· Web viewA cross sectional study was conducted to examine the relationship between compulsive hoarding and dengue fever. 52 adults notified by health vigilance authorities because

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

1 NAME OF THE CANDIDATE

AND ADDRESSMr. VIVEK VASUDEVAN 1st YEAR M.Sc. NURSING,KNN COLLEGE OF NURSING,SATTELITE,TOWN, YELAHANKA,BANGALORE-560062.

2 NAME OF THE INSTITUTE KNN COLLEGE OF NURSING, BANGALORE.

3 COURSE OF THE STUDY AND SUBJECT

1stYEAR M.Sc NURSING, MENTAL HEALTH NURSING.

4 DATE OF ADMISSION 01-07-2013

5 TITLE OF THE STUDY

EFFECTIVENESS OF COMPUTER ASSISTED TEACHING ON KNOWLEDGE REGARDING COMPULSIVE HOARDING DISORDER AND ITS EFFECT ON HEALTH AMONG POST GRADUATE STUDENTS OF SELECTED DEGREE COLLEGES AT BANGALORE.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT

1

6. BRIEF RESUME OF THE INTENDED WORK

6.1. INTRODUCTION

“God prospers me not to raise my standard of living, but to raise my standard

of giving.” 

― Randy Alcorn

Many of us hang on to treasures and memorabilia from the past, but our

homes are not so overwhelmed with clutter that it becomes detrimental to our health and

safety, let alone our sanity1. Collecting is undertaken by all. Most people enjoy acquiring

and using their possession and nearly everyone keeps some they don’t need or use. What

motivates collecting changes across the life span. In childhood, items are collected for

leisure or enrichment. In adulthood, it is often for monetary reasons and in old age, the

collecting of items may be for reasons of sentimentality or security. Collecting rarely

leads to distress or dysfunction and the behavior undertaken secretly.2

The earliest reference to hoarding occurred in Dante Aligheri’s Divine

Comedy, an epic poem written early in the 14th century. Other references to hoarding

have appeared in literature since then. Charles Dickens’ character, Krook, in Bleak

House (1862) was described as “possessed with documents” in a shop where “Everything

seems to be bought and nothing sold.”3

The first systematic study and definition of hoarding was published in

1993 by Frost and Gross. Here hoarding was defined for the first time as “the acquisition

of, and failure to discard, possessions which appear to be useless or of limited value”.

This study was the first to describe hoarding in a large sample of people, and it framed

our earliest picture of hoarding and the phenomena associated with that.3

Compulsive hoarding or pathological collecting, or, informally, pack

ratting is a pattern of behavior that is characterized by the excessive acquisition of an

inability or unwillingness to discard large quantities of objects that cover the living areas

of the home. Compulsive hoarding behavior has been associated with health risks,

2

impaired functioning, economic burden, and adverse effects on friends and family

members.4

Hoarding is characterized by two parts. The first is the accumulation of

things that have little or no value. The second is the inability to part with things that the

hoarder has accumulated. Typically, hoarders pile up old newspapers, food cartons, cans,

mail, lists, notes, clothes, garbage and other debris. There are also instances of animal

hoarding, where an individual collects and houses dozens to hundreds of animals.1

Hoarding usually begins slowly, but builds over time. Hoarding can lead

to a wide range of serious problems as it gets worse. For people who live in the home,

these risks include, tripping and falling over things, being hurt and even killed when

items fall on them, developing health problems from mold or pests that live in the clutter,

delays in receiving emergency care, injury or even death. In addition to these problems

that affect people who live in a hoarded home, hoarding presents risks for neighbors,

building owners, and for the property itself. These risks may include public health

problems (e.g., spread of pest infestation) for adjacent apartments and homes, structural

problems because of too many heavy items (for example, books) that are too much for the

load limits of the building, flooding when pipes are in need of repair, fire from electrical

wiring or heating systems in need of repair, lost property value and of rent income for

landlords who must make costly repairs due to hoarding or who have to pay legal fees

(e.g., to end a tenant’s lease)5

Compulsive Hoarding is a condition that is caused by both biological and

psychological factors. Because of this, it is critical that individuals facing this condition

receive specialized treatment services, In addition to helping the person struggling with

Compulsive Hoarding Syndrome, it will be equally important to include any family

members, or other support who are impacted by the condition. Often times there is

incredible frustration built up, even anger.  As these emotions intensify, arguments ensue

that only serve to create a more tense and uncomfortable environment. As such, we have

a lot of tips to help guide family members and the individuals who all are undergoing

compulsive hoarding disorder.6

3

Systematic management and treatment of compulsive hoarding are under

processing. Education and increased social support plays an important role in early

dedication of compulsive hoarding disorder. Many people who hoard have very limited

social support. Supporting them will provide a way for the people to discuss their

situation, improve solutions and helps them to reduce anxiety, depression and sense of

burden. Gaining knowledge will help the hoarder to know the nature of disease.7 The

most common drug assisted treatments involve the use of the tricyclic antidepressant

clomipramine (Anafranil) and the selective serotonin reuptake inhibitors (SSRI) such as

paroxetine. Cognitive behavioral therapy (CBT) is also showing the most promising

therapy which is derived from the cognitive behavioral model for the treatment of

compulsive hoarding disorder.2

6.2. NEED FOR THE STUDY

Compulsive hoarding is a disorder characterized by difficulty discarding

items that appear to most people to have little or no value. This leads to an accumulation

of clutter such that living and workspaces cannot be used for their intended purposes. The

clutter can result in serious threats to the health and safety of the sufferer and those who

live nearby. Often people with compulsive hoarding also acquire too many items - either

free or purchased.8

Hoarding is a serious public health hazard that poses significant health and

safety risks for individuals, families, and communities. Research indicates that

compulsive hoarding is a growing social and environmental problem across the United

States, affecting as many as 2-5% of the population. Hoarders often live chaotically in

their own private clutter until it spreads so far that it evolves into medical emergencies or

can only be contained by the law.8  It is a common psychiatric condition that’s affect an

estimated 700,000 to 1.4 million Americans, but few receive adequate treatment.9

Compulsive hoarding affects approximately 2-5% of the adult population.10 Childhood

onset is the norm with one study showing that 66% began hoarding in childhood, 25% in

their twenties and 9% after the age of 24. Recent studies showing that 65% of compulsive

4

hoarders are either single or unemployed and up to 55% experienced family conflict

resulting from their condition.2

Based on estimates from a study of US college students the prevalence of

compulsive hoarding is roughly 2 - 4%. Data extrapolated from the number of those with

OCD presenting with compulsive hoarding, supplies a figure of less than 1 in 200 or

0.5%.  OCD has a lifetime prevalence of 1 - 2% of the population and around 25% to

30% of patients with OCD are clinical compulsive hoarders. Recent demographics

concluded that those who have higher level education may be more likely to hoard

things.10

A study conducted found hoarding in nearly 4% of a U.S. sample and

when the researchers adjusted this figure to fit population demographics, the estimated

prevalence was 5.3%, making hoarding far more common than OCD. Hoarding occurred

more often among men than women and increased with age. A representative sample of

the German population showed a very similar prevalence rate of 4.6%, although there

were no gender differences. In a UK study of over 5,000 twins, 2.3% met criteria for

clinically serious hoarding and like the first U.S. study, men who hoarded outnumbered

women.3 It has been found that 2-4% of college students are compulsive hoarders.

Research shows that between 25-35% of all hoarders are also afflicted with obsessive

compulsive disorder.11 People who are compulsive hoarders are likely to be single due to

the fact that their social life is stunted due to their hoarding.3

A study was conducted among college students to assess hoarding

behavior. The current study examined hoarding in 563 unselected college students in US.

The study identified four domains of hoarding behaviors as measured by the 26-item

Saving Inventory-Revised: Difficulty Discarding, Acquisition Problems, Clutter, and

Interference/Distress. The result showed that the students showed significant correlations

with social anxiety, depressive symptoms, and worry. The study also concludes

that, hoarding behaviors showed a surprisingly strong relationship with anxiety

sensitivity, similar in magnitude to the relationship between hoarding and OCD

symptoms.12

5

Recent studies from India have examined the phenomenology of OCD in

children using the children’s version of the Yale-Brown Obsessive-Compulsive Scale

(CY-BOCS).In a study of 58 children and adolescents, all aged 16 years and below,

contamination obsessions were (62%), followed by obsessions related to aggression

(57%), somatic (12%), and hoarding (7%).13

A comparative study was conducted to find the health effect of

compulsive hoarding disorder such as substantial disability and functional impairment.

This present study compared compulsive hoarders and non-hoarding OCD patients across

a variety of quality of living (QOL) domains. Subjects were 171 coonsecutive adult

patients (34 compulsive hoarders, 137 non-hoarding patients with DSM-IV OCD) treated

openly between 1998 and 2004 in the UCLA OCD Partial Hospitalization Program (OCD

PHP) in US. The result showed both groups had low overall QOL scores across multiple

domains. Compulsive hoarders had significantly lower levels of satisfaction with their

safety than non-hoarding OCD patients, were more often the victims of both violent and

non-violent crime, felt less safe in their neighborhoods, and felt less protected against

attack. The study concluded that compulsive hoarders have lower QOL than non-

hoarding OCD patients in the domains of safety and living situation.14

An epidemiological study from India showed the prevalence of 0.6%. This

rate is considerably lower compared to the 2-3% rate reported in the European and North

American studies. However, similar low rate ranging from 0.5-0.9% was observed in a

study from Taiwan. It is not clear why lifetime prevalence rate of OCD is lower in some

countries although the rates are not very low compared to the conservative estimate of

1% rate of OCD. However, further research is needed into the epidemiological aspects of

OCD in India since the data available is limited.15

A study was conducted which aimed to provide data on the prevalence and

correlates of clinically significant hoarding in a large sample of patients with OCD from

the Indian subcontinent. They examined 200 patients with Diagnostic and Statistical

Manual of Mental Disorders, Fourth Edition OCD for clinically

6

significant hoarding using the Saving Inventory-Revised, followed by a clinical

interview. Twenty patients (10%) had clinically significant hoarding. In all

cases, hoarding did not appear to be related or secondary to other OCD symptoms. The

results suggest that clinically significant hoarding is relatively prevalent in Indian patients

with OCD and that it appears to be largely unrelated to the OCD phenotype.16

Hoarding has long been identified as a community health problem and has

been found to have a significant economic and social burden on communities at large. To

date, there have been no academic studies on the long-term effects of abatements, and we

know almost nothing about the financial and emotional costs of these approaches, both to

the community and the individuals who hoard and their families. This significantly limits

professional and government agencies in their ability to intervene and respond in

appropriate, effective, and ethical ways.17 Hoarding is a behavior that may manifest either

as a symptom (most commonly in OCD) or as a possible syndrome that develops with

age.18

According to the available literature the investigator has realized that the

health risks associated with compulsive hoarding disorder and studies also suggests that

researches in hoarding disorder in India is limited and it’s been concluded that further

studies should be done. It’s been seen that hoarding disorder is becoming a new

millennium disorder in developing world and the people are not aware of the ill effects

that may cause due to hoarding. Researches had indicated that people who are highly

educated are more prone to have compulsive hoarding disorder. Now in the developing

world people are so well educated and they never get mugged up and hence the

investigator felt the need to impart the knowledge regarding various aspects of

compulsive hoarding and its management among PG students in selected degree colleges

in Bangalore.

6.3. REVIEW OF LITERATURE

A review of literature refers to the activities involved in identifying and

searching for information on a topic and developing an understanding of the state of

7

knowledge on that topic. Review of literature is a crucial summary of research on a topic

of interest generally prepared to put a research problem in context to identify gaps and

weakness in prior studies so as to justify a new investigation.

Section A: literature related to incidence and prevalence on compulsive hoarding

disorder.

Section B: literature related to cause and clinical manifestation of compulsive

hoarding disorder

Section C: literature related to ill effects of compulsive hoarding disorder on health.

Section D: literature related to the management of compulsive hoarding disorder.

Section E: literature related to effectiveness of computer assisted teaching.

SECTION A: LITERATURE RELATED TO INCIDENCE AND PREVALENCE

ON COMPULSIVE HOARDING DISORDER

A study was conducted to examine prevalence and heritability of

compulsive hoarding in large sample of twins in UK. A total 5022 twins completed

validated measures of comprehensive hoarding. The prevalence of severe hoarding was

determined using empirical derived cutoffs. Genetic and environmental influences on

compulsive hoarding were estimated using liability threshold models and maximum

likelihood univariate model fitting analyses. (female twins; N=4,355). The result was

total of 2.3% of twins met criteria for caseness, with significantly higher rates observed

for male (4.1) than for female twins (2.1%) twins. Model fitting analyses in female twins

showed that genetic factors accounted for approximately 50% of variance in compulsive

hoarding with non shared environment factors and measurement error accounting for the

other half. The study concluded that compulsive hoarding is highly prevalent and

heritable, in women, with non shared environment factors.19

8

A study was conducted to examine the demographic, clinical and co-

morbid patterns in a large sample of adult subjects at OCD specialty clinic in India. The

samples Consecutive patients (n=545) who consulted a specialty OCD Clinic over 5 years

at a large psychiatric hospital in India were evaluated with the Yale-Brown Obsessive-

Compulsive Scale, and the Clinical Global Impression scale. Earlier age onset of OCD

(years) was characterized by male preponderance (19.61±7.98 vs. 25.19±10.39,

U=23453.5, p=<0.001), positive family history of OCD (19.60±10.02 vs. 22.27±9.20,

U=16590.5, p<0.001) and presence of tic disorder (16.28±8.21 vs. 22.01±9.38, OR=0.86,

p=0.001). In addition, early age of onset was associated with presence of sexual

obsessions (18.92±7.49 vs. 22.88±9.82, OR=0.96, p=0.02), hoarding (19.61±9.32 vs.

22.21±9.36, OR=0.95, p=0.009), repeating rituals (19.76±8.37 vs. 23.29±9.84, OR=0.95,

p=0.006) and need to touch compulsions (16.40±7.19 vs. 22.36±9.43, OR=0.89, p<0.001.

The findings concluded that early onset OCD could be valid and get severe as age

increases.20

A study was conducted which aimed to provide data on the prevalence and

correlates of clinically significant hoarding in a large sample of patients with OCD from

the Indian subcontinent (2012). They examined 200 patients with Diagnostic and

Statistical Manual of Mental Disorders, Fourth Edition OCD for clinically

significant hoarding using the Saving Inventory-Revised, followed by a clinical

interview. Twenty patients (10%) had clinically significant hoarding. In all

cases, hoarding did not appear to be related or secondary to other OCD symptoms. The

results suggest that clinically significant hoarding is relatively prevalent in Indian patients

with OCD.16

SECTION B: LITERATURE RELATED TO CAUSE AND CLINICAL

MANIFESTATION OF COMPULSIVE HOARDING DISORDER.

A study was conducted to examine the association between Intolerance of

uncertainty (IU) and hoarding behaviors. Participants consisted of 279 college students

from a large southern university. The results revealed that IU was a significant predictor

9

of hoarding severity after controlling for relevant covariates. Moreover, when looking at

the relationships among IU sub factors and hoarding, results indicated that Factor

1(intolerance of uncertainty) was significantly associated with hoarding. The current

study provides additional evidence that IU is an important individual difference variable

associated with various anxiety related conditions. The study concluded that uncertainty

and intolerance is a unique and robust predictor of hoarding behaviors.21

A study was conducted to examine the prevalence, co-morbidity and

etiology of hoarding symptoms in adolescence in Sweden. A population-based sample of

15-year old twins (N = 3,974) completed the Hoarding Rating Scale-Self Report. Model-

fitting analyses divided hoarding symptom scores into additive genetic, shared, and non-

shared environmental effects. The prevalence of clinically significant hoarding symptoms

was 2% (95% CI 1.6-2.5%), with a significantly higher prevalence in adults both boys

and girls. Exclusion of the clutter criterion (as adolescents do not have control over their

environment) increased the prevalence rate to 3.7% (95% CI 3.1-4.3%). The results

relatively showed hoarding symptoms in adolescents, particularly girls were distress and

emotional impairment. 22

A cross sectional study was conducted to compare demographic and

clinical features of OCD patients with and without hoarding symptoms. The samples used

were 1001 diagnostic and statistical manual of mental disorder – IV (DSM-IV) OCD

patients from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum

Disorders (CTOC). The tool used was Dimensional Yale-Brown Obsessive-

Compulsive Scale and Statistical univariate analyses. The results showed approximately

half of the sample (52.7%, n = 528) presented hoarding symptoms.  Hoarding was seen as

the severe dimension with mean score of 3.89. The most common life

time hoarding symptom was the obsessive thought of needing to collect and keep things

for the future (44.0%, n = 440). It also concluded that OCD hoarding patients are more

likely to present certain clinical features like anxiety, major depression, posttraumatic

stress, attention deficit/hyperactivity disorder and compulsive buying.23

A study was conducted by comparing 235 hoarding to 389 non-hoarding

participants in Baltimore. They found that, compared to non-hoarding individuals,

10

hoarders were more likely to have symmetry obsessions and repeating, counting, and

ordering compulsions; poorer insight; more severe illness; difficulty initiating or

completing tasks; and indecision. Hoarders had a greater prevalence of social phobia and

generalized anxiety disorder. Hoarders also had a greater prevalence of obsessive-

compulsive and dependent personality disorders. Five personality traits were

independently associated with hoarding: miserliness, preoccupation with details,

difficulty making decisions, odd behavior or appearance, and magical thinking. Hoarding

and indecision were more prevalent in the relatives of hoarding than of non-hoarding

probands. Hoarding in relatives was associated with indecision in probands.24

A study was conducted to examine the relationship between clinically

significant hoarding and attention deficit hyperactivity disorder (ADHD) in California.

The samples examined were 155 OCD affected individuals (114 probands and 41

relatives; age ranges 4-82 yrs). The result showed that in total, 11.8% met criteria for

definite ADHD, whereas an additional 8.6% had probable or definite ADHD

(total=20.4%). In total, 41.9% of participants with ADHD also had hoarding compared to

29.2% of participants without ADHD. Hoarding was the only demographic or clinical

variable independently associated with ADHD (odds ratio=9.54, P<0.0001). The study

was concluded that ADHD rates elevated in the sample of individuals with childhood-

onset OCD compared to the general population rate of ADHD, and there was a strong

association between ADHD and clinically significant hoarding behavior.25

SECTION C: LITERATURE RELATED TO ILLEFFECTS OF COMPULSIVE

HOARDING DISORDER ON HEALTH.

A cross sectional study was conducted to examine the relationship

between compulsive hoarding and dengue fever. 52 adults notified by health vigilance

authorities because of inappropriate trash accumulation in vacant lots in Goiania, Central

Brazil, completed a questionnaire regarding the presence and severity

of hoarding behavior. 5 dimensions of hoarding are evaluated with instruments such as

difficulty using spaces due to clutter, difficulty discarding possessions, excessive

acquisition of objects, emotional distress and functional impairment due

to hoarding behaviors. The sample was primarily male, with an average age of 49 years.

11

The result showed that 86% percent of the sample scored 14 or greater on the hoarding

rating scale (HRS-I), indicating pathological hoarding. The study concluded that hoarding

disorder can have impact on dengue and associated with public health.26

A internet survey study was conducted to examine excessive acquisition in

hoarding. Participants, 878 self-identified with hoarding and 665 family informants (not

matched to hoarding participants). Among hoarding participants who met criteria for

clinically significant hoarding, the results 61% met criteria for a diagnosis of compulsive

buying and approximately 85% reported excessive acquisition. Family informants

indicated that nearly 95% exhibited excessive acquisition. The survey concluded that

those who acquired excessively had more severe hoarding; their hoarding had an earlier

onset and resulted in more psychiatric work impairment days; and they experienced more

symptoms of obsessive-compulsive disorder, depression, and anxiety.27

A study was conducted to examine the neural mechanisms of impaired

decision making in Hoarding disorder (HD) in patients with well-defined primary

hoarding disorder (HD) compared with patients with OCD and healthy control subjects

(HCs). The setting used was private hospital in USA. The samples were of 107 adults (43

with HD, 31 with OCD, and 33 HCs). Neural activity was measured by functional

magnetic resonance imaging in which actual real-time and binding decisions had to be

made about whether to keep or discard possessions. The results showed that, Compared

with participants with OCD and HC, participants with HD exhibited abnormal activity in

the anterior cingulate cortex and insula .Patients with HD showed relatively lower

activity in these brain regions. The findings suggested that patients with HD have

problems in identifying appropriate emotional response or decision making.28

SECTION D: LITERATURE RELATED TO THE MANAGEMENT OF

COMPULSIVE HOARDING DISORDER

A study was conducted to examine efficacy of a specialized group

cognitive and behavior therapy (GCBT) for compulsive hoarding on a large population

from US ( Females with high education, unemployed , married and non partnered ). The

samples were 31 clients diagnosed with hoarding participated in five groups. Four groups

12

met once weekly for 2 hour over 16 weeks (n=27) and one group met for 20 weeks (n=5).

All participants had two individual 90-min home sessions. Self-report assessments were

completed at baseline, mid-treatment, and post-treatment about hoarding behavior and

symptoms. The result showed significant improvement from pre- to post-treatment on the

Saving Inventory Revised. In conclusion the study demonstrates the feasibility and

modest success of cognitive and behavior therapy methods in

improving hoarding symptoms.29

A quantitative study was conducted in Germany to measure the response

to standardized pharmacotherapy in compulsive hoarders using paroxetine. 79 patients

with OCD (32 patients with the compulsive hoarding syndrome and 47 patients without

prominent hoarding symptoms) were treated openly with paroxetine (mean dose

41.6 ± 12.8 mg/day; mean duration 80.4 ± 23.5 days) according to protocol. All subjects

were free of psychotropic medication for at least four weeks prior to study entry. Subjects

were assessed before and after treatment with the Yale-Brown Obsessive-Compulsive

Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Scale

(Ham-A), Global Assessment Scale (GAS).Both compulsive hoarders and non-hoarding

OCD patients improved significantly with treatment (p < 0.001), with nearly identical

changes in Y-BOCS, HDRS, Ham-A, and GAS scores. The study suggested that

serotonin reuptake inhibitor (SRI) medications such as paroxetine are effective for

treatment compulsive hoarding disorders.30

A study was conducted to investigate the feasibility of age-adapted,

manualized behavioral treatment for geriatric hoarding in San Diego. The samples were

11 older adults (mean age: 66 years) with hoarding disorder. Treatment encompassed 24

individual sessions of psychotherapy that included both cognitive rehabilitation targeting

executive functioning and exposure to discarding/not acquiring. Hoarding severity was

assessed at baseline, mid-treatment, and post treatment. The results showed that clinical

and statistical changes in hoarding severity at post treatment. 8 participants were

classified as treatment responders, and 3 as partial responders. Partial responders reported

severe/extreme hoarding and psychiatric co morbidities at baseline, thus it concluded that

13

cognitive rehabilitation and exposure therapy has a significant effect on geriatric

hoarding. 31

SECTION-E: REVIEW OF LITERATURE RELATED TO COMPUTER

ASSISTED TEACHING.

A study was conducted to find the effectiveness of visual research method

in the treatment of compulsive hoarding disorder using computer in London. Using a

participatory photography methodology, a purposive sample of 12 members of a hoarding

therapy group was recruited. Participants were asked to take photographs which best

captured their hoarding problems. The photographs were then used to encourage narrative

dialogue in a subsequent semi structured interview. The result showed 7 key themes

emerged from the data including: Feelings of isolation and vulnerability, lifestyle

disruption, losing and misplacing, clutter and metaphor, rationalization of the acquisition

of hoarded items, failed previous support and the benefits of a therapy support group. The

study concluded that photography methodology may be particularly helpful when

generating qualitative evidence, knowledge and in the treatment of compulsive

hoarding.32

A study was conducted to find the effectiveness of Photograph-

aided assessment of clutter in diagnosis and treatment of hoarding disorder in US. 32

professionals with experience of hoarding cases were shown pictures from the inside of

10 houses and asked to decide whether the house belonged to a person with hoarding

disorder (HD). Participants also rated different features of the room appearing in each

picture (overall amount of possessions, tidiness, functionality, number of different classes

of items, and cleanliness). The result showed that sensitivity for HD was high. Rooms

belonging to HD individuals were rated as significantly more cluttered, more untidy, less

functional, containing a higher number of different classes of items, and being less clean

than the rooms from the remaining groups. The study concluded that the use of

photograph aided assessment is an effective way to diagnosis and to impart knowledge

regarding hoarding disorder.33

14

A study conducted on nursing students to learn and retain the theory and

skill of hand washing more effectively when taught using computer-assisted learning

compared with conventional face-to-face methods. Two-hundred and forty-two first year

nursing students of mixed gender; age; educational background and first language

studying at one British university were recruited to the study. Participant attrition

increased during the study. Result of study is Knowledge scores increased significantly

from baseline in both groups and no significant differences were detected between the

scores of the two groups. Skill performance scores were similar in both groups at the 2-

week follow-up with significant differences emerging at the 8-week follow-up in favor of

the intervention group; however, this finding must be interpreted with caution in light of

sample size and attrition rates. The conclusion of study is computer-assisted learning

module was an effective strategy for teaching both the theory and practice of hand

washing to nursing students and in this study was found to be at least as effective as

conventional face-to-face teaching methods34.

A study was conducted to compare the effectiveness of expert-assisted

learning (EAL), peer-assisted learning (PAL), and computer-assisted learning (CAL) on

participants' procedural skills acquisition in the simulated setting. 60 medical and nursing

students practiced urinary catheterization in an expert-, peer- or computer-assisted,

simulation-based, learning environment. Effectiveness of training was evaluated in the

simulated setting using an immediate post-test and, one week later, on a retention and

standardized patient-based transfer test. All groups performed similarly on the pre-, post-,

and retention tests. At transfer, the EAL group performed significantly better than the

PAL group as measured by global clinical performance, catheterization checklist scores,

and number of breaks in aseptic technique (P < .05). Communication and catheterization

global ratings were equivalent for all groups (P > .05). Results of study are CAL is as

effective as expert feedback for teaching procedural skills to novices in the simulated

setting.35.

6.4. STATEMENT OF PROBLEM

15

“A study to assess the effectiveness of computer assisted teaching on knowledge

regarding compulsive hoarding disorder and its effect on health among post

graduate students of selected degree colleges at Bangalore”

6.5. OBJECTIVES OF THE STUDY

1. To assess the pre-test level of knowledge regarding compulsive hoarding disorder and

its effect on health among PG students

2. To find the effectiveness of computer assisted teaching on knowledge regarding

compulsive hoarding disorder and its effects on health among PG students.

3. To determine the association between pre-test knowledge score regarding compulsive

hoarding disorder and its effect on health with selected demographic variables of PG

students.

6.6. HYPOTHESIS

H1: There will be a significant gain in mean post-test knowledge scores of PG students

regarding compulsive hoarding disorder and its effect on health after attending computer

assisted teaching as compared to the mean pre-test knowledge scores.

H2: There will be significant association between pre-test knowledge score regarding

compulsive hoarding disorder and its effect on health with selected demographic

variables of PG students.

6.7. OPERATIONAL DEFINITIONS

Assess: In this study assess refers to the activity to decide the scores on knowledge

regarding compulsive hoarding disorder through self structured knowledge questionnaire.

Effectiveness: Refers to significant gain in knowledge as determined by significant

difference between pre-test and post-test knowledge scores.

Computer assisted teaching: It is a method of teaching the PG students with the help of

computer by using power point presentation for a period of 40 to 45 minutes.

16

Knowledge: refers to the correct responses of PG students of the sample on compulsive

hoarding as elicited by structured knowledge questionnaire.

Compulsive hoarding disorder: - Compulsive hoarding otherwise known as

“pathological collecting” or “pack ratting” is a behavior of collecting excessive quantities

of poorly useable item of little value, failing to discard items and difficulty organizing

tasks.

PG students: Students studying in college who are doing their post graduation in any

course aged between 22- 42 yrs.

6.8. ASSUMPTIONS

• Students may have some knowledge regarding compulsive hoarding disorder and its

effect on health

• The students may respond to the structured knowledge questionnaire regarding

compulsive hoarding disorder and its effect on health

• Computer assisted teaching may be an effective teaching strategy in imparting

knowledge on compulsive hoarding disorder and its effect on health for PG students.

• Adequate knowledge on compulsive hoarding disorder and its effect on health may help

the PG students in early identification of the problem and reduce its ill effects on health.

6.9. DELIMITATIONS

The study is delimited to

• 50 PG students at selected degree colleges.

• 4 weeks period of data collection only.

• Effectiveness of computer assisted teaching in terms of knowledge scores only.

• Measurement of knowledge of degree students once before and after

administration of computer assisted teaching.

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7. MATERIALS AND METHOD OF STUDY

7.1 SOURCE OF DATA COLLECTION

PG degree students in selected degree colleges at Bangalore.

7.2 METHODS OF DATA COLLECTION

7.2.1 TYPE OF STUDY OR RESEARCH APPROACH

Evaluative study, Quantitative approach

7.2.2 RESEARCH DESIGN

Pre experimental, one group pre-test- post-test design.

7.2.3 VARIABLES:

Independent variable – Computer assisted teaching on hoarding disorder and its effect

on health

Dependent variable – Knowledge of PG students on hoarding disorder and its effect

on health.

Attribute variables – Age, Sex, Educational qualification, Marital status, of P.G.

students, etc.

7.2.4 SAMPLING TECHNIQUE

Convenient sampling technique

7.2.5 SAMPLE AND SAMPLE SIZE:

50 PG students aged between 22-42 yrs.

7.2.6 SELECTION CRITERIA

INCLUSION CRITERIA:

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1. PG students who are willing to participate in the study.

2. PG students belonging to selected degree colleges.

3. PG students who are available at the time of the study

EXCLUSION CRITERIA:

1. PG Students who had attended any educational programme before on

compulsive hoarding disorder.

2. PG Students who have not given consent to participate in the study.

7.2.7 DURATION OF THE STUDY

One month period of data collection (4weeks)

7.2.8 TOOL OR INSTRUMENT

Section A: Socio demographic data.

Section B: Structured knowledge questionnaire on compulsive hoarding disorder

and its effects on health

7.2.9 DATA COLLECTION AND PROCEDURE

A formal consent from the respective degree college authorities will be obtained. Written

consent will be taken from the participants after explaining the purpose of the study. Pre-

test will be conducted using structured knowledge questionnaire to assess the knowledge

of PG students and on the same day a computer assisted teaching (CAT) will be done. On

8th day, a post-test will be conducted by using the same knowledge questionnaire.

7.2.10 PLAN FOR STATISTICAL ANALYSIS

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The data obtained will be tabulated and analyzed in terms of the objectives of the study

by using descriptive and inferential statistics.

The plan for data analysis is as follows:

Descriptive statistics:

a) Frequency and percentage distribution will be used to analyze the socio

demographic variables.

b) Mean, mean percentage and standard deviation will be used to assess the pre-test

and post-test knowledge score of PG students.

Inferential statistics:

a. Paired“t” test will be used to assess the effectiveness of computer assisted

teaching programme on compulsive hoarding disorder.

b. “Chi- square” test will be used to find out the association between pre-test

knowledge score on compulsive hoarding disorder and its effect on health with selected

demographic variables of PG students.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION ON PATIENT OR HUMAN/ ANIMAL? IF SO,

DESCRIBE BRIEFLY

Yes, computer assisted teaching will be provided and structure knowledge

questionnaire will be administered to assess the knowledge regarding compulsive

hoarding disorder and its effect on health to the PG students.

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7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED?

Yes, ethical clearance will be obtained from the ethical committee of the institution.

Written consent will be taken from the authority of PG colleges and from the subjects,

confidentiality and anonymity of subjects will be maintained.

8. LIST OF REFERENCES

1. Hoarding: A Compulsive Mental Disorder. Available from URL :http://www.elementsbehavioralhealth.com/dual-diagnosis/hoarding-a-compulsive-mental-disoder

2. Panic anxiety. Available from URL: http://www.pamguide.com.au/anxiety/hoard.php

3. Dante to DSM-V:A Short History of Hoarding. Available from: http: www.ocfounda tion.org hoarding dante to dsm-v.aspx

4. Compulsive hoarding disorder. Available from URL : http: en.wikipedia.org wiki co Mpulsive hoarding #Symptoms

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5. Hoarding and housing. Cristina Sorrentino Schmalisch. PhD LICSW. Available from URL http://www.ocfoundation.org/hoarding/housing_services.aspx

6. The compulsive hoarding center; Offering hope and inspiration for change. Available from URL: http://compulsivehoardingcenter.com/Compulsive_Hoarding.html

7. Sujthra-The Nursing journal of India. Vol 8. 2013 pg no- 53 “ Hoarding : A new

disorder of the millennium”

8. Specialty Programs ; USCD Obsessive-Compulsive disorder Clinic. Available from URL http://psychiatry.ucsd.edu/OCD_hoarding.html

9. Compulsive Hoarding: Over view and implication for community health nurses. Fleury G Gaudette .Available from: http://www.ncbi.nlm.nih.gov/pubmed/22857404

10. The effects of hoarding disorder on families : An integrative review Buscher TP Dyson. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/23869617

11. Compulsive hoarding syndrome; Mediangels Medical team India .Available from URL: http://www.mediangels.com/8-8-466-99-knowledge-center-Compulsive-Hoarding- Syndrome-Introduction.aspx

12. Hoarding behaviors in a large college sample. Coles ME Frost Heimberg RG Steketee G Available from URL : http://www.ncbi.nlm.nih.gov/pubmed/12547379

13. Obsessive compulsive disorder ;Y C Janardha Reddy Shoba Srinath Vol 1. 2007 pg no- 108 “Understanding and Future directions”

14. Quality of life and functional impairment in compulsive hoarding. Sanjaya saxsena Catherine R. Et.al. Available from URL: http: www.ncbi.nlm.nih.gov pmc articles PMC3009837

15. An overview of Indian research in obsessive compulsive disorder. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146215/

16. Clinically significant hoarding in obsessive-compulsive disorder: Results from an Indian study Chakraborty V Cherian AV .Et.al. NIMHS INDIA. Available from http://www.ncbi.nlm.nih.gov/pubmed/22796017

17. The Hoarding Project; Jennifer Sampson PhD; Available from URL http://thehoardingproject.org/wp-content/uploads/2013/07/Research-Sponsorship-Request.pdf

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18. Hoarding; Obsessive Symptom or Syndrome. Randy A Sansone .Et.al. Available from URL http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848465/

19. Prevalence and heritability of compulsive hoarding: A Twin Study. Alessandra C AvailablefromURL:http://psychiatryonline.org/data/Journals/AJP/3903/09aj1156.PDF

20. Impact of age of onset of illness on clinical phenotype in OCD. Narayanaswamy JC  Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/22503329

21. Intolerance of uncertainty as a vulnerability factor for hoarding behaviors; Oglesby ME  Medley AN  Norr AM  Capron DW  Korte KJ  Schmidt NB .Available from URL :http://www.ncbi.nlm.nih.gov/pubmed/22921482

22. Prevalence, Co morbidity and Heritability of hoarding symptoms in adolescence: A population based twin study in 15-year olds. Ivanov VZ Mataix-Cols D Serlachius E Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/23874893

23. Clinical features of obsessive-compulsive disorder with hoarding symptoms: A multicenter study. Torres AR  Fontenelle LF  Ferrão YA do Rosário MC. (2012) Et.al. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/22464941

24. Hoarding in obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study. Samuels JF  Bienvenu OJ 3rd  Pinto A  Fyer AJ. Et.al. (2007) Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/16824483/

25. ADHD prevalence and association with hoarding behaviors in childhood-onset OCD. Sheppard B Chavira D Azzam A  Grados MA Umaña P Garrido H Mathews CA ( 2010 ) Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/20583294

26. Psychiatry disorders and dengue: is there a relationship? Caixeta L Azevedo PV Caixeta M. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/22297880

27. Excessive acquisition in hoarding, Frost RO Tolin DF Steketee G Fitch KE Selbo-Bruns A. Available from URL http://www.ncbi.nlm.nih.gov/pubmed/19261435

28. Neural mechanisms of decision making in hoarding disorder. Tolin DF Stevens MC Villavicencio AL Norberg MM Calhoun VD Frost RO Steketee G Rauch SL  Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/22868937

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29. Group cognitive and behavioral treatment for compulsive hoarding: A preliminary trial. Muroff J Steketee G Rasmussen J Gibson A Bratiotis C Sorrentino C. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/19569229

30. Paroxetine treatment of compulsive hoarding, Sanjaya Saxena, Arthur L. Brody. Available from URL : Jr.http://www.sciencedirect.com/science/pii/S00223956600086

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31. Novel Treatment for Geriatric Hoarding Disorder: An Open Trial of Cognitive rehabilitation Paired with Behavior Therapy. Ayers CR Saxena S Espejo E Twamley EW .Et.al Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/23831173

32. Visual Research Methods: A Novel Approach To Understanding The Experiences of Compulsive Hoarders: Satwant Singh, Colin Jones ; Available from URL: http: www .scopemed.org mno=18850

33. Photograph-aided assessment of clutter in hoarding disorder: Is a picture worth a thousand word. Available from URL http://www.ncbi.nlm.nih.gov/pubmed/22930673

34. Bloom field. The effect of computer assisted learning Vs conventional teaching method on acquisition and retention of hand washing theory and skills in nursing students. Available from URL http://www.ncbi.nlm.nih.gov/pubmed/19762016

35. Learning in the simulated setting: A comparison of expert peer and computer assisted learning. Walsh CM. Available from URL: http://www.ncbi.nlm.gov/pubmed/21955760

9. SIGNATURE OF CANDIDATE

10. REMARKS OF GUIDE A relevant study to prevent and

manage hoarding disorder among

highly qualified students.

11.1 NAME AND DESIGNATION OF GUIDE Mrs. Roselene Monthero

Associate Professor

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Mental Health Nursing

11.2SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE

DEPARTMENT

Mrs. Roselene Monthero

Associate Professor

Mental Health Nursing

11.6 SIGNATURE OF HOD

12.1 REMARKS OF PRINCIPAL A good and feasible study to

educate on preventing hoarding

disorder among PG students.

12.2 NAME OF THE PRINCIPAL Prof. Mrs. Jobi Jacob

Principal

K.N.N College of Nusing

CA 23/B A Sector

Yelahanka New Town

Bangalore – 64

12.3 SIGNATURE

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