Nirbhay Thesis

“A DESCRIPTIVE STUDY TO ASSESS THE
KNOWLEDGE ATTITUDE AND PRACTICE

REGARDING USE OF HELMET AMONG
GRADUAND STUDENTS AT SELECTED
COLLEGES”
COMMUNITY HEALTH NURSING
A Dissertation Submitted to
MAHARASHTRA UNIVERSITY OF HEALTH

SCIENCES, NASHIK
In Partial Fulfillment of the Requirement
For M.Sc. Degree in Nursing
2018
Name of the course :- M.Sc. Nursing.
Name of Subject/ Specialty :- Community Health Nursing
Admission Year/Academic Year :- 2016-2017/ 2017-2018
Topic: - “A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE
ATTITUDE AND PRACTICE REGARDING USE OF HELMET
AMONG GRADUAND STUDENTS AT SELECTED COLLEGES”.

TABLE OF CONTENT
CHAPTER CONTENT PAGE NO.
1 INTRODUCTION 1-3
Background of the study 4-7
Need of the study 8-9
Problem statement 10
Objectives of the study 10
Hypothesis 10
Operational definition 11-12
Scope of the study 13
Assumption 13
Limitations 13
Ethical Aspects 14
Conceptual framework 15-17

II REVIEW OF LITERATURE 19-33
1. Literature related to assess the knowledge regarding use 20-23

of helmet
2. Literature related to assess the attitude regarding use of 24-26

helmet
3. Literature related to assess the practice regarding use of 27-33
helmet
III METHODOLOGY 34-50
Research approach 34
Research design 35
Identification of target and accessible population 35
Sampling technique 36
Sampling size 36
Variables 37
Inclusion and exclusion criteria 38
Tool preparation 38
Feasibility test 43
Content Validity, Pilot study and Reliability 44-45
Data collection and Method of data collection 46-47
Plan for Data analysis 48
Flow chart of Research Process 50

IV DATA ANALYSIS AND INTERPRETATION 52-75
Section 1: Frequency and Percentage distribution of 55-61
graduand students according to their demographic
variables.
Section 2 : Assessment and association of knowledge score 62-63
of graduand students regarding use of helmet
Section 3 : Assessment and association of attitude score of 64-66
graduand students regarding use of helmet
Section 4: Assessment and association of practice score of 67-69
section 5 : Correlation between knowledge, attitude and 70-75
practice of graduand students regarding use of helmet
V FINDINGS, DISCUSSION, CONCLUSION, 76-87
SUMMARY, IMPLICATIONS AND
RECOMMENDATIONS.
Major findings of the study 77-80
Discussion 80-81
Conclusion 82
Summary 83
Implications 84
Recommendations. 86
BIBLIOGRAPHY 88-92
ANNEXURE 93-116
ABSTRACT 117
ENDORSEMENT BY THE PRINCIPAL AND GUIDE

LIST OF TABLES
TABLE PAGE
NO. TITLES NO.
1. Knowledge assessment 41
2 Attitude assessment 42
3. Scoring of practice 42
4. Frequency and percentage distribution of graduand students according 56
to their demographic variables
to age
to religion
to their education
to birth order
to type of family
10. Knowledge score of graduand students regarding use of helmet 62
11. Knowledge score of graduand students according to demographic 63
variables regarding use of helmet
12. Attitude score of graduand students regarding use of helmet 64
13. Attitude score of graduand students according to demographic variables 66
regarding use of helmet

14. Practice score of graduand students regarding use of helmet 67
15. Practice score of graduand students according to demographic variables 68
regarding use of helmet
16. Correlation between knowledge, attitude and practice scores 70

LIST OF FIGURES
FIGURE PAGE
NO. TITLES NO.
1. Conceptual Frame Work 17
2. Schematic Representation of Research design 50
to Age in years
to religion
to their education
to birth order
to type of family
8. Knowledge score of graduand students regarding use of helmet 62
9. Attitude score of graduand students regarding use of helmet 65
10. Practice score of graduand students regarding use of helmet 67
11. Correlation between knowledge vs attitude scores 71
12. Correlation between attitude vs practice scores 72
13. Correlation between knowledge vs practice scores 73

LIST OF ANNEXURE
SR. NO. ANNEXURE
I Letter requesting expert opinion to establish content validity of
research tool
II Acceptance form for tool validation
III Blue print of Structured Questionnaire
IV Content validity certificate
V Letter seeking permission to conduct pilot study
VI Letter seeking permission to conduct main study
VII Consent form for the participant
VIII Tool
IX Criteria rating scale for validity of the tool
X Certificate for English editing of the thesis
XI List of experts consulted for the content validity of
research tool
XII Permission letter to use library
XIII Abbreviations
XIV Statistical formulae used in the study

CHAPTER I
INTRODUCTION
Road Traffic Injuries are among the third leading causes of death for people
between 5 – 45 years of age. Unless immediate and effective measures are taken,
Road Traffic Injuries are predicted to become the 5th leading cause of death in the
world, resulting in an estimated 2.4 million deaths each year which can be avoidable
by taking simple road safety measures. Soon, pillion riders of two wheelers will have
to compulsorily wear helmet. Soon, pillion riders of two wheelers will have to
compulsorily wear helmet.1
Road traffic injuries constitute a serious public health problem. There is
considerable empirical evidence indicating that helmet use effectively reduces
motorcycle-related injuries. Helmet use lessens serious injuries, lowers mortality rates
and reduces the need for hospital resources.2
With the expansion in road network, motorization and urbanization in the
country, the number of road accidents have surged. Road traffic injuries (RTIs) and
fatalities have emerged as a major public health concern, with RTIs having become
one of the leading causes of deaths, disabilities and hospitalizations which impose
severe socio-economic costs across the world. World Health Statistics 2008 cited in
Global Status Report on Road Safety states that RTIs in 2004 were the 9th leading
cause of death and at current rates by 2030 are expected to be the 5th leading cause of
death, overtaking diabetes and HIV/AIDS3.
Motor vehicle population has grown at a compounded annual growth rate of
10% during 2000-2009, fuelled by a rising tide of motorization. Concomitantly, traffic
risk and exposure have grown. During the year 2010, there were around 5 lakh road
accidents, which resulted in deaths of 134,513 people and injured more than 5 lakh
1
persons in India. These numbers translate to 1 road accident every minute and 1 road
accident death every four minutes.3
Two-wheelers can be extremely convenient when travelling a short distance
with one or two people. Thanks to their light-weight mechanism and affordable price,
two-wheelers have always been the preferred choice for many. In addition, if there is
not much luggage or one is only travelling within the vicinities of a city, especially at
peak hours, then two-wheelers tend to be the preferred mode of transport over four-
wheelers. However, the alarming increase in the number of two-wheeler related
accidents and deaths has caused a serious concern in India and globally3.
Motorcycle crash victims form a high proportion of those killed or injured in
road traffic crashes. Injuries to the maxillofacial region, following motorcycle crashes,
are a common cause of severe morbidity and mortality. World-wide, road traffic
injuries have been reported to be the leading causes of death among young people
aged 15-29 years.4
In India, 53.1% of road accident victims were in the age group of 25 to 65
years in 2010, with pedestrians, bicyclists and two-wheelers, who comprise the most
unprotected road users, accounting for around 40% of all fatalities. Amongst the
vehicle categories, two-wheelers accounted for the highest share in total road
accidents (23.8%) in 2010. Road traffic accidents present an economic burden on the
countries amounting to 1-3% of the gross domestic product (GDP).5
According to the WHO, India loses $20 billion on road accidents. It seems
intuitive that helmets should protect against head injuries but it is seen that many two
wheeler users prefers not to use one. A review of sixty-one observational studies
showed that motorcycle helmets were found to reduce the risk of death and head
injury in motorcyclists who crashed. From four higher quality studies helmets were
2
estimated to reduce the risk of death by 42% (OR 0.58, 95% CI 0.50 to 0.68) and from
six higher quality studies helmets were estimated to reduce the risk of head injury by
69% (OR 0.31, 95% CI 0.25 to 0.38).6
As per The Motor Vehicles Act (1988) of India 129 r/w177, every person
driving or riding a two wheeled motorcycle shall, while in a public place, wear
protective headgear. Road accidents are an outcome of the interplay of various factors
of which adherence/enforcement of road safety regulations is very important. Higher
exposure to road accident risk may be mitigated by behavioral standards by adhering
to road safety regulations and policy interventions7.
Globally, road traffic injuries (RTIs) have increased from the 12th leading
cause of disability-adjusted life years (DALYs) in 1990 to the 10 th leading cause of
DALYs in 2010. RTIs are the leading cause of death for young people (aged 15–29
years) worldwide. Low- and middle-income countries (LMICs) are estimated to be
responsible for 90% of the global RTI burden, with Asia accounting for 763,101
fatalities and 15.1 million DALYs annually. The road traffic fatality rate in Southeast
Asia is higher than any other Asian region, with an annual fatality rate of 21.2 road
traffic deaths per 100,000 people as of 2010. South Asia and Central Asia report an
annual death rate of 19.2 and 17.1 per 100,000 populations, respectively. According
to the Cambodia Road Crash and Victim Information System (RCVIS), within
Southeast Asia, Cambodia reports one of the highest annual road traffic fatality rates
per 10,000 registered vehicles (13.1), compared to Lao PDR (7.9) and Vietnam (3.0).8
3
BACKGROUND OF STUDY
Motorcycle accidents, among other types of road accidents, form a fatal
category of motor traffic accidents (NHTSA, 2007). Several studies have been
done on issues around motorcycle injury protection (Chang & Yeh, 2006; Hung,
Stevenson & Ivers, 2008; Julianet al., 2002; Brown et al., 2009; Lin et al.,
2003). This is because motorcyclists are more at risk of sustaining injury than
motor vehicle drivers; per mile travelled, motorcycle riders have a 34 times risk
of death than the drivers of other types of vehicles. They are also 8 times more
likely to be injured (NHTSA, 2007).9
In middle and low-income countries, motorcycles form a common
means of transport (WHO, 2006). Motorcyclists form a significant proportion of
people who are affected by road traffic accidents, for example in Tanzania 181
lives were claimed due to motorcycle accidents during the first quarter of 2010
(Nkwame, 2010).9
This is partly due to the rapidly increasing number of motorcycles from
6,700 in 2007 to 85,000 in 2009, a 13 fold increase in the period of 2 years
(Nkwame, 2010). The reason behind the reported increase in number of
commercial motorcycles is the fact that motorcycles are sold at relatively
cheaper prices than other vehicles and good earnings from the motorcycle taxi
business which encourages more people especially youths to join this business
(Solagberu et al., 2006).10
Injuries are a major but neglected global public health problem,
requiring concerted efforts for effective and sustainable prevention. Injuries
from all causes are a leading cause of death with 5.1 million people dying in
2000. Road traffic injuries account for the majority of morbidity and mortality
4
due to all forms of injuries. Globally every year 1.2 million people are killed
and 20 million–50 million receive moderate to severe injuries as a result of road
traffic crashes.11
In the Eastern Mediterranean Region, every year more than 13200
people die from road traffic injuries– 362 deaths per day. Most of those who die
are young males at their most productive age, forcing many families in low
socioeconomic groups into poverty. If the current trend continues, mortality and
morbidity due to road traffic injuries will rise many fold, especially in low-
income and middle-income countries, putting tremendous strain on their scarce
resources.12
Of those affected 90% come from vulnerable groups (pedestrians,
public transport users, motorcyclist and cyclists). Road traffic injuries cost 1%–
1.5% of GNP to low and middle-income countries in direct and indirect costs.
Road traffic injuries are among the leading causes of death and life-long
disability globally. The World Health Organization (WHO) reports that about
million people die annually on the world’s roads, with 20–50
million sustaining non-fatal injuries. Globally, road traffic
injuries are reported as the leading cause of death among young
people aged 15–29 years and are among the top three causes of
mortality among people aged 15–44 years. The Institute for
Health Metrics and Evaluation (IHME) estimated about 907
900, 1.3 million and 1.4 million deaths from road traffic injuries
in 1990, 2010 and 2013 respectively 13
5
The statistics of RTA in our country shows that the actions taken by the
government are still not adequate to prevent accident cases. Strategy of WHO
2004”Road safety is no accident” attracts the whole world’s attention towards
the rapidly growing incidences of road traffic accident. This slogan gives us a
positive belief and encourages us to take measures regarding prevention from
road traffic injuries.14
Roadside KAP Surveys of motorcycle drivers and passengers were
carried out in three of the study provinces - Phnom Penh, Kandal, and Kampong
Speu (phase I provinces). These surveys were used to gain insight into the
knowledge, attitudes, and practices around helmet wearing in the three
provinces, and monitor changes in knowledge, attitude, and practices at the sites
over the study period. To ensure safety of interviewers, eligible interview
locations included places such as gas stations and rest stops that did not require
a driver to actively stop his or her motorcycle to participate in the survey.
Interview locations were selected from among eligible locations that were close
to the observational sites. A total of 19 sites were selected across the three
provinces (Phnom Penh = 10; Kandal = 5; Kampong Speu = 4).15
KAP surveys were conducted semi-annually over the study period
(November 2010, May 2011, November 2011, May 2012, and November 2012)
by trained interviewers over a five-day period each time. Survey data were
collected through face-to-face interviews. As with observational studies,
interviews were conducted at varying times during the day, and day of the week
to ensure a mix of respondents. Through the use of a closed-ended
questionnaire, we aimed to capture respondents' knowledge, attitudes, and self-
reported behavior patterns related to helmet use, including, but not limited to:
6
knowledge of legislation, perceptions on enforcement, helmet ownership, and
factors influencing helmet purchase, frequency of helmet use as drivers and
passengers, and reasons for use or non-use of helmets. Other background
information on the type of motorcycle the respondent was traveling on,
motorcycle ownership and demographics was also collected.15
7
NEED FOR STUDY
“
There are no accidents without intensions” – Alex miller quote
Many people around the world die in motorcycle collisions Road traffic
injuries are a major public health problem and a leading cause of death and injury
around the world. Each year nearly 1.2 million people die as a result of road crashes,
and millions more are injured or disabled. In many low-income and middle-income
countries, where motorcycles and bicycles are an increasingly common means of
transport, users of two-wheelers make up a large proportion of those injured or killed
on the roads. Motorcycle and bicycle riders are at an increased risk of being involved
in a crash. This is because they often share the traffic space with fast-moving cars,
buses and trucks, and also because they are less visible.16
With the rapid expansion of motor vehicle use in low- and middle-
income countries, road traffic-related death and injuries are increasing sharply.
Projections show that, between 2000 and 2020, road traffic deaths will decline
by about 30% in high-income countries but increase substantially in low- and
middle-income countries. Without appropriate action, by 2020, road traffic
injuries are predicted to be the third leading contributor to the global burden of
disease and injury. More than one million people died from road traffic crashes
in low-and middle-income countries in 2000; according to the World Health
Organization, that number could nearly double by 2020.17
Helmets are recommended for motorcyclists to reduce the risk of head
injuries. They can lower mortality between 32% and 50%.India has a national
helmet law that makes helmet use mandatory for both motorcycle drivers and
pillion riders (co-passengers). However, the notification and enforcement of this
8
law rests with individual states and is generally weak. In a recent exercise
conducted by the WHO, the enforcement of helmet law in India was rated 4 on a
scale of 10 (where 0 was least and 10 was highly effective).18
In middle and low-income countries, motorcycles form a common
means of transport. Motorcyclists form a significant proportion of people who
are affected by road traffic crashes. The reason behind the reported increase in
number of commercial motorcycles is the fact that motorcycles are sold at
relatively cheaper prices than other vehicles and good earnings from the
motorcycle taxi business encourages more people especially youths to join this
business.. Negative attitudes towards helmet use among other factors; explain
the reason behind the reported low rate of use. Some reasons for non-adherence
and non-use of helmet include feelings of discomfort due to heat during the hot
weather, and lateral vision and hearing ability impairment. However it has been
shown that helmets do not impair hearing ability and the lateral vision can be
complemented by lateral head rotation.19
So many numbers of deaths are occurring among youths of India
because of riders without helmet. As a community health nurse I felt the need to
study on this aspect, which helps to understand about the concept of use of
helmet in graduand students.
9
PROBLEM STATEMENT
“A descriptive study to assess the knowledge attitude and practice
regarding use of helmet among graduand students at selected colleges.”
OBJECTIVES OF THE STUDY
 To assess the knowledge regarding use of helmet among the graduand
students in selected colleges.
 To assess the attitude regarding use of helmet among the graduand
 To assess the practice regarding use of helmet among the graduand
 To find out the correlation between knowledge and practice regarding
use of helmet among the graduand students in selected colleges.
 To find out the correlation between knowledge and attitude regarding
use of helmet among the graduand students in selected colleges.
 To find out the correlation between attitude and practice regarding use
of helmet among the graduand students in selected colleges.
 To find out the association between knowledge, attitude and practice
scores with selected demographic variables among graduand students.
HYPOTHESIS
H1: There is significant relation between the knowledge Attitude and practice
score regarding use of helmet among graduand students.
H2: There is significant association between knowledge Attitude and practice
score with selected demographic variable among graduand students.
10
OPERATIONAL DEFINITIONS
I. Assess:
According to Longman business dictionary: “To make a judgment about a
person or situation after considering all the information”
In this study: It refers to identifying the knowledge, opinion and daily use of
helmet among graduand students”
II. Knowledge
According to oxford dictionary: “knowledge is information and skills acquired
through experience or education”.
In this study: “the term knowledge refers to the respondent verbal
response regarding the use of helmet.
III. Attitude
According to oxford dictionary: “A settled way of thinking or feeling about
something”
In this study: “It refers to opinion of graduand students towards use of helmet”
IV. Practice:
According to oxford dictionary: “The actual application of use of an idea,
belief or method as opposed to theories relating to its”
In this study: “It refers to daily application of helmet during drives among
graduand students”.
11
V. Helmet:
According to oxford dictionary: “ A hard or padded protective hat, various
types of which are worn by soldiers, police officers, motorcyclists, sports
players, and others.
In this study: “it refers to the protective hat that is used by graduand’ students
while riding motorcycles”.
VI. Graduand students:
According to oxford dictionary: “a person who is about to receive an
academic degree.
In this study: “it refers to the students who were doing under and post-
graduation course”.
12
SCOPE OF THE STUDY
1. These study findings will indicate the existing knowledge regarding use
of helmet among the graduand students.
2. These study findings will indicate the existing attitude regarding use of
helmet among the graduand students.
3. These study findings will indicate the existing practice regarding use of
4. These study findings will indicate the need to improve the knowledge
attitude and practice regarding use of helmet among the graduand
students.
5. This study will motivate the graduand student regarding use of helmet
according to level of the knowledge attitude and practice.
6. This study may open avenues further related studies in depth.
ASSUMPTION
 Students will have limited knowledge regarding use of helmet
 Students will have favorable and unfavorable attitude towards use of
helmet
 Students will have poor practice regarding use of helmet
LIMITATIONS
The study was limited to sample size 100 only.
13
ETHICAL ASPECT
The dissertation committee of university and college had approved the
research proposal .while conducting research ethical aspect had been taken into
the consideration .investigator had taken the prior permission from the
respective authority to conduct the proposed research .informed consent had
been taken from the participant before conducting the test, confidentiality and
anonymity had been maintained of the information given by participants.
14
CONCEPTUAL FRAMEWORK
A conceptual framework is a theoretical approach to the study of
problems that are scientifically based and emphases the selection, arrangement
and classification of its Concepts.
The conceptual framework provides a certain frame of reference for
clinical practice research and education. The utility of conceptual models comes
from the organization it provides for thinking, for observations and for
interpreting what is seen. It also gives directions to the investigator for relevant
question on phenomena and point out solutions to practical problems.
Conceptualization is a process of forming ideas, which utilize and
form conceptual framework for the development of research design. Conceptual
framework deals with abstracts (concepts) that were assembled by virtue of their
relevance to a common theme.
The conceptual framework for the present study is based on Health
Belief Model. It is one of the most widely used models to explain the belief on
health promotion of the people. This model was first developed in the early
19503 by Becker, Drachman RH and Kircht TP (1974). Later the model is
modified to include the influence of health motivation.
This model is comprised of 3 primary components.
i. Individual perceptions
ii. Modifying factors
iii. Likelihood of behavior and initiating or engaging in action.
15
i. Individual Perceptions:
An individual estimated perceived specific knowledge and the degree of
concerns on particular problem associated with a given health condition
graduand student knowledge, attitude and practice regarding use of helmet.
ii. Modified factors:
The graduand student perception is influenced and modified by various
demographic factors like age, education, religion, Birth order, type of family.
Variety of selected demographic variables.
iii. Likelihood Action:
It is the factor that purports to trigger health action. Information guide sheet will
provide adequate knowledge and help in developing positive attitude towards
graduand students.
16
Figure No. 1 Conceptual framework Based on Modified health belief model
Individual Likelihood action

Modified factors
perception
Selected variables  Good

Knowledge attitude and practice regarding use of helmet among the graduand students knowledge
Age Sex  Average
Education
knowledge
Religion Birth order
 Poor
knowledge
 Positive attitude
 Negative
attitude
 Good practice
 Poor practice
Perceived threat by Recommended action

graduand student
Develop information booklet on
regarding use of
helmet in order to remove
helmet
misconception regarding helmet and
improve knowledge attitude and
practice regarding use of helmet
1) Not included Source of
information
Feedback
 Radio
 Television
 Magazine
2) Included  Books and
journals
 Mass media
 Health
17
personnel
SUMMARY
This chapter deals with introduction ,background of the study ,need of the study
problem statement, objective of the study, operational definitions, scope of the
study, assumptions, limitations, ethical aspect and conceptual framework.
18
Chapter II
REVIEW OF LITERATURE
Literature is a kind of intellectual light, which like the Light of the sun
may sometimes enable us to see what we do not like”
Samuel Johnson.
Review of literature is a key step in research process. The review of
literature in a research report is a summary of current knowledge about the problem.
The major literature review is conducted at the beginning of the research process
and limited review is conducted during the generation of the research report to
identify new studies (Nancy burns).
Review of literature involves the systematic identification, location, scrutiny and
summary of written materials that contain information on research problem (Polit and
Hungler 1991).
The major goal of the review of the literature is to develop a strong
knowledge base to carry out research and other non-research scholarly activities in
educational and clinical practice settings, in educational areas. The purpose of this
chapter is to give on account of the literature reviewed by the investigator for
studying the problem. Review of literature broadens the understanding and gives
insight into the problem under study. This chapter attempts to presents a broad
review of studies done, the methodology adopted and conclusion arrived by earlier
investigators and helps to study the problem in depths. It also serves as a valuable
19
quick to understand, what has been done what is still unknown and untested. The
present study is to assess the knowledge, attitude and practice regarding use of
The review of literature for the present study is explained under the
following headings:
1. Literature related to assess the knowledge regarding use of helmet
2. Literature related to assess the attitude regarding use of helmet
3. Literature related to assess the practice regarding use of helmet
1. Literature related to assess the knowledge regarding use of helmet
Jessica Laureano Phillips et.al (Sep 2016) A study to examine the knowledge
regarding trends and use of helmet in Several US states repealed universal motorcycle
helmet laws in the 1990s and 2000s. We retrospectively analyzed the National Trauma
Data Bank's National Sample Program for 2003-2010. We also obtained data on US
motorcycle fatalities reported in the Fatality Analysis Reporting System and population
data from the U.S. Census Bureau to calculate motorcycle-related fatality rates over time.
A total of 255,914 patients met inclusion criteria, of whom 148,524 (58%) were
helmeted. During the study period, helmet use increased from 56% in 2003 to 60% in
2010 (p < 0.001). However, motorcycle-related fatality rates also increased in states with
and without universal helmet laws. However, fatalities due to motorcycle crashes have
also increased during the same period.20
20
Kim CY (28 April 2015) In this study the incidence and cost of motorcycle
accidents are projected to increase. Motorcycle helmets are accepted as an effective
strategy for reducing the morbidity. The review only included articles that were primary
studies, written in English, evaluations of periods after 1994, and published in a peer-
reviewed journal. Two independent authors extracted data using predefined data fields.
Meta-analysis was done using the R-meta for package. Twelve papers met the criteria for
inclusion. Meta-analysis demonstrated that nonhelmeted patients required $12,239 more
in hospital costs per patient. Nonhelmeted patients also required more post discharge care
and were more likely to use publicly funded insurance. Studies also found lower injury
severity and better hospital course in the helmeted population. Motorcycle helmet use
reduces morbidity and contributes to significant health care cost savings. 21
Javad Rezazadeh.et.al. (2014 ) In this cross sectional study states that Traffic
crashes are the most common causes of serious fatal injuries in all age groups. 360
motorcyclists were selected from different fuel stations of Bojnourd in 2012. The data were
collected using a questionnaire including demographic characteristics and information
regarding knowledge, attitude, and performance. The results of one-way ANOVA showed
a significant relationship between knowledge and attitude and age, marital status,
occupation, level of education, place of residence, and having driver's license. However, no
significant relationship was found between knowledge and attitude and history of accident
in the past 12 months. Considering the fact that using helmets has preventive effects on
death and severity of injuries and in this study motorcyclist had moderate knowledge and
attitude in this regard, authorities are required to plan for increasing the society’s level of
knowledge regarding utilization of helmets.22
21
John Civertron (September 2012) The experimental study was conduct on a
system for the automatic classification and tracking of motorcycle riders with and without
helmet. The trained classifier is incorporated into a tracking system where motorcycle
riders are automatically segmented from video data using background subtraction. The
heads of the riders are isolated and then classified using the trained classifier. Each
motorcycle rider results in a sequence of regions in adjacent time frames called tracks.
These tracks are then classified as a whole using a mean of the individual classifier
results. The study shows that the classifier is able to accurately classify whether riders are
wearing helmets or not.23
Stefanie Uibel.et.al. ( 4 April 2012 ) In this retrospective study assembles the
most recent findings concerning research in the field of bicycle traumata combined with
the factor of bicycle helmet use. Due to this plurality of global publications and special
subjects, short time reviews help to detect recent research directions and provide also
information from neighbor disciplines for researchers. It can be stated that to date, that
although a huge amount of research has been conducted in this area more studies are
needed to evaluate and improve special conditions and needs in different regions, ages,
nationalities and to create successful prevention programs of severe head and face
injuries while cycling Focus was explicit the bicycle helmet use.24
Bachani.A.M.et.al.(March 2012) An observational study states that Road
traffic injuries (RTIs) are a leading cause of disability and fatality globally. Motorcycle-
related injuries, mainly head injuries, and related deaths and disabilities are a significant
contributor to the burden of disease in low- and middle-income countries. Helmets have
been proven to be an effective way to reduce the risk of head injury. As motorcycle use
22
continually increases in Cambodia, head injuries and related deaths and disabilities are
expected to rise. Two separate methodologies were employed for this study. The
observed proportion was up to 10 times higher among drivers compared to passengers.
Study reveal that the proportion of helmet wearing across all study sites was 25% at night
and 43% during the day among all motorcyclists.25
Norvell D.C.et.al.(September 2002) The cohort study conducted to determine
the association of helmet use with death in a motorcycle crash. The relative risk of death,
accounting for the matching on motorcycle and adjusted for age, sex, and seat posit this
on, for a helmeted rider compared with an unhelmeted rider was 0.61 (95% confidence
interval: 0.54, 0.70). The study suggest that conditional Poisson regression is useful for
the analysis of traffic crash data, where occupants are naturally matched in a vehicle and
where crash-related confounders may be difficult or impossible to measure.26
2. Literature related to assess the attitude regarding use of helmet
Tu Anh Trinh.et.al. (2016) In this experimental study a number of social
campaigns and interventions have been implemented to tackle the problem, still the
children helmet wearing rate has been relatively low. Research was conducted in Ho Chi
Minh City during 3-month period. The study was carried out with a sample size of 288.
The study concluded that, normative influence and habit had positively influenced on
parents’ behavior. Perceived behavioral control, attitude, injunctive norm, descriptive
norms, and habit remained a significant predictor of parents’ intention to safety helmet
usage among children, and they mediated the impact of the campaign on parents’
intention. Descriptive norm was not significant in predicting parents’ behavior. Practical
23
implications for policy makers in promoting campaigns and intervention were also
discussed.27
Ashfaq Ahmad Klair (August 2015) In this experimental study recommends
interventions through continuous road safety educations programs and intensive law
enforcement to enhance the rates of safety helmet use among motorcycle riders in
Pakistan. In Pakistan motorcycle riders contribute more than 35% of road death toll
annually. Wearing a standard, good quality motorcycle helmet can reduce the risk of
death by 40% and the risk of serious injury by over 70%. A very low safety helmet use
rate is reported among Pakistani motorcyclists. This study was to explore the
determinants of helmet use among motorcyclists and establish a link between different
variables and use of helmet Participant’s between 41 to 50 years age group were using
safety helmet with higher percentage. Respondents with higher educational attainments
were using helmet in higher percentage. Law enforcement emerged as major determinant
of safety helmet use and 65.22% previously penalized riders were found respecting
helmet law. 38.53% private employees were found using safety helmet. This study
recommends interventions through continuous road safety educations programs and
intensive law enforcement to enhance the rates of safety helmet use among motorcycle
riders in Pakistan. 28
Ioanna Zorba (2014-2015) A descriptive study on the Hellenic Motorcycle
Institute ‘Moto thesis’ studied perceptions on helmet usage and unorthodox practices
regarding helmet use in Greece. This study recognized that the development of
motorcyclist literature is the basis for the overall improvement (quantitative and
qualitative) of motorcyclist practiceThe response in total was 40.7% out of a target of
24
1,000 people (90% of them were pupils and 10% students; 70% of them were men and
46% used a motorcycle). Regarding the questionnaire to the motorcyclists, Motothesis
addressed the motorcyclist clubs of the Hellenic Motorcyclists Federation (MOT.O.E.),
asking them to fill out the online survey (only one response per club); the clubs were
asked to discuss this subject with their members and to fill out the questionnaire as a
result of this discussion. In total 36% of the clubs responded; most of them were located
in the Northern part of Greece 29
Emmanuel Geofrey Mwakapasa (November 2011)A cross-sectional survey
was conducted in urban and peri-urban areas of Dares Salaam region in May, 2011 at
randomly selected commercial motorcycle parking points. A total of 273 conveniently
selected eligible commercial motorcyclists participated. Face-to-face interviews were
performed using a standard questionnaire while observation was conducted using an
observation checklist. Data was analyzed using SPSS version 16.0. All commercial
motorcyclists were males, with the majority (64.8%) with primary education. The
proportion of commercial motorcyclists who reported to wear helmet was 81.3%.
However about two thirds of them (67.6%) reported to not wear helmet consistently.
Helmet wearing was strongly predicted by having a positive attitude towards helmet for
passengers (p=0.005), protective ability of helmet against head injury (p=0.003), wearing
helmet during night (p=0.001) and wearing helmet even for the experienced rider
(p=0.000). 30
25
Evi Germeni.et.al (October 2010) A study was conducted to Evaluate the
impact of a school-based helmet promotion program on eligible adolescent drivers. The
741 second grade students were selected with cluster randomized controlled trial. The
school environment has been often identified as a prosperous venue for public health
improvement 4 public, 4 private and 4 vocational high schools situated in Attica, Greece.
The samples were sorted by type and randomly assigned to receive a 1-month
intervention, based on the concepts of the Health Belief Model. This study suggests that
educational programs targeting road safety can lead to significant positive changes if
implemented during critical life periods, such as the transition to driving status.31
Karkhanesh M et.al. (April 2006) a study conduct to evaluate the scientific
evidence for helmet use following legislation to identify the effectiveness of legislative
interventions to increase bicycle helmet use among all age groups. While the baseline rate
of helmet use among these studies varied between 4% and 59%, after legislation this
range changed to 37% and 91%. Helmet wearing proportions increased less than 10% in
one study, 10-30% in 4 studies, and more than 30% in 7 studies.While the effectiveness
of bicycle helmet legislation varied all studies demonstrated higher proportions of helmet
use following legislation, particularly when the law was targeted to a specific age group.
Legislation increased helmet use among cyclists. These results support legislative
interventions in populations without helmet legislation.32
Kimberly.M.et.al.( August 2002) This study sought to determine the
impact of Maryland’s all-rider motorcycle helmet law (enacted on October 1, 1992) on
preventing deaths and traumatic brain injuries among motorcyclists. Statewide
motorcyclist fatalities occurring during seasonally comparable 33-month periods
26
immediately preceding and following enactment of the law were compared. The
motorcyclist fatality rate dropped from 10.3 per 10 000 registered motorcycles prelaw to
4.5 post law despite almost identical numbers of registered motorcycles. Motorcyclists
wearing helmets had a lower risk of traumatic brain injury than those not wearing
helmets. Maryland’s controversial motorcycle helmet law appears to be an effective
public health policy and may be responsible for saving many lives.33
3. Literature related to assess the practice regarding use of helmet
Cody S Olsen (7 march 2016) in this cross sectional study Helmets were
effective in reducing injury in both helmet law settings; lower effectiveness estimates
were observed in universal law states. We pooled data from eleven states: five with
universal laws requiring all motorcyclists to wear a helmet, and six with partial laws
requiring only a subset of motorcyclists to wear a helmet. Data were combined in the Crash
Outcome Data Evaluation System’s General Use Model and included motorcycle crash
records probabilistically linked to emergency department and inpatient discharges for
years 2005-2008. We estimated adjusted relative risks (RR) and 95 % confidence intervals
(CIs) for head, facial, traumatic brain, and moderate to severe head/facial injuries
associated with helmet use within each helmet law setting using generalized log- binomial
regression. Reported helmet use was higher in universal law states (88 % vs. 42 %).
Median charges, adjusted for inflation and differences in state-incomes, were higher in
partial law states Injuries to the head and face,including traumatic brain injuries, were
more common in partial law states. Medical charges and rates of head, facial, and brain
injuries among motorcyclists were lower in universal law states.34
27
Kamulequeya.L.H.et.al. (September 2015) In this cross sectional study data
was conducted by using pretested interviewer administered questionnaires. Proportions
and means were used to summarize data. Odds ratios were calculated for association
between wearing helmets and occurrence and severity of head injury. All 328 participants
recruited were male. Of these, 18.6% used Protective gear and 71.1 % sustained head
injury. Helmets protected users from head injury and significantly reduced its severity
when it occurred. Protective gear use was low, with high occurrence of head injury
among commercial motorcycle riders in Uganda. This study suggest that there is more
effective strategies are needed to promote protective gear use among Uganda's
commercial motorcycle riders.35
Hooten.K.G.et.al. (August 2014) In this study helmet use in two-wheeled
vehicle accidents is widely reported to decrease the rates of death and traumatic brain
injury. In 2000, the State of Florida repealed its mandatory helmet law to make helmet
use optional for individuals older than 21 with $10,000 of health insurance coverage. To
better ascertain the risks of cervical spine injury with non-helmet use in all two-wheeled
vehicles, we analyzed the University of Florida level one trauma center experience. We
reviewed the Traumatic injury database over a five-year period (January 1, 2005, to July 1,
2010) for all patients involved in two-wheeled vehicle accidents. Patients were stratified
according to vehicle type (motorcycle, scooter, and bicycle), helmet use, and the presence
or absence of a cervical spine injury. 36
28
Akaateba M.A. et.al. (22 November 2013) In this cross sectional study
states that Motorcyclists' injuries and fatalities are a major public health concern in many
developing countries including Ghana. This study therefore aimed to investigate the
prevalence of helmet use among motorcyclists in Wa, Ghana. The method used involved
a cross-sectional roadside observation at 12 randomly selected sites within and outside the
CBD of Wa. A total of 14,467 motorcyclists made up of 11,360 riders and 3107 pillion
riders were observed during the study period. Based on logistic regression analysis,
higher helmet wearing rates were found to be significantly associated with female gender,
weekdays, and morning periods and at locations within the CBD. The study concluded
that despite the existence of a national helmet legislation that mandates the use of helmets
by both riders and pillion riders on all roads in Ghana, helmet use is generally low in Wa.
This suggests that all stakeholders in road safety should jointly intensify education on
helmet use and pursue rigorous enforcement on all road types especially at locations
outside the CBD to improve helmet use in Wa.37
Srinivasulu Pothireddy.et.al. (2013) In this study the pattern of injuries in
road traffic accidents helps us to know the Measures to be taken at different levels to
reduce suffering to human beings. Out of 131 sample the injuries to the limbs (96%) and
head (95%) occurred in most of the cases Followed by chest and abdomen. In head
region, scalp contusion, fissured fracture of the skull and subdural hemorrhage were more
commonly seen than other injuries. Contusions were more commonly seen in scalp and
brain unlike that of Abrasions present on chest, abdomen and limbs. Femur fracture
(n=16) was more than other long bones. This study is concluded that Head injury was the
29
primary cause of death (69%) in most of the cases. Fatal motorcycle accidents are
associated with a wide spectrum of injuries involving multiple anatomical regions. 38
Matthew Byrnes et.al. (January 2012) The study was conducted to determine
the impact of motorcycle helmet use and helmet legislation on the risk of death or injury
due to motorcycle accidents. There has been a marked improvement in the safety profiles
of cars and in car crash outcomes; there has been a marked worsening in outcomes of
motorcycle collisions. Motorcycles account for only 2% of vehicle registrations in the
United States, but motorcycle collisions account for 10% of traffic deaths. Further,
motorcycle riders are 34 times more likely to die in a traffic collision than automobile
drivers. Motorcycle helmet use has been suggested to be an effective way to reduce death
and disability after traffic collisions, and enactment of universal helmet laws has been
suggested as a means to enforce helmet use.39
Bette.C.L.et.al. (2009) The literature search in this review was of 507 citations,
from 1990 through 2009, identified in the U.S. National Library of Medicine. Out of 86
prescreened articles, 25 were potentially relevant to the topic and 11 were finally included
in the review. Of 11 studies, eight were published articles, two were published reports, and
one was an unpublished article. Helmet wearing proportions increased less than 10% in
one study, 10–30% in four studies, and more than 30% in seven studies. The authors used
Fatality Analysis Reporting System data, from 1980 through 1998, for motorcycles that
crashed with two riders and either the driver or the passenger, or both, died. The relative
risk of death, accounting for the matching on motorcycle and adjusted for age, sex, and
seat position, for a helmeted rider compared with an unhelmeted rider was 0.61 The
authors suggest that conditional Poisson
30
regression is useful for the analysis of traffic crash data, where occupants are naturally
matched in a vehicle and where crash-related confounders may be difficult or impossible
to measure.40
Liu B et.al. (2008) An observational study conducted on people who
regularly uses helmet. Motorcycle helmets were found to reduce the risk of head injury
and from five well-conducted studies the risk reduction is estimated to be 72%.
Insufficient evidence was found to estimate the effect of motorcycle helmets compared
with no helmet on facial or neck injuries. Study revealed that Motorcycle helmets reduce
the risk of mortality and head injury. Further well-conducted research is required to
determine the effects of helmets and different helmet types on mortality, head, neck and
facial injuries. An overall findings suggest that global efforts to reduce road traffic
injuries may be facilitated by increasing helmet use by motorcyclists.41
Hung DV (December 2006) in this observational study investigate the rate
of helmet use among motorcycle drivers in Hai Duong province of Vietnam during
winter/spring 2005, and to compare the rates of helmet use by road types. Population-
based observational surveys is used Male pillion passengers were less likely to wear
helmets than female pillion passengers (OR 0.78, 95% CI 0.72 to 0.85). The number of
adult drivers using helmets is larger as compared with that of young drivers (OR 8.56,
95% CI 5.93 to 12.19). The rates of helmet use were significantly higher (p<0.001) on
compulsory roads and were 59.01%, 39.97%, 24.22%, 12.7% and 9.54% for national,
provincial, district, commune and Hai Duong inner-city roads, respectively. Helmet
legislation has increased the rate of helmet use by motorcycle drivers on compulsory
31
roads. Elsewhere, rate of helmet use is very low; indicating that in the absence of
legislation and enforcement, motorcyclists in Vietnam will not wear a helmet. 42
Dr. Reza Mohammadi (2005) Two cross sectional observations were
conducted in 14 cities independently on 2005 and 2007. 10% of registered motorcycles
were observed and interviewed (n=1114 in each observation). Results revealed that
87.9% used motorcycle for the commercial purposes. All motorcyclists were male, mostly
aged 18-29 years old. Death rate significantly rose from 122 to 254 per 100000
motorcyclists in Fars province since first observation (p < 0.0001). Helmet usage rate was
constant (13%). Recorded crashes increased from 16.4% to 23.1% in safe community
setting (p < 0.0001). 11% carried more than one pillion. No significant effect was noticed
between two settings. Interventions were not constant in safe community cities.
Community involvement into the safe program could ensure sustainability of initiatives.43
Thompson DC(2000) The case control study conduct to determine whether
bicycle helmets reduce head, brain and facial injury for bicyclists of all ages involved in a
bicycle crash or fall. No randomized controlled trials were found. This review identified
5 well conducted case control studies were selected. Helmets provide a 63%-88%
reduction in the risk of head, brain and severe brain injury for all ages of bicyclists.
Helmets provide equal levels of protection for crashes involving motor vehicles (69%) and
crashes from all other causes (68%). Injuries to the upper and mid facial areas are reduced
65%.study conclude that Helmets reduce bicycle-related head and facial injuries for
bicyclists of all ages involved in all types of crashes including those involving motor
vehicles.44
32
Wen-Ta Chiu.et.al.(2000)This study evaluated the effect of the motorcycle
helmet law implemented in Taiwan on June 1, 1997. Collecting data on 8795 cases of
motorcycle-related head injuries from 56 major Taiwanese hospitals,we compared the
situation 1 year before and after implementation of the helmet law. After implementation
of the law, the number of motorcycle-related head injuries decreased by 33%from 5260
to 3535. Decreases in length of hospital stay and in severity of injury and better outcome
were also seen. The likelihood ratio χ2 test showed that severity decreased after the law’s
implementation (P<.001). Full helmets were found to be safer than half-shell helmets.
The helmet law effectively decreased the mortality and morbidity from motorcycle-
related head injuries.45
Matthew S. Thompson (June 1989) A case-control study in which the
case patients were 235 persons with head injuries received while bicycling, who sought
emergency care at one of five hospitals. One control group consisted of 433 persons who
received emergency care at the same hospitals for bicycling injuries not involving the
head. A second control group consisted of 558 members of a large health maintenance
organization who had had bicycling accidents during the previous year. Based on his
research head injuries and deaths among army motorcyclists during the Second World
War.This study concluded that adoption of a crash helmet as standard wear by all
motorcyclists would save considerable lives, lost working time, and hospital resources46
33
CHAPTER III
RESEARCH METHEDOLOGY
Research methodology involves the systematic procedure, by which the
investigator starts from the initial identification of the problem to the final
conclusion. It is a science of study how research is done scientifically. The present
study was aimed at to asess knowledge attitude and practice regarding use of helmet
among graduand students at selected colleges. The research methodology is a way to
structure a study and to gather and analyze information in a systematic fashion
(Polit D.F. & C. T., 2009).
This chapter deals with a brief description of the different steps which were
under taken by the investigator for the study. It includes the research approach,
research design, variables, setting, population, and sample size, sampling technique,
description of the tool, content validity, pilot study, data collection procedure and
plan for data analysis.
Research approach
Research approach is the most significant part of any research. The
appropriate choice of the research approach depends on the purpose of the research
study. An evaluative approach is selected for the study.
34
Research design
The research design is a researcher plan for obtaining answers to the research
questions for testing the hypothesis. The research design spells out the basic
strategies the researcher adopts to develop information, which is accurate and
interpretable. Polit and Hungler stated that a research design incorporates the most
important methodological decisions that a researcher makes in conducting a research
study.
The research design used in this study is non-experimental descriptive
survey design.
IDENTIFICATION OF TARGET AND ACCESSIBLE
POPULATION
Population
According to (Polit & hungler, 1998), the term population includes all persons,
event and objects under study. In this study the population consisted of graduand
students who are present in colleges.
1. Target Population
According to (polit and beck), the target population is defined as, the
aggregate of cases about which the researcher would like to generalize.
In this study target population was all the graduand students present in the
colleges of selected district.
35
2. Accessible Population
According to an (N cy Burn and Susan K.) the accessible population is
defined as, the portion of the target population to which the researcher has
reasonable access.
In this study, accessible population consisted of all graduand students at
selected college
SAMPLE AND SAMPLING TECHNIQUE
Sample:-
According to (Burns, N 2000), Sample is a subset of population selected for
particular study and members of the sample are the subjects.
In the present study subjects are graduand students.
Sample size:-The sample size was 100 graduand students of selected colleges
Sampling Technique:-
According to (Polit and Beck), the sampling technique defined as, the set of
sampling units chosen for the study is called the sample.
Sampling is the process of selecting a Portion of a population represents the entire
population.
The study was based on convenient sampling technique. The subjects are
selected conveniently because of their accessibility and proximity to the
investigator. Non-probability Convenient sampling technique was used for selecting
the sample for the study.
36
VARIABLES UNDER STUDY
1. Independent Variable
According to Suresh K Sharma (2014) “An independent
variable is a stimulus or activity that is manipulated by researcher to create
an effect on the dependent variable. It is also called intervention or
experimental variable.”
In this study, the independent variable was selected demo graphic
characteristics of the sample such as Age, Gender, Education, Religion,
and Type of family, birth order.
2. Dependent Variable
According to Polit and Beck (2008), Dependent variables are
the variables hypothesized to depend on or be caused by another variable;
the outcome variable of interest.
In this study the dependable variable was Knowledge, Attitude and
Practice score of graduand students regarding use of helmet.
37
CRITERIA FOR SAMPLE SELECTION
The criteria for sample selection are mainly depicted under two headings which
includes the inclusive and exclusive criteria.
a. Inclusion criteria
1. The students who are studying at selected graduate college.
2. The students who are available during data collection period.
3. Students who are actively willing to participate in the study.
b .Exclusion criteria
1. Students who are ill during the time of data collection.
TOOL PREPARATION
The instrument selected for the study was the vehicle that would obtain best data to
draw conclusion pertinent to the study (Treece & Treece).
Development of tool was based on research study for the collection of data;
structured knowledge questionnaires, Likert scale and checklist were used in
research study. A questionnaire was formulated after reviewing the literature. There
were 10 questions for knowledge, 10 for attitude and 10 for practice.
38
Development of the tool
According to compact oxford reference dictionary (2003), it
is a device used to carry out a particular function based on the objectives
of the study. After designing an experiment the statistical treatment of the
problem begins. Collection of data is the first step in the statistical
treatment of the problem. The tool acts as a best instrument to assess and
collect the data from the respondents of the study.
The tool used is a structured questionnaire, likert scale and check list to
assess the knowledge, attitude and practice.
The steps followed in preparing tool were:
1) Review of literature.
2) Preparation of Blueprint
3) Consultation with experts
4) Validation from experts
1) Review of related literature
Books, journals, reports, articles, published and unpublished research
studies were used to develop the tool.
2) Preparation of the blueprint
The blueprint of items pertaining to the domain of knowledge attitude and
practice was prepared as per the objectives and conceptual framework. The
blueprint of knowledge, practices and attitude scale regarding use of
helmet includes laws of helmet, uses, importance.
39
3) Consultation with experts
The tool was given to the experts from the field of community Health
Nursing, Statistics, Education and English language experts. Their
opinions and Suggestions were considered to modify the tool. The research
consultant and guide were consulted when finalizing the tool.
4) Description of the tool
The tool consists of four sections.
Section A- Demographic data on 5 different variables such as age, gender,
educational qualification, birth order, religion, type of family, birth order
Section B- It consists of 10 items of General information regarding uses of
helmet among grandaunt students. Each item has four options with one
most appropriate answer. Thus for 10 items, the maximum obtainable
score was 10.
Section C- it consists of 10 items of five point attitude likert scale
regarding use of helmet. The maximum score to correct response to each
item was five and minimum score is one. Thus for 10 items, the maximum
obtainable score was 50. The total attitude subjected for classification as
Bad (below 50% score) and Good (above 50% score).
40
Section D-it consists of 10 items regarding practice of use of helmet. Each
item has two options yes or no.
Response mode:
The subjects responded to each item by choosing one of the four options
for structured knowledge questionnaire. Only one option was true for the
asked question and respondents had to tick what they consider the right
option.
Scoring mode:
For assessing Knowledge
Each correct answer is given a score of one and wrong answers a score of
zero. The maximum score was 10. To interpret the knowledge the scores
were distributed as follows.
Inadequate 0-4 0-50 %
knowledge
Moderately adequate 5-7 51-70 %
knowledge
Adequate knowledge 8-10 71-100 %
Table no.1: For assessing Knowledge
41
Table no. 2: For assessing attitude
Category of Attitude Score in percentage
Bad attitude 0-50 %
Good attitude 51-100%
For assessing Practice
Checklist:-A checklist was developed for assessing the level of practice of
graduad students regarding use of helmet of selected colleges. This tool
was developed in order to attain the objectives of the study.
Table no. 3: Scoring of practice
Category for practice Percentage
Poor 0 to 50 %
Average 51 to 70 %
Good 71 to 100 %
42
SETTING OF THE STUDY
The study was conducted at selected colleges due to geographical
proximity, feasibility of the study and the availability of the graduand
students.
The selection of the settings was done on the basis of:-
a) Feasibility of conducting the study.
b) Availability of samples.( graduand students)
Feasibility of the study
Feasibility helps the investigator to determine, if the graduand
students understand the items and if the directions given are clear. The
purpose is to reveal problem selected to answering and to point out
weakness in the administration, organization and distribution of the
instrument.
There was not any difficulty in conducting the pilot study
because permission also granted to conduct the study by respected
authority of the selected colleges and subject were also available,
investigator established rapport with them easily and subjects were also co-
operative and they were ready to participate in the study so this study was
feasible from the point of view of investigator
Availability of samples
The samples graduand students are available during this study data
collection.
43
VALIDITY, PILOT STUDY AND RELIABILITY
Content validity
According (Laura A. Talbot, 1995), “Content validity is the
degree to which the item in an instrument adequately represents the
universe of the content”. Content validity has a special relevance to the
individuals design a list to measure knowledge in specific content area.
The entire section of the tool was validated by 13 nursing experts, 1
English literature. Their suggestions were taken into consideration and the
modifications were incorporated in the preparation of the tool.
Pilot study
“A pilot study is a miniature run of the main study." The pilot study was
conducted in selected college from 21/11/2017 to 30/11/2017 as per laid
down criteria. 10 graduand students were selected from college for pilot
study from non-probability convenient sampling technique.
The investigator visited the college and selected 10 graduand
students by using convenient sampling technique and data was collected
from the graduand students by using structured interview questionnaire.
The social demographic data consisting of 5 items, 10 questions to assess
the knowledge 10 questions for assessment of attitude and 10 questions for
practice on graduand students regarding use of helmet. The investigator
took average time of about 50 to 60 minutes for each gaduand student. The
tool was found to be feasible to collect required information. The subject
44
responded well for the questions and they did not experience any difficulty
in understanding the tool. The findings of the pilot study were analyzed.
The pilot study helped the investigator to visualize practical problems that
could be encountered while conducting the main study also gave an insight
into the actual process of data collection and analysis. The subjects who
were included in the pilot study were excluded in the main study.
Reliability
According to S.K Sharma “Reliability of the tool is a major
criterion for assessing the quality and accuracy. It is the degree of
consistency with which it measures the attribute.”
Reliability analysis was done by Guttmann split half coefficient.
The reliability is checked by using 10 samples; the reliability is 0.82 , 0.73
and 0.84 shown that tool is highly reliable.
DATA COLLECTION METHOD
45
The most important and crucial aspect of any investigation is the
collection of appropriate information, which would provide necessary data
to answer the questions raised in the study.
As far as the purpose of this descriptive study to assess the
knowledge attitude and practice regarding use of helmet among graduand
students at selected colleges.
It is necessary to derive information directly from them through a
structured knowledge questionnaire, Likert scale and checklist.
1) Permission from the concerned authority.
Prior to collection of the data, permission was obtained from the Principal
in colleges and the informed consent from the entire participants was taken
before starting the study.
2) Period for data collection
The data gathering process began from the data were collected for period
of approximately days during the month of December. Samples (graduand
students ) were selected by Convenient sampling method were available
during the study (total 100 samples of graduand students).
 A formal permission was obtained from authorities of selected
colleges.
 The period of data collected was from 7/12/2017 to 29/12/2017
46
 Before giving the questionnaire, self -instruction of was given by the
investigator and the purpose of the study mentioned.
 Obtained the consent after assuring the subjects about the
confidentiality of the data
 Before interview, the purpose of the interview was explained to the
respondents with self-introduction and written consent of the respondents
was sought. The confidentiality about the data and finding was assured to
the participants.
 The investigator and the subject were seated in a quiet place facing
each other and then conducted the structured interview questionnaire to get
response for each item regarding social demographic data, knowledge,
attitude and practice on use of helmet.
 The data collection took average time of about 50 -60 minute and
responses by the respondents were marked down by investigator
immediately. Giving thanks to the respondents, the data collection
procedure was terminated.
 Thus the knowledge, attitude and practice regarding use of helmet of
100 graduand students from selected colleges were assessed.
47
PLAN FOR DATA ANALYSIS
The data analysis was planned to include descriptive and
inferential statistics. The following plan of analysis was made with the
opinion of experts. The analysis will be done based on the objectives and
hypothesis to be tested.
Items related to the background variables would be analyzed in terms of
frequency and percentages.
1. Descriptive statistics
2. Inferential Statistics
Descriptive statistics
1. Frequency and percentage distribution were used to analyze the
demographic data of graduand students regarding use of helmet.
2. Pearson’s correlation is used.
Inferential Statistics
Chi-Square Test
1. Association between knowledge score and demographic variable.
2. Association between attitude score and demographic variable. .
3. Association between practice score and demographic variable.
48
RESULTS
This chapter deals with the analysis and interpretation of data collected to
assess knowledge, attitude and practice of graduand students regarding use
of helmet. The purpose of this analysis was to reduce the data to a
manageable and interpretable form so that the research problems can be
studied and tested.
Analysis is the categorizing, ordering, manipulating and summarizing of
data to obtain answers to research hypotheses questions. The analysis and
interpretation of data of this study are based on data collected through
structured interview questionnaire.
The results were computed using descriptive and inferential statistics
49
DESIGN
Descriptive survey research design
PURPOSE
To assess the knowledge, attitude and practice of graduand students regarding use of helmet
STUDY SETTING
Selected colleges
TARGET POPULATION
Graduand students in the selected district
SAMPALING TECHNIQUE
Convenient sampling technique
SAMPLE
100 graduand students from selected college
TOOL FOR DATA COLLECTION
Structured questionnaire, likert scale and check list
DATA ANALYSIS
Descriptive and inferential statistics
FINDINGS AND CONCLUSION
Fig no. 2 schematic representation of research design
50
SUMMARY
This chapter dealt with research methodology ,research approach,
variables, research design ,setting of study , target and accessible population
,sampling and sampling technique , criteria for selection of samples ,selection and
development of tool, feasibility of study ,content validity , reliability , pilot study ,
data collection method and plan for data analysis.
51
CHAPTER IV
ANALYSIS AND INTERPRETATION OF DATA
The analysis and interpretation of the data involve the objective material in
the possession of the researcher and his subjective reactions and to derive from the
data the inherent meaning in that relation to the problem. To avoid making
conclusions or interpretations from insufficient or invalid data, the final analysis
must be anticipated in detail, when plans are being made for collecting information.
The problem should be analyzed in detail to see that what data are necessary in its
solution and to be assured that the method used will provide definite answers. The
researcher must determine whether or not the factor chosen for study will satisfy all
the conditions of the problem and if the sources to be used will provide the requisite
data.
Analysis is a “process of fitting data together, of making the invisible
obvious of linking and attributing consequences to antecedents. It is a process of
conjecture and verification, of correction and modification, of suggestion and
defense”. (Morse J. M. & Field P.A., 2005)
Analysis is the categorizing, ordering, manipulate and summarizing of the
data to obtained answers to the research question
52
This chapter deals with the analysis and interpretation of data
collected from 100 graduand students in selected colleges, in order to
assess knowledge, attitude and practice. The purpose of the analysis is to
reduce the data to a manageable and interpretable form, so that the
research problem can be studied and tested.
The data collected were analyzed according to the plan for data analysis
which includes both Descriptive and Inferential Statistics. The data
findings have been tabulated according to the plan for data analysis and
interpreted under the following objectives.
OBJECTIVES OF THE STUDY
 To assess the practice regarding use of helmet among the graduand
 To find out the correlation between knowledge and practice regarding use
 To find out the correlation between knowledge and attitude regarding use
 To find out the correlation between attitude and practice regarding use of
helmet among the graduand students in selected colleges.
53
HYPOTHESIS
 H1: There is significant relation between the knowledge Attitude and practice
score regarding use of helmet among graduand students.
 H2: There is significant association between knowledge Attitude and practice score
with selected demographic variable among graduand students.
ORGANIZATION OF THE DATA
The collected data is tabulated, analyzed, organized and presented under
the following headings:
Presentation of data:
SECTION I: Frequency wise and percentage wise distribution of
graduand students according to their selected demographic variables
SECTION II Assessment and association of knowledge score of graduand
students regarding use of helmet.
SECTION III: Assessment and association of attitude score of graduand
students regarding use of helmet.
SECTION IV: Assessment and association of practice score of graduand
students regarding use of helmet
SECTION V: Correlation between knowledge, attitude and practice of
54
SECTION 1
Description of graduand students with regards to demographic
variables
This section deals with percentagewise distribution of subjects according
to their demographic variables. By using convenient sampling technique
100 subjects were drawn from the study population, who were graduand
students in selected colleges. The data obtained to describe the sample
characteristics including age, gender, and educational status, type of family
and birth order.
55
Table No. 4:-Shows the frequency and percentage distribution of
graduand students according to their demographic variables
Sr. No. Variable Groups Frequency Percentage
19-21 10 10.00
22-24 33 33.00
1 Age
25-27 30 30.00
28-30 27 27.00
Hindu 49 49.00
Muslim 21 21.00
2 Religion
Christian 30 30.00
Other 0 0.00
Postgraduate 47 47.00
3 Education
Undergraduate 53 53.00
First 40 40.00
Birth Second 14 14.00

4
Order Third 30 30.00
Fourth 16 16.00
Nuclear 60 60.00
Type of
5 Joint 30 30.00
Family
Extended 10 10.00
56
Table No. 5:- Frequency and percentage distribution of graduad
students according to their age
19-21 10 10.00
22-24 33 33.00
1 Age
25-27 30 30.00
28-30 27 27.00
Above table depicts that, in graduand students most of them 33 (33%)
were between 22-24 years, 30 (30%) between 25-27 years, 27 (27%)
between 28-30 years and 10 (10%) between 19-21 years.
Age Distribution
33
35 30
30 19-21
27
25
20 22-24
Frequency
15
10 10 25-27
5
0 28-30
19-2122-2425-2728-30
Figure no. 3: The Bar diagram shows graduand students according to their
age
57
Table no.6: percentage distribution of graduands students according
to their religion
Hindu 49 49.00
Muslim 21 21.00
2 Religion
Christian 30 30.00
Other 0 0.00
Above table depicts that graduand students most of them 49% were
Hindus, 30% were Christian and 21% were Muslim.
Religion
49
50 Hindu Muslim Christian

40 30 Other
30 21
Frequency
20
10
0
0
HinduMuslimChristianOther
Religion
Figure no.4: Bar diagram shows graduand students according to their
religion
58
Table no.7: - Frequency and percentage distribution of graduand
students according to their education
Postgraduate
47 47.00
3 Education
Undergraduate
53 53.00
Above table depicts that graduand students 53% are undergraduate and
47% are postgraduate.
Education
Postgraduate 47%
Postgraduate
Undergraduat e
Undergraduate 53%
Figure no.5: Doughnut diagram shows graduand students according
to their educational status
59
Table no.8: - Frequency and percentage distribution of graduand
students according to their birth order
First 40 40.00
Second 14 14.00
4 Birth Order
Third 30 30.00
Fourth 16 16.00
Above table depicts that graduand students majority of them 40% of first
birth, 30% of third birth, 16% of fourth birth and 14% of second birth.
Birth Order
40
40
30
30
frequency
First Second Third

16 Fourth
20 14
10
0
First Second Third Fourth
Birth Order
Figure no.6: - The cylindrical diagram shows graduand students
according to their birth order
60
Table no.9: Frequency and percentage distribution of graduand
students according to their type of family
Nuclear
60 60.00
Type of
5 Joint
30 30.00
Family
Extended
10 10.00
Above table depicts that graduand students majority of them 60% were
staying in nuclear type of family, 30% were in joint type of family and
10% were extended type of family.
Type of Family
Extended, 10
Joint, 30 Nuclear Joint

Extended
Nuclear, 60
Figure no.7: The pie diagram shows graduand students according to
their type of family
61
Section II
Assessment of knowledge score of graduand students regarding use of
helmet
Table no.10:-knowledge score of graduand students regarding use of helmet
Variable Groups Score Frequency Percentage
Inadequate 5 5.00
0-4
Knowledge Moderate 56 56.00

5-7.
Adequate 39 39.00
8-10.
Above table depicts that graduand students most of them 56% having moderate
,39% having adequate ,5% of them having inadequate knowledge regarding use of
helmet
Knowledge
60 56
40 39
Frequency
Inadequate Moderate
20
Adequate
0
5
Inadequate Moderate Adequate
Fig no.8: Line diagram showing knowledge score of graduand
students.
62
Table no.11: Description of graduand students according to their
knowledge score
Knowledge
Sr. Chi Significanc
Variable Groups Adequat d.f. p value
No. Inadequate Moderate Square e
E
19-21 2 8 0
22-24 3 18 12
1 Age 15.04 6 0.02 Significant
25-27 0 17 13
28-30 0 13 14
Hindu 3 28 18
Muslim 2 12 7 Not
2 Religion 3.22 4 0.52
Christian 0 16 14 Significant
Other 0 0 0
Educatio Postgraduate 1 33 13
3 7.58 2 0.02 Significant
n Undergraduate 4 23 26
First 4 20 16
Birth Second 0 10 4 Not

4 6.36 6 0.38
Order Third 0 16 14 Significant
Fourth 1 10 5
Nuclear 4 34 22
Type of Not
5 Joint 0 17 13 2.63 4 0.62
Family Significant
Extended 1 5 4
63
Above table depicts that the p value of the association test with knowledge
was less than 0.05 concludes that there was significant association between age
(x2=15.4), education (x2=7.58) with knowledge regarding use of helmet. The p
value of the association test with knowledge was more than 0.05 concludes that
there was no any significant association between religion (x 2=3.22),birth order
(x2=6.36),type of family (x2=2.63) with knowledge regarding use of helmet.
Section III
Assessment of attitude score of graduand students regarding use of
helmet
Table No.12:- Attitude score of graduand students regarding use of
helmet
Bad 44 73.33
10-30.
Attitude
Good 56 93.33
31-50
Above table depicts that graduand students most of them 93.33 were having good
and 73.33 were having bad attitude regarding use of helmet.
64
Attitude
60 56
50
44
40
Frequency
30 Bad
Good
20
10
0
Bad Good
Fig no.9: The bar diagram shows attitude score of graduand students
The below table depicts that the association of attitude score with selected
demographic variables of the study participants. The association calculated
by chi square, d.f and p value of demographic variables.
65
attitude score
Sr. Attitude Chi p

Variable Groups d.f. Significance
No. Bad Good Square value
19-21 9 1
22-24 17 16
25-27 10 20
28-30 8 19
Hindu 23 26
Muslim 10 11
2 Religion 0.93 2 0.62 Not Significant
Christian 11 19
Other 0 0
Postgraduate 23 24
3 Education 0.87 1 0.34 Not Significant
Undergraduate 21 32
First 19 21
Birth Second 7 7
4 1.05 3 0.78 Not Significant
Order Third 11 19
Fourth 7 9
Nuclear 29 31
Type of
5 Joint 10 20 1.98 2 0.37 Not Significant
Family
Extended 5 5
Above table depicts that the p value of the association test with attitude was less
than 0.05 concludes that there was significant association between age (x 2=12.99)
attitude regarding use of helmet. The p value of the association test with attitude
was more than 0.05 concludes that there is no any association between religion
66
(x2=0.93),education (x2=0.87),birth order (x2=1.05) , type of family (x2=1.98)
attitude regarding use of helmet.
Section IV
Assessment of practice score of graduand students regarding use of helmet
Table No.14:- Practice score of graduand students regarding use of helmet
Inadequate 1 1.67
0-4
Practice Moderate 51 85.00

5-7.
Adequate 48 80.00
8-10.
Above table depicts that graduand students most of them 85% were
having moderate ,80% having adequate and 1.67% were having inadequate
practice regarding use of helmet.
Practice
60
40 51 48
Frequency
Inadequate
20 Moderate Adequate
0
1
Inadequate Moderate Adequate
Fig no.10: The line diagram shows practice score of graduand students
67
practice score
Sr. Practice Chi p

Variable Groups d.f. Significance
No. Inadequate Moderate Adequate Square value
19-21 0 10 0
22-24 1 18 14
25-27 0 16 14
28-30 0 7 20
Hindu 1 27 21
Muslim 0 10 11 Not
2 Religion 1.89 4 0.76
Christian 0 14 16 Significant
Other 0 0 0
Postgraduate 0 32 15
3 Education 10.74 2 0.00 Significant
Undergraduate 1 19 33
First 1 20 19
Birth Second 0 9 5 Not

4 2.73 6 0.84
Order Third 0 14 16 Significant
Fourth 0 8 8
Nuclear 0 31 29
Type of Not
5 Joint 1 16 14 9.29 4 0.054
Family Significant
Extended 1 4 5
68
Above table depicts that the p value of the association test with practice
was less than 0.05 concludes that there was significant association between
age (x2=19.02) practice regarding use of helmet. The p value of the
association test with practice was more than 0.05 concludes that there was
no any association between religion (x 2=0.76), education (x2=10.74), birth
order (x2=2.73), type of family (x2=9.29) practice regarding use of helmet.
As above result shows that there is significant association between
knowledge Attitude and practice score with demographic variable age
among graduand students.
Hence the hypothesis H2 is accepted.
H2: There is significant association between knowledge Attitude and
practice score with selected demographic variable among graduand
students.
69
Section V
Correlation between knowledge, attitude and practice of graduand
students regarding use of helmet
In this section deals with the relation between the knowledge score,
attitude score and practice score. This relation studies with the scattered
diagram of Karl Pearson’s correlation coefficient formulae.
Table no.16: Correlation between knowledge, attitude and practice
scores
Sr.no. Variables Correlation coefficient
A. KNOWLEDGE VS ATTITUDE 0.79
B. ATTITUDE VS PRACTICE 0.78
C. KNOWLEDGE VS ATTITUDE 0.92
70
Knowledge vs Attitude
45
40
35
Attitude
30 Series1
25
20
0 2 4 6 8 10 12
Knowledge
Figure no. 11: scatter diagram showing correlation between
knowledge vs attitude score.
Correlation coefficient = 0.79
Above table and figure shows that there is significant correlation between
knowledge vs attitude score of graduand students as Correlation
coefficient is 0.79.
71
Attitude vs Practice
12
10
8
Practice
6
Series1
4
0
20 25 30 35 40 45
Attiutde
Figure no.12 : Scatter diagram showing correlation between attitude
vs practice score.
attitude vs practice score of graduand students as Correlation coefficient is
0.78.
72
Knowledge vs Practice
12
10
8
Practice
6
Series1
4
0
0 2 4 6 8 10 12
Knowledge
Figure no.13: Scatter diagram showing correlation between
knowledge vs practice score.
Knowledge vs practice score of graduand students as Correlation
coefficient is 0.92
As above result shows that there is significant relation between the
knowledge Attitude and practice score regarding use of helmet among
graduand students.
Hence the hypothesis H1 is accepted.
73
So H1 and H2 hypothesis is accepted.
 H1: There is significant relation between the knowledge Attitude and
practice score regarding use of helmet among graduand students.( H 1
Accepted )
 H2: There is significant association between knowledge Attitude and
students. .( H2 Accepted )
74
. SUMMARY
This chapter dealt with the data analysis and interpretation and for this
purpose various methods has been utilized by investigator for data analysis
that is descriptive and inferential statistics were widely used. In that
frequency and mean percentage were calculated. Total 30 questions were
analyzed based on the response of the participants regarding use of helmet.
The major findings has been discussed briefly in this chapter and
presentation of that made by investigator by using cylindrical diagram, line
diagram, pie chart, bar diagram and others.
Association between demographic variables with knowledge attitude and
practice score were calculated by Chi- square test. Karl pearson’s
correlation coefficient formulae was used to find out significant relation
between the knowledge Attitude and practice score regarding use of
helmet among graduand students.
75
CHAPTER V
FINDINGS, DISCUSSION, CONCLUSION, SUMMARY,
IMPLICATION AND RECOMMENDATIONS
This chapter presents a summary of the study undertaken including the
conclusion from the findings, implications, discussion of the study and thus it helps
to put together all the pieces of the research study. this chapter ends with suggestion
and recommendation for future research in this field.
The study was conducted with the purpose to assess knowledge attitude and
practice of graduand students regarding use of helmet in selected colleges.
The data were collected by using structured questionnaire from 100 graduand
students .The analysis of the findings was done according to the study objectives by
using descriptive and inferential statistics.
The objectives of the study were as follows:
 To assess the practice regarding use of helmet among the graduand students
in selected colleges.
 To find out the correlation between knowledge and practice regarding use
76
 To find out the correlation between knowledge and attitude regarding use
 To find out the correlation between attitude and practice regarding use of
helmet among the graduand students in selected colleges.
MAJOR FINDINGS OF THE STUDY
Finding related to demographic variables:
 In this study the majority of graduand students 33 (33%) were between 22-
24 years, 30 (30%) between 25-27 years, 27 (27%) between 28-30 years
and 10 (10%) between 19-21 years.
 Majority of graduand students 49% were hindus,30% were Christian and
21% were Muslim.
 Majority of graduand students 53% were undergraduate and 47% were
postgraduate.
 Majority of graduand students 40% of first birth, 30% of third birth, 16%
of fourth birth and 14% of second birth.
 Majority of graduand students 60% were staying in nuclear type of family,
30% were in joint type of family and 10% were extended type of family.
77
Finding related to knowledge score of graduand students regarding
use of helmet
 In this study the majority of graduand students 56% having moderate, 39%
having adequate, 5% of them having inadequate knowledge regarding use
of helmet
Finding related to attitude score of graduand students regarding use
of helmet
 The majority of graduand students 93.33 were having good and 73.33 were
having bad attitude regarding use of helmet.
Finding related to practice score of graduand students regarding use
of helmet
 The majority of graduand students 85% were having moderate, 80%
having adequate and 1.67% was having inadequate practice regarding use
of helmet.
Finding related to association of knowledge score with selected
demographic variables
 There was significant association between age (x 2=15.4), education
(x2=7.58) with knowledge regarding use of helmet.
 There was no any significant association between religion (x 2=3.22), birth
order (x2=6.36),type of family (x 2=2.63) with knowledge regarding use of
helmet.
78
Finding related to association of attitude score with selected
 There was significant association between age (x 2=12.99) attitude
regarding use of helmet.
 There was no any significant association between religion (x 2=0.93),
education (x2=0.87), birth order (x2=1.05) , type of family (x 2=1.98)
attitude regarding use of helmet.
Finding related to association of practice score with selected
 There was significant association between age (x 2=19.02) practice regarding use
of helmet.
 There was no any association between religion (x 2=0.76), education
(x2=10.74), birth order (x2=2.73), and type of family (x 2=9.29) practice
regarding use of helmet.
Finding related to correlation between knowledge score, attitude score
and practice score of graduand students regarding use of helmet
 In this study correlation between knowledge score, attitude score and
practice score of graduand students was studies with the of Karl pearson’s
correlation coefficient formulae.
 It shows that there is significance correlation between knowledge vs
attitude score of graduand students as Correlation coefficient is 0.79,there
is significant correlation between attitude vs practice score of graduand
79
students as Correlation coefficient is 0.78 and there is significant
correlation between Knowledge vs practice score of graduand students as
Correlation coefficient is 0.92.
DISCUSSION
The findings of the study have been discussed with reference
to the objectives and hypothesis along with finding of the other studies.
Section I: Description of graduend students according to their selected
Majority of graduand students 33 (33%) were between 22-24 years,
Majority of graduand students 49% were Hindus, Majority of graduand
students 53% were undergraduate, Majority of graduand students 40% of
first birth, Majority of graduand students 60% were staying in nuclear type
of family.
Section II: Description of graduend students according to their
assessment and association of knowledge score
Majority of graduand students 56% having moderate knowledge score and
significant association between age (x 2=15.4), education (x2=7.58).
Section III: Description of graduend students according to their
assessment and association of attitude score
80
Majority of graduand students 93.33 were having good attitude score and
significant association between age (x 2=12.99).
Section IV: Description of graduend students according to their
assessment and association of practice score
Majority of graduand students 85% were having moderate practice score
and significant association between age (x 2=19.02)
Section V: Description of graduend students according to there
correlation between knowledge, attitude and practice score
There is significance correlation between knowledge vs attitude score of
graduand students as Correlation coefficient is 0.79,there is significant
correlation between attitude vs practice score of graduand students as
Correlation coefficient is 0.78 and there is significant correlation between
Knowledge vs practice score of graduand students as Correlation
coefficient is 0.92.
81
CONCLUSION
The following conclusions were drawn on the basis of the findings of the study.
 The present study shows that graduand students majority of them Majority
of graduand students 33 (33%) were between 22-24 years, Majority of
graduand students 49% were hindus, Majority of graduand students 53%
were undergraduate, Majority of graduand students 40% of first birth,
Majority of graduand students 60% were staying in nuclear type of family.
 Majority of graduand students 56% having moderate knowledge score and
significant association between age.
 Majority of graduand students 93.33 were having good attitude score and
significant association between age.
 Majority of graduand students 85% were having moderate practice score
and significant association between age.
This study shows that there is significance correlation between knowledge
and attitude score, there is significant correlation between attitude and practice
score and there is significant correlation between Knowledge and practice score of
graduand students.
82
Summary
The purpose of the present study was to assess the knowledge, attitude and
practice regarding use of helmet among graduand students of selected colleges.
The present study can be justified on the fact that most of the graduand student has
moderate knowledge and practice, good attitude regarding use of helmet. It is
beneficial for graduand students to know the importance of wearing helmet.
The descriptive research design was use for the study, which consist of
100 graduand students that are selected on the basis of convenient sampling
technique. The structured knowledge questionnaire, Likert scale and checklist was
given to assess knowledge, attitude and practice score of graduand students.
Based on the objectives and the hypothesis the data was collected and
analysis by using descriptive and inferential statistics.
The findings of the study were showed that graduand student has moderate
knowledge (56%) and practice (85%), good attitude (93.33%) regarding use of
helmet. It is beneficial for graduand students to know the importance of wearing
helmet.
83
IMPLICATIONS OF THE STUDY
The findings of this study have implications in various areas of nursing
namely Nursing practice, nursing education, nursing administration and nursing
research.
Nursing practice
Nursing service has directs significant impact on human health. The expanded
role of the professional nurse emphasizes those activities which promote health and
preventive behavior among peoples. The most of the grduand students do not have
the adequate knowledge regarding use of helmet; the presence study is an attempt to
assess knowledge, attitude and practice regarding use of helmet among graduand
student at selected colleges.
As a part of multi dimensional approach the presence study findings would
help the community health nurse:-
 To develop and understanding about the knowledge, attitude and practice
regarding use of helmet among graduand student at selected colleges..
 To provide the education regarding use of helmet and prevention from
accidents as a part of promotes service.
84
Nursing administration
Nurse administrators are the back bone for providing facilities to
improve knowledge and attitude regarding use of helmet.
Findings of the present study will help:
 The nurse administrators can organize continue education program for
graduand students to update the knowledge and disseminate to the
 The nurse administrators can also organize and plan different program to
impost the information on use of helmet to the students in the selected
colleges.
 Community health nurses should have better knowledge on use of helmet
so that they can provide education in community members to changing
there attitude towards use of helmet.
Nursing education
Findings of the present study depicts that nurses requires broad
knowledge to provide education regarding use of helmet which can
improve the knowledge, change attitude towards use of helmet and
improve practice .
Nurse educator can plan the strategies to overcome the problems
regarding use of helmet through the community based education to the
nursing students.
85
Nursing research
Nursing depends upon the selection systematic application and evaluation
of knowledge from basic sciences. The present study will help:
 To undertake research in any areas like urban and rural community area so
that the nurse can contribute to the prevention regarding accidents.
 To undertake more researches in this area to determine the existing
knowledge, attitude and practice regarding use of helmet among graduand
students to identify needs and bring more awareness.
RECOMMENDATIONS
On completion of the study based on findings and keeping the limitations
in view, the following recommendations are offered for further research.
1. A similar study can be conducted on larger sample for wider
generalizations.
2. A study can be done to assess the knowledge attitude and practice
regarding use of helmet among bike riders.
3. A comparative study can be conducted to assess the knowledge attitude
and practice regarding use of helmet among graduand students in rural and
urban community.
4. Health education program can be conducted to enhance the knowledge,
modify attitude and improve practice regarding use of helmet among
graduand students.
86
5. Manuals, information booklet, and self instruction modules may be
develop in community health areas for general public.
6. An experimental study can be conducted which structured learning
program on knowledge and attitude towards use of helmet.
7. Same study can be conducted on public residing in different geographical
areas.
Summary
This chapter dealt with findings, discussion and conclusion, implication,
recommendations of the study.
87
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33. Kimberly.M.et.al. Autopsy Study of Motorcyclist Fatalities: The
Effect of the 1992 Maryland Motorcycle Helmet Use Law. 2002
August; 92(8): 1352–1355.
34. Cody S.et.al. Motorcycle helmet effectiveness in reducing head,
face and brain injuries by state and helmet law.December 2016;
3(1): 8.
35. Kamulequeya.L.H.et.al. The scourge of head injury among
commercial motorcycle riders in Kampala; a preventable clinical
and public health menace. September 2015; 5(3):1016-22.
36. Hooten.K.G.et.al. Helmet use and cervical spine injury: a review of
motorcycle, moped, and bicycle accidents at a level 1 trauma
center. 2014 August 1;31(15):1329-33.
37. Akaateba.M.A.et.al. A cross-sectional observational study of
helmet use among motorcyclists in Wa, Ghana.22 November
2013;64:18-22.
91
38. Srinivasulu.P.et.al. Pattern of injuries to motorcyclists infatal road
traffic accidents.2013;4(2): 513-518.
39. Matthew.B.et.al. Motorcycle helmet use and legislation: a
systematic review of the literature. January 2012.
40. Bette.C.L.et.al. Helmets for preventing injury in motorcycle riders.
2009.
41. Liu.B.et.al. Helmets for preventing injury in motorcycle
riders.2008.
42. Hung.D.V.et.al. Prevalence of helmet use among motorcycle riders
in Vietnam. December 2006; 12(6):409-13.
43. Reza.M.et.al. The Impact of Safe Community Program on safety
promotion among motorcyclists in IR Iran with focus on helmet
usage.2005.
44. ThompsonD.C.et.al. Helmets for preventing head and facial injuries
in bicyclists.2000;(2):CD001855.
45. Wen-Ta Chiu.et.al. The Effect of the Taiwan Motorcycle Helmet
Use Law on Head Injuries.may 2000;90(5).
46. Thompson.R.S.et.al. A case-control study of the effectiveness of
bicycle safety helmets.1989 May 25;320(21):1361-7.
92
ANNEXURE-I
LETTER REQUESTING EXPERT OPINION TO ESTABLISH

CONTENT VALIDITY OF RESEARCH TOOL
From,
Final year M.sc Nursing
---------------------------
Forwarded through,
The Principal
Respected Sir/Madam
Subject: Request for expert opinion and suggestions to establish

content validity of the research tool.
I am post graduate nursing student from….. I have selected the
below mentioned topic for research study to be submitted to Maharashtra
university of health science, Nashik as a partial fulfillment of the
requirement for M. Sc. Nursing
Topic: “A descriptive study to assess the knowledge attitude and

practice regarding use of helmet among graduand students at selected
colleges.”
Here with I have enclosed
1. Structured Questionnaire schedule compressed of 4 parts

a) Demographic profile
b) Structured knowledge questionnaire
c) Likert scale
d) Checklist
2. Rating scale for rating the tool
3. Content validity certificate
4. Blue print of distribution of items
I request you to go through the items and give your valuable

description of the tool suggestions and opinions to develop the content
validity of the tool. Kindly suggest modifications, additions and deletions,
if any, in the Remark column.
Thanking you.
Yours sincerely
Place:
Date:
93
ANNEXURE- II
ACCEPTANCE FORM FOR TOOL VALIDATION
NAME: ………………………………………….
DESIGNATION: ……………………………….
NAME OF COLLEGE / HOSPITAL: ………………………
Statement of acceptance or non -acceptance
I give my acceptance / non acceptance to validate the tool TOPIC OF THE
STUDY “A descriptive study to assess the knowledge attitude and
practice regarding use of helmet among graduand students at selected
colleges.”
REMARK
PLACE:
DATE: signature
94
ANNEXURE III
Blue print of Structured Questionnaire
Regarding use of helmet among graduand students
Item Question Total Percentage(%)
Knowledge (I) 1-10 10 33.33%
Attitude (II) 1-10 10 33.33%
Skill (III) 1-10 10 33.33%
Total 30 100%
95
ANNEXURE-IV
CONTENT VALIDITY CERTIFICATE
This is to certify that, I have validated the tool on “A descriptive study to assess
the knowledge attitude and practice regarding use of helmet among graduand
students at selected colleges”. By ……………………….2nd year M. Sc. Nursing
student of…………………………………...
Signature of the expert,
Place:………………..
Date:……………….. Designation and Address.
96
ANNEXURE-V
LETTER SEEKING PERMISSION TO CONDUCT PILOT STUDY
Date
TO
…………………………………………………..
……………………………………………… ….
Sub: -To get permission for Pilot research study.....................
RESPECTED SIR / MADAM,
This is to certify that ……………………………….Bonafide student of M.Sc. Nursing
(Community Health Nursing) second year he is undergoing research study on “A
descriptive study to assess the knowledge attitude and practice regarding use of
helmet among graduand students at selected colleges”. Which is required for partial
fulfillment of M.sc. Degree in Nursing.
So we request you kindly grant permission to conduct Pilot study.
Thanking you Principal
97
ANNEXURE-VI
LETTER SEEKING PERMISSION TO CONDUCT MAIN STUDY
Ref .No. Date.
TO
…………………………………………………..
……………………………………………… ….
Sub: -To get permission for main research study.....................
RESPECTED SIR / MADAM,
This is to certify that ……………………………….Bonafide student of
M.Sc. Nursing Community Health Nursing second year he is undergoing
research study on “descriptive study to assess the knowledge attitude
and practice regarding use of helmet among graduand students at
selected colleges ”Which is required for partial fulfillment of M.sc.
Degree in Nursing.
So we request you kindly grant permission to conduct main study.
Thanking you
Principal
98
ANNEXURE - VII
CONSENT FORM FOR THE PARTICIPANT
CONSENT
I..................................................................................................... hereby
give my consent for my participation in the study titled “A
descriptive study to assess the knowledge attitude and practice
regarding use of helmet among graduand students at selected colleges”
I have been explained about the study and I am fully aware of the study
and I am participating in it with my own interest.
Date: signature of the participant
Place:
99
ANNEXURE – VIII A
TOOL
Instruction: kindly give tick [√] for the most appropriate answers in the
brackets given on the right side of each item.
Dear respondents, in this section the interviewer will ask some questions
for which there is a need to answer by you. The interviewer places tick
mark to the corresponding questions. Each correct answer will be awarded
a score. Your responses will be kept confidential and is only for the study
purpose. Kindly do the needful.
Following questions are divided as:-
Section A -: Demographic Performa
Section B -: General information regarding uses of helmet
Section C –: Likert Scale
Section D -: Checklist
100
Section A - Demographic Performa
1. Age:
a) 19-21 years { }
b) 22-24 years { }
c) 25-27 years { }
d) 28-30 years { }
2. Religion:
a) Hindu { }
b) Muslim { }
c) Christian {}
d) Others {}
3. Educational qualification
Postgraduate { }
Undergraduate {}
4. Birth order in the family
a) first { }
b) second { }
c) third {}
d) fourth and above {}
5. Type of family
a) Nuclear family { }
b) Joint family { }
c) Extended family { }
101
Section B - General information regarding uses of helmet among
grandaunt
1) What is a helmet
a) Bike accessories { }
b) Gear protector { }
c) Protective Cap { }
d) Bike part { }
2) Why is it so important to wear a helmet
a) To reduce the risk of serious brain injury or death during accidents { }
b) To look good { }
c) To follow the traffic law { }
d) To hide face { }
3) What is the penalty for not wearing a helmet?
a) Fine of rupees 1000 { }
b) Fine of rupees 100 { }
c) 6 months imprisonment { }
d) Cancellation of driving license { }
4) What will protect you from head injury?
a) Driving experience { }
b) Driving in highways { }
c) Wearing a helmet { }
d) Praying before drive
{ }
102
5) What is the minimum age limit to get a permanent license?
a) 16yr { }
b) 18yr { }
c) 20yr { }
d) 21yr { }
6) Who has to wear helmet during drives?
a) Men { }
b)Women { }
c)Children { }
d)All of the above { }
7) Which is the cause of death among motorcycle riders EXCEPT?
a) Wearing leather jacket {}
b) Speed { }
c) Inexperience drivers { }
d) Not wearing helmet { }
8) How can we prevent the road traffic accidents?
a) Prayer { }
b) Following traffic rules { }
c) Using public transport { }
d) Using non geared vehicle { }
103
9) The recent circular on motorcycle regulation by government of Maharashtra for
getting new driving license states that
a) Have to submit in writing that the two-wheeler rider will not ride in highways{ }
b) Have to submit in writing that the two-wheeler rider will not make any accidents { }
c) Have to submit in writing that the two-wheeler rider as well as the pillion rider will
wear helmets.{ }
d) Have to submit in writing that the two-wheeler rider will not take children in the
pillion seat { }
10. Which one of the following is NOT a type of helmet?
a) Full face helmet { }
b) Long face helmet { }
c) Modular helmet { }
d) Open face helmet { }
104
SECTION – C
Likert scale for attitude of the grandaunt regarding uses of helmet
Strongly Strongly
Statement agree Agree uncertain Disagree disagree
1.Wearing a helmet is not
necessary when there are no
traffic police around
2. Helmet is not necessary for the
pillion rider
3. Helmet is important for driver
safety.
4. Wearing a helmet on my bike
wouldn’t look cool.
5..Helmet wearing is necessary
even for the experienced rider
6. Wearing helmet reduces the
severity of head injury in the
crash,
7. Wearing Helmet is more
necessary during daytime than
night.
8.Helmets are uncomfortable
105
9. Wearing Helmet is more
necessary when riding in the city
than outside the city area.
10.Wearing Helmet is not
necessary for small children
Section- D
Checklist for practices of the grandaunt regarding uses of helmet
QUESTIONS yes no
1. Are you using a branded helmet?
2. Are you carrying the helmet during the drives?
3. Are you following all the traffic rules?
4. Are you taking care of the helmet?
5. Are you cleaning your helmet regularly?
106
6. Are you comfortable in rotating your head after wearing helmet?
7. Will you wear helmet during hot weather?
8. Are you wearing helmet at day drives as like as the night drives?
9. Are you wearing helmet when riding in small roads as highways?
10 Do you use helmet for children?
Answer key
Question Answer Question Answer
1 6
2 7
3 8
4 9
5 10
Note:
107
ANNEXURE-IX
CRITERIA RATING SCALE FOR VALIDITY OF THE TOOL
Dear sir / Madam,
Kindly go through the content and place right mark against
questionnaire in the following columns ranging from relevant to not
relevant. When founds to be needs modification, kindly give your opinion
in the remarks column.
SECTION A - DEMOGRAPHIC DATA
Sl. Items Relevant Needs Not relevant Remarks
No modification
1.
2.
3.
4.
5.
108
SECTION-B
STRUCTURED QUESTIONNAIRE (Knowledge)
Sr. Items Relevant Needs modification Not relevant Remarks
No
10.
Note- Each item has only one answer. The correct answer carries ‘1’
score and wrong answer carries ‘0’ score.
109
SECTION-C
Likert scale (Attitude)
Sr. No Items Relevant Needs modification Not relevant Remarks
10.
110
SECTION-C Checklist (practice)
Sr. No Items Relevant Needs modification Not relevant Remarks
10.
Note- Each item has only one answer. The correct answer carries ‘1’
score and wrong answer carries ‘0’ score.
111
ANNEXURE- XI
CERTIFICATE FOR ENGLISH EDITING OF THE THESIS
This is to certify that…………………………………… who is
conducting a research study on – topic “A DESCRIPTIVE STUDY TO
ASSESS THE KNOWLEDGE ATTITUDE AND PRACTICE
REGARDING USE OF HELMET AMONG GRADUAND
STUDENTS AT SELECTED COLLEGES.”
He has given the thesis to me for English editing. I have edited his
thesis.
NAME:
DESIGNATION:
INSTITUTION:
SIGN:
DATE:
PLACE :
112
ANNEXURE-XII
LIST OF EXPERTS CONSULTED FOR THE CONTENT
VALIDITY OF
RESEARCH TOOL
SR. NO. NAME OF THE DESIGNATION AND DEGREE

EXPERT COLLEGE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
113
ANNEXURE-XII
PERMISSSION LETTER TO ASSESS THE LIBRARY FOR
REVIEW OF LITERATURE
TO,
The Librarian
-------------------------------
-------------------------------
Sub: To get permission to assess the library for review of literature
This is to certify that …………………………………………. Is a
bonafide student of M.Sc. Nursing final Year of this institution. He is
undergoing for research study that purpose he would like to assess the
library for review of literature.
So make necessary arrangements and do the needful.
Thanking you
Principal
DATE:
PLACE:
114
ANNEXURE-XIII ABBREVATIONS
RTI’s Road Traffic Injury’s P P value

HIV/AIDS Human Immune Virus S.D. Standard deviation
Acquired Immune Deficiency
www World Wide Web
Syndrome
GDP Gross Domestic Product r Reliability
WHO World Health Organization
DALYs Disability Adjusted Life Years
LMICs Low and middle Income countries
RCVIS Road Crash And Victim
Information System
NHTSA National high way traffic safety
GNP Gross national product
IHME Institute For Health Matrix and
Evaluation
KAP Knowledge Attitude Practice
U.S. United States
ANOVA Analysis of variance
CI’s Confidence Intervals
RR Relative Risk
% Percentage
d.f. Degree of Freedom
i.e. That is
N Total sample
< > Greater than and less than
115
ANNEXURE – XIV
STATISTICAL FORMULAE USED IN THE STUDY
Pearson’s Correlation:
    
 X  X  Y  Y 
r 
nσ x σ y
2* r
Reliabilit y =
1 r
---------------------------------------------------------------------------------------------------------
Chi-Square Test:
(| O - E |) 2
χ 2  E
Where O – Observed Frequency
E – Expected frequency
d.f. = (r-1)* (c-1)
Expected Frequency = Row Total * Column Total

Grand Total
Level of significance α = 5% = 0.05
---------------------------------------------------------------------------------------------------------
‘t’ test :
_ _ 2 2
_ _ S.D.1 S.D.2
(X  X2 )
t 1
S.E.( X1  X2 )  
S.E( X1  X2 ). n1 n2
 
Where X1  mean of sample 1 X2  mean of sample 2
S.D.1  standard deviation of sample 1 S.D.2  standard deviation of sample
116
ABSTRACT
Problem statement
“A descriptive study to assess the knowledge attitude and practice
regarding use of helmet among graduand students at selected colleges”
Objectives of the study
1. To assess the knowledge regarding use of helmet among graduand
2. To assess the attitude regarding use of helmet among graduand students in
selected colleges.
3. To assess the practice regarding use of helmet among graduand students in
selected colleges.
4. To find out the correlation between knowledge and practice regarding use
of helmet among graduand students.
5. To find out the association between knowledge attitude and practice scores
with selected demographic variables among graduand students.
6. To find out the correlation between knowledge and attitude regarding use
of helmet among graduand students.
7. To find out the correlation between attitude and practice regarding use of
helmet among graduand students.
117
HYPOTHESIS
H1: There is significant relation between the knowledge Attitude and
practice score regarding use of helmet among graduand students.
H2: There is significant association between knowledge Attitude and
students.
METHODS AND MATERIALS
The research approach used was evaluative approach. The research design
selected for the study was a description design. The setting was selected colleges. The
sample includes graduand students; sampling technique was used convenient
sampling. The Structured knowledge questionnaire was used to collect data from
samples. The pilot study was conducted with 10 samples. Reliability was established
by Guttamann split –half method. Data was analysed by using descriptive and
inferential statistics.
RESULTS
 In this study the majority of graduand students 33 (33%) were between 22-24
years, 30 (30%) between 25-27 years, 27 (27%) between 28-30 years and 10
(10%) between 19-21 years.
 Majority of graduand students 49% were hindus,30% were Christian and 21%
were Muslim.
118
 Majority of graduand students 53% were undergraduate and 47% were
postgraduate.
 Majority of graduand students 40% of first birth, 30% of third birth, 16% of
fourth birth and 14% of second birth.
 Majority of graduand students 60% were staying in nuclear type of family, 30%
were in joint type of family and 10% were extended type of family.
 In this study the majority of graduand students 56% having moderate, 39% having
adequate, 5% of them having inadequate knowledge regarding use of helmet
 The majority of graduand students 93.33 were having good and 73.33 were
having bad attitude regarding use of helmet
 The majority of graduand students 85% were having moderate, 80% having
adequate and 1.67% were having inadequate practice regarding use of helmet.
 There was significant association between age (x 2=15.4), education (x2=7.58) with
knowledge regarding use of helmet.
 There was no any significant association between religion (x 2=3.22), birth order
(x2=6.36),type of family (x2=2.63) with knowledge regarding use of helmet
 There was significant association between age (x 2=12.99) attitude regarding use of
helmet.
 There was no any significant association between religion (x 2=0.93),education
(x2=0.87),birth order (x2=1.05) , type of family (x2=1.98) attitude regarding use of
helmet.
 There was significant association between age (x 2=19.02) practice regarding use
of helmet.
119
 There was no any association between religion (x 2=0.76), education (x2=10.74),
birth order (x2=2.73), type of family (x2=9.29) practice regarding use of helmet.
 There is significance correlation between knowledge vs attitude score of graduand
students as Correlation coefficient is 0.79,there is significant correlation between
attitude vs practice score of graduand students as Correlation coefficient is 0.78
and there is significant correlation between Knowledge vs practice score of
graduand students as Correlation coefficient is 0.92.
INTERPRETATION AND CONCLUSION
The data were analyzed by applying descriptive and inferential statistics.
The result of the study indicated that graduand students in selected colleges
had moderate knowledge and practice and good attitude regarding use of
helmet. The hypothesis are proved and accepted.
120

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“A DESCRIPTIVE STUDY TO ASSESS THE

KNOWLEDGE ATTITUDE AND PRACTICE

COMMUNITY HEALTH NURSING

MAHARASHTRA UNIVERSITY OF HEALTH

In Partial Fulfillment of the Requirement

For M.Sc. Degree in Nursing

Name of Subject/ Specialty :- Community Health Nursing

Admission Year/Academic Year :- 2016-2017/ 2017-2018

Topic: - “A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE

ATTITUDE AND PRACTICE REGARDING USE OF HELMET

AMONG GRADUAND STUDENTS AT SELECTED COLLEGES”.

CHAPTER CONTENT PAGE NO.

Background of the study 4-7

Need of the study 8-9

Objectives of the study 10

Operational definition 11-12

Scope of the study 13

Conceptual framework 15-17

II REVIEW OF LITERATURE 19-33

1. Literature related to assess the knowledge regarding use 20-23

2. Literature related to assess the attitude regarding use of 24-26

Identification of target and accessible population 35

Inclusion and exclusion criteria 38

Content Validity, Pilot study and Reliability 44-45

Data collection and Method of data collection 46-47

Plan for Data analysis 48

Flow chart of Research Process 50

IV DATA ANALYSIS AND INTERPRETATION 52-75

Section 1: Frequency and Percentage distribution of 55-61

graduand students according to their demographic

Section 2 : Assessment and association of knowledge score 62-63

of graduand students regarding use of helmet

Section 3 : Assessment and association of attitude score of 64-66

graduand students regarding use of helmet

Section 4: Assessment and association of practice score of 67-69

graduand students regarding use of helmet

section 5 : Correlation between knowledge, attitude and 70-75

practice of graduand students regarding use of helmet

V FINDINGS, DISCUSSION, CONCLUSION, 76-87

SUMMARY, IMPLICATIONS AND

Major findings of the study 77-80

ENDORSEMENT BY THE PRINCIPAL AND GUIDE

NO. TITLES NO.

4. Frequency and percentage distribution of graduand students according 56

to their demographic variables

5. Frequency and percentage distribution of graduand students according 57

6. Frequency and percentage distribution of graduand students according 58

7. Frequency and percentage distribution of graduand students according 59

8. Frequency and percentage distribution of graduand students according 60

9. Frequency and percentage distribution of graduand students according 61

10. Knowledge score of graduand students regarding use of helmet 62

11. Knowledge score of graduand students according to demographic 63

variables regarding use of helmet

12. Attitude score of graduand students regarding use of helmet 64

13. Attitude score of graduand students according to demographic variables 66

regarding use of helmet

15. Practice score of graduand students according to demographic variables 68

regarding use of helmet

16. Correlation between knowledge, attitude and practice scores 70

NO. TITLES NO.

1. Conceptual Frame Work 17

2. Schematic Representation of Research design 50

3. Frequency and percentage distribution of graduand students according 57