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CHAPTER-III METHODOLOGY

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Page 1: 12 CHAPTER 3shodhganga.inflibnet.ac.in/bitstream/10603/27566/12/12_chapter 3.pdfThe DMQ-R has 20 self-report items designed to determine the motives behind drinking behaviour ( Cooper,

CHAPTER-III

METHODOLOGY

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CHAPTER-III METHODOLOGY 75-96

3.1 Introduction 77

3.2 Objectives of the Study 78

3.3 Hypotheses of the Study 78

3.4 Scope of the Study 79

3.5 Methodology (Procedure) 80

3.6 Construction of Research Tools 81

3.7 Reliability and Validity of Research Tools 82

3.8 Sample for the study 86

3.9 Data Collection 87

3.10 Scoring Procedure 88

3.11 Statistical Techniques used in the Study 91

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Chapter – III

METHODOLOGY

3.1 INTRODUCTION

College students who have the habit of drinking alcohol are the designated population to

undergo an experimental psychosocial education. This is about the use of alcohol and related

problems, to investigate changes in their drinking motives. There are many factors which

influences the drinking habits of the students. We observe that adverse conditions favor students

to consume alcohol for timely relief. This condition can be avoided and other alternative

methods can be applied. Once the students habituate themselves with other alternatives, then it

may prove a life time success.

Approaching students was not an easy task but made it possible with good rapport with

them. Taking feasibility into consideration, this includes: Conducting individual sessions, time

management, and study materials suited for each individual (because each student is different in

their drinking motives and drinking pattern). The sessions mainly focused on building cognitive

behavioral skills to deal with alcohol misuse.

After addressing the factors and its associated questions, it’s very critical to conduct a thorough

review and synthesis of the knowledge. This knowledge search helped to determine the stage of

the science and how the study is proposing the extension to the present knowledge. All the

research tests have a new intervention or compare two interventions that have already been

supported as effective through the prior research. With a proper intention replicating a prior

intervention study is always good and acceptable; in fact, replication studies are needed in order

to generate systematic reviews, the strongest level of evidence (i.e., level 1 evidence) is needed

to change the clinical practice. (MelnykMazurek Bernadette &Beedy Morrison Dianne

2012)1.

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To put forward the message to students that ‘drink safely’ is not an easy task. To do so

the researcher took certain steps as follows.

3.2. OBJECTIVES OF THE STUDY

Keeping the purpose of the study in mind, the following specific objectives were

formulated.

• To give education about the real facts about when, how and why alcohol is a problem.

• To give relevant information on alcohol use among college students to understand the

myths about drinking and reduce their drinking habits to better life.

• To find out how far this psychosocial education can bring changes among college

students

The students, belong to the age 18 to 23, seemed to be vulnerable to alcohol problems

because they are unaware of the real facts about alcohol use. This study is to find out how far a

psychosocial education can help the students to understand the dangers of alcohol consumption

(Health hazards due to excess use of alcohol) and to find out the reduction in motives and

intake.

3.3. HYPOTHESIS OF THE STUDY

Hypothesis means what we predict about the relationships of the different variables or its

influences between them. The hypothesis is the one delineates how much expectation from the

experiments to impact the study’s outcome. Hypotheses are basically invested in research work

to establish the tests of statistical significance. In research work the intervention studies provides

the opportunity to have a profound impact on outcomes and the things that affect most in

research work. The researcher always aimed at developing and disseminating new knowledge to

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the work which the investigator finds from the investigation and that proves the experiences in

that particular work. The researcher incorporates very carefully the knowledge of so what, what

exists and what is the next step, all these factors for the study to remain relevant, focused and

effective. For designing, conducting, and analyzing the intervention work, these characteristics

are very critical.

The hypotheses are as follows

1. There are no significant differences between the graduate students of 1st year, 2nd year and

3rd year regarding effects of alcohol usage.

2. There is no significant relationship between alcohol consumption and their living conditions.

3. There may not be any significant difference between their age and alcohol drinking motives.

4. There may not be any significant relationship between family status and alcohol drinking

motives and misuse of alcohol.

5. There is no significant relationship with the type of course and alcohol drinking motives and

misuse of alcohol.

6. There is a significant association between psychosocial education in alcohol related problems

and change in the attitude towards drinking among students.

7. There is significant association between psychosocial education in alcohol related problem

and its effects in reducing alcohol misuse among college students

3.4 SCOPE OF THE STUDY

More males are affected by alcoholism than females in India. Recent surveys show that drinking

is increasing among the youth and women. Consumption of alcohol is apparently on the rise in

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India. The total alcohol consumption and prevalence of alcohol-related problems are high in all

the nations, especially in developing nations

Alcoholism takes away health, wealth, peace, relatives, friends and contaminates every zone of

human activity. It generates in the young lassitude and aimlessness in life and corrodes their

health, happiness and youthful dynamism. It is the need of the hour to deal with this problem. In

this study the researcher is trying to eliminate alcohol misuse from a small portion of college

students.

3.5. PROCEDURE

A permission was sought from the principal to carry out this study in the college with the

under graduate students. The data was collected for a period of one year (2011). To establish a

good rapport with the subjects it was assured that their responses and identities would be strictly

kept confidential and not disclosed anywhere. This conviction made them comfortable and

confident enough to give their answers frankly, honestly, and openly, whatever they felt. In this

way subjects were encouraged to give their proper cooperation during the testing. They were

willing to give written consent showing their readiness to participate in this research work. The

researcher promised that their participation in this study was confidential and the present study

was meant only for this particular research work. Next step was random selection of students,

who drank alcohol, into intervention groups. The researcher included those respondents who

fulfilled the study criteria and were available for data collection. After that questionnaires were

administered and provided psychosocial education. After education same questionnaires

administered to find out the efficacy of the education. This procedure continued with 225

students individually with in a period of one year.

The questions were carefully chosen according to the needs of the study. They were the

socio-demographic details of the students and the alcohol related information from the students.

Psychosocial education materials- Selected from various brief interventions in management of

individuals with alcohol-related problems

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The psychosocial education material chosen from the Brief Alcohol Screening and

Intervention for College Students (BASICS) (Dimeff LA, Baer JS, Kivlahan DR, Marlatt GA.

1999)2 and also from other educational books mainly concentrated on the following items.

• Definition, meaning and use of alcohol,

• What motivates drinking?

• Why we need to control the intake of alcohol?

• What is moderate drinking?

• Who are beneficiaries of moderate drinking?

• Alcoholism

• How alcohol intake affect physically, psychologically, socially economically?

• What are the preventive methods to reduce excessive drinking among college

students?

The implementation of the psychosocial education is expected to promote:

• Accurate knowledge about alcohol

• To reduce alcohol consumption in heavy drinkers

• To reduce alcohol-related negative consequences

• Healthier choices among college students regarding alcohol

• To improve coping skills for alcohol-related risk reduction

3.6 CONSTRUCTION OF THE TOOLS

After careful analysis of the nature of the study the researcher decided to use the following

tools to ascertain the accuracy of the data and have an objective evaluation. The reliability and

validity of this instrument has been documented in a wide range of international and national

settings, using college students, general population and clinical samples.

Data for the study was collected using:

Socio-demographic data sheet

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Contains Name, Gender, Age, Course and Year, College, whether currently living with the

family or not, Type of family and whether they belong to nuclear, extended or joint family

Standardized Questionnaires

Keeping in mind that the tools should be appropriate for the data the researcher discussed with

the guide and other senior professors in the field and from a thorough literature search provided

(Loucks-Horsley, S., Hewson, P., Love, N., and Stiles, K. 1998,3Yadav S.K.

2008,4MelnykMazurek Bernadette &Beedy Morrison Dianne 2012)1 the most suited

excellent tools for this research study among undergraduate students. Two of the following tools

were used, keeping in view that outlook, attitude, and behavior towards drinking is largely the

result of culture and environment, parents, peers, and others who play an important role in the

lives of young people. The tools are

Drinking Motives Questionnaire-Revised (DMQR ) and

Alcohol Use Disorders Identification Test (AUDIT)

The results are primarily depended on the data analysis from DMQR, AUDIT questionnaires

and socio demographic details. These tools were handed over to each student by the researcher.

The researcher took utmost care in explaining each question and clearing their doubts, before the

psychosocial education. Both Drinking Motives Questionnaire-Revised (DMQR) and Alcohol

Use Disorders Identification Test (AUDIT) questionnaires are widely used in college

population to assess their drinking and prepare for preventive measures to avoid alcohol misuse.

The researcher also found these questionnaires most suited for this study to assess the drinking

habits and prevent them from problem drinking. The education mainly stressed on the reasons

why they are motivated to drinking and the bad effects of drinking. The same questionnaires are

used again after the psychosocial education, to find out changes if any, in their attitude towards

drinking

3.7RELIABILITY AND VALIDITY OF THE RESEARCH TOOLS

Many studies have been under taken using these two tools, and in the previous chapter it is

clearly explained about its reliability

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3.7.1 Description of Drinking Motives Questionnaire-Revised (DMQR)

This questionnaire has 4 domains; each domain has 5 different kinds of motives for drinking.

Each Domain or sub-scale comprise drinking for different reasons (5 items), 1st sub-scale is

having 5 items for coping motives, 2nd 5 items for conformity motives, 3rd sub-scale is having 5

items for social motives, and the 4th sub-scale or domain is having 5 items for enhancement

motives. The respondents were required to answer what are the reasons behind their drinking in

a five point scale ranging from 1 (never) to 5 (always). Calculating the mean of the scores of

each sub-scale items revealed what motivated them for drinking. Evidences are available from

many of the research studies that the questionnaire’s psychometric properties and its reliability

and validity with an undergraduate population is good. (Stewart S H et al, 1996,5S.H. Stewart,

Chambers Laura 2000,6 Masayo Geshi et al, 2007, 7 Read et al. 2003)8

Measures

Drinking Motives Questionnaire-Revised (DMQ-R). The DMQ-R has 20 self-report

items designed to determine the motives behind drinking behaviour (Cooper, 1994).9

Constructed in line with the motivational model of alcohol use, the DMQ-R was validated

through confirmatory factor analysis and norm on adolescents 13 to 19 years old (Kuntsche, E.,

Knibbe, R., Gmel, G., & Engels., R. 2005)10 The DMQ-R measures four motives: social (e.g.,

‘How often do you drink to celebrate a special occasion with friends?’), conformity (e.g., ‘How

often do you drink to be liked?’), enhancement (e.g., ‘How often do you drink because you like

the feeling?’), and coping (e.g., ‘How often do you drink to forget your worries?’). Each factor is

represented by five items, to which respondents rate the relative frequency at which they

consume alcohol for that reason on a five point instrument (1 =never, 5 = always). High factor

scores reflect higher factor endorsement independent of alcohol consumption frequency

(Stewart et al., 2000).7(Cooper et al. 1992,11 Cooper 1994),12 with confirmation of the

reliability of the factor structure. (Grant et al., 2007).13

3.7.2 Description of Alcohol Use Disorders Identification Test (AUDIT)

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In the present study AUDIT is used to find out the frequency and quantity of alcohol use, the

possible occurrence of dependence and alcohol problems. These are the three main points upon

which the education depended.

. The AUDIT consists of 10 items that are rated on a 5-point Likert scale as follows:

1. How often do you have a drink containing alcohol?

Never; monthly or less 2-4 times a month; 2-3 times a week; 4 or more times in a week

2. How many drinks containing alcohol do you have on a typical day when you are drinking?

1; 2to 3; 4 to 5; 6; 7to9; 10 or more

3. How often do you have 6or more drinks on 1 occasion?

Never; Less than monthly; Monthly; Weekly; Daily or almost daily

4. How often during the past year have you found that you were not able to stop drinking once

you had started?

Never; Less than monthly; Monthly; Weekly; Daily or almost daily

5. How often during the past year have you failed to do what was normally expected of you

because of drinking?

Never; Less than monthly; Monthly; Weekly; Daily or almost daily

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6. How often during the past year have you needed a first drink in the morning to get yourself

going after a heavy drinking session?

Never; Less than monthly; Monthly; Weekly; Daily or almost daily

7. How often during the past year have you had a feeling of guilt or remorse after drinking?

Never; Less than monthly; Monthly; Weekly; Daily or almost daily

8. How often during the past year have you been unable to remember what happened the night

before because you had been drinking?

Never; Less than monthly; Monthly; Weekly; Daily or almost daily

9. Have you or has someone else been injured as a result of your drinking?

No; Yes, but not in the past year; Yes, during the past year

10. Has a relative, friend or a doctor or other health care workers been concerned about your

drinking or suggested you cut down?

No; Yes, but not in the past year; Yes, during the past year

This scale is developed by the World Health Organization to identify persons with

hazardous and harmful alcohol consumption as well as alcohol dependence. Though other self-

report instruments have been found to be useful, yet the AUDIT has the advantages of being

short, easy to use, and flexible in providing valuable information and feedback to people. The

above mentioned tool is consistent with ICD-10 definitions of harmful alcohol use and alcohol

dependence. It is valid in many countries and available in many languages.

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The AUDIT consists of ten questions. The first three items measure the quantity and

frequency of regular and occasional alcohol use. The next three questions ask about the

occurrence of possible dependence symptoms, and the last four questions inquire about recent

and lifetime problems associated with alcohol use. Quality assessment includes being able to

identify people with alcohol dependence but also people who are early-stage problem drinkers.

There are two types of early-stage problem drinkers, they being hazardous drinkers and harmful

drinkers. Hazardous drinkers have risky patterns of alcohol use but have not yet had any alcohol-

related problems. Harmful drinkers have either experienced physical or mental issues related to

alcohol but are not deemed to be dependent. The AUDIT was specifically designed to identify

hazardous and harmful drinkers. It was proposed that a combination of a brief interview, clinical

examination, and one or more laboratory tests may be the key in assessing dependence and early

stage problem drinking. The 10-item questionnaire (AUDIT) assesses alcohol consumption,

dependence symptoms, and personal and social harm related to drinking. The Core specifically

focuses on drinking and its effects over the past year in an attempt to identify persons with

relatively current problems. The frequency of occurrence of harmful behaviors and behaviors

related to dependence help differentiate the AUDIT from other assessment tools. Examples of

questions from the Core include “How often do you have a drink containing alcohol”? The

response to choose were – “Never or no drinks, once in a month or less , 2 or 4 times in a month,

2 or 3 times in a week, 4 or more than 4 times in a week” and “How often during the last year

have you failed to do what was normally expected from you because of drinking? The options

were – “Never, monthly once on less, Monthly more than once, Weekly once or more, Daily”.

Each multiple choice answers are assigned a score from 0-4. The AUDIT’s overall focus on

current or heavy problematic drinking is designed to identify persons appropriate for therapeutic

intervention. The core is simple and easy to administer. It takes participants approximately 5 min

to complete. Scores on the core range from 0-40, where 40 correlates with very problematic

drink behaviors. (Babor F. et al, 2001)14

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3.8 SAMPLES FOR THE STUDY

A sample is a small proportion of the population selected for observation and analysis.

The sample comprised 225 full time male under graduate students using purposive sampling

method. Only under graduate male students were selected as they were more in number and the

age group of 18 to 23 years falls in this group, that the researcher is interested in. It may be

noted that the boys are numerous in this category who are the habit of alcohol misuse. They

consume alcohol on various occasions than girl students. There selected population had boys

pursuing BCOM, BBM, and BCA, so the researcher selected 75 students from each year (1st,

2nd, and 3rd year) .There were 225 students in all who had the habits of alcohol misuse. The

following table may help to provide a clear picture in this regard.

A

A

All the 225 male students from different UG programme filled the questionnaires individually

and participated for a minimum of two hours sessions on alcohol related problems and

preventive measures. It took more than a year to finish all the 225 sessions with 225 students.

3.9 DATA COLLECTION

No. of

students

BCOM No. of

students

BBM No. of

students

BCA Total

students

25 1st year 25 1st year 25 1st year 75

25 2nd year 25 2nd year 25 2nd year 75

25 3rd year 25 3rd year 25 3rd year 75

Total students 225

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The sample collected from a universe of college students (3000 students from UG &PG)

studying from 2009 to 2011 in KristhuJayanthi CollegeBangalore,Karnataka using

convenience sampling method.

Target group: 225 male drinking students from the age group of 18 to 23, doing their UG course

for 3 years in KristuJayanti College, Bangalore, Karnataka India using purposive sampling

method.

Data Analysis

The collected data was edited, coded, tabulated, grouped and organized according to the

requirement of the study and then entered into SPSS (statistical package for social sciences) for

analysis. All data analyses were conducted with SPSS 17.0 Descriptive statistics such as

frequency distribution, percentage, mode and standard deviation were used for both

questionnaires before and after education. Paired t-test was used to compare DMQR and AUDIT

before and after psychosocial education. Chi-square tests and two analyses of variance

(ANOVAs) were used to examine the possible influence of socio-demographic variables on

DMQR & AUDIT before and after psychosocial education. The reported degrees of freedom

vary across these analyses. The impact of the education was assessed using t-tests, and chi-

square tests for categorical data. Since a large number of chi-square tests were conducted, a p-

value of 0.05 was taken to indicate statistical significance. Finally, p-values less than 0.05 were

considered statistically significant Two way analysis of variance (ANNOVA) and Pearson chi

square were used to compare DMQR and AUDIT with regard to drinking motives and alcohol

use and the influence of socio-demographic variables.

Ethical issues in consideration:

Proper consent and approval was taken from the respondents before administering the

questionnaires, and the responses obtained were kept confidential and have been used for

purpose of the present study only.

3.10 SCORING PROCEDURE

3.10.1 The Drinking Motives Questionnaire-Revised (DMQR)

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Contains 20 reasons why people might be motivated to drink alcoholic beverages. Participants

are rated on a 5-point Likertscale. The DMQR consists of 20 items that are rated on a 5-point

Likert scale as follows:

Almost

Never/Never

Some of the

time

Half of the

time

Most of the

time

Almost

Always/Always

1 2 3 4 5

The DMQR yields four primary scales. Description of the scales and item loadings are listed

below. Scale scores are calculated as the sum of respective items. No items are reverse scored.

Scale Name

(Abbr.) Description

Item

loadings

Social (SOC) This scale has items reflecting social motives for alcohol use. 3, 5, 11, 14,

16

Coping (COP) This scale has items reflecting coping motives for alcohol use. 1, 4, 6, 15,

17

Enhancement

(ENH)

This scale has items reflecting enhancement motives for alcohol

use.

7, 9, 10, 13,

18

Conformity

(CON)

This scale has items pertaining to external social pressures that

push an individual to conform and engage in alcohol use.

2, 8, 12, 19,

20

The measure yields in four scale scores reflecting different motives for drinking

(Kuntsche Emmanuel et al, 2009)15

3.10.2 Alcohol Use Disorders Identification Test (AUDIT)

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Each person is different in their drinking motives and drinking patterns. But scores from the

questionnaire we can analyze appropriate intervention based on their levels of risk. Commonly

used interventions and its corresponding scores from the questionnaire are as follows,

Risk Level Intervention AUDIT Score

Zone I Alcohol Education 0-7

Zone II Simple Advice 8-15

Zone III Simple Advice plus 16-19 (Brief Counselling and Continued

Monitoring)

Zone IV Referral to Specialist 20-40 (Diagnostic Evaluation and Treatment)

The AUDIT cut-off score may vary slightly depending on the drinking patterns prevailing

in a country, the alcohol content of standard drinks, and the nature of the screening program. In

the present study also the researcher used AUDIT exactly in the above mentioned way. The

AUDIT was developed under the guidelines of the World Health

Organization (WHO) and has become the main instrument used to identify

the risk and the problems of the alcoholic drinkers. It has high specificity and

sensitivity across wide cultural and social spectrum. It has a simple scoring scale and can be

completed by the patient/client.

Patter of Scoring

• Questions 1 to 8 scores are from left to right – 0, 1, 2, 3, 4.

• Questions 9 and 10 scores from left to right – 0, 2 and 4. Total Range 0 to 40.

1. Total scores of 8 or more are recommended as indicators of hazardous and harmful

alcohol use, as well as possible alcohol dependence.

2. People with scores of 15 or more may be considered prime candidates for a diagnosis of

alcohol dependence.

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More detailed interpretation of a patient’s total score may be obtained by determining the

questions on which the points were scored.

• Questions 2 or 3 – a score of 1 or more indicates consumption at a hazardous level.

• Question 4 to 6 – Points scored above 0 (especially weekly or daily symptoms) imply the

presence or beginning of alcohol dependence.

• Questions 7 to 10 – Any points scored indicate that alcohol-related harm is already being

experienced.

The final two questions should also be reviewed to determine whether patients give evidence of a

past problem (i.e., yes, but not in the past year). Even in the absence of current hazardous

drinking, positive responses on these items should be used to discuss the need for vigilance by

the patient.

The four levels of risk and corresponding AUDIT scores shown in are presented as general

guidelines for assigning risk levels based upon AUDIT scores. They may serve as a basis for

making clinical judgments to tailor interventions to the particular conditions of individual

patients. This approach is based upon the premise that higher AUDIT scores are generally

indicative of more severe levels of risk. The cut-off points, however, are not based on sufficient

evidence to be normative for all groups or individuals. Clinical judgment must be used to

identify situations in which the total AUDIT score may not represent the full risk level, e.g.,

where relatively low drinking levels mask significant harm or signs of dependence. Nevertheless,

these guidelines can serve as a starting point for an appropriate intervention. If a patient is not

successful at the initial level of intervention, follow-up should yield a plan to step the patient up

to the next level of intervention.

Some people needs just one session of awareness program to deal with their drinking. Who score

in the range eight to fifteen needs just simple counselling which can provide them with stay on

with the limits and if they exceed the limits alcohol can harm them. They also should be aware of

who can normally drink, if any medical or other conditions, they are advised not to drink, and

then they have no choice they have to stay away. Normal people can drink at low levels but they

should see to it they don’t exceed the limits.

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The drinking limits should take into account both the typical quantity per week (AUDIT

questions 1 and 2) as well as frequency of heavy drinking (intoxication) episodes (AUDIT

question 3). A brief intervention is appropriate for those drinking above the weekly low-risk

limit, even if they are not experiencing harm. Some may not drink frequently but when they

drink, they drink 6 or more drinks at a time. This can cause harm to the person or he may harm

others. The important point to remember is that each person is different in their drinking and the

intervention also should concentrate on this point. (Babor F. et al, 2001)14

3.11 STATISTICAL TECHNIQUS USED

The details of the analysis used are presented here. The types of analysis used are

a) Simple arithmetic mean

b) Standard deviation

c) Simple corrélation

d) 't' Statistics

e) Chi- square

f) ANOVA

g) Regression Analysis

a. SIMPLE ARITHMETIC MEAN

Simple arithmetic mean otherwise called the centre of gravity or Location parameter or

the measure of the central tendency denoted by x is computed by the formula.

xi/nx ∑=

Where n, is the size of the sample, i varying through all the measured observations. This

is used to know the central tendency of each one of the variables considered.

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b. Standard deviation

The measure of dispersion denoted by s is used to find how the different observations in

each one of the variables used in the study varies around the centre of the distribution. This is

computed by the formula.

S = ( )2xxin

1 −∑

c. Simple Correlation

Simple Correlation is used to find the association or strength of relation between pairs of

variables. It is computed by the formula

r = ( )( )yyxx1

n−−∑ ( S.D of x. S.D. of y)

Where S.D stands for Standard Deviation

r is tested by the formula t = r 2r1/2n −−

d. 't' Statistic

The students’t’ or the’t’ statistic is used to test the significance of the difference between

pairs of means. The’t’ statistic is

t=( )

+

−+

+−

2221

2

22

2

1121

n

1

n

1

2nn

snsnxx

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Where 1x and 2x are the means of the two variables s1 and s2 are the standard

deviations of the two variable n1 and n2 are the number of observations in each.

Paired t test statistic, t = d/s/√n-1

e. Chi square test statistic, ∑[ (O – E)2/E] to find the presence of any relation between two

attributes.

f ANOVA

ANOVA or an analysis of variance is used to test the difference of several means and

also to test the overall effect of the different methods with respect to gender and medium.

g. Regression Analysis

Regression analysis is a powerful and flexible procedure for analyzing associative relationship

between one dependent variable and one or more independent variables. It can be used to

1. Determine whether the independent variables explain the variability in the dependent variable;

whether the relationship exists.

2. Predict the values of dependent variable.

3. Determine the structure and form of relationship.

Determine how much variation in the dependent variable can be explained by the independent

variable

Here Computation was done with the help of SPSS package.

After the data analyses were over, the relevant tables and charts are discussed in the

Chapter- IV and the results of the study are also presented in the following chapter.

Page 21: 12 CHAPTER 3shodhganga.inflibnet.ac.in/bitstream/10603/27566/12/12_chapter 3.pdfThe DMQ-R has 20 self-report items designed to determine the motives behind drinking behaviour ( Cooper,

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