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182 © 2019 Indian Psychiatric Society - South Zonal Branch | Published by Wolters Kluwer - Medknow
Effectiveness of a Structured Training Module
on Different Learning Domains among Yuva
Parivarthakas under Yuva Spandana Program
Pradeep Banandur S., Gautham M. Sukumar, Mutharaju Arelingaiah, Lavanya Garady1, Jyoti M. Koujageri1,
Sateesh L. Sajjanar2, Basavaraj Hadapad3, M. S. Ramesh3, Gururaj Gopalkrishna
ABSTRACT
Background: Yuva Spandana (YS) is a youth mental health promotion program implemented across all 30 districts of
Karnataka. Yuva Parivarthakas (YPs - youth change agents) are trained to provide mental health promotion services to
any “youth with issues” through Yuva Spandana Kendras (guidance centers) situated within district stadiums across
Karnataka. Aim of the study was to evaluate the change (comparing before and after training) in different learning domains
(cognitive – knowledge, affective – attitude, and psychomotor – practice) among trainees (YPs) attending YS training.
Methods: Quasiexperimental study design was utilized for this study. A semistructured interview schedule was developed
and used before and after the training. Data were analyzed by descriptive statistics. The difference in change of mean
score was assessed using the paired t-test. The shift in the proportion of trainees post-training in the three domains was
assessed using McNemar’s test. Results: The mean (±SD) age of trainees was 27.5 ± 3.3 years. Majority of them were
males (63.8%), had completed bachelor’s degree (53.4%), and were residing in rural Karnataka (77.7%). The knowledge
and attitude scores significantly improved (P < 0.001) post-training, without significant improvement in practical skills.
Conclusion: It is recommended that future training programs need to be focused on creating opportunities to YPs in
order to increase their practical skills to work with youth having issues.
Key words: Attitude, knowledge, learning domains, practice, training
Key messages: <XYD6SDQGDQDWUDLQLQJSURJUDPEULQJVLQVLJQL¿FDQWSRVLWLYHFKDQJHLQWKHGRPDLQVRINQRZOHGJH
and attitude among trainees. This research suggests incorporation of more practice-related aspects in both in-house
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Access this article online
Website:
www.ijpm.info
Quick Response Code
DOI:
10.4103/IJPSYM.IJPSYM_144_19
Yuva Spandana Program, Department of Epidemiology, Centre for Public Health, NIMHANS, 1Department of Epidemiology,
Yuva Spandana Program, NIMHANS, 2Department of Youth Empowerment and Sports, Government of Karnataka, 3Department
of Youth Empowerment and Sports, Youth Services, Government of Karnataka, Bengaluru, Karnataka, India
Address for correspondence: Dr. Gautham M.Sukumar
#214, 2nd Floor, Department of Epidemiology, Dr. M V Govindaswamy Building, NIMHANS, Hosur Road, Bengaluru - 560 029, Karnataka,
India. E-mail: drgauthamnimhans@gmail.com
Submitted: 16-Mar-2019, Revised: 17-Apr-2019, Accepted: 01-Aug-2019, Published: 09-Mar-2020
This is an open access journal, and articles are distributed under the
terms of the Creative Commons Attribution-NonCommercial-ShareAlike
4.0 License, which allows others to remix, tweak, and build upon the
work non-commercially, as long as appropriate credit is given and
the new creations are licensed under the identical terms.
For reprints contact:
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How to cite this article:
Banandur SP, Sukumar GM, Arelingaiah M,
Garady L, Koujageri JM, Sajjanar SL,
et al (ႇHFWLYHQHVVRI DVWUXFWXUHG
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Banandur,
et al
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Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020 183
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of age.[1] It is a “young nation” as it is home to the
largest youth population in the world. Youth is a
ver y crucial period of life due to rapid physical,
physiological, psychological, and behavioral changes.
In general, though youth is considered as a healthy
phase of life, major issues, such as academic and
career, substance use and abuse, sexually transmitted
infections, unplanned pregnancies, homicide, suicide,
and motor vehicle crashes (including those caused
by drinking and driving), either start or peak during
these years.[2] Behavioral patterns during youth impact
healthy and productive adult life. It also increases the
risk of noncommunicable diseases.[3] Further, the youth
are vulnerable to the influence of socioenvironmental
factors such as family, peers, school, and neighborhood,
impacting on their overall development including their
health and well-being.[4,5]
Traditional Indian family system had provided the
necessary support for all in the family. Dwindling
traditional family systems, amidst globalization and
technological revolution, have brought changes in
individuals, family, and society. Particularly, support
available within families and community is reduced.
Hence, a need for support for youth is being felt
as more relevant. As a result, professional help for
resolving issues gained much importance in recent
years, but affordability, availability, accessibility,
and stigma limit reach to all youth in need of such
support. Considering these realities, providing early
support facilitates them to adopt healthy behaviors
and, in turn, helps the adult population to have
a better, productive future.[6] Support from either
formal or informal systems help to empower the
youth in this stage of metamorphosis. In this line,
Yuva Spandana (YS) (meaning responding to youth),
a youth mental health promotion program, was
introduced by the Department of Youth Empowerment
and Sports, Government of Karnataka, with the
technical support from Centre for Public Health,
Department of Epidemiology, National Institute of
Mental Health and Neuro Sciences.
The program YS was implemented in line with
Karnataka Youth Policy 2012, with an objective to help
the youth to help themselves, by providing guidance
in their respective districts (“Youth for Youth”). Yuva
Parivarthakas (YPs; meaning change agents of youth)
work in the districts as youth motivators and youth
guidance providers. YPs in the program are between
21–35 years of age, have completed bachelors’ degree,
are residents of the local districts, and know the
language of Kannada. They are selected through a
systematic procedure. The youth are informed about
training as YPs through local print and visual media
mentioning required qualification and experience by
the Department of District Youth Empowerment and
Sports. A three-step interview process, namely group
discussion, brief written test, and personal interview
is conducted to select YPs.[7] At the macro level, the
program aims to create alternative support systems
within the existing system to deal effectively with the
dynamic social system in India and to support the youth
to avail timely help. Yuva Spandana Kendras (meaning
youth response centers), established in district stadiums
across Karnataka, provide such support and guidance
to youth having any issues. The issues addressed under
the program are education and academics, relationship,
personality development, health and lifestyle, safety,
gender, sex and sexuality issues.[7] To achieve the same, a
5-day structured training program is conducted to train
some youth to serve as YPs. This paper evaluates the
effectiveness of this training on domains of knowledge,
attitude, and skills of the trainees. This training
was expected to improve their knowledge about the
activities and procedures related to the program and
to develop appropriate attitude and skills to work with
youth and community.
METHODOLOGY
We utilized a quasiexperimental study design to
evaluate the changes in knowledge, practice, and
attitude of trainees attending YS training between
the year 2014 and 2017. The trainees were from all
30 districts of Karnataka.
About the training
The training program of YPs utilized 10 modules
developed by an expert team, adopted and piloted
for its feasibility.[7] It was a 5-day, in-house training
program developed using a systematic, logical process
in a scientific manner, utilizing stakeholder, and
expert consultations. The training program consisted
of didactic lectures, group work, role play, and other
feasible adult learning methods. Trained resource
persons from within team YS, faculty from within and
outside the department of Epidemiology, NIMHANS
delivered the sessions in a uniform manner. Aim of
the training was to empower YPs with the necessary
cognition, attitude, and skills to implement activities
and services of YS in their respective districts. The
detailed training program schedule is listed in Table 1.
Tool for assessment
A semistructured self-reporting questionnaire was
developed and piloted for its usability. The tool was used
to assess change in self-reported knowledge, attitude,
and practice among YPs before and after training.
The tool was developed by reviewing the literature
and consulting experts in the field. Face validation
Banandur,
et al
(ႇHFWLYHQHVVRI<XYD6SDQGDQDWUDLQLQJ
184 Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020
of the tool was done by experts working in the field.
The questionnaire contained 10 questions related to
knowledge, attitude, and practice domains. Knowledge
and attitude domains had three questions each, and
practice domain had four questions. Each question in
the tool was scored on a six-point rating scale from 0 to
5 (0 – “very poor,” 1 – “poor,” 2 – “average,” 3 – “good,”
4 – “very good,” and 5 – “excellent”). The maximum
total summary score for knowledge and attitude
domains was 15 each. The total score for practice was
20. The overall possible total score for the interview
schedule was between 0 and 50.
All 373 trainees who were trained in 11 training
programs conducted under the program YS from
2014 to 2017 were considered for the assessment. The
assessment was carried out at two level: pretraining
and immediate post-training. All YPs were given the
questionnaire on the first and the last days of training.
YPs were made to sit next to each other with an arm
stretch distance to avoid copying and duplication. They
were asked to circle their responses to each question.
All participants were provided 30 minutes to complete
the task.
Statistical analysis
Descriptive statistics such as mean and percentage were
calculated for understanding the disposition of the
study population. Effectiveness of the training program
was assessed by
1. Im provement in m ea n scores post-training
compared with pretraining
2. Im provement in score grades post-training
compared with pretraining.
Paired t-test was applied to test for significant change
in mean knowledge, attitude, and practice scores of YPs
before and after training and among different subgroups
of age, sex, education, and domicile. The distribution
was assessed for normality using the Shapiro–Wilk test.
Scores obtained by YPs in knowledge, attitude, and
practice assessment were expressed as the percentage
of the maximum possible score in each domain
(Score obtained/Maximum possible score*100). Based
on these percentages, level of knowledge, attitude and
SUDFWLFHZHUHJUDGHGVFRUHJUDGHVDV*UDGH,
26%–49% (Grade-II), 50%–74% (Grade-III), and
75% (Grade-IV). Significant proportion change in
different score grades before and after training was
assessed. The proportion of trainees who shifted from
lower grades to higher score grades was assessed using
McNemar’s test of significance.
Ethical approval
Ethical approval for the study was obtained from the
institutional ethics committee of National Institute of
Mental Health and Neuro Sciences.
RESULTS
We utilized the data of all 373 YPs who were trained.
The mean (±SD) age of YPs was 27.5 ± 3.3 years; the
majority (63.8%) were males, had completed (53.4%)
bachelor degree, and came from rural areas (77.7%).
A signifi ca nt improvem en t in kn ow ledge and
attitude (PZDVREVHUYHGDIWHUWKHWUDLQLQJ
Though an improvement in scores of practice domain
was observed, it was not statistically significant. All
the subgroups showed significant improvement in
Table 1: Session information and timings for each topic covered under Yuva Spandana
Days Topics Duration (min)
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Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020 185
knowledge (P DQG DWWLWXG H P
after the training. With regard to practice, only
postgraduates (P DQG UXUDO P <3V
demonstrated significant improvement [Table 2].
Level of knowledge [Table 3]: All 17 YPs who had scored
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score grades after training. Nearly 47% of these 17
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Similarly, 91% of all YPs in score Grades II and III
showed an increase to the next grade. Nearly 71% of
all YPs who were in Grade IV before training continued
to remain in Grade IV. Overall, 53.3% (199) of all YPs
showed an improvement in score grades after training,
36.1% continued to remain in the same score grades,
whereas the remaining (10%) showed down-shift in
score grades.
Level of attitude [Table 3]: Out of seven YPs who had
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showed improved score grades after training. Five of
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to 50%–74%. Similarly, 34 YPs who had score
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score grades after training. More than 70% of all YPs
with the score Grades II and III showed an increase to
next grade. About 83% of YPs who were in Grade IV
before training continued to remain in Grade IV.
Overall, 40% (149) of all YPs showed an improvement
in score grades after training, 50.6% (189) continued
Table3UHDQGSRVWWUDLQLQJWHVWVFRUHVRI<XYD3DULYDUWKDNDVDWWHQGLQJWUDLQLQJ
Domains and subgroups Pretraining (mean±SD) Post-training (mean±SD) “
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Banandur,
et al
(ႇHFWLYHQHVVRI<XYD6SDQGDQDWUDLQLQJ
186 Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020
to remain in the same score grades and the rest (9%)
showed downshift in score grades.
Level of practice [Table 3]: Two YPs who had score
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score grades after training. Both the YPs improved their
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of all YPs in score Grades II and III showed an increase
to next grade. Overall, 18.2% (68) of all YPs showed
improvement in score grades after training, 68% (254)
continued to remain in the same score grades and
rest (13.6%) showed downshift in score grades.
DISCUSSION
Overall, our study showed that YPs obtained requisite
improvement in knowledge and attitude related to
youth issues after the training. However, there was no
statistically significant improvement observed in the
domain of practical skills.
Develop ed in -line with the Karna taka Youth
Policy-2012, this unique program is probably the first
state-level program that looks at delivering youth health
promotion services by trained youth volunteers called
YPs. The concept of YS is in-line with the concept of
“homophily,”[8,9] which specifies that social contact
occurs at a higher rate among similar individuals than
among dissimilar individuals. This facilitates behavioral
change or adoption among youth.[10,11] Thus, training
youth as YPs is an appropriate investment towards
youth empowerment. Their training is expected to
Table 3: Change in knowledge, attitude and practice
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Pretraining Post-training
Grade I Grade II Grade III Grade IV Total
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indication of effectiveness of the training. ¶,QGLFDWHVRWKHUZLVH
directly and indirectly impact service delivery, client
satisfaction, and overall success of the program.
Hence, it is not only a crucial strategy of the program
but also a challenging one, as it involves translation
of a lay-volunteer to a semi-skilled service provider,
with sufficient quality to meet the service needs of
beneficiaries.
To achieve the same, the program utilized indigenous
modules that were developed through a systematic
and logical process. The process of developing modules
involved stakeholders and expert workshops consisting
of youth, parents, teachers, and professionals. Around
4,162 perso n-hours were expen ded to deve lop
ten modules.[7,11] The detailed process of module
development is available in a study conducted at
NIMHANS.[10] Structure, content, and mode of
training of all the 10 modules were finalized in the
expert workshops as well. The training was customised
to address cognitive (knowledge), affective (attitude),
and psychomotor domains (practice).
Majority of the YPs selected and trained under the
program were males. It is because of the ratio of 1:3,
which was followed for female and male to recruit YPs.
Knowledge level among the majority of the trainees
improved to better grades after the training. Many
training programs for various purposes generally
demonstrate an improvement in cognitive/knowledge
capacities.[12] Our training was particularly successful
in thi s aspect, as nearly 53.3% (n = 199) of
trainees reported improved knowledge levels. At
the same time, about 10% (n = 39) of our trainees
showed downgradation in knowledge level after the
training. Ideally, this should not happen. However,
in real-life situations, these things are likely. These
participants (whose grades got lower) were not selected
to work as YPs in the field. It is very true that a small
portion of trainees tend to remain same and may not
improve post training. Attitude change is a key thing
about behavior change, and it reduces knowledge,
attitude, and practice gap. Our study revealed that
about 40% of the trainees moved to better attitude
grades, and the majority (50.6%) remained in the same
grade post-training. A few trainees downshifted after
the training. Improvement is lesser as compared with
knowledge as attitudinal changes need some time to
manifest, unlike knowledge, and as attitude change
happens as a process. The finding was in consensus
with a study, which showed no significant improvement
on the aspect of emotional responses post-training.[12]
Individuals undergo a process of receiving information,
analyzing and synthesizing the same, and relate
the same to their life events. Some even conduct a
trial before they consider moulding their attitudes
Banandur,
et al
(ႇHFWLYHQHVVRI<XYD6SDQGDQDWUDLQLQJ
Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020 187
and behavior.[13] In addition, our classroom-based
assessment may not be reflective of the measurement
of the actual attitude change. It is likely that the
changes could be better observed in response to real-life
situations or cues rather than as rational responses to
the simulation events created for training.[14] The actual
improvement could have been much higher, but it is a
matter of speculation.
With regard to practical (psychomotor) skills, only
18.2% showed improvement post-training. Lack of
improvement in practical skills of trainees implies that
the schedule adopted for training was more knowledge
and attitude oriented rather than focused on the
practical skills required for an efficient delivery of YS
activities in their respective districts. This demands
the inclusion of sessions focusing on the practical
skills required for the efficient delivery of YS activities
in the districts. It might also be important to have
a component of handholding and supervision for
the trainees in the field. This is likely to ensure the
quality of services delivered under the program. From
this learning, a field training component to provide
practical exposure to trainees focussed on improving
their practical skills in delivering program activities
has been subsequently included. An Objectively
Structure Practical Examination (OSPE) method for
evaluating improvement in psychomotor skills may
be incorporated in the future in classroom training.
As assessment of psychomotor domain was done
immediately after training in a classroom setting, it does
not exactly reflect skill acquisition by trainees. This is
one limitation of this assessment. It has been planned to
repeat follow-up assessment to measure skills acquired
due to the training and experience.
Practical skills are expected to improve with handholding
and support in the field, which is currently in-built into
the program. A lesser improvement in practical skills
may be due to the timing of the post-test assessment,
which was done immediately after the classroom
training. Results might have been better if this was
conducted after a certain period of on-site training. We
also observed that the trainees who had postgraduation
or came from rural areas showed more improvement
in their practical skills compared with other groups.
This may be attributed to increased chances of being
connected to real-life experience compared with urban
areas as well as more years of experience in addressing
the adversities faced personally. However, there are no
data to support this argument.
The interview schedule utilized for the study had only
10 questions to explore all these three domains. Except
for face validation, we have not done any systematic
assessment on psychometric properties (testing) of the
tool we developed. Only the major aspects were covered
in the questionnaire. Hence, the results of this study
need to be interpreted keeping in mind this limitation.
Further, a few questions did not test attitude or skills;
rather, they tested “knowledge” about attitude and
skills. Another potential limitation of the study is the
absence of a control group.
This is the first evaluation of a training module for a
comprehensive mental health promotion model. The
training module developed was based on a desk review
and consultation of stakeholders, and experts. There
was no experience previously of such community
mental health promotion model in the country.
This assessment does not provide information on
expected frequency or contents of refresher training
nor anyway helps us to measure the quality of their
work in the field, after completion of the training.
This requires a longitudinal and objective assessment
of quantity and quality of work done by the trained
YPs. The digitized management information system
specifically developed for program YS is equipped
to provide such information, thereby providing
opportunities for such an analysis to be conducted
in the near future.
CONCLUSION
The training program was effective in improving
the requisite knowledge and attitude of YPs as lay
counsellors to provide youth mental health promotion
services in Karnataka under the program YS. It is
recommended that future training programs need to
be focused on creating opportunities to YPs in order
to increase their practical skills to work with youth
having issues. It is also recommended that the tools
for assessing the effectiveness of the training program
need to be strengthened, incorporating more measures
covering psychomotor domain assessment.
Acknowledgements
The authors would like to express their sincere gratitude
to the Department of Youth Empowerment and Sports,
Government of Karnataka for the constant direction,
support and funding for this program. The authors
would also like to sincerely thank all the resource
persons of training and trainees who attended.
Financial support and sponsorship
Department of Youth Empowerment and Sports,
Government of Karnataka and Centre for Public
Health, Department of Epidemiology, NIMHANS.
&RQÁLFWVRILQWHUHVW
There are no conflicts of interest.
Banandur,
et al
(ႇHFWLYHQHVVRI<XYD6SDQGDQDWUDLQLQJ
188 Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020
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