|Year : 2019 | Volume
| Issue : 4 | Page : 267-272
Impact of single classroom-based peer-led organ donation education exposure on high-school students and their families
Lakshya Aggarwal1, Smita Mishra2, Manish Agrawal3, Dheeraj Shah4
1 Class 11, Arwachin International School, Delhi, India
2 Department of Pediatric Cardiology, JP Hospital, Noida, Uttar Pradesh, India
3 Department of Pediatrics, Saraswathi Institute of Medical Sciences, Hapur, Uttar Pradesh, India
4 Department of Pediatrics, University College of Medical Sciences and GTB Hospital, Delhi, India
|Date of Submission||01-Jul-2019|
|Date of Acceptance||26-Nov-2019|
|Date of Web Publication||31-Dec-2019|
Dr. Manish Agrawal
Department of Pediatrics, Saraswathi Institute of Medical Sciences, Hapur - 245 304, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Aims: The aim of the study is to assess the impact of single classroom-based, organ donation education session by high-school students on improvement in knowledge and intent to donate organs in their peers and their families. Settings and Design: Quantitative interventional study with before-after design done in high-school sections of two private schools of Delhi in July and August 2018. Subjects and Methods: Participants were all 1583 high-school students present on the day of activity. Organ donation education was provided by 30-min presentation in individual classrooms, along with distribution of frequently asked questions booklet on organ donation by 44 self-motivated high-school students to the peers. We collected pre- and post-intervention questionnaire and family interaction feedback responses from participants, within 1 week before, on intervention day and 3 weeks after it. Main outcome measures were improvement in students' knowledge, intent to donate, family discussion, and actual organ donor pledge registrations. Results: There was a significant improvement in students' knowledge (mean scores increased from 9.16 to 13.91 [P = 0.000]). Significantly increased (P = 0.000) proportion of students had positive intent to donate (66.9% vs 80.9%) and wanted to encourage their family members for organ donation (72.6% vs 87.2%) after the intervention. 1144 (84.2%) students reported discussion in their families, 250 (18.4%) students' families planned to take, and 67 (4.9%) families (one or more persons) actually took organ donor pledge after the intervention. Conclusions: The educational intervention by peers, instead of health-care personnel, led to significant improvement in high-school students' knowledge, intent to donate, family discussion, and actual organ donor pledge registrations.
Keywords: Educational intervention, organ donor pledge, organ transplantation, peer education
|How to cite this article:|
Aggarwal L, Mishra S, Agrawal M, Shah D. Impact of single classroom-based peer-led organ donation education exposure on high-school students and their families. Indian J Transplant 2019;13:267-72
|How to cite this URL:|
Aggarwal L, Mishra S, Agrawal M, Shah D. Impact of single classroom-based peer-led organ donation education exposure on high-school students and their families. Indian J Transplant [serial online] 2019 [cited 2020 Feb 25];13:267-72. Available from: http://www.ijtonline.in/text.asp?2019/13/4/267/274603
| Introduction|| |
Organ transplantation is the only alternative which provides improved quality renewed life to end-stage organ failure patients nearing death. Deceased organ donation rate in India, as well as some other countries, is abysmally low as compared to the needs.,, Lack of awareness, religious beliefs and superstitions, and family's opinion significantly influences the individual's personal decision for deceased organ donation and filling of organ donor pledge.
The educational interventions on adolescents have the potential to not only improve their knowledge at right age but also trigger the family discussion on the forbidden topic of deceased organ donation in our society, which can have greater impact on actual organ donation rates.,,, Organ donation educational intervention studies done in different countries on adolescent students have shown variable impact on their intent for organ donation.,,,, Most such studies have imparted organ donation education through health-care professionals, organ donor family members, and/or organ transplant recipients. Peer-led educational intervention has been shown to have better response than nonpeer-led intervention in imparting healthy nutrition education in school students. We aimed to study the impact of high-school organ donation awareness education on knowledge and intent for deceased organ donation in students, discussion with their family members, and actual organ donor pledge registrations by using a novel approach of imparting education by the peer high-school students.
| Subjects and Methods|| |
This interventional study with before-after design was carried out in July and August 2018, in two private schools of Delhi, India.
All high-school students (grade 9–12), present on the day of intervention, from two schools located in East Delhi, were enrolled as participants. A team of four self-motivated high-school students was formulated under the leadership of first author to conduct the study activities. A PowerPoint presentation of 42 slides was prepared by the team of students to impart knowledge about various aspects of deceased organ donation in nonconvincing manner. The slides contained information about organ donation and transplantation, difference between living and deceased organ donation, one short real story of a donor and a recipient, brain stem death and its certification, myths clearing, and organ donor pledge registration process. Students used this presentation to impart knowledge during intervention in both the schools.
An anonymized questionnaire consisting of three parts was designed by the team of students. It included the demographic data; multiple-choice single correct response-type questions on awareness, knowledge, perception, and beliefs of organ donation, transplantation, and brain death; and questions on intent to fill donor registration form and intent to encourage their family members for organ donation. The same questionnaire was used for the collection of pre- and post-intervention anonymous responses from the participants.
A frequently asked questions (FAQ) booklet, based on the information given in presentation, was prepared for distribution to the participants after the presentation to help them discuss the subject matter with their family members, relatives, and friends at home. A copy of Form-7, organ donor registration form of competent authority, was provided to all the participants along with the booklet for their perusal. A family interaction feedback form, to collect information about family's response after interaction at home, was also prepared by the team of students. It contained questions on: occurrence of discussion with family; family's response to discussion; any family member already taken organ donor pledge before the activity, planned to take, and took organ donor pledge after the activity. The questionnaire, FAQ booklet, presentation for imparting education and family interaction feedback form as well as study protocol were prepared in consultation and final approval of a team of senior pediatric cardiologist, pediatrician, and clinical psychologist.
As described in [Figure 1], preintervention questionnaire response was collected from all the high-school students of first school within 1 week prior to the intervention day. The participants were informed verbally about the study prior to filling of preintervention questionnaire that day. The data gathered in preintervention questionnaire depicted the baseline awareness and intent to donate in our study participants. The students carried out the educational intervention individually per se ction, in all 14 sections of the first school, in 1 day (in four slots of 1 h each). The intervention consisted of 30 min of PowerPoint presentation through multimedia projectors in the classrooms, followed by 10 min for questions and answers to address participants' queries. Thereafter, participants completed responses in the postintervention questionnaire in 10 min. After that, the FAQ booklet and one form-7 for family interaction was distributed to each participant. More volunteers from different classes of first school were sought to join the team to conduct further campaign in second school. Three weeks after the intervention day, responses on the family interaction feedback forms were collected from the students who were present on the intervention day.
The team conducted 1-h workshop to train additional student volunteers to do similar activity in the second school. Same sequence of events was followed in second school as explained above for first school except that on intervention day, all student volunteers simultaneously carried out sessions individually or in pairs per se ction (they completed activity in all sections in 1 h that day).
The study has been approved by the Institutional Review Board of Arwachin International School with waiver of consent (AIS-01/18-19) and also by the Ethics Committee of Saraswathi Institute of Medical Sciences (SIMS/EC/2019/02/08). Participants understand that the names, initials would not be published, and all standard protocols will be followed to conceal their identity.
In questionnaires, one mark was awarded for each correct and zero for wrong response. We used mean and standard deviations to represent continuous data such as age and total marks obtained, and percentages to describe categorical data such as response to individual questions and other demographic parameters. Unpaired Student's t-test was used to compare continuous variables in pre- and post-intervention data, as it was not possible to do paired t-test due to the anonymous nature of our data. Proportions were compared with Pearson's Chi-square test. Odds ratio and 95% confidence intervals were calculated to see the association between participants' responses to questions and their grades. IBM SPSS Statistics for Windows, Version 25.0. IBM Corp., Armonk, NY, USA was used for data analyses.
| Results|| |
We included 1583 students (400 and 1183 from school 1 and 2, respectively) in the study. The participants were studying common curriculum in 9th and 10th grades and subjects like Science (Math), Biology and Humanities in 11th and 12th grades. There were average 29 and 38 student participants per classroom in first and second school, respectively. Out of 1583 participants who filled preintervention questionnaire, 1421 were present on intervention day and attended the presentation and filled the postintervention questionnaire. Out of these, 1358 students completed the family interaction feedback forms. [Table 1] presents the demographic details of participants in various phases of the study. There was no evidence of any significant difference between three phases for any of these parameters.
|Table 1: Demographic details of the participants (preintervention, postintervention, and family interaction feedback)|
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The comparative result of answers to pre- and post-intervention questionnaire of the participants is presented in [Table 2] and [Table 3]. The awareness about deceased organ donation was low in our study participants which improved significantly after the educational intervention as shown by increase in proportion of correct responders for the questions in the questionnaire. The proportion of students who scored more than and equal to 10 questions correctly increased from 46.1% to 95% after the intervention (P = 0.000). The mean score also increased significantly from 9.16 to 13.91 (P = 0.000).
|Table 2: Analysis of responses to questions before and after the intervention|
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|Table 3: Analysis of responses to individual questions before and after the intervention|
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The participants' intent to fill organ donor registration form was 66.9% before the intervention and the proportion of participants significantly (P = 0.000) increased to 80.9% after educational intervention. Similarly, the proportion of students, who wanted to encourage their family members for organ donation, increased significantly from 72.6% to 87.2% after the educational intervention (P = 0.000).
Class-wise analysis of the responses [Table 4] revealed that the improvement in mean score for awareness questions and increase in proportion of students, who wanted to encourage their family members for organ donation, was statistically significant individually for every class, but the best response was seen for students of Class 11. Similarly, the increase in proportion of students with positive intention for organ donor registration was statistically significant individually for every class, but the best response was seen for students of Class 9.
|Table 4: Class-wise analysis of scores obtained before and after the intervention|
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In family interaction feedback form, 1144 (84.2%) students reported having discussion on organ donation in their home after our educational intervention. The family's response to discussion was reported to be “very positive” in 142 (10.5%), “positive” in 485 (35.7%), and “neutral” in 600 (44.2%) student families. 82 (6%) of students reported that one or more of their family members or relatives had already registered their organ donor pledge before our activity. 250 (18.4%) students reported that one or more of their family members had planned to take organ donor pledge after the activity and 67 (4.9%) students reported that one or more of their family members had registered their organ donor pledge after our activity. Out of these 67 student families, 25 people of 18 families submitted their duly filled organ donor pledge registration forms (form-7) with us for submission to authorities and rest others filled their organ donor pledge registration forms online.
| Discussion|| |
In this study, we examined the impact of deceased organ donation awareness education by peers (student-to-student education model) on knowledge and intent for organ donation in high-school students, discussion with their family members, and actual organ donor pledge registrations. The knowledge about deceased organ donation in our study population was low, which improved significantly after the educational intervention conducted by peers. The improvement in knowledge also led to increase in the intent to donate in students, and their willingness to encourage their family members for organ donation, with impact being better in Class 9 and 11. Majority of our participants reported family interaction, which led to actual organ donor pledge determinations and registrations in their families.
Limitations of our study were that we could not carry out one-to-one pairing of responses in preintervention, postintervention, and family interaction feedback due to anonymous response collection procedures; and we could not track the entire donor registrations as most of them were reported to be done online. Although we appealed and assumed the responses to be truly representing the responder's feelings, since our study was questionnaire-based, there remains a scope of bias.
Despite various government and nongovernment organizations working to encourage organ donation in society, the deceased organ donor rates are poor in India and other countries worldwide.,, Panwar et al. in their survey found that poor deceased organ donation rates in India are due to lack of awareness (80.1%), religious beliefs and superstitions (63.4%), and lack of faith in health-care system (40.3%) in our population. Our study participants' knowledge and awareness about deceased organ donation was also poor. The poor knowledge in high-school students could be due to lack of adequate formal education about organ donation and transplantation in their curriculum and also due to poor reach to them of awareness campaigns done in society, as most of them are targeted to the adult population.
Similar to our findings, Milaniak et al. also reported that after their 45-min educational intervention on organ donation, by transplant coordinator, transplant recipients, and donor family on 680 high-school students, more than 80% students were willing to donate their organs after their death. The advantage of increased awareness in high-school students about organ donation is that it increases the chances of family discussion on this forbidden topic. Earlier studies have also reported that 70% and 58% students, respectively, were likely to discuss the topic with family members after their educational interventions, on organ donation and transplantation, general or specific to kidney transplantation, done by trained adult volunteers or doctors, on high-school students (adult-to-student education model)., Better response in terms of discussion with family members in our study could be due to education by peers (student-to-student education model). Yip et al. also in their review of nutrition education programs done in schools found that peer-led education programs had improved outcomes in students toward healthy eating as compared to nonpeer-led education programs. Family discussion leading to their awareness about various aspects of deceased organ donation is very critical in success of any awareness program on deceased organ donation in society. Panwar et al. in their survey found that family's opinion was important in 88.4% respondents' decision regarding organ donation and 40.9% would change their opinion if not supported by their families. Family's understanding of individual's wish for deceased organ donation is also important as the consent of next of kin is mandatory for actual organ donation after death of the individual. The response of family discussion in our study was reported to be positive or very positive in 46.2% of student families which corroborates with the findings of an earlier study by Waldrop et al.
| Conclusion|| |
We conclude that classroom-based peer-led (student-to-student) organ donor education exposure to high-school students leads to significant improvement of students' knowledge, intent to donate, intent to encourage family members, family discussion about it, and families' organ donor pledge registrations. Educating high-school students has a potential to indirectly improve their family members' thinking about organ donation and thus creating positive impact on our society. Including organ donation and transplantation education in regular classroom educational curriculum of high-school students may lead to increased peer to peer interaction on the topic of organ donation which like in our study may serve as the catalyst for family discussion and may potentially change the beliefs of not only high-school students but also their families and thus whole society for organ donation. Future studies should assess the impact of the formal classroom education on deceased organ donation and transplantation so that educational authorities in India and other countries may decide to include or optimize the education on organ donation and transplantation in regular school curriculum in high-school classes and thus bring long-term change in thinking of our society related to deceased organ donation.
We are thankful to Mr Arun Sharma, Director, Arwachin International School (AIS), Dilshad Garden, for his support and encouragement in execution of the project. We are thankful to Mrs. Sangita Sharma, Headmistress and coordinator at AIS for her crucial support, guidance, and help in conducting this work in both the schools. We are thankful to Shreet Agrawal, Pranav Parashar, and Aditya Bhatt (student volunteers) for being part of primary students group and helping in execution of the study.
We are thankful to Payasuni Charitable Trust, New Delhi, and Indian Academy of Pediatrics Delhi State Branch, New Delhi, and their office bearers for supporting the project and providing required sponsorship for the materials used.
Financial support and sponsorship
The study was funded by Payasuni Charitable Trust, New Delhi and Indian Academy of Pediatrics Delhi State Branch, New Delhi.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Srivastava A, Mani A. Deceased organ donation and transplantation in India: Promises and challenges. Neurol India 2018;66:316-22.
] [Full text]
Tamuli RP, Sarmah S, Saikia B. Organ donation – “Attitude and awareness among undergraduates and postgraduates of North-East India”. J Family Med Prim Care 2019;8:130-6.
] [Full text]
Shroff S. Legal and ethical aspects of organ donation and transplantation. Indian J Urol 2009;25:348-55.
] [Full text]
Panwar R, Pal S, Dash NR, Sahni P, Vij A, Misra MC. Why are we poor organ donors: A survey focusing on attitudes of the lay public from Northern India. J Clin Exp Hepatol 2016;6:81-6.
Cantarovich F. The role of education in increasing organ donation. Ann Transplant 2004;9:39-42.
Cantarovich F, Cantarovich D. Education and organ donation: 'The unfinished symphony'. Transpl Int 2012;25:e53-4.
Li AH-T, Rosenblum AM, Nevis IF, Garg AX. Adolescent classroom education on knowledge and attitudes about deceased organ donation: A systematic review. Pediatr Transplant 2013;17:119-28.
Anantachoti P, Gross CR, Gunderson S. Promoting organ donation among high school students: An educational intervention. Prog Transplant 2001;11:201-7.
Cárdenas V, Thornton JD, Wong KA, Spigner C, Allen MD. Effects of classroom education on knowledge and attitudes regarding organ donation in ethnically diverse urban high schools. Clin Transplant 2010;24:784-93.
Reubsaet A, Brug J, Nijkamp MD, Candel MJ, Van Hooff JP, Van Den Borne HW. The impact of an organ donation registration information program for high school students in the Netherlands. Soc Sci Med 2005;60:1479-86.
Shu J, Fok T, Mussen L, Mohamed M, Weernink C, Abbott C, et al
. Impact of the educational resource one life …many gifts on attitudes of secondary school students towards organ and tissue donation and transplantation. Transplant Proc 2011;43:1418-20.
Smits M, Van Den Borne B, Dijker AJ, Ryckman RM. Increasing Dutch adolescents' willingness to register their organ donation preference: The effectiveness of an education programme delivered by kidney transplantation patients. Eur J Public Health 2006;16:106-10.
Yip C, Gates M, Gates A, Hanning RM. Peer-led nutrition education programs for school-aged youth: A systematic review of the literature. Health Educ Res 2016;31:82-97.
Girlanda R. Deceased organ donation for transplantation: Challenges and opportunities. World J Transplant 2016;6:451-9.
Milaniak I, Przybylowski P, Wierzbicki K, Sadowski J. Organ transplant education: The way to form altruistic behaviors among secondary school students toward organ donation. Transplant Proc 2010;42:130-3.
Piccoli GB, Soragna G, Putaggio S, Mezza E, Burdese M, Vespertino E, et al
. Efficacy of an educational programme for secondary school students on opinions on renal transplantation and organ donation: A randomized controlled trial. Nephrol Dial Transplant 2006;21:499-509.
Rosenblum AM, Horvat LD, Siminoff LA, Prakash V, Beitel J, Garg AX. The authority of next-of-kin in explicit and presumed consent systems for deceased organ donation: An analysis of 54 nations. Nephrol Dial Transplant 2012;27:2533-46.
Waldrop DP, Tamburlin JA, Thompson SJ, Simon M. Life and death decisions: Using school-based health education to facilitate family discussion about organ and tissue donation. Death Stud 2004;28:643-57.
[Table 1], [Table 2], [Table 3], [Table 4]