SYNOPSIS

A Quasi-Experimental Study to Assess the Effectiveness of Structured-

Teaching Programme on Knowledge Regarding Covid Pandemic Control
over the Sign and Symptom of Covid-19 Vaccination Among Adults (18-35)
Age group People in a Selected Rural Area of District Kangra, Himachal
Pradesh.

“MASTER OF SCIENCE IN NURSING”

COMMUNITY HEALTH NURSING

SONALI SAHOTRA

SUBMITTED TO

Ms. Tamanna

HIMACHAL PRADESH UNIVERSITY

SESSION: 2021-2023

DATE OF SUBMISSION: 23-08-2021

 GURU DRONACHARYA COLLEGE OF NURSING YOL CANTT,
DHARMASHALA

HIMACHAL PRADESH UNIVERSITY-SHIMLA

CERTIFICATE

Certified That This Is Bonafide Work of Sonali Sahotra, M.Sc. Nursing 1st Year Student of
Guru Dronacharya College of Nursing, A quasi-experimental study to assess the
effectiveness of structured-teaching programme on knowledge regarding covid
pandemic control over the sign and symptom of covid-19 vaccination among adult (18-
35) age group people in a selected rural area of District Kangra, Himachal Pradesh.

…………………………… ……………………….

SONALI SAHOTRA Mr. Ram Kumar Garg

M.Sc. Nursing 1st year Professor cum Principal

COMMUNITY HEALTH NURSING

GDCN, Yol Cantt

GURU DRONACHARYA COLLEGE OF NURSING, YOL CANTT, (H.P)

HIMACHAL PRADESH UNIVERSITY- SHIMLA

A Quasi-Experimental Study to Assess the Effectiveness of Structured-

Teaching Programme on Knowledge Regarding Covid Pandemic Control
Over the Sign and Symptom of Covid-19 Vaccination Among Adults (18-
35) Age Group People in a Selected Rural Area of District Kangra,
Himachal Pradesh.

---------------- ---------------
Supervised By: Submitted By:
Ms. Tamanna Sonali Sahotra
Assistant Professor M.Sc. Nursing 1st year
Community Health Nursing Community Health Nursing
GDCN, Yol Cantt. Dharamshala, Kangra GDCN, Yol Cantt. Dharamshala,
Kangra
 Approval Performa for ethical committee for Research

Guru Dronacharya College of Nursing, Yol Cantt, Dharamshala District Kangra

Himachal Pradesh.

Name of the candidate Ms. Sonali Sahotra

HOD& Department Ms. Tamanna
COMMUNITY HEALTH NURSING
Title “A Quasi-Experimental Study to
Assess the Effectiveness of Structured-
Teaching Programme on Knowledge
Regarding Covid Pandemic Control
Over the Sign and Symptom of Covid-
19 Vaccination Among Adults (18-35)
Age Group People in a Selected Rural
Area of District Kangra, Himachal
Pradesh.”
Course with Specialty M.Sc. Nursing (COMMUNITY
HEALTH NURSING)
Admission Session 2021-23
HPU Registration No 14-KCN-34
In which date research committee has plan Research committee of Guru
of thesis been presented and approved Dronacharya College of Nursing, Yol
Cantt, Dharamshala District Kangra
Himachal Pradesh form on
MEMBERS OF THE RESEARCH AND Remarks SIGNATURE
ETHICAL COMMITTEE Approved/Not
approved
Principal, GDCN, Yol Cantt, Dharamshala

H.O.D –Mental Health Nursing

H.O.D- Medical Surgical Nursing

H.O.D- Community Health Nursing

H.O.D – Obstetric & Gynaecological

Nursing

H.O.D- Child Health Nursing

Ethical and legal consultant (Sr. Advocate)

Statistician (member)

Medical Officer (member)

 Social Worker (member)

Declaration by student

I Sonali Sahotra hereby declare that all the mentioned information submitted by me is true,
correct, valid and best of my knowledge.

Sign of Student
Researcher

Declaration by research guide

I hereby declare that all the mentioned information collected by student researcher is true,
correct, valid and best of my knowledge.

Sign of Research Guide

Ms. Tamanna

Assistant Professor

Community Health Nursing

Approved: Yes/No
Mr. Ram Kumar Garg
Principal cum
Chairperson of research committee and ethical committee
Guru Dronacharya College of Nursing
 CHAPTER-1
INTRODUCTION
“ANTIVIRALS AND VACCINES”
1.1 BACKGROUND OF THE STUDY

CO' stands for corona, 'VI' for virus, and 'D' for disease. Formerly, this disease was referred
to as '2019 novel coronavirus' or '2019-nCoV.' The COVID-19 virus is a new virus linked to
the same family of viruses as severe acute respiratory syndrome (SARS) and some types of
common cold.1

The best way to prevent and slow down transmission is to be well informed about the
COVID-19 virus, the disease it causes and how it spreads. Protect yourself and others from
infection by washing your hands or using an alcohol-based rub frequently and not touching
your face.1

Covid-19 Pandemic is defined as an infectious disease caused by a newly discovered

coronavirus. Most people infected with the COVID-19 virus will experience mild to
moderate respiratory illness and recover without requiring special treatment.2

The Novel Coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a

new strain of coronaviruses that cause the coronavirus disease 2019 (COVID-19) and was
declared a pandemic by the World Health Organization (WHO).3

The COVID-19 is a highly infectious disease that can be spread directly or indirectly from an
infectious person to a healthy person through the eye, nose, and mouth via droplets produced
when coughing or sneezing [2, 5, 6]. The exact source of the disease is uncertain.3

However, rodents and bats have been suspected by many researchers [5, 7]. The SARSCoV-2
can survive up to 8-10 hours over porous surfaces (like paper, wood, sponge, and fabric) and
a little more than 8-10 hours on nonpermeable surfaces (glass, plastics, metals, etc.). It has an
incubation period of usually 2-14 days [2,8]. Its symptoms are similar to that of common cold
or flu. Also, others include fever, dry cough, shortness of breath, and pneumonia [5].3
The availability of a safe and effective vaccine for COVID-19 is well-recognized as an
additional tool to contribute to the control of the pandemic. To increase the chances of
success we must test all candidate vaccines until they fail. 4

The COVID-19 vaccines that are currently in development or have been approved are
expected to provide at least some protection against new virus variants because these
vaccines elicit a broad immune response involving a range of antibodies and cells.5

There is no way to ensure you have zero risk of getting the virus that causes COVID-19. So,
it is important to understand the risks and know how to reduce your risk as much as possible
if or when you do resume some activities, run errands, and attend events and gatherings.6

Since it has been predicted that SARS-CoV-2 originated from bats, the genome of this virus
naturally matches about 96% of bats’ genome. This virus’s genome contains a single open
reading frame (ORF) that encodes a polyprotein, cap structure at 5′, and apoly-A-tail at 3’.
Cap structure and poly-A-tail are the two untranslated regions (UTRs).7

The genomic structure of SARS-CoV-2 starts from the 5′end. Then, there are two viral
replicases, open reading frame (ORF 1a and 1b). COVID-19 takes on a pandemic form in a
very short time.7
Developing immunity through vaccination means there is a reduced risk of developing the
illness and its consequences. This immunity helps you fight the virus if exposed. Getting
vaccinated may also protect people around you, because if you are protected from getting
infected and from disease, you are less likely to infect someone else.8

For a single dose vaccine, immunity will generally occur two weeks after vaccination. For
two- of dose vaccines, both doses are needed to achieve the highest level of immunity
possible.9

Presently, based on the recommendations by National Expert Group on Vaccine

Administration for COVID-19 (NÉGVAC), the schedule of Covishield vaccine under
National Covid-19 Vaccination Strategy is to administer the 2nd dose at 12–16-week interval
(i.e., after 84 days), after administration of 1st dose.10

The COVID-19 vaccines are safe for most people 18 years and older, including those with
pre-existing conditions any kind, including auto-immune disorders. These conditions include:
hypertension, diabetes, asthma, pulmonary, liver and kidney disease, as well as chronic
infections that are stable and controlled.11

Stay at the place where you get vaccinated for at least 15 minutes afterwards, just in case you
have an unusual reaction, so health workers can help you. Check when you should come in
for

a second dose – if needed. Most of the vaccines available are two-dose vaccines. Check with
your care provider whether you need to get a second dose and when you should get it. Second
doses help boost the immune response and strengthen immunity.11

In most cases, minor side effects are normal. Common side effects after vaccination, which
indicate that a person's body is building protection to COVID-19 infection include: Arm
soreness, Mild fever, Tiredness, Headaches Muscle or joint aches.11

It’s common to experience some mild-to-moderate side effects when receiving vaccinations.
This is because your immune system is instructing your body to react in certain ways: it
increases blood flow so more immune cells can circulate, and it raises your body temperature
in order to kill the virus.12

Like any vaccine, COVID-19 vaccines can cause side effects, most of which are mild or
moderate and go away within a few days on their own. As shown in the results of clinical
trials, more serious or long-lasting side effects are possible. Vaccines are continually
monitored to detect adverse events.12

Reported side effects of COVID-19 vaccines have mostly been mild to moderate and have
lasted no longer thana few days. Typical side effects include pain at the injection site, fever,
fatigue, headache, muscle pain, chills and diarrhoea. The chances of any of these side effects
occurring after vaccination differ according to the specific vaccine.12

Experiencing side effects after getting vaccinated means the vaccine is working and your
immune system is responding as it should. Vaccines are safe, and getting vaccinated will help
protect you against COVID-19.12
 3

1.2 NEED OF STUDY

“Protect yourself and others from COVID-19”

If COVID-19 is spreading in your community, stay safe by taking some simple precautions,
such as physical distancing, wearing a mask, keeping rooms well ventilated, avoiding crowds,
cleaning your hands, and coughing into a bent elbow or tissue.13

A curfew is said to be an order which specifies a time during which specific regulations are
applied. It refers to the time when people are required to return to and stay in their houses.14

Janata curfew was organized on 22nd March 2020 before the complete lockdown in which
the citizens of India were requested to avoid public spaces and to stay in their houses from 7
pm- 9 pm. Janata curfew was the beginning of the battle for India against novel coronavirus.14

Persons with symptoms should: - wear a medical mask, self-isolate, and seek medical advice
as soon as they start to feel unwell. Symptoms can include fever, fatigue, cough, sore throat,
and difficulty breathing.15

It is important to note that early symptoms for some people infected with COVID-19 may be
very mild; follow instructions on how to put on, take off, and dispose of medical masks;
follow all additional preventive measures, in particular, hand hygiene and maintaining
physical distance from other persons.15

It is also normal for a virus to change, or mutate, as it infects people and this virus has done
so. There are several variants which have been named for the regions they were first
discovered but they have now spread to other areas and countries, some proving to be more
contagious as well as more deadly.16
According to researchers in China, these were the most common symptoms among people
who had COVID-19, Fever 99%, Fatigue 70%, Cough 59%, Lack of appetite 40%, Body
aches 35%, Shortness of breath 31%, Mucus/phlegm 27%. Some people who are hospitalized
for COVID-19 have also have dangerous blood clots, including in their legs, lungs, and
arteries.16

Transmission of COVID-19 through the droplets of infection into two ways, Direct spread: -
by droplets that land on the face (mouth, eyes) or hands of another person. Spread by direct
contact has been seen to occur within a distance of 3 feet or 1 meter. Indirect spread: - by
contact with a surface contaminated by respiratory droplets.17

The droplets settle on surfaces (floor, furniture, clothes, keyboards, mobiles etc.). The virus
can survive on contaminated surfaces for up to 2-3 days.

Global scenario COVID-19 spread rapidly across the world in a span of less than 3 months: -

• December 31, 2019 – Cluster of 27 pneumonia cases of unknown etiology were reported
from Wuhan, China.

• January 9, 2020 – Novel coronavirus was detected as the causative agent. Disease named as
COVID-19.

• January 20, 2020 – Coronavirus disease spread to 3 countries outside China.

• January 31, 2020 – Disease spread to 20 countries including India (9826 cases confirmed,
213 deaths).

• March 13, 2020 – Disease spread to 123 countries, first death reported in India (Karnataka)

• April 28, 2020 – 29,54,222 confirmed cases and 2,02,597 deaths reported worldwide (212
countries/territories/areas).17

On 11th March 2020 WHO declared COVID-19 as a pandemic. The spread of disease in
India would be following the possible scenarios, Focus on International travellers, screening,
isolation, contact tracing, Physical distancing, hand and respiratory hygiene, home quarantine
and isolation.17
Current strategy: “BREAK THE CHAIN” of transmission, so that India does not progress to
widespread community transmission of disease. The lock down period is a measure to
prevent progression of transmission.17

COVID Care Centre (CCC), Only for cases that have been clinically assigned as mild or very
mild cases or COVID suspect cases. Makeshift facilities set up in hostels, hotels, schools,
stadiums, lodges etc., both public and private. Must necessarily be mapped to one or more
Dedicated COVID Health Centres and at least one Dedicated COVID Hospital for referral
purpose.17

Isolation in a health facility is for, all confirmed positive cases of COVID-19 in order to
prevent transmission of infection Isolation is for the period of disease.

Home quarantine is for, all asymptomatic individuals who have undertaken international
travel

from any COVID-19 infected countries or interstate travel from any COVID-19 infected state
in the last 28 days. Home quarantine is for a period of 14 days since the day of travel. All
those who fit the definition of ‘contact’ should be- home quarantined and monitored for
symptoms of COVID-19.17

A contact in the context of COVID-19 is one who, provided direct care to a COVID-19
positive person without personal protective equipment (PPE), Stayed in the same close
environment of a COVID-19 patient (including workplace, classroom, household,
gatherings). Travelled in close proximity (1 m) with a symptomatic person who later tested
positive for COVID-19.17
Epidemiological criteria, A positive SARS-CoV-2 antigen-detecting rapid diagnostic test
(Ag-RDT) in an asymptomatic person not meeting epidemiological criteria. A patient with
severe respiratory illness (fever and at least one other symptom such as cough or difficulty
breathing (shortness of breath)) AND that requires hospitalisation AND with no other
aetiology that explains clinical picture/presentation of the patient.17

1.3 STATEMENT OF PROBLEM

A quasi-experimental study to assess the effectiveness of structured-teaching programme on
knowledge regarding covid pandemic control over the sign and symptom of covid-19
vaccination among adult (18-35) age group people in a selected rural area of District Kangra,
Himachal Pradesh.

1.4 OBJECTIVES
1) To assess the pre-test knowledge score regarding control over the sign and symptoms of
1st and 2nd doses of covid-19 vaccination.
2) To assess the sign and symptoms of vaccination.
3) To assess the post-test knowledge score regarding sign and symptoms outcomes of the 1st
and 2nd doses of vaccination.
4) To find out the association between pre-test and post-test knowledge score with their social
demographical variables.

1.5 OPERATIONAL DEFINITIONS

1) Knowledge: - In this study knowledge refers to the awareness or information to the adults
regarding covid pandemic control over the sign and symptom on covid-19 vaccination.
2) Assess: - In this study assess means to judge, evaluate the views and knowledge regarding
control over the sign and symptom on covid-19 vaccination by using structure questioner.
3) Attitude: - A feeling or opinion about covid-19 vaccination, when it is shows in individual
behaviour.
4) Effectiveness: -The degree to which something is special is producing the desired result.
In my study it refers to determine the extent the information in the booklet has achieved the
6
desired outcome as measured by gain in the post-test knowledge regarding covid pandemic
control over the sign and symptom on covid-19 vaccination.
5) Adult: - This refers to the adult i.e., male and female whose age is group between 18-35
years.
6) COVID-19: - COVID-19 is defined as an infectious disease caused by a newly discovered
coronavirus. Most people infected with the COVID-19 virus will experience mild to
moderate respiratory illness and recover without requiring special treatment.
7) Pandemic: - A pandemic is defined as “an epidemic occurring worldwide, or over a very
wide area, crossing international boundaries and usually affecting a large number of people”.
8) Structure: -Teaching Programme: - In this study it is a structure teaching activity given to
the adults for an hour, which includes questioners, flash cards, video, charts and pamphlets.

1.6 ASSUMPTIONS
1) The adults having knowledge regarding control over the sign and symptom on covid-19
vaccination.
2) PPT will help the adults (18-35) to gain knowledge regarding control over the sign and
symptom on covid-19 vaccination.

1.7 HYPOTHESES
H1: - There will be significant difference between the pre-test and post-test knowledge scores
of adults regarding control over the sign and symptom on covid-19 vaccination.
H2: - There will be significant association between pre-test and post- test knowledge score
with the selected socio-demographic variables of adults.

1.8 DELIMITATIONS
The study is delimited to
• 80 sample sizes
• Adults
• Selected urban and rural area of District Kangra.

1.9 CONCEPTUAL FRAMEWORK

Modified conceptual framework based on General system model (Ludwig Von Bertalanffy’s,
1968). Conceptual framework refers to the modified concept or abstractions that are assemble
together in some rationale scheme by virtue of them of their relevance to a common theme.
Theoretical and conceptual framework provides an important context for a scientific
investigation. A conceptual framework deals with concepts and preposition that state the
relationship between the concepts. It presents logically constructed concepts to provide
general

explanations of the relationship between the concepts of the research study, without using a
single existing theory.

The conceptual framework for the present study is Ludwig von Bertalanffy’s, modified
general system model (1968) to assess the effectiveness of structure-teaching programme on
knowledge regarding covid pandemic control over the sign and symptom on covid-19
vaccination among adults. This model has three components, namely Input, Throughput,
Output.
INPUT: - The matter, energy and information are received from the environment and in the
study, input is considered as the various socio-demographic variables which influenced the
respondents. In the present study, the investigator assesses the knowledge regarding covid
pandemic control over the sign and symptom on covid-19 vaccination among adults.

THROUGHPUT: - Throughput referred to the process by which the system processes input
and releases an output. In the present study, the throughput was the processing of information
where structure- teaching programme given to adults on control over the sign and symptom
on covid-19 vaccination.

OUTPUT: - Output” refers to the energy, matter, and information that leave a system into
the environment. It is considered as no gain in knowledge level regarding covid pandemic
control over the sign and symptom on covid-19 vaccination and possible gain in experimental
group obtained through the processing of the post-test that is received in the form of post-test
scores as per criterion measure.

FEEDBACK: - Feedback is the emphasis to strengthen the input and throughput, in this
study it is emphasis to find out the effectiveness of input and throughput.

REVIEW OF LITERATURE

Review of literature is one of the most important aspects in the research process. It is an
account of what is already all about a particular phenomenon. The main purpose of literature
review is to convey to the reader about the work already done and the knowledge that have
been already established on a particular topic of a research. It is the written of the state of
evidence on research problem.

In review of literature is organized and presented under the following: -

1) Jie Liu, Yan Tong, Shaoqiong Li, Zhiqiang Tian, He Lu, Jianzhong Zheng (2020),
conducted a cross-sectional study design to assess the COVID-19 related knowledge,
attitudes, and behaviours of employees among who are returning to work during the COVID-
19 prevention and control period as well as their compliance with recommended COVID-19
preventive behaviours. To prevent the return of an outbreak in these places, people returning
to the workforce are expected to follow proper health behaviours. Sample was 698. Six
hundred and ninety-eight (53.7%) participants showed high compliance, and 602 (46.3%)
showed low compliance. High education level (odds ratio [OR] = 5.598, 95% confidence
interval [CI]: 1.846–16.976), white-collar occupation (OR = 1.992, 95% CI: 1.331–2.983),
high knowledge of COVID-19 (OR = 1.704, 95% CI: 1.303–2.229), no anxiety (OR = 0.646,
95% CI: 0.463–0.901), and quarantining (OR = 1.320, 95% CI: 1.039–1.676) predicted better
compliance with preventive behaviours (p < 0.05).18

2) Manal Mohamed Ahmed Ayed, Thorea Mohamed Mahmoud, Fatma El Zahra

Kamal, (2020), conducted a study to assess the impact of a structured teaching program
regarding COVID -19 on knowledge, attitudes, and practices among secondary school
students in Sohag city in Egypt. Sample size was 260 secondary school students who were
selected randomly was included in this study from two different secondary schools in Sohag
city. A pre/post quasi-experimental design was adopted Out of 260 students who answered
the questionnaires, (57.3%) were female and (42.7%) were male. The age of the participants
ranged from 15 to 18 years old. (40%) of them were 16 to 17 of age. Regarding residence,
nearly to three quarters (74.00%) of students was from urban areas and (26%) were from
rural areas.19

3) Md. Masud Rana, Md. Reazul Karim, (2020), conducted a cross-sectional study to
assess the knowledge of the general people among COVID-19 preventive measures in
Bangladesh.

No vaccine or effective drug is available for the control, prevention, and treatment of
COVID-19. Preventive measures are the only ways to be protected from the disease and
knowledge of the people about the preventive measures are a vital matter. Sample size was
436 adults. Only 21.6% of the respondents had good knowledge of the COVID-19 preventive
measures. The highest 67.2% of them knew that washing hands with soap could prevent the
disease, but contrarily, the highest 72.5% did not know that avoidance of touching mouth,
nose, and eyes without washing hands was a preventive measure. Only 28.4% and 36.9% of
the respondents knew that maintaining physical distancing and avoiding mass gatherings
were measures of prevention of COVID-19 respectively.20

4) Mohammed K. Al-Hanawi, Yasmin Abudawood, (2020), conducted a study to assess

the knowledge, attitudes, and practices of the Saudi public, among COVID-19, during the
pandemic. Sample size was 3,388 participants, a total of 3,427 participants completed the
questionnaire. After excluding 39 respondents who reported living outside the KSA, the final
sample consisted of 3,388 participants. Of the total sample, 1966 (58.03%) were women, and
1422 (41.97%) were men. However, the results showed that men have less knowledge, less
optimistic attitudes, and less good practice toward COVID-19, than women. We also found
that older adults are likely to have better knowledge and practices, than younger people.21

5) Muhammed Elhadi, Ahmed Alsoufi, (2020), conducted a a cross-sectional study to

determine the knowledge, attitudes, and practice regarding COVID-19 and assessed the
acceptance of the COVID-19 vaccine among healthcare workers and the general population.
5,087 participants. Of these, 6227 (41.3%) were male and 8860 (58.7%) were female, with a
mean (SD) age of 30.6 ± 9.8 years. Moreover, 485 (3.2%) participants were infected with
COVID19 at the time of the study, while 2000 (13.3%) had been previously infected. Overall,
2452 (16.3%) participants agreed, and 3127 (20.7%) strongly agreed, with “having concerns
about serious vaccine-related complications.” Mask-wearing adherence was reported by
10,268 (68.1%) of the participants. Most participants (14,050, 93.1%) believed that the
vaccine should be provided for free, while 7272 (48.2%) were willing to buy it. Regarding
vaccine acceptance and efficacy, 12,006 (79.6%) reported their willingness to take the
vaccine with an efficacy of 90% or more, 9143 (60.6%) with an efficacy of 70% or more, and
only 6212(41.2%) with an efficacy of 50%.22

6) Weifang Kong, Yuting Wang (2020), conducted a multi-centre study, study aims to
compare the epidemiology and the clinical characteristics of SARS-CoV-2 infection in
asymptomatic and symptomatic individuals among covid -19 sign and symptoms. Sample
was 511 confirmed SARS-CoV-2 infection cases. Compared to the symptomatic patients, the
asymptomatic cases were younger (P < 0.001), had similar co-morbidity percentages (P =
0.609), and came from higher altitude areas with lower population mobility (P < 0.001) with
better defined epidemiological history (P < 0.001). 27.4% of well-documented asymptomatic
cases developed delayed symptoms after the pathogenic diagnosis. 60% of asymptomatic
cases demonstrated findings of pneumonia on the initial chest CT, including well-recognized
features of coronavirus disease-19.23

7) Santangelo OE, Armetta F, (2020), conducted a cross-sectional study, evaluate the

knowledge, attitude and practices towards SARS-CoV-2 among the nursing students of
University of Palermo during the rapid rise period of the COVID-19 pandemic. A
multivariate linear regression model was used and adjusted Odds Ratios (OR) are presented.
Sample was about 525 students were interviewed and their mean age was 21.8. The overall
score indicates good practices among the three courses of study (p=0.025). The Multivariable
logistic regression showed that the dependent variable "Practice poor score" is statistically
significant associated with these independent variables: "Other country of birth" (OR 17.7,
95% CI 2.31-136.03), "second" (OR 2.65, 95% CI 1.21-7.80) and "third" (OR 2.96, 95% CI
1.31-6.72) year of study, "low perceived health status"(OR 2.35, 95% CI 1.04-5.30) and
"Knowledge poor score (OR 3.05, 95% CI 1.06-8.77).24

8) Ting Chen, Wenbing Zeng, (2020), conducted a study, CT quantitative analysis of

ground-glass opacity (GGO), consolidation, and total lesion volume and its relationship with
clinical features for assessing the severity of coronavirus disease 2019 (COVID-19). Sample
size of 84 patients with COVID-19. Patients were divided into two groups: severe group (n =
23) and non-severe group (n = 61). Patients in the severe group had higher baseline
neutrophil percentage, increased high-sensitivity C-reactive protein (hs-CRP) and
procalcitonin levels, and lower baseline lymphocyte count and lymphocyte percentage (p <
0.001). The severe group also had higher GGO score (p < 0.001), consolidation score (p <
0.001), total lesion score (p < 0.001), and percentage consolidation (p = 0.002), but had a
lower percentage GGO (p = 0.008). The total lesion score demonstrated the best performance
when the data cut-off was 8.2%.

10

Furthermore, the area under the curve, sensitivity, and specificity were 93.8% (confidence
interval [CI]: 86.8-100%), 91.3% (CI: 69.6-100%), and 91.8% (CI: 23.0-98.4%),
respectively.25

9) Sunita Jakhar, Allen P. Ugargol, (2020), conducted a cross-sectional study, evaluate the
awareness and preparedness regarding PPE and protocols for the same among frontline
healthcare providers in India during theCOVID-19 pandemic and also explore the need and
availability status of PPE kits for frontline health workers across India. Sample was included
a total of 65 healthcare. Out of the 87 providers reached out to, only 65 of them answered the
questionnaire in its entirety reflecting a response rate of 74.71%. Approximately 49% of the
respondents had never used PPE during their clinical duties and as high as 60% of the
respondents reported that they were not being provided appropriate PPE routinely.
Concerningly, only 24.62% of the respondents confirmed positively that they had been
provided with appropriate PPE kits during their clinical duties, 23.08% of them said they
probably received the PPE while 20% of them were unsure of either.26

10) Wang K, Wong Ely, (2020), conducted a cross-sectional study, to assess the impact of
the coronavirus disease 2019 (COVID-19) pandemic on change of influenza vaccination
acceptance and identify factors associated with acceptance of potential COVID-19
vaccination Sample was 806 participants. More nurses changed from vaccination refusal to
hesitancy or acceptance than those changed from acceptance to vaccination hesitancy or
refusal (15.5% vs 6.8% among all participants, P < 0.001). 40.0% participants intended to
accept COVID-19 vaccination, and those in private sector (OR: 1.67, 95%CI: 1.11-2.51),
with chronic conditions (OR: 1.83, 95%CI: 1.22-2.77), encountering with suspected or
confirmed COVID-19 patients (OR: 1.63, 95%CI: 1.14-2.33), accepted influenza vaccination
in 2019 (OR: 2.03, 95%CI: 1.47-2.81) had higher intentions to accept it. Reasons for refusal
and hesitation for COVID-19 vaccination included "suspicion on efficacy, effectiveness and
safety", "believing it unnecessary", and "no time to take it".27

11) Chopra S, Ranjan P, (2020), conducted a cross-sectional study, to assess the impact of
COVID-19 on lifestyle-related behaviours: eating, physical activity and sleep behaviour. A
validated questionnaire to assess the changes in lifestyle-related behaviour was administered
on adults across India using a Google online

11

survey platform. Sample size was 995. A total of 995 responses (58.5% male, mean age 33.3
years) were collected. An improvement in healthy meal consumption pattern and a restriction
of unhealthy food items was observed, especially in the younger population (age <30 years).
A reduction in physical activity coupled with an increase in daily screen time was found
especially among men and in upper-socio-economic strata. Quarantine induced stress and
anxiety showed an increase by a unit in nearly one-fourth of the participants.28

12) Fernandes, Melisa; Thakur, Jyoti R; Gavanje, Manisha S. (2021), conducted a study
to assess the knowledge regarding COVID 19 pandemic diseases among the nursing students.
Rapid spread of the COVID-19 pandemic has become a major cause of concern for the health
care professionals in all over the world. All health care professional must be aware of the
latest information on the COVID-19 outbreak. Non probability Convenience sampling
method was used for sampling. Sample was 421. Pre designed and pre tested questionnaire
was used in this study. A total of 421 nursing students participated across Maharashtra state.
Result revealed that majority of sample had average knowledge of COVID -19.29

13) Angela Braver, Shivraj Khaire (2021), conducted a study to assess the knowledge,
attitude and practices towards Covid -19 outbreak, among the urban and rural residents of
Maharashtra State. The knowledge, attitudes and practices (KAP) toward COVID-19 play an
integral role in determining a society’s readiness to accept behavioural change measures from
health authorities. Assessing the KAP related to COVID-19 among the general public would
be helpful to provide better insight to address poor knowledge about the disease and the
development of preventive strategies and health promotion programs. Study participants
overall KAP level towards Covid-19 was 23.31% of the respondents had good knowledge
score, 99% of the respondents had good practice score and 38% of the respondents had
positive attitude towards covid-19.30

14) Archana Kumaria, PiyushRanjan (2021), conducted a cross-sectional survey study to

assess knowledge, attitude, practices, and concerns regarding COVID-19 vaccination among
the general population because of associated myths and/or misinformation. This study is
dedicated to develop and validate a tool to interpret vaccine acceptance and/or hesitancy by
assessing the knowledge, attitude, practices, and concerns regarding the COVID vaccine.
Sample was on 201 participants. The construct validity was established via principal
component analysis. Cronbach’s alpha value was used to assess the reliability of the

12

questionnaire. The 39-item questionnaire to assess the knowledge, attitude, practices, and
concerns regarding the COVID-19 vaccine was developed. The Cronbach’s alpha value of
the questionnaire was 0.86 suggesting a good internal consistency.31

15) Hwang JH, Kim YH, (2021), conducted a Cohort Study, aimed to evaluate
retrospectively the clinical and chest CT findings of COVID-19 and to analyze CT findings
and determine their relationships with clinical severity. Sample was 271, were assessed. The
presence of CT findings and distribution of parenchymal abnormalities were evaluated, and
CT patterns were classified as bronchopneumonia, organizing pneumonia (OP), or diffuse
alveolar damage (DAD). Age, lymphocyte count, levels of C-reactive protein, and
procalcitonin were significantly different in the two groups. Forty-five of the 271 patients had
normal chest. CT findings. The most common CT findings among the remaining 226 patients
were ground-glass opacity (98%), followed by consolidation (53%). CT findings were
classified as OP (93%), DAD (4%), or bronchopneumonia (3%) and all nine patients with
DAD pattern were included in the severe group.32

16) Eric J Haas 1, Frederick J Angulo, (2021), conducted a study, to assess the Impact and
effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19
cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel.
Sample was aged 16 years and older. National surveillance data from the first 4 months of the
nationwide vaccination campaign to ascertain incident cases of laboratory-confirmed SARS-
CoV-2 infections and outcomes, as well as vaccine uptake in residents of Israel aged 16 years
and older. During the analysis period (Jan 24 to April 3, 2021), there were 232 268 SARS-
CoV-2 infections, 7694 COVID-19 hospitalisations, 4481 severe or critical COVID-19
hospitalisations, and 1113 COVID-19 deaths in people aged 16 years or older. By April 3,
2021, 4 714 932 (72·1%) of 6 538 911 people aged 16 years and older were fully vaccinated
with two doses of BNT162b2. In all age groups, as vaccine coverage increased, the incidence
of SARS-CoV-2 outcomes declined. 8006 of 8472 samples tested showed a spike gene target
failure, giving an estimated prevalence of the B.1.1.7 variant of 94·5% among SARS-CoV-2
infections.33

17) Tamam El-Elimat, Mahmoud M. AbuAlSamen, (2021), conducted a cross-sectional

study, to assess the acceptability of COVID-19 vaccines and its predictors in addition to the
attitudes towards these vaccines among public in Jordan. Sample size was 3,100. The public

13

acceptability of COVID-19 vaccines was fairly low (37.4%) in Jordan. Males (OR = 2.488,

95CI% = 1.834–3.375, p < .001) and those who took the seasonal influenza vaccine (OR =
2.036, 95CI% = 1.306–3.174, p = .002) were more likely to accept COVID-19 vaccines.
Similarly, participants who believed that vaccines are generally safe (OR = 9.258, 95CI% =
6.020–14.237, p < .001) and those who were willing to pay for vaccines (OR = 19.223, 95CI
%

= 13.665–27.042, p < .001), once available, were more likely to accept the COVID-19
vaccines. Systematic interventions are required by public health authorities to reduce the
levels of vaccines’ hesitancy and improve their acceptance.34

18) Kumari A, Ranjan P, (2021), conducted a cross-sectional study, to assess knowledge,

barriers and facilitators of COVID-19 vaccine and vaccination programme administered on
adults across India using a Google online survey platform. Sample size was 1294. Most of the
participants had limited knowledge regarding the eligibility of vaccines in vulnerable
population groups such as people with allergies (57.89%) and immune-compromised patients
(62.98%), pregnant and lactating women (41.89%) and patients with chronic illness
(34.78%). Older participants (>45 years) were more willing to take the COVID-19 vaccine (p
< 0.001) as they believed the vaccine is not harmful and considered it as societal
responsibility. Younger participants (<45 years) and those residing in urban settings raised
concerns on the availability of the vaccine and authenticity of the vaccine (p < 0.001).35

19) Vishranti Bhagwan Giri, (2021), conducted a cross-sectional study to assess the risk
perceptions, knowledge and information sources among perimenopausal and postmenopausal
women. This year January 2020. The pandemic of the Covid-19 pandemic has created
anxiety among every woman in the society, including all women. This study aimed to
examine COVID -19 related risk perceptions, knowledge, and information sources among
perimenopausal and postmenopausal women in the Aurangabad in Maharashtra. Sample size
was 155 perimenopausal women. The Participants perceived their risk of COVID -19 due to
their age and other disease conditions. The participants demonstrated less knowledge about
COVID- 19. The 5 major sources from which they obtained information about Covid-19 were
the television, newspapers, health professionals, the internet, and family and friends.
Participants placed a high level of confidence in these sources. There was no significant
relationship between the perceived risk of contracting Covid-19 and knowledge about the
disease.36

14

20) Al-Domi H, Al-Dalaeen A, (2021), conducted a cross-sectional study, to assess the effect
of COVID-19- quarantine on healthy nutritional behaviour and lifestyle practices among
Jordanian population. A cross-sectional study among Jordanian population was conducted
using an online questionnaire between March and April 2020. Sample size was 4473. A total
of 4473 respondents were included in the study; obese (n = 1135), normal body weight (n =
1561), and underweight (n = 116). During COVID-19 quarantine, a significant increase in
bodyweight (12.9% underweight, 28.5% normal body weight, 36.4% overweight' and 41.1%
of obese (p < 0.001) was reported. Moreover, the number of snacks between meals (p <
0.001), number of main meals (p < 0.001), and the smoking rate was also increased
significantly; however, there was no significant difference regarding physical activity among
various weight status groups (p < 0.05).37

15

METHODOLOGY

Methodology is significant part of the study which enables the researcher to project the
research undertaken. Methodology is systematic, theoretical analysis of method applied to a
field of study. It comprises the theoretical analysis of the body, method and principle
associated with a branch of knowledge. It is the most important part of the research, it is the
framework conducting a study, it indicates the general pattern for organizing the procedures
together valid and reliable data for an investigation. This method discusses the methodology
used for quasi-experimental study.
This chapter include following elements
3.1 Research approach
3.2 Research design
3.3 Research setting
3.4 Target population
3.5 Sample
3.6 Sample size
3.7 Sampling technique
3.8 Sampling criteria
3.9 Variables, selection
3.10 Development of tool
3.11 Description of tool
3.12Validity of tool
3.13 Reliability of tool
3.14 Pilot study
3.15 Data collection procedure
3.16 Ethical consideration
3.17 Plan of data analysis

16

RESEARCH APPROACH

An educative and evaluative research approach and a pre-experimental research design with
one group pre-test- post-test design will be using in study. A quantitative research approach
will be using to assess the effectiveness of structured-teaching programme on knowledge
regarding covid pandemic control over the sign and symptom of covid-19 vaccination among
adult (18-35) age group people in a selected rural area of District Kangra, Himachal Pradesh.

As data has to be expressed in numerical terms and data collection will be complete within
giving period and time so quantitative research approach will be conducted.
RESEARCH DESIGN

An educative and evaluative research approach and a pre-experimental research design with
one group pre-test- post-test design was used in study.

Thus, research designing symbolically represented as:

Pre-test Intervention Post-Test

O1 X O2
O3 ------- O4

FIGURE 4: - SCHEMATIC PLAN OF THE STUDY

O1- Assessing the pre-test knowledge of experimental group regarding

X- Administering of structured teaching programme to experimental group regarding covid

pandemic control over the sign and symptom of covid-19 vaccination among adult (18-35)
age group people

O2 – Assessing the post-test knowledge of experimental group regarding covid pandemic

control over the sign and symptom of covid-19 vaccination among adult (18-35) age group
people

O3 - Assessing the pre- test knowledge of control group regarding covid pandemic control
over the sign and symptom of covid-19 vaccination among adult (18-35) age group people

O4- Assessing the post- test knowledge of control group regarding covid pandemic control
over the sign and symptom of covid-19 vaccination among adult (18-35) age group people.
18

RESEARCH SETTING

The setting will be conducted for study on the basis of:

• Convenience and familiarity with the setting

• Availability of sample

• Feasibility of conduction of study

The study was conducted on covid pandemic control over the sign and symptom of covid-19
vaccination among adult (18-35) age group people in a selected rural area of District Kangra.
POPULATION

The population of the study will be adults 18-35 years of age group.

TARGET POPULATION

The population of adults will be 18-35 years of age group of rural area of District Kangra.

ACCESSIBLE POPULATION

It includes adults of 18-35 years age.

SAMPLE, SAMPLE SIZE & SAMPLE TECHNIQUE:

Sample- It includes adults 18-35 years of age group of Rural Area of Distt. Kangra, H.P.

Sample size- It will be comprised of 80 adults 18-35 years of age group, whereas 40 samples
in the control group and 40 samples in the experimental group in selected area.

Sampling technique- Purposive sampling technique will be used to select the sample.
Purposive sampling is non- probability strategy in which subjects are selected by means of
purpose, accessibility and proximity of the researcher.

CRITERIA FOR THE SELECTION OF THE SAMPLE:

Inclusion criteria:

This study includes those who will:

1) In the age group of 18-35 years.

19

2) Who will be available/present at the time of data collection.

Exclusion criteria:

This study excludes those will;

1) Not willing to participate in the study.

2) Adults who are not the resident of selected area.

3) Who will be living in urban area.

VARIABLES:
Dependent variables - It includes the knowledge of adults regarding covid pandemic control
over the sign and symptom of covid-19 vaccination

Independent variables - It includes structured planning teaching programme for improving

knowledge of adults regarding covid pandemic control over the sign and symptom of covid-
19 vaccination

Extraneous variables- Age, gender, family income, occupation, marital status, educational
status, residence, employment status.

SELECTION AND DEVELOPMENT OF TOOL:

A self-administered structured knowledge questionnaire will be prepared to evaluate the

effectiveness of structure teaching programme on covid pandemic control over the sign and
symptom of covid-19 vaccination among adult (18-35) age group people.

Structured knowledge questionnaire will be conducted to get extra and complete information
from adults (18-35) age group people.

The following step will be considering while preparing the tool

• Review of literature

• Based on expert’s opinion

• Investigator’s personal experience.

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Tool includes 2 parts:

Part-I Comprised of socio demographic data

Part-II Comprised of self-administered structured knowledge questionnaire on knowledge

regarding covid pandemic control over the sign and symptom of covid-19 vaccination among
adult (18-35) age group people.

DESCRIPTION OF TOOL

The self-administered structured knowledge questionnaire consisted of 2 parts:

Part-I: - Comprised of socio-demographic data such as age, gender, religion, area of
residence, source of information.

Part-II: - Comprised of structured knowledge questionnaire with 40 multiple choice

questions.

Each correct answer will be giving score (1) and wrong answer score (0). The maximum
score will be 40.

VALIDITY OF THE TOOL

Content validity will be establishing by obtaining valuable opinions and suggestions from 8
experts of different nursing colleges to know about the adequacy, appropriateness and
completeness of the content of instrument to make amendments in the tool to get better
results. These experts from different specialty of nursing.

REALIABILITY OF TOOL

The reliability of structured knowledge questionnaire was tested for internal consistency and
feasibility by using Spearman’s Brown prophecy formula. Reliability of the tool obtained was
r =0.8. So, tool will be found to be reliable and feasible to conduct to study.

PILOT STUDY

The pilot study will be conducted on covid pandemic control over the sign and symptom of
covid-19 vaccination among adult (18-35) age group people in a selected rural area of district
Kangra.

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DATA COLLECTION PROCEDURE

 Formal permission will be obtaining from the Principal of Guru Dronacharya College
of Nursing, Yol Cantt, Kangra, Himachal Pradesh.

 Formal permission will be obtaining from the different Pradhan of Rural Area of
District Kangra, Himachal Pradesh.
 Participants will be selected by Purposive Sampling technique.
 From the rural areas 40 adults will be selected during the time of data collection.
  18-35 years of adult were taken as a sample.
 40 adults were selected for control group and 40 for experimental group.
 A written informing consent will be taking from the study participants.
 The researcher will be explaining the purpose of the study.

PLAN FOR DATA ANALYSIS

The data obtaining plan will be analyze on the basis of objectives and hypothesis of the study
by using descriptive and inferential statistics.

Descriptive statistics:

 Socio – demographic variables will be analysed in term of frequency and percentages.

 Knowledge score on covid pandemic control over the sign and symptom of covid-19
vaccination among adult (18-35) age group people will be analyze in term of mean
and standard deviation.

Inferential statistics:

 Difference between pre-test and post-test knowledge score will be analysed by using
paired t- test.
 Association between socio demographic variables and knowledge score will be
analysed by using chi- square

22

REFERENCES

1) Key Message and Actions for COVID-19 Prevention and Control

2) https://www.who.int/covid-19

3) Research Article: - “Controlling the Spread of COVID-19: Optimal Control Analysis”;

World Health Organization, “Coronavirus Disease 2019 (COVID-19), Situation Report -51,
Data as reported by 11 March 2020,” https://www.who.int/emergencies/disease/novel-
coronavirus-2019/situation-reports.
4) Accelerating a safe and effective COVID-19 vaccine: - https://www.who.int/

5) The effects of virus variants on COVID-19 vaccines: - https://www.who.int/

6) Visiting Older Adults in Residential Communities: - https://www.cdc.gov/

7) Prospective Role of Peptide-Based Antiviral Therapy Against the Main Protease of SARS-
CoV-2: - https://www.ncbi.nlm.nih.gov/pmc/

8) https://www.who.int/covid-19

9) https://www.immunize.org/

10) Administration of Second Dose of Covishield ... – https://www.mohfw.gov.in

11) COVID-19 advice for the public: Getting vaccinated: - https://www.who.int/

12) Side Effects of COVID-19 Vaccines: - https://www.who.int/

13) Coronavirus disease (COVID-19) advice for the public: When and how to use masks: -
https://www.who.int/covid-19

14) Janata Curfew: - THE HINDU & TIMES OF INDIA NEWSPAPER ARTICLES

15) https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

16) https://www.webmd.com: - - Coronavirus and COVID-19: What You Should Know (Is
there more than one strain of SARS-CoV-2?)

17) https://www.mohfw.gov.in/: - ppt for MO at PHCs for covid-19 management

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18) Jie Liu, Yan Tong, Shaoqiong Li, Zhiqiang Tian, He Lu, Jianzhong Zheng (2020)
https://doi.org/10.21203/rs.3.rs-40330/v1

19) Manal Mohamed Ahmed Ayed, Thorea Mohamed Mahmoud, Fatma El Zahra Kamal,
(2020) https://doi.org/10.21203/rs.3.rs-60327/v1

20) Md. Masud Rana, Md. Reazul Karim, (2020), https://doi.org/10.1371/journal.pone.

21)Mohammed K. Al-Hanawi, Yasmin Abudawood, (2020)

https://www.ncbi.nlm.nih.gov/pmc/
22) Muhammed Elhadi, Ahmed Alsoufi, (2020) https://www.biomedcentral.com/

23) Weifang Kong, Yuting Wang (2020) https://pubmed.ncbi.nlm.nih.gov/

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