Introduction

Gastroenteritis

Gastroenteritis is commonly known as Infectious diarrhea, stomach flu or Gastric flu. 1 gastroenteritis is defined as diarrhea, or increased movement of the bowels regardless of the presence/absence of other symptoms like fever, abdominal pain and or vomiting. 2

Knowledge, Attitude, and Practice (KAP)

A KAP survey is carried out to gather data on the knowledge (i.e., what is known), attitudes (i.e., what is thought), and practices (i.e., what is done) of a given population regarding general and/or specialized topics.3 The knowledge, attitude, and practice around the causes of gastroenteritis and its risk factors were the main topics of our study. Data from a KAP survey can be utilized for the following things:

- To pinpoint knowledge gaps, cultural precepts, and behavioral patterns that might reveal needs, issues, and obstacles to aid in the planning and execution of interventions.

- To get a deeper grasp of widely accepted knowledge, attitudes, and behavior-influencing variables.

- To track changes brought about by interventions.

- To help in better prognosis and treatment practices. 4

Questionaire

The KAP questionnaire is used in pre-counseling to evaluate the patient's comprehension of the ailment, attitude toward it, and practices that could have contributed to the development of gastroenteritis. To compare any differences in their knowledge, attitude, and practices that happened as a result of the intervention, the same questionnaire is utilized in post-counseling.

Material and Methodology

Sources of Data Collection

• Self-constructed KAP questionnaire

• Self-constructed Case Report Form (CRF)

• Interview with patients

The Observational study was conducted for a period of 12 months.

Sample Size Calculation

The following equations are used for calculating sample size:

X=Z2p(1-p)/e

n=NX/X+ (N-1)

Where Z= Value of the normal curve corresponding to the level of confidence

(Z=1.96 for 95%confidence interval)

N = Desired sample population (150)

n = Required Sample size

p = Prevalence of disease (16.15)47

e = Desired margin of error (0.05)

Calculation

X = (1.96)2* 0.066(1-0.066)/(0.05)2

X = (3.84) *0.066 *0.934/0.0025

= 94.685184

n=NX/X+ (N-1)

n = 150*94.685184/94.685184+149

n = 58.28 ≈ 58

Based on the prevalence of gastroenteritis, it is calculated as 58 cases of patients who meet the inclusion criteria to be collected for the study.

Patients with Gastroenteritis cases in the General Medicine Department of The Oxford Medical College were considered.

Following the ethics committee's approval, the CRF of hospitalized patients with gastroenteritis was obtained from the department of general medicine. Demographic information such as name, age, sex, occupation/education, and history such as medical, familial, and social history were recorded.

The outcomes were assessed using knowledge, attitude, and practice scores together with statistical analysis software like SPSS.

Methods

• Every document used in the study was validated and translated into the local Kannada language.

• With the aid of a panel of experts from various professions, the self-constructed KAP Questionnaire on Gastroenteritis was validated.

• The Oxford Medical College in Attibele, Bangalore, granted ethical permission after consulting their institutional ethics committee.

• The consent from the patient was obtained through an informed consent form in English and Kannada language.

• Data collection from case sheets and medical records about the patient's demographics (name, age, gender, etc.) as well as information on laboratory tests and diagnoses.

• Collection of data in a self-constructed CRF to assess Etiology and Risk factors.

• Assessment of knowledge, attitude and practice towards Gastroenteritis among the adults using score. And provided patient counseling using PIL

• POST Counseling assessment of interventions was made after PC to assess the KAP

• The obtained data was subjected to a suitable statistical method.

• Provided the feedback result to clinicians and other relevant groups.

Validation of knowledge attitude and practice questionnaire developed for patients with gastroenteritis

Questionnaire Development

A comprehensive examination of the literature will be done to see what questions already exist in the questionnaires and to determine which scales and items are pertinent to gastroenteritis.

Preparation and selection of questions about gastroenteritis from the numerous published articles.

Validation

A questionnaire is distributed to professionals, laypeople, and patients. A total of 15 people made up the panel, including 3 medical experts, 2 assistant professors, and 10 patients and laypeople. Questionnaires are gathered and graded based on their relevance, simplicity, clarity, and ambiguity.

Each question's relevance, clarity, simplicity, and degree of ambiguity in evaluating knowledge, attitude, and practice were examined, and scores were entered into Microsoft Excel sheets.

Healthcare specialists and an assistant professor will make up the expert group that will review the item's internal content validation. The item will be face verified by a panel of laypeople and patients.

Using the SPSS statistical analysis program, Cronbach's alpha is determined. For corrected items, Cronbach's alpha co-efficient should be 0.7 or above.

To analyze how each item correlates with the entire domain, total score correlation will be used. An item would be removed if the correlation value was less than 0.2, which showed that the item did not correlate with the overall scale.

The research team will thoroughly analyze and review all feedback from content and face validation. The items were changed, deleted, or kept intact.

Using the findings of the study and the expert consensus, the final questionnaire will be created.

RESULTS

This study includes 58 patients who were admitted to the general medicine department with Gastroenteritis.

Validation of KAP Questionnaire of Gastroenteritis

The KAP questionnaire was given to 15 members consisting of 3 Health care professionals, 2 Asst. Professor, 10 lay person and patients and scores were obtained by them. Table 1, Figure 1.

The average scores were obtained from the panel members for validation of KAP questionnaire and tabulated. The overall average of all the parameters (Relevance, Simplicity, Ambiguity and Clarity) was found to be 3.86 and the I-CVI (%) was found to be 96.67%. The average of each item of the questionnaire along with its respective I-CVI was presented in Table 2.

Average Scores of Each Question with Item Level Content Validity Index (I-CVI)%

Overall score with Scale Level Content Validity Index(S-CVI)

The overall average of all the parameters, including relevance, clarity, simplicity, and ambiguity, was found to be 3.84, 3.83, 3.908, 3.87 and its S-CVI (%) were found to be 96.15, 95.98, 97.72, 96.93% respectively. All the parameters involved in the validation of the KAP questionnaire evaluation along with its respective S-CVI was presented in the Table 3, Figure 2.

The Cronbach’s alpha coefficient

The Cronbach's alpha coefficient was determined by using SPSS software and was found to be 0.774 which indicates that all the items present in the questionnaire on Gastroenteritis is acceptable and there is no need of correction in the questionnaire. Hence all the items present in the KAP questionnaire on Gastroenteritis were validated. Table 4, Figure 3.

Out of 58 study participants, 33 had good knowledge scores before counselling. 48 out of 50 patients had good knowledge scores following counselling. The knowledge score has significantly increased after counselling. Table 5, Table 6, Table 7, Table 8, Figure 4.

Out of 58 study participants, 19 had good Attitude scores before counselling. After therapy, 34 out of 50 patients showed positive attitude. Thus, there is a significant increase in the attitude score post-counseling. Table 9, Figure 5.

The Figure 6 and Table 10 show out of 58 study subjects, 37 had good Practice scores before counseling. Post counseling 49 of 50 patients showed good Practice scores. Thus, there is a significant increase in the Practice score post counseling

Following counselling, it was discovered that the poor Practice score had reduced from 21 to 1.

Overall KAP Score of Patients Studied

The Figure 7 and Table 11 represent a significant increase in the overall KAP score from 19% to 86% post counseling.

Statistical Values of KAP Before and After Counselling

Patients' knowledge, attitude, and practice were determined to be 8±5.88, 13.2±4.92, and 14.57±2.88, respectively, on a mean and SD basis. After the intervention, knowledge, attitude, and practice were 42.71±3.9, 46.2± 3.52, and 42.57± 5.38, respectively.

Additionally, our KAP study's P-value was found to be less than 0.05, indicating that the results are statistically significant. Table 12, Table 13, Table 14, Table 15.

DISCUSSION

The experiment evaluated people's understanding, attitudes, and practices of gastroenteritis. A KAP survey is meant to collect data on a population's knowledge (i.e., what is understood), attitudes (i.e., what is believed), and practices (i.e., what is performed) about general and/or specialized matters. We are unaware of any prior research on the validity of the KAP questionnaire specifically for adult gastroenteritis. Owing to this, we constructed our questionnaire. The self-constructed KAP questionnaire was found to have the appropriate levels of simplicity, clarity, ambiguity, and significance after validation. 4

The KAP survey is used in pre-counseling to assess the patient's knowledge of the ailment, attitude toward it, and practices that could have contributed to the onset of gastroenteritis. In order to compare any differences in their knowledge, state of mind, and habits that occurred as a result of the intervention, the same survey is used in post-counseling.

There were 58 individuals recruited in the current trial, 32 of whom had gastroenteritis and 26 of whom did not.

In a cross-sectional study, Hailemariam Mekonnen Workie et al. (2016) evaluated the mother's knowledge, attitude, and practice regarding diarrheal illness prevention and home-based care in children under the age of five. Using a pretested, standardised, and structured questionnaire, mothers were questioned. The researchers came to the conclusion that while the spenders knew a lot about house management and diarrhoea prevention, they had a terrible attitude about it. The attitude and behaviours of the carers will undoubtedly improve as a result of patient counselling and health education. 5

Eliud Wainaina and colleagues conducted a cross-sectional study in 2017 utilising pretested questionnaires and collected stool samples to ascertain the knowledge, attitude, and practices of food safety among food handlers in urban Kenyan settlements. 6 They noticed behaviours that potentially spread the Norovirus, such as not washing hands before handling ready-to-eat food and touching ready-to-eat food with bare hands. It was also noted that people lacked fundamental awareness of illness transmission methods. The health situation in Kenya would undoubtedly improve with more training in sanitary procedures and information about Norovirus transmission pathways. 7, 8, 9

A self-structured questionnaire that was first verified by a panel of five experts, then by 10 patients, and finally used to evaluate 58 patients, was used to measure knowledge, attitude, and practices. The purpose of this study is to evaluate the Knowledge, Attitude, and Practice scores of patients with gastroenteritis after receiving assistance from a pharmacist.

The overall scale level content validity index or face content validity index (S-CVI%) for all validating parameters like Relevance, Simplicity, Clarity, and Ambiguity was found to be 96.69% in the validation of the KAP questionnaire on gastroenteritis. The overall item level content validity index or internal content validity index (I-CVI%) for all the questionnaire items was found to be 96.87%. Using SPSS software, Cronbach's alpha was computed for the aforementioned data. The Cronbach's alpha coefficient was determined to be 0.774, indicating that all of the KAP questionnaire's gastroenteritis-related items were considered acceptable and that no changes or corrections were required. As a result, every item in the GE KAP questionnaire was verified.

The study evaluated the GE's total KAP score and found that, out of 58 study participants, 19% had satisfactory KAP and 81% had unsatisfactory KAP. After patient counselling, the study subjects' total KAP score increased to 86%, which is satisfactory. Patients' knowledge, attitude, and practice were found to have standard deviations and means of 8±5.88, 13.2±4.92, and 14.57±2.88. Following patient counselling, it was discovered that knowledge attitude practice was 42.71±3.9, 46.2±3.52 and 42.57±5.38. Inappropriate attitudes and practices are caused by incomplete awareness of the disease and risk factors. Counseling can help these groups, which will raise their KAP. Thus, adopting healthy lifestyle choices and maintaining good cleanliness can lessen the burden of GE as a disease, which can be accomplished through patient education and awareness.

Conclusion

58 cases of gastroenteritis including patients who were both male and female were examined throughout the course of the research's six-month duration in this observational study. The majority of the patients, according to the findings of the study, were between the ages of 18 and 80. Using self-structured validated questionnaires, the goal of determining the KAP score of gastroenteritis patients was accomplished. The participants were counselled before and after the scoring process with the use of patient information leaflets. Results were obtained after statistical analyses were performed on the data collected from GE patients. According to the study's findings, the study population's KAP significantly improved after receiving therapy. The primary disadvantage of gastroenteritis is that its early-stage symptoms may not be recognized and might be misdiagnosed. Neglected symptoms include mild nausea, stomach pain, and diarrhoea. Early identification can therefore stop the disease from progressing provided the patients are well-informed about it. The study also revealed that the majority of patients had inadequate knowledge, attitudes, and practices, establishing the clinical pharmacist's responsibility in patient education.