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CHAPTER-III
METHODOLOGY
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
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.
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
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
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
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
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
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)
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
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.
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
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
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)
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)
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.
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.
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.
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
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.
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