan ortalaması 11.82±3.69 iken, araştırma sonrası 16.32±2.81 saptandı (p<.001). Deney grubunun, araştırma öncesi güneşten korunma karar dengesi algılanan zarar alt boyutu puan ortalaması 8.87±2.91 iken, araştırma sonrası anlamlı düzeyde azaldı (8.55±4.72, p<.001). Kontrol grubu çocukların güneşten korunma davranışları, öz yeterlilik düzeyleri ve karar dengesi yarar ve zarar alt boyutlarında istatistiksel olarak anlamlı bir değişim saptanmadı (p>0.05). Hem deney hem kontrol grubun ön izlemi ile son izlemi arasında güneşten korunma davranışları değişim aşamaları açısından saptanan farklar -güneş koruyucu ürün kullanımı (?2=68.83, p<.001), güneşten koruyucu giysi kullanımı (?2=50.61, p<.001), güneş gözlüğü kullanımı (?2=61.41, p<.001), gölgede kalma (?2=62.22,p<.001), geniş kenarlı şapka kullanma (?2=65.13, p<.001)- istatistiksel olarak çok anlamlı bulundu. Doğrusal regresyon sonucuna göre; son izlemde güneşten korunma öz yeterlilik puan ortalaması, güneşten korunma karar dengesi yarar ve zarar alt boyutları puan ortalamalarının çocukların güneşten korunma davranışlarını etkileyen değişkenler olduğu belirlendi (p<.05). Sonuç: Bu çalışma, güneşten korunmaya yönelik hemşirenin eğitim ve izlem programı ile çocukların güneş koruyucu ürün ve giysi kullanma, şapka ve güneş gözlüğü takma ve gölgede kalma gibi güneşten korunma davranışlarını arttırdığı, öz yeterlilik ve karar dengesi algısını geliştirdiğine ilişkin kanıtlar sağlamıştır. Okul sağlık hizmetlerinde, hemşireler bu programdan örnek bir model olarak yararlanarak öğrencilerin sağlığının korunması ve geliştirilmesine katkı sağlayabilirler. Anahtar sözcükler: Teoriler üstü model; çocuk; güneşten korunma; öz yeterlilik; karar dengesi; hemşire
Background: Approximately 25% of lifelong sun exposure is formed prior to the age of 18. A significant correlation between exposure to ultraviolet radiation in childhood and skin cancer in adulthood draws attention to the importance of sun protection behaviors to be applied in this period. School-age children are easily reachable to promote preventive health behaviors. The aim of the study is to determine the effect of nurse health education and follow up programme on sun protection behaviors of children. Methods: The study as a randomized controlled group trial was implemented in February- October 2014. Purposive non probability sampling was used to select 25 schools in Izmir Karşıyaka district and research was conducted in two schools where attending the children coming from medium families. Risk assessment for skin cancer was performed by Fitzpatrick classification with 260 children before the study. Out of these children, 144 were found to be risky and were randomized to intervention (n = 40) and control (n = 40) groups according to their age, gender, and skin type. In the survey, effect size was identified as 0.73 by a 5% error and 80% confidence. After obtaining the parents' and the children's written consents, data were collected through face-to-face interviews using with, the instruments (stages of change, the decisional balance scale, child and parental sun protection behavior form, self-efficacy form) on sun protection based on the transtheoretical model. Turkish validity and reliability study of the scale was conducted by Aygün and Ergün (2013). Intervention group were trained about sun protection behaviors in six sessions. Each session lasted 45 minutes. Refresher training was organized on the 15th day, on 1st month 2nd month after first session. At the beginning and at the end of the program, decisional balance and self-efficacy of children was evaluated. Data were analyzed by frequencies, regression, Wilcoxon signed-rank test, paired samples t-test, independent samples t-test, Mann-Whitney U test, Friedman's test and Chi-square test. Written consent was taken from children and their parents, schools and from the local ethics committee. Results: 50% of children were girl and the mean age was 8.27±0.44. Skin types were; 22.5% type I, 41.2% type II, 36.3% type III. While pretest mean score of sun protection behavior scale of intervention group was 19.25±5.44, after the research it increased significantly (33.05±4.23, p<.001). In intervention group while self-efficacy pretest mean score was 20.50±6.68, it was found to be 35.85±4.70 (p<.001) in posttest. In intervention group; while pros scores of decisional balance was found 11.82±3.69, for the posttest it was found 16.32±2.81 (p<.001). In intervention group; while cons scores of decisional balance was found 8.87±2.91 in pretest, it was significantly increased in the posttest (8.55±4.72, p<.001). No increase in the mean scores for sun protection behaviors, self-efficacy and the decisional balance was found significantly (p>0.05) in the control group. In both intervention and the control group, the differences of stages of change of sun protection behaviors between the pre and posttest was found statistically very significant respectively –sunscreen (?2=68.83, p<.001), sun protective clothing (?2=50.61, p<.001), sunglasses (?2=61.41, p<.001), stay in the shade (?2=62.22, p<.001), a wide-brimmed hat usage (?2=65.13, p<.001). According analyses of the linear regression; self-efficacy, pros and cons of decisional balance were determined as the effective variables on children's sun protection behavior (p<.05) in posttest. Conclusion: This study demonstrated evidence that the interventions of this nurse health education and follow up programme has been effective on increasing sun protection behaviors (usage of sunscreen, hat and sunglasses and stay in shade) through improving self-efficacy and decisional balance. Key Words: Transtheoretical model; child; sun protection; self-efficacy; decisional balance; nurse
Background: Approximately 25% of lifelong sun exposure is formed prior to the age of 18. A significant correlation between exposure to ultraviolet radiation in childhood and skin cancer in adulthood draws attention to the importance of sun protection behaviors to be applied in this period. School-age children are easily reachable to promote preventive health behaviors. The aim of the study is to determine the effect of nurse health education and follow up programme on sun protection behaviors of children. Methods: The study as a randomized controlled group trial was implemented in February- October 2014. Purposive non probability sampling was used to select 25 schools in Izmir Karşıyaka district and research was conducted in two schools where attending the children coming from medium families. Risk assessment for skin cancer was performed by Fitzpatrick classification with 260 children before the study. Out of these children, 144 were found to be risky and were randomized to intervention (n = 40) and control (n = 40) groups according to their age, gender, and skin type. In the survey, effect size was identified as 0.73 by a 5% error and 80% confidence. After obtaining the parents' and the children's written consents, data were collected through face-to-face interviews using with, the instruments (stages of change, the decisional balance scale, child and parental sun protection behavior form, self-efficacy form) on sun protection based on the transtheoretical model. Turkish validity and reliability study of the scale was conducted by Aygün and Ergün (2013). Intervention group were trained about sun protection behaviors in six sessions. Each session lasted 45 minutes. Refresher training was organized on the 15th day, on 1st month 2nd month after first session. At the beginning and at the end of the program, decisional balance and self-efficacy of children was evaluated. Data were analyzed by frequencies, regression, Wilcoxon signed-rank test, paired samples t-test, independent samples t-test, Mann-Whitney U test, Friedman's test and Chi-square test. Written consent was taken from children and their parents, schools and from the local ethics committee. Results: 50% of children were girl and the mean age was 8.27±0.44. Skin types were; 22.5% type I, 41.2% type II, 36.3% type III. While pretest mean score of sun protection behavior scale of intervention group was 19.25±5.44, after the research it increased significantly (33.05±4.23, p<.001). In intervention group while self-efficacy pretest mean score was 20.50±6.68, it was found to be 35.85±4.70 (p<.001) in posttest. In intervention group; while pros scores of decisional balance was found 11.82±3.69, for the posttest it was found 16.32±2.81 (p<.001). In intervention group; while cons scores of decisional balance was found 8.87±2.91 in pretest, it was significantly increased in the posttest (8.55±4.72, p<.001). No increase in the mean scores for sun protection behaviors, self-efficacy and the decisional balance was found significantly (p>0.05) in the control group. In both intervention and the control group, the differences of stages of change of sun protection behaviors between the pre and posttest was found statistically very significant respectively –sunscreen (?2=68.83, p<.001), sun protective clothing (?2=50.61, p<.001), sunglasses (?2=61.41, p<.001), stay in the shade (?2=62.22, p<.001), a wide-brimmed hat usage (?2=65.13, p<.001). According analyses of the linear regression; self-efficacy, pros and cons of decisional balance were determined as the effective variables on children's sun protection behavior (p<.05) in posttest. Conclusion: This study demonstrated evidence that the interventions of this nurse health education and follow up programme has been effective on increasing sun protection behaviors (usage of sunscreen, hat and sunglasses and stay in shade) through improving self-efficacy and decisional balance. Key Words: Transtheoretical model; child; sun protection; self-efficacy; decisional balance; nurse
Açıklama
Anahtar Kelimeler
Hemşirelik, Nursing