A Study to Assess The Effectiveness of Video Assisted Teaching on Knowledge and Pre-Procedural Anxiety Level of Patients Undergoing Upper Gastrointestinal Endoscopy at Tertiary Care Hospital, Bathinda, Punjab.

Diagnostic tests such as endoscopy are anxiety-provoking. Anxiety is very much common in majority of patients undergoing gastro intestinal endoscopy. Endoscopy plays a major role in diagnosis and management of gastro intestinal disorders and in clinical research. Informing the patients about the procedure to become aware regarding the procedure is one of the best method to reduce anxiety and increase satisfaction among patients undergoing upper gastro intestinal endoscopy. This aim of study was to evaluate the effectiveness of video assisted teaching on knowledge and anxiety level among Patients undergoing upper gastrointestinal endoscopy procedure. A quantitative evaluative research approach with Quasi-experimental two group pre test post test design was used to attain the objectives of this study. 60 patients undergoing upper gastrointestinal endoscopy were selected from selected hospital by convenience sampling technique. Data was collected by using self-structured knowledge questionnaire for assessing knowledge related to Upper Gastro Intestinal Endoscopy Procedure, And to assess the level of anxiety using standardized Beck Anxiety Inventory (BAI) Scale. As intervention, video assisted teaching were administered to the experimental group to evaluate its effectiveness by performing Pre and Post Test. Results: The findings of study revealed that the statistically significant improvement in all aspects of patient knowledge score of experimental group at pre and post implementation of video assisted

Results: The findings of study revealed that the statistically significant improvement in all aspects of patient knowledge score of experimental group at pre and post implementation of video assisted teaching program (p<0.001), there was no significant improvement in control group in absence of intervention.There were statistically significant improvements of level of anxiety of experimental group at pre and post implementation of video assisted teaching program (p<0.001) and in control group the anxiety level continued to remain high in the absence of Video assisted Teaching.It was also found that there was significant relationship between pre knowledge versus post knowledge and pre anxiety versus post anxiety in control group with (P< 0.05) While there was no significant association between pre knowledge versus than 20 million endoscopies are performed yearly in the United States.Out of this, 30.6% endoscopies are Upper GI endoscopy.India lacks a centralized database of these procedures.However, in the hospital under study, an average of 3500 endoscopies is carried out yearly.Upper GI endoscopy constitutes about 75% of these procedures. [7]. RESEARCH METHODOLOGY 2.1 Research Approach and Design: A quantitative evaluative research approach with Quasi-experimental two group pre test post test design was used to attain the objectives of this study.This study was conducted among participants undergoing upper gastro endoscopy at selected tertiary care hospital, bathinda, Punjab.

Population and Sample:
The population for this study comprised of the patient's undergone upper gastrointestinal endoscopy at selected tertiary care hospital, bathinda, Punjab.The sample size of the present study was 60 participants.(i.e.) 30 in experimental group and 30 in control group.In this study the samples were selected by using non-probability convenience sampling technique, was used to assign the participants to experimental and control group.

Criteria for Sample Selection Inclusion criteria:
1) Patients who are willing to participate.Exclusion criteria: 1) Patients who are cognitively and sensory impaired.

Description of the tool:
Section A-Socio-demographic data of patients undergoing upper gastrointestinal Endoscopy.Section B-Structured Knowledge Questionnaire.It consisted of 10 items.Each item has four options.Each correct option was given a score of one and zero for incorrect option.The maximum score on knowledge was 10.The knowledge score was interpreted as Poor, Average and Good.Section C -A beck anxiety inventory (BAI) was used to assess the level of anxiety among patients undergone upper gastrointestinal endoscopy in endoscopic unit at selected tertiary care hospital, bathinda, Punjab.It consists of 21 items each measured using a 4 point likert scale.Response option: 0= Not at all, 1= Mildly, but it didn't bother me much, 2= Moderately -it wasn't pleasant at times, 3= Severelyit bothered me a lot respectively.The total score is calculated by finding the sum of the 21 items.

Scoring key
Level of Anxiety 0-21 low anxiety 22-35 moderate anxiety 36 and above potentially concerning levels of anxiety

Description of the intervention:
Video assisted teaching include on the following aspects: ─ Introduction and meaning of Endoscopy ─ Parts of upper gastro intestinal system.─ Indications and purpose for upper gastro endoscopy procedure.─ Preparation of patient before, during and after upper gastro endoscopy procedure.

Data collection process:
Approval was obtained from the Institutional Ethical Committee of Adesh University, Bathinda, the researcher had taken formal permission from Medical superintendent, Dean college of nursing, Nursing superintendent, Principal college of nursing, Adesh university HOD-Endoscopy.Written consent was taken from the participants before data collection.The Patients were informed that the confidentiality of data will be maintained.The data was collected over a period of 6 weeks during the months of February and March, 2020.Participants were selected by using convenience sampling technique.Before the intervention the level of knowledge and level of anxiety was assessed as pre-test by the investigator for both the experimental and control group.After assessing the level of knowledge and anxiety level video assisted teaching for 10 minutes was given by the investigator for experimental group, for control group no intervention was given.In experimental group the level of Knowledge with the same Structured Knowledge Questionnaire and the level of anxiety with the same beck anxiety inventory (BAI) scale was assessed as post-test after ten minutes of video assisted teaching.

RESULTS:
The analyzed data was organized and presented in the form of tables which was organized under the following sections: Section-1: Frequency and percentage distribution of socio demographic variables of patients underwent upper gastrointestinal.Section-2: Findings related to level of knowledge regarding Upper Gastro Intestinal endoscopy among patients underwent endoscopy procedure in experimental and control group by means of Mean and standard deviation Section-3: Findings related to pre procedural anxiety level regarding Upper Gastro Intestinal endoscopy among patients underwent endoscopy procedure in experimental and control group by using Beck Anxiety Inventory scale by means of Mean and standard deviation.Section-4: Findings related to the effectiveness of video assisted teaching on level of knowledge regarding upper Gastro Intestinal endoscopy among patients underwent endoscopy procedure in experimental group by means of "t" Test.Section-5: Findings related to the effectiveness of video assisted teaching on pre procedural anxiety regarding upper gastro intestinal endoscopy among patients underwent endoscopy procedure in experimental group by means of "t" Test.Section-6: Findings related to association between the level of knowledge and level of pre procedural anxiety among experimental and control group of patients underwent Endoscopy procedure by means of Chi Square test.Section-7: Findings related to association between level of knowledge, pro procedural anxiety level with their selected demographic variables by means of Chi Square test.

DISCUSSION:
In the present study, in experimental group before intervention, 22 (73.3%) of the respondents had poor knowledge (score 0 -3), 8 (26.7%) of the respondents had average knowledge (Score 4-7) and none of the respondents had good knowledge (score 8-10) related to upper gastrointestinal endoscopy.Similarly in the control group 20 (66.7%) had poor knowledge, 10(33.3%)had average knowledge and none had good knowledge related to upper gastrointestinal endoscopy.Before intervention, The Mean pre -test knowledge level of respondents underwent upper gastrointestinal endoscopy in the experimental group was 2.67 with a Standard Deviation of +/-1.184 and Range of 4.Where as in the control group the Mean pretest level of knowledge among respondents underwent upper gastrointestinal endoscopy was 2.73 with a S.D of +/-1.143 and Range of 4. After providing Video assisted teaching programme related to upper gastrointestinal endoscopy, the level of knowledge in the experimental group changed.Among 23 (76.7%) had average knowledge, 7 (23.3%)had Good Knowledge and None of the respondents had poor knowledge related to upper gastrointestinal endoscopy.Where as in the control group 19 (63.3%) of the respondents continued to have Poor Knowledge, 11 (36.7%) had average knowledge and none had Good Knowledge indicating that in the absence of Teaching there will not be any improvement in level of Knowledge.After intervention the Mean post -test knowledge level of respondents underwent upper gastrointestinal endoscopy in the experimental group was 6.27 with a Standard Deviation of +/-1.596 and Range of 5.Where as in the control group the Mean posttest level of knowledge among respondents was 3.00 with a S.D of +/-1.145 and Range of 4. Before video assisted teaching, in the Experimental group 14 (46.7%) of the respondents had low Anxiety level (Score 0-21), 12 (40%) of the respondents had Moderate Anxiety level (Score 22-35) and 4 (13.3%) of the respondents were potentially concerned levels of Anxiety related to upper gastrointestinal endoscopy procedure.The Mean pre procedural anxiety level among respondents was 22 with a S.D of +/-9.638 and Range of 34 where as in the Control group the Mean pre procedural Anxiety level was 25.8 with a S.D of +/-12.090and a Range of 36.However after the video assisted teaching 28(93%) of the respondents had Low Level of Anxiety, only 2 (6.7%) of the respondents had Moderate level of Anxiety and none of the respondents had potentially concerning levels of Anxiety.There was no significant level of change in Anxiety level among Control group respondents in both pre-test and posttest phases in the absence of video assisted teaching.Following video assisted teaching, the mean post-test Anxiety level as measured by Becks Inventory Scale in the Experimental group was 11.03 with a S.D of +/-6.071 and a Range of 27.Where as in the Control group the Mean Anxiety level was 23.97 with a S.D of 11.134 and a Range of 41, indicating that the anxiety level continued to remain high in the absence of Video assisted Teaching.A paired "t" test was compiled to determine whether the observed difference in mean pre-test and mean post-test knowledge level of experimental group was statistically significant.The observed "t" value of 15.138 was higher than the table value (P<0.001)indicating that the observed difference in mean was statistically significant.Similarly, "t" test was conducted to determine whether observed difference in mean scores of control group respondents knowledge level was statistically significant.The observed value 1.861 was less than the Table value indicating that the observed difference in mean was not statistically significant.An unpaired "t" test conducted to see whether the observed difference in Pre test Mean scores of experimental and control group was statistically significant.The observed value of 0.222 was less than Table value indicating the difference in pretest mean knowledge level between the groups was not statistically significant.However the observed Mean difference in post test knowledge level of experimental and control group was statistically significant as observed "t" value of 9.110 was higher than that of table value at 0.001 level of significance.A paired "t" test was compiled to determine whether the observed difference in mean pre-test and mean post-test anxiety level of experimental group was statistically significant.The observed "t" value of 11.851 was higher than the table value (P<0.001)indicating that the observed difference in mean was statistically significant.Similarly, "t" test was conducted to determine whether observed difference in mean anxiety level of control group respondents knowledge level was statistically significant.The observed value 1.977 was less than the Table value indicating that the observed difference in mean anxiety level was not statistically significant.An unpaired "t" test conducted to see whether the observed difference in pre-test Mean scores of experimental and control group was statistically significant.The observed value of 1.346 was less than table value indicating the difference in pretest mean scores between the groups was not statistically significant.However the observed Mean difference in post-test anxiety level of Experimental and Control Group was statistically significant as observer "t" value of 5.586 was higher than that of table value (P<0.001) level of significance.So it was clearly noted that the verbal information not only improves the knowledge but also has great impact on reducing the anxiety level among patients undergoing upper gastro endoscopy.

CONCLUSION:
The current study findings suggest that video assisted teaching programme is effective teaching method, which can easily be administered to group of patients, which in turn will improve the knowledge and reduce their anxiety levels.So it is concluded that the video assisted teaching developed by the researcher was found to be helpful in decreasing anxiety and enhancing knowledge among the patient undergoing upper gastro endoscopy.The video assisted teaching can be introduced in the nursing interventions as part of their patient care.
6. ACKNOWLEDGEMENT: In the name of ALLAH s.w.t the most Merciful, Omnipotent and Beneficent, First and foremost praise is to ALLAH, the Almighty, the greatest of all, on whom ultimately we depend for sustenance and guidance.I would like to thank Almighty Allah for giving me opportunity, determination and strength to do my research.His continuous grace and mercy was with me throughout my life and ever more during the tenure of my research and also with the people behind my life for inspiring, guiding and accompanying me through thick and thin.With great proud and privilege, I take immense pleasure to express my sincere gratitude and heart full thanks to my respected Principal and guide Mr. Shridhar K.V Professor & H.O.D of Department of Medical Surgical Nursing and Principal of College of Nursing, Adesh University Bathinda, for his support, guidance and advice throughout the research project.My profound and sincere thanks to all the Associate and Assistant Professors and Lecturers of College of Nursing, Adesh University Bathinda, Punjab for their helping hands throughout the completion of my study.With great proud and privilege, I immensely owe my profound sense of gratitude , affection and love goes to my dearest parents Mr. Shawkat Ahmad Dar and Mrs. Negeena Banoo and my beloved siblings, they stood by me during the ups and downs of my life.They have been selfless in giving me the best of everything and I express my deepest gratitude for their love without which this work would not have been completed.Finally, I would like to thank everybody who was important for the successful realization of this thesis.

Table No .2(a): Table showing difference between pre and post test knowledge scores for study group LEVEL OF KNOWLEDGE Score Level Pre Test - Experimental Pre Test - Control Post Test - Experimental Post Test - Control
Table No. 2(b): Table showing Pre-Test Mean, Mean Percentage, Median, Range, Minimum and Maximum level of knowledge of experimental and control Group IJFMR2205072 Volume 4, Issue 5, September-October 2022 7 .