|Year : 2013 | Volume
| Issue : 2 | Page : 57-63
Awareness of physiotherapy among the Anganwadi workers in Dakshina Kannada: A survey
Tania Johnsey, Narasimman Swaminathan, Sydney Rebello, Kavitha Vishal
Department of Physiotherapy, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India
|Date of Web Publication||16-Sep-2013|
Father Muller Medical College, Kankanady, Mangalore - 575 002, Karnataka
Source of Support: None, Conflict of Interest: None
Purpose: The physiotherapist facilitates optimum functional independence, health and well being of the community. An idea of the range of conditions that a physiotherapist can treat will help the community to benefit from their skill. Anganwadi workers (AWW) play a key role in health education and care at the primary care settings especially in rural India. Objectives: The objective of this study was to assess the awareness of physiotherapy among AWW in Dakshina Kannada. Materials and Methods: A cross-sectional survey using a validated questionnaire was conducted among 112 AWW. The data obtained were analyzed and described. Results: Fifty percent of the 112 respondents were not aware of the role of physiotherapy in many of the impairments and only 3% of the AWW were informed during their training period regarding physiotherapy. Conclusion and Implications: Awareness about physiotherapy among the AWWs who participated in the study was poor. Adequate awareness programs among the AWW with regard to physiotherapy, through the various means of information transfer, can be beneficial in helping them to direct the people who are in need of such services.
Keywords: Community, physiotherapist, Anganwadi workers,Community based rehabilitation
|How to cite this article:|
Johnsey T, Swaminathan N, Rebello S, Vishal K. Awareness of physiotherapy among the Anganwadi workers in Dakshina Kannada: A survey. Muller J Med Sci Res 2013;4:57-63
|How to cite this URL:|
Johnsey T, Swaminathan N, Rebello S, Vishal K. Awareness of physiotherapy among the Anganwadi workers in Dakshina Kannada: A survey. Muller J Med Sci Res [serial online] 2013 [cited 2020 Sep 19];4:57-63. Available from: http://www.mjmsr.net/text.asp?2013/4/2/57/118224
| Introduction|| |
The physiotherapist facilitates optimum functional independence, health and well being of the community. This is achieved by specialized manual techniques, electrotherapeutic modalities, exercises, advice and counseling to patients and care givers, provision of adaptive devices and mobility aids, education and training. An idea of the range of conditions that a physiotherapist can treat will help understand their role. 
India with a population of over 1 billion having diverse socio cultural geographical features has 75% of persons with disabilities (PWDs) living in rural areas.  The escalating cost of health care, the increasing economic constraints, and the shortfalls in service provision have all contributed to the difficulty in the rehabilitation of the disabled. Hence, the urgent need to develop innovative ways to utilize therapists in the community. Thus the need of community-based rehabilitation (CBR) programs is much relevant in a fast-developing country like India.  The physiotherapist's (PT) role in CBR can be understood only if the level of community awareness about the potential of physical therapy to effect a change in health status and social participation of people is good.
Over the years, development planning in India has focused on reducing the burden of illness and mortality among women and children. The Integrated Child Development Services (ICDS) is one of the programs that have been geared towards this. Its package of services that comprise of supplementary nutrition, immunization, health checkups, referral services, preschool informal education, nutrition and health education is provided by trained Anganwadi workers (AWW) in the Anganwadi center. An Anganwadi, literally meaning "courtyard play center", serves a population of 400-800 people and is located within accessible distance (100-200 m) from beneficiary households. 
The role of AWWs has been appreciated as the most dedicated and committed of public servants who can develop grass-root contacts.  A study conducted in Gorakhpur, Uttar Pradesh, confirms that AWW can help in early detection of childhood disabilities in children below 6 years. This indicates that adequate orientation and training among the AWWs regarding early detection of incipient and preventable disabilities can help to prevent permanent disabilities in children.  The importance of AWWs in the field of health cannot be overlooked because they are the solitary means of house-to-house access of health system for the identification of physical problems in the common man and also for the provision of basic health care.
The AWW is a front line community-based voluntary worker of the ICDS program. In spite of the ongoing direct interventions like ICDS, India still contributes to about 21% of the global burden of child deaths before the fifth birthday due to inadequate awareness about nutrition and health facilities in the community  The AWWs are a good source of identifying the people with disabilities in the community and creating awareness among the public about the various rehabilitation facilities and the role played by physiotherapists.  It is hoped that through the training of AWWs, the community especially the vulnerable women and children groups would get the adequate health and education services and over a period of time, the situation in India would improve. 
Although many studies have been conducted to identify the awareness of physicians, nurses and medical students about physiotherapy, no studies have been conducted so far to identify the awareness among Anganwadi workers about the advantages and services provided by physiotherapists. It is evident that only those AWW who have good knowledge can help the community regarding physiotherapy care and thus the need of this study was felt.
Objective of the Study
This study was intended to assess the awareness about Physiotherapy among the AWWs.
| Materials and Methods|| |
The study was approved by the Institutional review board of Father Muller Charitable Institutions (FMCI). The study was conducted in two phases. In the first phase, a detailed self administered questionnaire was prepared with only closed ended questions in three sections. The questionnaire was given for validation to experts in the field of community based rehabilitation, with a requisition letter to validate the questionnaire.
The final questionnaire [Appendix I] [Additional file 1] was derived based on the opinions and consensus of these experts. The final questionnaire contained both closed and open ended questions in three sections. This was then translated to Kannada and validated for the language accuracy. A questionnaire that contained three sections was used.
Section 1 required the background information that included name, age, gender, educational qualification, job designation, working location, population covered, when and where was the training given, duration of training, work experience (no of years) and contact no. Section 2 required the details on the source of information about physiotherapy services. Section 3 contained 8 open ended questions regarding the awareness about the various physiotherapy services.
A pilot study was conducted on two Anganwadi workers at the Child Development Project Office, Valencia, Mangalore to identify the practicability of the questionnaire.
In the second phase of the study, the permission was sought to conduct the study from the Deputy Director; Department of Women and Child Development; Dakshina Kannada and the Principal of Anganwadi Training Center, Ullal, Mangalore. The questionnaires were distributed among the Anganwadi workers on their scheduled meeting dates. Adequate time was given to complete the questionnaire and doubts were clarified appropriately. A total of 112 AWWs participated in this survey after obtaining informed consent.
The details and the responses of each candidate were entered and coded. Each respondent has filled in more than one answer, each answer has been coded and frequency was analyzed. Then the data were grouped and described based on each question. Descriptive analysis was done for each data obtained using SPSS 14.
| Results|| |
Result 1. Demographic data:
Result 2. Source of information of AWW about physiotherapy: On evaluation, it was noticed that most of them became aware of PT during their visit to hospital (24%) or through television/radio (21%). The second two leading sources of information were medical professionals (15%) and friend/ family member (13%). camps (6%), magazines (7%) and newspaper (9%) were the other sources of information that were the least utilized for creating awareness about physiotherapy. On the other hand, 5% report that they have no source of information about physiotherapy.
Result 3. Conditions that have been referred for physiotherapy by AWW
The conditions for which a reference has been made by AWW for physiotherapy, it was detected that a majority of them (77%) had not yet referred any cases for PT. Out of the 20% of the conditions that had been correctly referred, 12%, 5% and 3% had referred pain related conditions, nerve related problems such as weakness or paralysis and nonambulatory children respectively.
A small percentage of the AWWs claim that they have referred patients with bone cancer, fracture (1%) and cough (2%) for PT
Result 4. Conditions that could be referred by AWW for physiotherapy: Out of the total 112 respondents, nearly 50% of the AWW have written that they don't know which conditions can be managed by a physiotherapist.
Body pain is the condition in which 15% of the total informants have agreed that a referral can be made to the PT. This is followed by 12% of the AWW consenting to refer people with physical complaints, deformities or handicaps and 10% of the AWW stating that those with nerve related problems such as polio, paralysis, weakness and numbness can be referred to a physiotherapist. A minority (3%) of the AWW have answered that children who can't ambulate can be referred for physiotherapy management.
However, it has been observed that 6% and 4% of the AWW wrongly believe that problems of speech, mental retardation and bone cancer, fracture, accident related bone problems can be referred to a physiotherapist.
Result 5. Conditions that need not be referred by AWW for physiotherapy: 71% of the responses received say that they don't have any idea about the conditions that don't require PT. Out of the 29% of the responses received, only 7% of the answers are that reference won't be made for those patients who have complaints of fever, cold, headache, stomach ache and those who don't have any physical problems; 7% said that they won't refer patients with cancer, diabetes mellitus and asthma; 6% of the conditions that need not be referred are those related to heart problems. Incurable diseases, TB, AIDS, Leprosy and Bed ridden cases account for 7% of the conditions that need not be referred. A very small percentage (2%) of the conditions that need not be referred are problems of wounds and bleeding.
Result 6. Equipments or techniques used in physiotherapy according to AWW: 82% of the AWW don't have an idea about what equipment or technique is used by a physiotherapist for treatment. 8% of them believe that equipment such as needles, scalpels, oil, sand, magnet and mud is used in physiotherapy. 7% of the responses have been correct as AWW wrote about the modalities such as traction, electric current, hot, ice and wax those are being used. 3% of the responses are that exercises using cycles, toys, ball, massage, wheelchair and walker are used for physical therapy.
Result 7. Age criteria for reference for physiotherapy treatment according to AWW: 36% of the AWW agree that all age groups can be treated. On the other hand, 10% of AWW replied that only people in certain age groups can be treated by a physiotherapist. Out of the responses received, 54% of AWW admit that they don't know which age groups of people can be treated by a physiotherapist.
Result 8. Nearest physiotherapy center in their locality: 43% of AWW are aware of the nearest physiotherapy center in their locality. 39% don't know if there are any centers for physiotherapy nearby or in their locality. 18% of the respondents say that there exist no centers or facilities for physiotherapy in their locality.
Result 9. Providing guidance for a person for physiotherapy: when asked about how a patient who requires physiotherapy will be guided by an AWW to a physiotherapy center, 36% of them responded saying that they would take them to the PHC doctors who will direct them to a physiotherapist. 12% of AWWs said that they will refer them to the nearest health center, hospital or PT center. A majority of them, 52% don't know how to obtain adequate physiotherapy services for a patient who required physiotherapist services.
Result 10. Information required by AWW regarding physiotherapy(PT):
47% of the AWW don't know what information is needed for them regarding PT. Full information on all kinds of PT have been requested by 32% of the AWW. 12% of the information that is required is in regard to services for joint and back pain, leg weakness. Information on benefits of physiotherapy and the conditions that can be managed by a physiotherapist account for 6% of the total information that is required. And lastly, 3% would like to know the number of days PT should be administered to a person requiring it.
| Discussion|| |
The study was carried out to find the awareness of physiotherapy among the Anganwadi workers in Dakshina Kannada. A main feature of this study was that the questions assessing awareness were asked as open ended questions which enabled the respondents to express their views freely. It has been understood from the literature that the AWWs can be a good source of creating public awareness about the various health care facilities and their adequate training helps in early identification and management of various impairments, thus preventing permanent disabilities. 
Some of the roles of AWWs are to organize nonformal education session, assist primary health care staff in providing health services, coordinate with block administrators, local school, health staff and the community and work for other community based activities.  This implies that they can be a good source of public health education to a considerable number of the population and also refer the needy people to physiotherapy services. On analysis, it was observed that only a small percentage of AWWs were aware of physiotherapy services despite having a mean experience of 13.16 years of working in the community (refer to Result 1.) and majority of AWWs admit that they didn't know what conditions need not be referred to a physiotherapist (refer to Result 5). This situation could be improved if essential information is given regarding physiotherapy during their period of training. Health workers in adequate numbers, in the proper places, properly trained and supported are the backbone of an efficient public health care system. 
India accounts for a considerable proportion of the global burden of disease with 20% of disability adjusted life years. Nevertheless, inequalities in health care exist as individuals with the greatest need for health care have the greatest difficulty in accessing health services. 
The creation of health awareness and related services among socially disadvantaged individuals is a necessary step to encourage appropriate demand for available health services.  This is important as poor knowledge and attitudes of people with disabilities about general health services make them reluctant to use health services. Many socially disadvantaged people also have limited knowledge about their rights, health issues and about what health services are available. 
An appreciable finding is that even though only a trifling number of AWWs were informed during training (refer to Result 1), 20% of cases have been correctly referred by AWW (refer to Result 3). This can be attributable to the various sources of information (refer to Result 2) that have created awareness about physiotherapy services. The leading sources of information among AWW are visit to the hospital and through medical professionals. This indicates that adequate information conveyed through medical professionals, hospital staff and family members can improve the awareness regarding physical rehabilitation facilities for the disabled, thus enhancing an accessible and affordable public health care.
Most surveys on the incidence of disability agree that the incidence of disability is higher in the pediatric and geriatric age groups.  However, The age criteria which some of the AWWs believe can be referred to a physiotherapist ranges from a maximum of 65 years to a minimum of 10 years of age. Thus, it is essential that the AWW realize that physiotherapy can be adequately given to the physical disabled of any age group. In a handbook for parents of children with disabilities, it has been commented that 10% of Indian children below 14 years, that accounts for a staggering number of 30 million who have some kind of physical impairment. The available data also shows that only 5-10% of disabled children avail the benefits provided by the government. In the rural areas as well as in the slums, early identification is done through door-to-door surveys and screening children at Anganwadis. Therefore, it is necessary that AWWs know the various disabilities in children that can be managed by a physiotherapist. 
From our study, it is clear that only a small fraction of the population is aware about the nature of work involved in PT as the various equipments used in PT have been correctly identified by only 10% of AWWs (referto Result 6). One of the reasons as to why many of the AWW are not aware about adequate PT services is that there are no PT centers at an accessible distance (refer to Result 8) and another significant finding that requires attention is that 52% of AWWs lack awareness about how to guide a person to a physiotherapist (refer to Result 9) if needed. This could be one of the reasons as to why many of the rural population don't get adequate PT services contributing to inequities in public health care delivery systems in India. Even though one of the objectives of the PWD act,  is prevention and early detection of disabilities by educating the public through Primary health care (PHC), village health workers (VHW) and Anganwadi workers (AWW), awareness regarding physical rehabilitation is found to be inadequate among the AWWs.
On being asked as to what more information is needed, 32% of the AWW have asked for full information about all kinds of physiotherapy services (refer to result 10), PT services for pain, hand and leg weakness, benefits of PT, the conditions that can be managed by a physiotherapist and how many days of PT is required. This information can be utilized in planning further education or awareness program among the AWW.
| Conclusion|| |
There is unsatisfactory awareness about physiotherapy (PT) among the AWWs who participated in the study. Adequate education and training with regard to PT can help improve public health utilization by enhancing the awareness and accessibility for required health care. Awareness created through the appropriate media will empower the AWWs to identify and refer patients with those health conditions which can be benefited from physiotherapy service and thus boost public health in India.
Implications of the Study
Through this survey, we have analyzed the awareness of AWW about physiotherapy and have found out that that they stand in need of more education and awareness about the availability and benefits of various services in relation to physical therapy. The personnel and media sources through which AWWS obtained awareness about PT have also been studied, so that appropriate awareness can be generated through these sources.
Limitations of the Study
The study population is not homogeneously distributed in Dakshina Kannada. It includes a majority of respondents from Mangalore Taluk.
| Acknowledgements|| |
We are grateful to to Mrs. Kavita Raja, Mr. Amitesh and Mr. Jidesh V.V for their valuable suggestions and guidance in formulating the questionnaire, Mrs. Isabella, Health Supervisor, Department of Community Medicine, Father Muller Medical College and Ms. Ameesha, Anganwadi Training Center, Ullal, Mangalore for their valuable and timely assistance.
Ms. Raina, Ms. Alphonsa, Ms. Ranjeetha and Ms. Anujna for their selfless service and ever helping attitude. I am also grateful to all the participants of this study for their willing cooperation which has made this study possible.
| References|| |
|1.||Moving community physiotherapy forward - towards the 21 st century, eastern health board, 1997, Dublin. Available from: http://lenus.ie/hse/bitstream/10147/45698/1/8657.pdf [Last assessed on 2012 March 15]. |
|2.||Mahesh C, CBR India Representative, Charter of CBR India Network (CBRIN), cbrindianetwork, 5 Dec 2009. Available from: http://sites.google.com/site/cbrindianetwork/charter [Last accessed on 2012 Aug 30]. |
|3.||Twible R L, Henley E C. Preparing occupational therapists and physiotherapists for community based rehabilitation. Available from: http://www.aifo.it/english/resources/online/apdrj/selread100/ot_pt_for_cbr_twible_henley.pdf. [Last assessed on 2012 Sept 22]. |
|4.||Park K. Social welfare programmes. Preventive medicine in obstretrics, paediatrics and geriatrics. Preventive and Social Medicine. Jabalpur: Banarsidas Bhanot publishers. 19 th ed. 2007 chapter 10. p. 475. |
|5.||Desai G, Pandit N, Sharma D. Changing role of Anganwadi workers, A study conducted in Vadodara district. Healthline. J Indian Assoc Prev Soc Med. 2012;41-4. |
|6.||Mathur GP, Mathur S, Singh YD, Kushwala KP, Lele SN. Detection and prevention of childhood disability with the help of Anganwadi Workers. Indian Pediatr 1995;32:773-7. |
|7.||Manhas S, Dogra A. Awareness among Anganwadi Workers and the prospect of child health and nutrition: A study in Integrated Child Development Services (ICDS) Jammu, Jammu and Kashmir; India. Anthropologist 2012;14:171-5. |
|8.||Community participation - A training module for Anganwadi Workers, 1987. Society for participatory research in Asia. Available from: http://www.pria.org/publication/Community%20Participation%20%20A%20Training%20Module%20for%20Anganwadi%20Workers.pdf [Last assessed on 2012 Mar 06]. |
|9.||Datta K K. Public health workforce in India: Career pathways for public health personnel, 2009. Available from: http://www.whoindia.org/LinkFiles/Human_Resources_Public_Health_Force-Final_Paper.pdf [Last assessed on 2011 Dec 06]. |
|10.||Balarajan Y, Selvaraj S, Subramanian S V. Health care and equity in India. India: Towards universal health coverage 4. www.thelancet.com: 2011. p 377. Available from: http://www.hsph.harvard.edu/faculty/sv-subramanian/files/the_lancet_2011_377_505_515.pdf [Last assessed on 2011 Dec 06]. |
|11.||Improving public health in India: Need for innovative solutions in health care delivery. Report of the deliberations at Hyderabad, India, 2006. Available from: http://www.hss.iitm.ac.in/rt-ppp/PPPs/Miscellaneous/Improving%20health%20care%20in%20India.pdf [Last assessed on 2011 Nov 20]. |
|12.||R guidelines. Health component. WHO 2010. Available from: http://whqlibdoc.who.int/publications/2010/9789241548052_health_eng.pdf [Last assessed on 2011 Sep 04]. |
|13.||Peat M. The Magnitude of Disability. Community Based Rehabilitation. London NW1, United Kingdom; WB Saunders Company Ltd.: 1997, p 7-8. |
|14.||A handbook for parents of children with disabilities, Government of India, Planning commission, 2002. Available from: http://planningcommission.nic.in/reports/sereport/ser/stdy_ied.pdf. [Last assessed on 2012 Feb 11]. |
|15.||The Persons with Disabilities act, 1995. Acts in Disability. Disability India Network. Available from: http://www.disabilityindia.org/pwdacts.cfm [Last assessed on 2011 Dec]. |