Knowledge and Attitude of Students Towar

Knowledge and Attitude of students towards mental illness 1
ASMARA COLLEGE OF HEALTH SCIENCE
DEPARTMENT OF NURSING
RESEARCH PAPER
Title KNOWLEDGE AND ATTITUDE OF ASMARA COLLEGE OF HEALTH SCIENCES

STUDENTS TOWARDS MENTAL ILLNESS _IN ASMARA
February, 2012
BY:
Aman Shishay 08/014
Merhawi Teklemichael 08/086
Teklu Tsegai 08/158
Tesfaalem Tewelde 08/159
ADVISORS:
Mr. MOHAMMED HAMID M.Sc. PSYCHIATRIC NURSING
Mr. N. ARASU MANI M.Sc. PSYCHIATRIC NURSING
1
Knowledge and Attitude of students towards mental 2
ABSTRACT
Background: Mental illness is the term used to describe a broad range of mental and emotional
conditions. It is also used to refer mental impairments other than mental retardation, organic brain damage
and learning disabilities. In Eritrea the prevalence of mental illness is estimated that at least 280,800
people are likely to be affected by mental disorder. Approximately 64,800 people are likely to be
suffering from a severe mental disorder and a further 216,000 (10% of the adult population) from
moderate to mild mental disorder. The most commonly diagnosed mental illness in Saint Marry
Psychiatric Hospital from 2003 to 2008 were Epilepsy, Psychosis, Mood disorders, Neurotic stress and
somatoform disorders, Mental retardation, Dementia, Alcohol related Mental health disorders , Substance
abuse related Mental health disorders and others.
Objective: To investigate the knowledge and attitudes of college students toward mental illness.
Methods : In determining the knowledge and attitudes of the students towards mental illness, the research
design was a descriptive, crossectional survey, with a quantitative approach conducted on February 2012.
An adjusted, existing questionnaire, with, self-compiled, closed ended questions, was used to collect data.
Reliability was supported by a pilot study to test the questionnaire beforehand. Face and content validity
focused on readability, clarity and development of the questionnaire. The ethical principles were used to
make sure the rights of participants were protected. The ethical approval was obtained from ethical
committee of ACHS with reference #.......... Students were divided in to four groups namely: Nursing,
Public Health, Pharmacy and CLS. Data were collected by the researchers and entered in to a data base
EXCELL first and was converted to SPSS version 16.0 to be analyzed by a means of descriptive and
inferential statistics.
Result : The results were presented in tables of means and standard deviation, in which each variable had
its own table of analysis of variance. The results were as follows; knowledge about mental illness was
very good, but majority of the students didn‟t know the types of mental illness especially epilepsy and
drug abuse. Overall students have very good knowledge with a total score of 14.96 (±2.261) out off 18.
The total score of students towards attitude 84.89 (±9.48) from 109 shows students have good attitude
towards mental illness. Nursing (r=0.218, p=0.000) and Public Health students (r=0.557, p=0.049) have
positive correlation between knowledge and attitude in which weak and moderately positive correlation
respectively for each. Pharmacy (r=-0.012, p=0.968) and CLS (r=-0.177, p=0.528) students have good
knowledge, but negative attitude as it was indicated by the results which shows a negative correlation of
CLS (moderately negative correlation) and Pharmacy students (strong negative correlation) with overall
correlation of r=0.406, p=0.000.
Conclusion : Generally nursing and public health students had very good knowledge and positive
Attitude, but Pharmacy and CLS students have less knowledge and Attitude.
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ACKNOWLEDGEMENT
First of all, we would like to thank and praise God Almighty for giving us the strength, power and
courage to complete our studies. It is a great pleasure and honor to present you our first paper. This
would have not been possible without the support and participation of all of you who have traveled with
us on this journey.
The researchers are indebted to many individuals and the ACHS institution for a stimulation and
challenge. Only a few can be acknowledged in the brief space available to us.
No acknowledgement page would be complete without offering our deepest thanks to God who brought
us closer to on understanding of the most profound depth of human experience which is determination
and devotion.
We join every reader of this paper, in thanking Our advisors who shared a lot with us during this thesis;
for their guidance, patience, teaching and encouragement Mr. Mohammed Hamid MSc. Psychiatric
Nursing and Mr. N. Arasu Mani. MSc. Psychiatric Nursing,. , our remarkable advisers, for the original
knowledge which open in every page. We gratefully thank Mr.Ving for his support and guidance
throughout the study.
Mr. Ghirmay the Head of Department; for his care during our adjustment.
Mr. Zereabruk Tesfamariam, dean of the college for giving us detailed information about ACHS.
The final degree students and All staff of ACHS for their patience, tolerance and cooperation on the
process of data collection, which gives this research paper its unique characteristics.
And by way of conclusion the inevitable worry, if we have missed some one important in this lengthy
acknowledgement, we offer our humblest apologies. And to our many readers, thank you for spending
your time to read our first contribution research.
Table of contents pages
CHAPTER ONE…...........................................................................................................1
3
1. Introduction…..................................................................................................................1
1.1 Background…………………………………………………….
……………………………………………………1
1.2 Operational
definitions…..................................................................................................................................2
1.3 Problem statement.............................................................................................................................2
1.4 Significance of the

study...................................................................................................................................3
1.5Objectives............................................................................................................................................3
1.5.1 General......................................................................................................3
1.5.2 Specific…..........................................................................................................4
Assumptions................................................................................................4
CHAPTER
TWO.....................................................................................................................................5
2. Literature review...............................................................................................................5
CHAPTER THREE...........................................................................................................................11
3. Methodology........................................................................................................................11
3.1 Study area...........................................................................................................................11
3.2 Study population….................................................................................................................11
3.3 Study design……………………………………………………………………………………

11
3.4 Sample design…...................................................................................................................v
3.5 Data analysis…......................................................................................................................11
3.6 Ethical consideration................................................................................................................12
5. References............................................................................................................................14
4
List of Tables and Figures
Table 4.1:................................................Basic demographic characteristics of respondents
Fig 4.1...................................................................................................................shows gender proportion.

Fig 4.2….............................................Shows frequency of the students based on the departments. Fig
4.3…………………………….... Shows the proportion of students with the correct responses to the
question “How much do you know about mental illness?
Table 4.2……………………………… Shows the proportion of answers given to the source of

knowledge about mental illness.
Fig 4.4…......................shows the proportion of students with respect to the sources of their knowledge.
Table 4.3…… Shows the proportion of students with the correct responses to the knowledge questions.
Fig 4.5 ………………………Shows Proportion of students with the correct responses to the question,
“What are the types of mental illness?”
Fig 4.6….............Shows the proportion of students with the correct responses to the question.
“What are the causes for mental illness?”
Fig 4.7…................................Shows the proportion of students with the correct responses to the question,
“Does most mental illness can be treated like the medical problems?”
Fig 4.8…................................Shows the proportion of students with the correct responses to the question
“Is hospitalization for treatment of mental illness effective?”
Fig 4.9....................................Shows the proportion of students with the correct responses to the question
“Can a person who recovered from mental illness continue his occupation?”
Fig 4.10…...............................Shows the proportion of students with the correct responses to the question
“Can homecare help in recovery of mentally ill person?”
Fig 4.11….............................Shows the proportion of students with the correct responses to the question,
“Are you aware of some physical symptoms (like pain) in mentally ill persons without any physical
cause?”
Fig 4.12…...............................Shows the proportion of students with the correct responses to the question
“Does Mental illness only affects adults?”
Fig 4.13.................................Shows the proportion of students with the correct responses to the question,
“If known psychiatric patient murders somebody does he/she is not criminally responsible?”
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Fig 4.14….............................Shows the proportion of students with the correct responses to the question
“How many psychiatric hospitals do we have in Eritrea?”
Fig 4.15…............................Shows the proportion of students with the correct responses to the question,
“Does a mentally ill person qualified for casting vote?”
Table 4.4………………………………… Shows Mean and Standard deviation of attitude of students

towards mental illness based on their departments.
Table 4.4.1….....................................Shows Mean and Standard deviation of a questioner measuring

Attitude on Integrating people with mental illness to the community of students towards mental illness in
specific Departments.
Table 4.4.2..........................Shows Mean and Standard deviation of the questioner measuring Attitude on
Understanding and Tolerance of Mental Illness in students with specific Departments .
Table 4.4.3…………………… Shows Mean and Standard deviation of attitude of students towards
mental illness in specific Departments and total score.
Table 4.4.4………………. Shows correlation of knowledge and attitude of students with in the
departments.
Table 4.4.5…..........................................................shows the scores of knowledge in terms of mean and

standard deviation of the students in the departments.
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ACRONYM
APA : American Psychiatric Association
B.Sc.: Baccalaure Science
HMIS: Health Management Information System
MOH: Ministry Of Health
WHO: World Health Organization
SPSS: Short Package for Statically Storage
PHNP: Public Health Nursing Practitioner
PHCH: Public Health and Clinical Sciences
MLT: Medical Laboratory Technician
M.Sc.: Masters Science
et al. : and others
UoA: University of Asmara
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CHAPTER ONE
1. INTRODUCTION
1.1 BACKGROUND INFORMATION
1.1.1 BACKGROUND INFORMATION ON MENTAL ILLNESS
Health, as defined by the World Health Organization (2001:3), “is a state of complete physical, mental
and social well-being and not merely absence of disease or infirmity”. Andrew and Henderson (2005:1)
revised this definition by adding a spiritual aspect, hence it being a dynamic state of complete physical,
mental, spiritual and social well-being and not merely the absence of disease or infirmity. For all
individuals, mental, physical and social health is vital elements of life that are closely interwoven and
deeply interdependent. As an understanding of this relationship increases, it becomes even more apparent
that mental health is crucial to the overall wellbeing of individuals, societies, and countries. Mental
illness is the term used to describe a broad range of mental and emotional conditions. It is also used to
refer to mental impairments other than mental retardation, organic brain damage and learning disabilities.
The term „psychiatric disability‟ is used when mental illness significantly interferes with the
performance of major life activities such as learning, thinking, sleeping, eating and communicating
among others (WHO, 2001). Mental illness can be experienced over many years and the type, intensity,
and duration of symptoms varies from person to person (WHO,2001).In addition to this, mental illness or
mental disorder is clinically significant psychological or behavioral syndromes that occurs in an
individual and results in distress, disability, or significant risks (e.g., loss of freedom, stigma, suicide).
Categories of mental disorders include psychotic disorders, mood disorders, anxiety disorders,
Personality disorders, eating disorders, and others. The most common forms of mental illness are anxiety
disorders, schizophrenia and depressive disorders (APA, 2000).
Today, mental health problem is recognized as a public health problem in the world. It has a life time
prevalence of about 40 - 50% in the community. However, only a few people with mental disorders
generally receive treatment (Dahlberg, Waern and Runeson 2008:2). Following this, Farrer, Leach,
Griffiths, Christenssen and Jorm (2008:1) conclude that about 70% of individuals, suffering from mental
illness, do not seek help. Additionally, the World Health Organization (WHO) estimated that 450 million
people suffer from mental illnesses and at least 40 million people in the world suffer from severe forms of
mental disorders such as schizophrenia and dementia. No fewer than 20 million people around the globe
suffer from epilepsy which is also a mental disorder; and a further 200 million are incapacitated by less
severe mental and neurological disorders such as neuroses and peripheral neuropathy (WHO, 2001) of
which only a small proportion receives treatment (World Health Organization report, 2001:23). Hugo,
Boshoff, Traut and Stein (2003:715) also reiterate that although there has been increasing advances in
psychiatry, the community often has poor mental health knowledge and many people with mental illness
may be unaware that effective treatment is available in health facilities.
In Eritrea, based on the prevalence rates from the world mental health survey (2004) it is estimated that at
least 280,800 people (13% of the adult population which is estimated at 60% of the total 3.6 million
populations) are likely to be affected by mental disorder. Approximately 64,800 people (3% of the adult
population) are likely to be suffering from a severe mental disorder and a further 216,000(10% of the
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adult population) from moderate to mild mental disorder (MOH, Eritrea, 2011) and the most commonly
diagnosed mental illness in Saint Marry psychiatric hospital from 2003 to 2008 were Epilepsy, Psychosis,
Mood disorders, Neurotic stress and somatoform disorders, Mental retardation, Dementia, Alcohol related
Mental health disorders , Substance abuse related Mental health disorders and others (HMIS, Eritrea,
2011).Individuals who suffer from these mental illnesses have been stigmatized throughout history.
Studies conducted in North America and Western Europe, suggest that stigmatization is a major problem
in the community. According to Mehta et al., (2009:278), misunderstanding, prejudice, confusion , fear
and discrimination by the community against people with mental illness are common, which are
deeply socially damaging and a part of more widespread stigmatization. Mehta et al. (2009:278) further
state that stigmas against people with mental illness can contribute to negative outcomes, as well as
perpetuating self stigmatization and contributing to a low self-esteem. Stigmas interfere with the right of
people to participate fully in the community, because they are living in the difficult situation of rejection
and exclusion (Gureje et al. (2005:436-437). Furthermore, in many circumstances people, suffering from
mental illness, have no opportunities of having adequate housing, loans, health insurance and jobs
(Gureje et al. 2005:437). Studies on stigmatization in the community have shown that people with mental
illness have decided to stop taking treatment, isolated themselves from loved ones, or have given up on
the things they wanted to do, because of discrimination. Some people with mental illness report that the
stigma can at times be worse than the illness itself. People may be less willing to offer support and
empathy if someone is suffering from a mental illness rather than a physical health problem. For example
40% of people with mental illness in South Africa have said that they didn‟t socialize, because negative
stereotypes kept them isolated (Normsan et al 2008:852). Although studies about knowledge and attitude
towards mental illness in general and specifically what causes the stigma towards mental illness are not
available in Eritrea, according to MJ .Merlo (2010), the stigma was resulted due to lack of knowledge,
negative attitude and avoiding behavior towards them. In addition people with mental illnesses are often
stigmatized, due to a lack of knowledge and negative attitude about their illness, these are mental illness
can‟t be treated, mental illness is something to be ashamed of , mentally ill individual can‟t function,
mental illness is something figment of once imagination, (WHO ,2001, Lauber et al.,
2005:835).Therefore increased knowledge and positive attitude about mental illness has often been
reported to result in reducing stigma towards mental illness(Gureje et al.,2006:107)
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1.2 OPERATIONAL DEFINITIONS
Attitude: a learned predisposition to respond a consistently favorable or unfavorable manner with respect
to a given object.
Knowledge: It is the intellectual ability of ACHS students to answer the question regarding mental illness
by administering questionnaire.
Mental illness: A mental disorder or mental illness is a psychological or behavioral patterns generally
associated with subjective distress or disability that occurs in an individual which is not a part of normal
development or culture
Students: Are final year degree students who are studying in ACHS in the academic year of 2011/12, 2nd
semester
Stigma: Stigma as a social phenomenon is exercised by groups of humans, one towards another, to fulfill
psychological needs and to gain advantages, mostly economic.
1.3 PROBLEM STATEMENT
Several studies revealed inadequate knowledge about mental illness among the general population and
stigmatizing attitudes towards people with mental illness. The studies emphasized that lack of knowledge
and negative attitude toward mental illness and people experiencing them often underlie stigma which can
cause affected person to deny symptoms, delay treatment, be excluded from employment, housing or
relationships and interfere with recovery (Nordt, 2006:709). The annual report of WHO (2010) also
reported that the major constraints to the development of mental health program at country level are lack
of knowledge of the magnitude of mental health problem. Therefore to change these problems mental
health should be a concern for all of us, rather than only for those who suffer from a mental disorder and
the health professionals are expected to play a great role specially in changing the knowledge and attitude
of the public towards mental illness and to do this every health professional should be knowledgeable and
they should have positive attitude towards mental illness. However, it has not been determined whether
health professionals or health students held fewer stigmatizing attitudes than the general population
(Nordt et al., 2006:709). Moreover the researchers observed that some of the students in the college: to
stigmatize mentally ill individuals and unwillingness to talk about mental illness in general. In relation
with this, the mission of Asmara College of Health Sciences is to produce competent health professionals
who are equipped with the foundation knowledge, professional skills, attitudes and ethical principles, and
are capable of addressing national health needs by providing and continuously striving to improve health
care, hence mental health education is one factor to achieve this mission. However, most of the
departments in the college do not train their students in mental health. Does this affect the attitude and
knowledge of students towards mental illness? Do the students really have stigmatizing attitude toward
mental illness? The study will answer the problem.
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1.4 SIGNIFICANCE
The information gained at the end of the study will help the appropriate authority to verify the
effectiveness of the mental health course in changing the attitude and knowledge of the students towards
mental illness and they will come to know whether there is a need of intervention measures on the
students, so that to play a great role in changing (influencing) the knowledge and attitude of the public.
Then the stigma towards mental illness and people experiencing them may be reduced.
The study can be used as base line for further research.
1.5 Research question
What is the knowledge and attitudes of Asmara College of Health Science students towards
mental illness?
1.6 Aim
This research aimed at assessing the knowledge and attitudes of the students
towards mental illness.
1.7 OBJECTIVES
1.7.1. General objectives.
To assess the knowledge and attitude of final year degree students towards mental illness.
1.7.2. Specific objectives
To assess the knowledge and attitude towards mental illness among the students based on their
departments.
To compare the knowledge and attitude towards mental illness among the students based on their
departments.
To determine the possible correlation between knowledge and attitude of the students towards mental
illness.
To determine if Stigmatizing behavior about mental illness exists among the students.
1.8 Assumptions
The tools which, the researchers prepared will be adequate to measure level of knowledge and attitude of
students toward mental illness. The researchers assumed that students who have not taken mental health
course in their curriculum will have less knowledge and negative attitude towards mental illness than
those who have taken.
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CHAPTER TWO
2. LITERATURE REVIEW
This chapter includes the related literatures about concepts on mental health and illness, definition of
mental health knowledge and attitude, some misconceptions about mental illness and related studies,
studies related to knowledge and attitude on mental illness, in students. . The literature review was done
to identify deficiencies in previous research overseas and to fill a proven need, and to demonstrate the
underlying assumptions of the general research question (De Vos, 2005:124).
Most importantly, this literature review aimed at contributing towards the improvement of mental health
knowledge and attitudes of the students in ACHS. In this section, the core concepts which influenced the
context of this research are clarified and explained.
2.1 Concepts of Mental Health and Illness
Mental health professionals are faced with multitude of problems in defining mental illness and mental
health. One approach to differentiating mental health from mental illness is based on what a particular
culture regards as acceptable or unacceptable. In this view mentally ill are those who show violent social
norms and those threaten (or make anxious ) to those observing them .This definition is partly true. The
callous psychopathic person fits the definition, as does sometimes wild manic person and the
schizophrenic person who is displaying strange antics. However, this definition explicitly makes mental
illness a relative concept. Many forms of unusual behavior can be tolerated, depending on the prevailing
cultural norms. People whose only problem is that they see things and hear things that no one else does
may be put into a mental hospital, or they may be referred to us visionaries, depending on the belief of
their society (Leff 1981). The difficulty with defining mental illness through a particular behavior that is
unacceptable to society is that it does not tell us what behavior a society should accept. Some totalitarian
governments, to serve their own repressive goals, have classed all political dissidents as „mentally ill.‟
The field of mental illness is plagued by a host of myths and misconceptions. One myth is that to be
mentally is to be different and odd. Another misconception is that to be healthy, a person must be logical
and rational. All of us dream „irrational‟ dreams every night, and „irrational‟ emotions are not only
universal human experiences, but also essential to a fulfilling life. There are people who show extremely
abnormal behavior and are characterized as mentally ill: who are far more like the rest of us. There is no
obvious and consistent line between mental illness and mental health. In fact, all human behavior lies
somewhere along a continuum of mental health and mental illness. (E.M.Varcarolis , (2002)
Many psychiatrists still consider mental health normalcy, as the absence of psychopathology, but to
many, mental health is far more than the absence of disease. Cambell‟s definition (1995) states that
psychically normal (mentally healthy) persons are those who are in harmony with themselves and their
environment. They conform to the cultural requirements or injunctions of their community. They may
possess medical deviation or disease, but as long as this does not impair their reasoning, judgment,
intellectual capacity, and the ability to make harmonious personal and social adaptation, they may be
regarded as psychically sound or normal (Sadock 1999). Those who are‟ normal „or „mentally healthy‟
may have several areas of dysfunction at different times in their lives. We are different, have different
backgrounds, and reflect different cultural influences even within the same subculture. We grow at
1
different rates intellectually and emotionally, make different decisions at different times in our life,
choose or choose not to evaluate our behaviors and grow within ourselves, have deep seated spiritual
beliefs or not, and so on. Understandably, then, there can be no one definition of mental health that fits
all. However, there are some traits that mentally healthy people share and that contribute to a better
quality of life. Some of these traits of “mentally healthy” people are those who have the ability to love
and experience joy, capacity to deal with conflicting emotions, ability to live without fear, guilt or
anxiety, ability to take responsibility for one‟s own actions, ability to control one‟s own behavior, think
clearly ( problem solve, use good judgment, reason logically, reach insightful conclusions, be creative),
relate to others( from relationships, have close, loving, adaptive relationships, experience empathy
toward others, mange interpersonal conflict constructively), attain self defined spirituality, negotiate each
developmental task, ability to work and be productive, maintains a health self concept and self value,
ability to play and laugh, accurate appraisal of reality. And some signs of mentally ill people are sings of
Major Depressive Episode (loss of interest or pleasure in all or almost all usual activities and pastimes,
mood as described by person is depressed, sad, hopeless, discouraged), signs of Control Disorder, Under-
socialized, Aggressiveness (a repetitive and persistent patterns of aggressive conduct in which the basic
right of others is violated), signs of Schizophrenic Disorder (bizarre delusions such as delusions of being
controlled, auditory hallucinations, delusions with persecutory or jealous content), signs of Adjustment
Disorder with Work (inhibition in work or academic functioning were previously there was adequate
performance) and signs of Dependent Personality Disorder (passively allows others to assume
responsibility for major area of life because of inability to function independently, lack of self
confidence, example see self as helplessness, stupid.) (E. M. VARCAROLIS, 2002 , 8-10)
2.2 Mental Health Knowledge
Mental health knowledge describes knowledge and beliefs about mental disorders, which aid in their
recognition, management, or prevention (Francis et al., 2002:8). This also includes the ability to
recognize specific disorders, knowing how to seek mental health information, knowledge of risk factors
and causes, knowledge of self treatment and of professional help available, and attitudes that promote
recognition and appropriate health seeking (Francis et al., 2002:8). Mental health literacy encompasses an
individual‟s knowledge and beliefs about mental illness whilst poor mental health literacy often
represents a powerful barrier to treatment (Mamo, 2008:399).
2.2.1 The Effect of Adequate Knowledge
Better knowledge has often been reported to result in improved community attitudes towards people with
mental illness, whilst beliefs that mental illness are treatable, can encourage early treatment seeking and
promote better outcomes ( Gureje et al., 2006:2). It is a widely shared belief that an increase in the
community‟s mental health literacy should result in an improvement of attitudes towards people with
mental illness. More recently, community attitudes in some countries have changed as a result of
initiatives to improve the community‟s mental health literacy, and in becoming more like those of
professionals. However, the prevailing attitudes towards seeking professional help for such problems and
to what extent these beliefs actually influence service use for mental health problems are unknown (Kabir
et al., 2004:2). Studies that were performed in the USA and Canada found that prior experience with the
mental health care system was associated with a more positive attitude towards help seeking (Alonso,
2005:2). Matthias, Angermeyer, and Matschinger, (2005:1) also conclude that improved knowledge,
1
attitudes and behavior show the strongest evidence for effective interventions at present, than is direct
social contact with people with mental illness at the individual level, and social marketing at the
population level (Thornicroft, Brohan, Kassam and Lewis- Holmes, 2008:1).
2.2.2 The Effect of Inadequate Knowledge
Inadequate knowledge about mental illness and negative attitudes towards people with mental illness are
widespread in the general community (Nordt,2006:709). The inadequate mental health knowledge is said
to be problematic, because inadequate knowledge is associated with delays in treatment seeking,
decreased levels of treatment seeking, and utilization of non-optimal treatments (Mamo, 2007:1). In
addition as lack of mental health literacy can limit the optimal use of treatment services (Jorm et al.,
2005:1).
Another consequence of poor mental health knowledge is that the task of preventing and helping mental
disorders is largely confined to health professionals. However, the prevalence of mental disorders is so
high that the mental health workforce cannot help everyone affected and tends to focus on those with
severe and chronic problems (Jorm, 2000:399). Inadequate knowledge and negative attitudes have been
seen as factors limiting help seeking and such negative attitudes can involve self stigmatization, in which
a person has internalized the negative attitudes held by society and applied these to him- / herself (Jorm et
al., 2006:142). This attitude reduces the likelihood of a person who is depressed to seek professional help
(Jorm et al., 2006:142; Barney et al., 2006:51) similarly Gyllensten et al.,2011,revealed that that students
with more stigmatized beliefs had greater concerns about psychiatric medications and less favorable
beliefs regarding their effectiveness.
2.3 Attitude Toward Mental Illness
The word „attitude‟ was originally derived from the Latin word „aptus‟ meaning to „fit and ready for
charge‟, but this old version of interpreting attitude has now been replaced by more meaningful ones.
Today attitude is explained as a construct not directly observable but precedes behavior and guides ones
choices and decision making factors. Attitudes are perceived as responses that locate objects of thought
on dimensions of judgment. Objects of thought are the issues or the people about whom opinions are
based and dimensions of judgment describe the range over which evaluations extend as from good to bad
or from positive to negative (Mc Guire, 1986; Hogg & Vaughan, 1998). Some social psychologists
describe attitude as organized enduring systems developed by an individual‟s knowledge, feelings and
action tendencies with respect to various objects. Bootzin, Loftus and Zajonc (1983), describes attitude
as an attraction or aversion towards an object with what is known about that object.
2.3.1 The Effects of Attitude towards Mental Illness
Studies have shown that negative attitudes towards people with mental illness are widespread in the
general Public (Nordt, Rossler and Lauber, 2006:709). Negative attitudes and Discriminating behaviors
towards people with mental illnesses are often referred to as stigmas. Stigmas involve negative
stereotypes and prejudices and are often measured in terms of social distance (Watson et al., 2002:22-23;
Lauber et al., 2004:266). The stigmatizing of mental illnesses remains pervasive and problematic and
1
often results in active discrimination (Stuart, 2005:22). This is of concern for a number of reasons. People
may as a result be reluctant to seek treatment for or disclose mental health problems, even common forms
of anxiety and depression, for fear of social rejection and discrimination, or may discontinue treatment
(Watson & Corrigan, 2002:22). According to Lauber et al. (2004:266), having a medical understanding
of mental illness, identifying the Person as being ill and having a positive attitude towards medical
treatment, decreases social distance. Students with more stigmatized beliefs had greater concerns about
psychiatric medications and less favorable beliefs regarding their effectiveness ( Gyllensten et al.,2011).
Another study was done on the attitudes held by college students toward mental disorders and those who
experience them; a random phone survey was conducted of undergraduates at a medium-sized
Midwestern state university. Students were read a vignette portraying people experiencing symptoms of
either schizophrenia or major depressive disorder. They were then asked what they thought had caused
these symptoms; the likeliness that the people portrayed are mentally ill; the likeliness that they would do
something violent toward others; and their willingness to interact with them. Students are most likely to
attribute the causes of mental disorders to a chemical imbalance in the brain and stressful circumstances.
Students are significantly more likely to label people experiencing symptoms of schizophrenia as being
mentally ill. Students are significantly more likely to believe that people experiencing symptoms of
schizophrenia would do something violent toward others. Students who attribute the cause of mental
disorders to a genetic or inherited problem are significantly more willing to interact with people
experiencing mental disorders. Students who feel that people who experience mental disorders would do
something violent toward others are significantly less willing to interact with them
Negative view towards mental illness is the prime cause of false attitude and knowledge in community
people Schomerus G, Matschinger H, Angermeyer MC (2005) conducted a study on community study of
knowledge of and attitude to mental illness in Nigeria. The improvement of community tolerance of
people with mental illness is important for their integration. Little is known about the knowledge and
attitude to mental illness in sub-Saharan Africa, with a aim to determine the knowledge and attitudes of a
representative community sample in Nigeria. Poor knowledge of causation was common. Negative views
of mental illness were widespread, with as many as 96.5% (S.D =0.5) believing that people with mental
illness are dangerous because of their violent behavior. Most would not tolerate even basic social contacts
with a mentally ill person: 82.7% (S.E. =1.3) would be afraid to have a conversation with a mentally ill
person and only 16.9% (S.E =0.9) would consider marrying one. Socio-demographic predictors of both
poor knowledge and intolerant attitude were generally very few. Mental health literacy encompasses an
individual‟s knowledge and beliefs about mental illness whilst poor mental health literacy often
represents a powerful barrier to treatment (Mamo, 2008:39) Community attitudes and beliefs play a role
in determining the help seeking behavior and successful treatment of the mentally ill. Hugo et al, 2003
conducted a study on community attitudes toward and knowledge of mental illness in South Africa. The
aim of this study was to investigate the knowledge and attitudes of the general South African public
toward mental illness. The main findings were that cases were most often conceptualized as stress-related
or due to a lack of willpower rather than as medical disorders. Treatment advocated was more often to
talk the problem over than to consult professional medical help. Psychotherapy was the preferred
treatment option, particularly in vignettes where symptom presentation was subtle, and in cases of
substance abuse.
The beliefs and treatment on mental illness changes from place to place. Jorm AF (2000) conducted a
study on mental health literacy and public knowledge and beliefs about mental disorders. Although the
1
benefits of public knowledge of physical diseases are widely accepted, knowledge about mental disorders
(mental health literacy) has been comparatively neglected. To introduce the concept of mental health
literacy to a wider audience, to bring together diverse research relevant to the topic and to identify gaps
in the area. Much of the mental health information most readily available to the public is misleading.
Many members of the public cannot recognize specific disorders or different types of psychological
distress.
They differ from mental health experts in their beliefs about the causes of mental disorders and the most
effective treatments. Attitudes which hinder recognition and appropriate help-seeking are common.
However, there is some evidence that mental health literacy can be improved.
2.4 Some Common Misconceptions About Mental Illness and Related Studies
Several studies have found that many members of communities lack knowledge about mental illness,
especially with respect to beliefs about causes, treatment and behavior of mental illness and people
experiencing them (Jorm et al., 2006:143).
The common misconception about the causes of mental illness are, believes that mental illness is caused
by supernatural power forces provoked or unprovoked by patients, or it is a result of curse or possession
of evil spirits, and some says mental illness is not an illness but a curse caused by possession of witchcraft
and evil spirit or black magic (Stephen and Andreas, 2008:367-393). Elise (2006:1-2) agrees that
traditional communities believe that the mentally ill are caused by spirits and curses, with influences by
the moon, or that it is a divine punishment. According to Lauber (2003:5), misconception, from a
religious perspective, about mental illness may include that it is caused by sin, since the deliberate
breaking of God's commandments indeed results in such behavior that is hurtful to self and to others, a
person become mentally ill, because he broke a taboo, mental illness is caused by curse that is befallen on
the patient or family for the past sin or misdeed of previous life‟s. Elise (2006:1-2) reiterates that beliefs
of this nature keep the stigma and discrimination alive. Other studies have shown that beliefs about causes
may alter patterns of help seeking and responses to treatment. For example, in Malaysia beliefs by
psychiatric patients in supernatural causes were associated with greater use of traditional healers and
poorer compliance with medication (Jorm, 2000:397). Therefore, negative beliefs about causes and lack
of adequate knowledge have been found to sustain deep seated negative attitudes about mental illness
(Gureje, Olley, Ephraim-Oluwanuga and Kola, 2006:107). Conversely, better knowledge has often been
reported to result in improved attitudes towards people with mental illness ( (Gureje et al.,2006:107).
As Studies have shown that in the Western world, mental illnesses are generally thought to be caused by
psychosocial factors, such as environmental stressors, or childhood events. Biochemical and genetic
influences, although recognized as causal factors, are not considered as important environmental ones
(Jorm, 2000:397). Some studies suggest that serious mental illnesses, such as schizophrenia, are more
likely to be linked to genetic causal factors, compared to common mental disorders, such as depression
(Jorm, 2000:397). However according to Gill (2005:1), causes of mental illness is not synonymous, but
varies widely, from inherited chemical imbalances responsible for the development of such illnesses as
depression, bipolar disorder, and schizophrenia, to brain diseases, to causes that are more immediately
under our control. Improved knowledge about causes may lead to improved overall knowledge about
mental illness and promote supportive attitudes to the mentally ill (Gureje et al., 2006:105). In a survey of
1,596 Japanese, it was found that the most frequently cited cause was problems in interpersonal
relationships (Tanaka, Ogawa, Inadomi, Kikuchi and Ohta, 2005:96-101). Similarly, in a survey of South
1
Africans (55% Afrikaans speaking), 83% stated that schizophrenia was caused by psychosocial stress
(difficulties in work or family relationships, or stressful life events), whilst only 42.5% thought it was a
medical disorder (brain disease, heredity, constitutional weakness) (Hugo et al., 2003:715-719). Across
cultures, knowledge about the causes of mental illness varies and has never been very favorable,
worldwide (Issa, Parakoyi, Yussuf and Musa, 2008:43). This has been acknowledged by the World
Health Organization that has called for greater education of the public and greater openness.
There are also misconceptions about the treatment of mental illness that is," mental illness is something
that cannot be cured , traditional healing is the best way in treatment of mental illness rather than
psychiatric hospitals, mental hospitals are places where only dangerous mentally ill individuals are
treated with restraint is a major forms of treatment”. Amare Deribew, Yonas Shiferaw Tamirat,
December (2003).
People have fear about mental hospitals hence they hesitate to take their relatives to those hospitals for
treatments. Further an ex patient of mental hospital as well as his family members are often socially
isolated. This tells us, people seek help from mental hospital only as a last resort. However according to
(WHO, 2001), mental illness is treatable and the symptoms of mental illness often can be controlled
effectively through medication and/or psychotherapy i.e. schizophrenia a severe mental illness is
treatable. People suffering from schizophrenia can be helped with medication such as haloperidol,
respridone and other similar drugs to reduce their symptoms. A relapse can be prevented with
psychosocial interventions aimed at the family for the benefit of all. But sometimes the symptoms of
mental illness may go into remission, and for some people it causes continuous episodes that require
ongoing treatment. Untreated mental illness can disrupt an individual‟s personal, social, educational and
work activities and in some cases may lead to suicide. World Health Organization (WHO) added, the
cost of not treating mental illness may be high both in personal and financial terms were by a significant
indirect cost is made on the economy of a nation by mental illness. In this circumstances health
professionals can play an important role in community by making the public aware of some important
principles related to mental illness treatments. The principles that people has to know are, mental
illnesses, like physical illness, can be easily treated with medications and psychological methods.(arasu).
The treatment of mental illness is not just confined to drugs; It also includes many other psychological
therapies like behavior modification therapy, counseling, activity therapy, family therapy, group therapy,
rehabilitation, case management etc. (carlos et al.,2007:209). Continuity of treatment is more important
for curing mental illness. Treatment should never be tampered without the advice of a psychiatrist. In
majority of the mental illnesses, for example, mania, depression and other neurotic disorders like
dissociative disorder, patient completely recover without a residual effect, if the treatment is taken on a
regular basis and early detection and prompt treatment for mental illnesses gives better improvement in
psychiatric patients enabling them to lead socially productive lives. Finally Carlose et
al.,2007:221.retrived that 70% of individuals with severe mental illness like schizophrenia if remained
untreated for long period of time they are at risk for developing other complications like substance abuse
which intern make them at risk for medication noncompliance, hospitalization , homelessness, suicide
and illness including HIV infections. They tend to have more family problems and to exhibit more
hostility more destructive behavior and more violence than with single disorders.
1
Therefore increased knowledge and positive attitude about mental illness has often been reported to result
in improved attitudes towards people with mental illness and a belief that mental illnesses are treatable,
can encourage early treatment seeking, and promote better outcome. ( Gureje et al,2006:107)
Another common misconception about people with mental illness is that they cannot live independently,
let alone make significant contributions to the community (Norman et al., 2008:851). Throughout history,
however, people with serious mental illness have contributed enormously to societies in terms of politics,
culture, academic life, athletics, business, art and science. People with mental illness have been leaders
and visionaries, both enriching and expanding our knowledge and understanding in every area (Read et
al., 2006:304).
The worst misconceptions are about behavior of mentally ill individuals, some people believe that ,
mentally ill people show bizarre behavior ( i.e. Patients spent their time doing useless bizarre behavior
like twisting the hands, passing one fingers to another hand fingers and folding the hands together at the
back), mentally ill people are unstable and dangerous, and as a result people who have or had a mental
illness are viewed with suspicion and as dangerous persons.
Other misconceptions are, mental illness is something to be ashamed of, this idea arouses an
unsympathetic, cruel attitude towards a mentally ill person. This is the reason why people hide the mental
illness in the family. Mental illness is contagious, the fear that it is contagious is the main false notion
leads people to view suspiciously, or object to marital relations with a person belonging to the household
of the mentally ill (WHO,2001 ).
2.5 Studies on the Effect of Mental Health Course in Changing the Knowledge and Attitude
of Students Towards Mental Illness.
Mental health education contributes to the positive attitude and knowledge on mental illness. Sloat LM,
Frierson RL (2005) conducted a study on juror knowledge and attitudes regarding mental illness verdicts.
Study begin with a brief overview of the Not Guilty by Reason of Insanity (NGRI) and Guilty but
mentally ill (GBMI) verdicts in the United States and then report on a study of qualified jurors (n=96) in
which study examined jurors' understanding and attitudes about mental illness verdicts and the disposition
of mentally ill defendants. Results indicate that although the jury pool was highly educated, only 4.2
percent of jurors could correctly identify both the definitions and dispositions of defendants found NGRI
and GBMI. Jurors with lower educational levels were less likely to identify the dispositional outcome of a
GBMI verdict (p<.05). Eighty-four percent of respondents believed that juries should be informed of
dispositional outcome before deciding a verdict. Also, 68.4 percent of jurors erroneously believed that a
defendant found GBMI could not receive the death penalty. Among jurors who correctly identified the
definition of GBMI, those with lower educational levels were more punitive in their attitudes toward
disposition of the GBMI defendants, believing they should eventually be sent to prison (p<.05), so the
study proves that education is the key to develop positive attitude and knowledge in people.
Mental health training can lead to increases in confidence and a change in attitudes to mental illness.
Payne et al. (2002) conducted a study on knowledge, confidence and attitude towards mental health for
nurses direct and the effects of training. They found that confidence increased in nurses who received
1
mental health training. After training, attitudes towards depression had shifted in that nurses now felt
positive towards their role in treating depressed patients. Training in mental health can lead to increases in
confidence and a change in attitudes and would be beneficial for all health professionals.
Structured teaching program is an effective tool to increase nurse students knowledge on mental
illness.Haddad M,Butler GS and Tylee A (2010) conducted a study on school nurses involvement,
attitudes and training needs for mental health work in UK. A cross-sectional study was conducted using a
postal questionnaire sent to a random sample of 700 school nurses throughout the United Kingdom.
Questions concerned involvement in mental health work and training needs for this work. Attitudes were
measured using the Depression Attitude Questionnaire. Questionnaires were returned by 258 (37%)
nurses. Nearly half of respondents (46%) had not received any post registration training in mental health,
yet 93% agreed that this was an integral part of their job. Most (55%) noted that involvement with young
people's psychological problems occupied more than a quarter of their work time. They concluded that.
Working with young people who self-harm, and recognizing and being better equipped to assist in
managing depression and anxiety are key topics for staff development programs.
Personal contact with someone with mental illness and the importance of user involvement in training is
a significant factor to change belief and assumptions of a student nurse . Tim Schafer, Steve Wood et al.
(2010) conducted a survey of attitudes to mental illness that was completed with a cohort of pre-
registration nurses in 2007 in a large university Essex. . The background literature highlights the effects
of attitudes on stigma, disadvantage and discrimination and presents a brief review of the literature on
cultural variations in attitudes. It also briefly reviews the attitudes of health professionals to mental
illness. A survey using the Community Attitudes to Mental Illness questionnaire was completed and
ethnicity proved to be an important factor in accounting for variations in attitudes to mental illness.
Personal contact with someone with mental illness was also found to be a significant factor and the
importance of user involvement in training is discussed. The paper concludes with some
recommendations for nurse training that include greater use of teaching strategies that challenge beliefs
and assumptions and promote a commitment to multicultural mental health practice.
Pre-orientation teaching on mental illness contribute more for nursing students on their psychiatric
clinical exposure. Brunt D, Hansson L, LEufstadius C, Sandland M (2009) et al. conducted a study on
attitudes towards mental illness among health care students as a follow up study after completed clinical
placement. The aim of the study was to examine the changes in attitudes towards mental illness after
theoretical education and clinical placement among students from university program preparing for
different kinds of health professions. Three different questionnaires were used, measuring the level of
familiarity with mental illness and attitudes towards mental illness in general and towards specific
mental illnesses. The data were collected on two occasions, before the theoretical course and after the
completed clinical placement. The result showed that the attitudes toward mental illness in general had
changed in a less stigmatising direction after the clinical placement. The study concluded that the clinical
placement included in the university program to some extent could affect attitudes in a de-stigmatizing
direction, possibly because of the interaction with persons suffering from mental illness and experienced
supervisors.
Nursing students were more positive towards physically disabled people than their peers .Dannenberg
JW, Taal E, Burger G, Rasker JJ and TEN klooster PM et al (2006) conducted a study on attitude of
1
nursing students and non nursing peers towards people with physical or intellectual disabilities. A sample
of Dutch nursing students (n = 81) and an age-matched group of non-nursing peers (n = 48) completed
standardized scales measuring attitudes about physically or intellectually disabled people. Nursing
students were more positive towards physically disabled people than their peers, and more strongly
endorsed empowerment and similarity of intellectually disabled people. The study concluded that
educational interventions aimed at improving attitudes towards people with disabilities should include
focus on forms of contact beyond the context of formal care relationships.
Nursing students' attitudes about mental illness changes after clinical exposure.Creech SK studied the
changes in attitudes about mental illness among nursing students following a psychiatric affiliation. The
purpose of this study was to determine changes in nursing students' attitudes about mental illness
following a twelve-week psychiatric affiliation program in a state mental hospital. Data were collected by
means of two combined opinions about mental illness scales -- Cohen and Struening's factor analytically-
derived Opinions About Mental Illness (OMI) questionnaire and Ellsworth's empirically-derived
Opinions About Mental Illness Scale. The sample consisted of 95 student nurses from three diploma
schools of nursing.: Authoritarianism, Mental Hygiene Ideology, Social Restrictiveness, Interpersonal
Etiology, Non traditionalism, and Restrictive Control. Although significant changes were not found on
Benevolence and Protective Benevolence, there was a trend toward favorable changes on both attitudinal
dimensions.
A comparison of nursing students' attitudes about mental illness according to their year in college of
psychiatric nursing: a study done by Jung (2009) and was found that the higher the year in College, the
more positive the attitudes are about mental hygiene ideology and interpersonal etiology. This study
suggests that more positive attitudes about psychiatric illness can be induced by a more effective
educational experience]]
Stigma in mental illness: attitudes of medical students towards mental illness. Mas A Hatim (2010) from
Department of Social Preventive Medicine, University of Malaya Medical Centre, Kuala Lumpur :
conducted a study to the final year students who had knowledge and contact (undergone 8 weeks of
clinical psychiatric training) were less stigmatizing toward mentally ill patients. There were no significant
differences in the attitudes towards mentally ill patient among the first year students (no knowledge)
regardless they had previous contact or not.
2
CHAPTER THREE
METHODOLOGY
3.1 OVER VEIEW
This chapter will describe the research design and methodology that were used during this study;
including study area, study population, data collection method, data analysis, pilot study and ethical
considerations. The purpose of this chapter is to explain the research design and the methodology that
was applied to determine the knowledge and attitudes of final year degree students towards mental illness,
which included interrelated processes to achieve the objectives.
3.2 STUDY AREA:
The study area refers to the place where the research data is collected (Brink, 2006:64).
This study was conducted in ACHS Asmara, which comprises of four (4) divisions of Final year degree
students namely, Nursing, Public Health, CLS and Pharmacy .
The researcher obtained the necessary permission to conduct this study from the ethical committee of the
college.
3.2.1 Background information
The study was conducted in Asmara College of health sciences which is situated in the compound of the
former UoA and runs its activities mainly in the main building of its own and some more classrooms and
offices lent to it by related institution on a temporary base. According to the information gained from the
dean of the college Mr. Zereabruk Tesfamariam, ACHS was established as CHS in 1995 under the
University of Asmara. At that time the College had three program namely public health nursing
practitioner or public health and clinical sciences (PHNP or PHCH), medical laboratory technician
(MLT), and pharmacy. In the years 1996-2001, it developed four degree program in various disciplines :
public health nursing practitioner, pharmacy, nursing and clinical laboratory science, out of which, the
first two were five year degree programs and the latter ones 4 year degree programs . In august 2005, the
college was transferred from UoA to be integrated to the training institution namely Orotta School of
Medicine and Asmara College of Nursing and Health Technology under the umbrella of MOH. This was
followed by the process of integration of schools of Nursing and health technology with their
corresponding degree program of ACHS. Today this process of integration is fully accomplished.
At present ACHS is fully affiliated to the NBHE. The college is running four schools i.e. school of
pharmacy, school of Nursing, school of allied Health professionals and school of public Health.
Moreover, there are two supporting departments under the college: department of biomedical science
(BMSc) which is affiliated to the SAHP and department of Basic and Behavioral Science (BBSc) which
offer common courses in biomedical, Basic and Behavioral Science to all the programs. In addition to
this, the college has office of Associate Dean for Academic Affairs, Associate dean for Research and post
graduate studies, directorate of student affairs, as well as directorate of Administration and Finance
Offices.
2
Current total enrollment Of the ACHS is 1590 out of which 880(55.3%) are in degree and the remaining
710(44.7%) are in diploma program. The male to female ratio is almost 2:1. ACHS is situated in the
compound of the former UoA and runs its activities mainly in the main building of its own and some
more classrooms and offices lent to it by related institution on a temporary base. Asmara College of
health sciences has the following five schools:
School of nursing
Degree: B.Sc. in nursing (4 year program). , B.Sc. with area of concentration –for advanced standing
admission of registered Nurses with diploma
Diploma: General Nursing and midwifery (RN) (3 year program)
School of pharmacy
Degree: B.Sc. in Pharmacy (5 year program)
Diploma: pharmacy technician (2 year program)
School of Allied Health Professions
Degree: B.Sc. in Clinical Laboratory Science ( 4 year program)
Diploma: (2 year program), Medical Laboratory Science, Dental Therapy Radiology Technician/
Radiography and Optometry Technician.
School of Public Health
Degree: B.Sc. in Public Health (4 year program)
School of Basic and Bio-medical Science
Bio-medical Science Department
Basic and Behavioral Science Department.
Graduate Studies
M.Sc. in Nurse Anesthesia
3.3 STUDY POPULATION:
The respondents were final (fourth) year degree students. The college currently have110 final year degree
students out of them…… % (n=…..) are advanced placement who had been exposed to professional job
previously and the remaining ….%(n=…..) are regular students
2
3.4 STUDY DESIGN:
In this section the researcher describes the methodology that was used to undertake this research project.
The research methodology focused on the research process and the kinds of tools and procedure to be
used (Mouton, 2001:56).The research design is the blueprint of a study and its purpose is to maximise
control over factors that can interfere with the validity of the findings (Burns & Grove, 2007:237). It
focuses on the end product, the point of departure and the logic of the research (Mouton, 2001:56). It also
aids in making an informed choice, suited to the particular research goal and objectives (De Vos et al.,
2008:132). Therefore, for the purpose of this study, the research design was descriptive cross-sectional
survey with a quantitative approach which enabled the researcher to determine the students knowledge
and attitudes towards mental illness.
The study design was quantitative analytical cross-sectional study.
SAMPLING DESIGN
Convenience sampling was valued. Out of the total final year degree students only 93 students who were
easily available at the college were selected. Others were excluded due to inconvenience.
All final year degree students were selected and grouped in to four censuses.
Group one: are BSN (Nursing who have taken mental health course for a total of 10 credits of theory and
4 of clinical practice.
Group two: are Public health students who have taken community mental health course (2 credit hours).
Group three: are Pharmacy students who have taken only psychopharmacotherapuetics no other mental
health course.
Group four: are CLS students who have not taken the course at all.
Exclusion criteria: all advanced placement students who might had contact with mentally ill in their
working experience were excluded.
3.5 Pilot study: The pilot study was conducted in ACHS and participants in this pilot study would
not again participate in the main study. The sample size for the pilot study was 14.81% (12 participants,
i.e. three students from each department) of the sample size of the main study.
3.5. DATA COLLECTION METHOD:
For the purpose of this study, an existing structured closes-ended questionnaire which was posted in the
internet was free to use, therefore it was adjusted and employed to collect data. The questionnaire was
given to the eligible students and it was pretested before the study was conducted. It had three (3) parts,
the first part had questions that measure biographic data, the second part knowledge of the students about
mental illness and the third part was about the attitude of the students towards mental illness.
2
To become more valid and reliable the knowledge questions are adopted from a study done on
knowledge and attitude of students towards mental illness by J. G. Chikomo,2011in south Africa and was
modified after the pilot study. It was 13 items closed ended questionnaire measuring knowledge of the
students in respect of the disease itself, types of, causes, its treatment and some other related knowledge.
The questions about attitude are also adopted from the British national information center for health and
sociology of Britain which have been used to measure the attitude of the community annually since 1994
and also were used by Thomas et al. in summer 2009 to study the attitude of pharmacy students to ward
mental illness at the Samford University McWhorter School of Pharmacy and are modified in a way that
the students can understand. This attitude questionnaire was composed of 3 sections. The first section was
about the student‟s tolerance and understanding to ward mental illness. This is an 11-item scale in which
the response to each item is scored by the five point Likert scale from 1 (strongly agree) to 5 (strongly
disagree) or vice versa according to the favorability of the items because favorable response are agree in
some items and disagree on others.. Total scores range from 11 to 55, with higher scores representing
more positive attitudes. The second section was composed of the attitudes of the students on integrating
people with mental illness in to the community. This is six-item scale, same as in the first section
responses to each item was also based on the five point Likert scale from 5 (strongly agree) to 1 (strongly
disagree). Total scores range from 6 to 30, with higher scores representing more positive attitudes. The
last third section was to measure attitude based on Whatley‟s Social Distance Scale. This is an 8-item
scale in which respondents select one of three responses: agree, disagree, or not sure. Favorable responses
are “agree” on some items and “disagree” on others. Individual items are scored according to the
following method: favorable responses = 3; “not sure” responses = 2; and unfavorable responses = 1.
Total scores range from 8 to 24, with higher scores representing more positive attitudes.
3.6. DATA ANALYSIS:
Data was collected by the researchers, using a structured close-ended questionnaire. The participant
took about 7 days to fill in the questionnaire. Data analysis is conducted to reduce, organise, and give
meaning to the data (Burns & Grove, 2007:41) and involves breaking up the data into manageable
themes, patterns, trends and relationships (Mouton, 2001:108). The data analysis was performed by using
the Statistical Package for Social Sciences (SPSS) version 16.0 This package was used to seek for the
separation of means, with the observance of analysis of variance. The results were presented into tables
of means, in which each variable had its own table of analysis of variance. Results were also represented
by bar charts and graphs, which were used for the interpretations and discussions in chapter four. The
data collected were entered in to a data base EXCELL first and was converted to SPSS (Statistical
Package for Social Science version 16.0) to be analyzed by a means of descriptive and inferential
statistics.
In descriptive statistics: Mean standard deviation and mean scores of subject frequency and percentage
were used to quantifying the level of knowledge and attitude regarding mental illness among the students.
Inferential statistics: T-test for comparison of group one and two and also group one with group three and
group four. ANOVA test was used to compare mean of the four groups. Coefficient of correlation was
used to determine the relationship between knowledge and attitude toward mental illness.
2
3.7. ETHICAL CONSIDERATIONS:
As ethical issue is a great concern in a research, permission was requested to ACHS administration and
the research ethical committee of the college. Additionally as it was noted in each of the questionnaires,
the ethical issue was highly valued. For this reason identity of the respondents was kept confidential.
More over they had received a unique study code based on their departments and full right was given to
drop from filling the given questionnaire which was only applicable after reading the instructions and
before he/she begins to answer a single question of the entire portion provided.
2
CHAPTER FOUR
4 .DATA ANALYSIS, PRESAENTATION AND DISCUTION
4.1 OVER VIEW OF THE CHAPTER
This chapter presents the analysis and interpretation of the data collected during this research study. The
objectives of this study were to determine the knowledge and attitudes of the final year degree students in
Asmara College of Health Sciences towards mental illness, so that this chapter relates to the main aim,
namely to assess the knowledge and attitudes of the students towards mental illness, based on the
outcomes of the completed questionnaires by respondents. The researcher collected the research data from
the respondents by using a structured questionnaire, consisting of three sections:
□ Section A: Socio-demographic information.
□ Section B: Knowledge of students about mental illness.
□ Section C:Attitudes of students towards mental illness which are also divided in to three parts
for analysis purpose.
Attitude On Understanding and Tolerance of mental illness.
Attitude in integrating people with mental illness into the communit.y
Attitude based on Whatley’s Social Distance Scale.
After consultation with a statistician, from the total population of 110 final year degree students of the
college 93 students who fulfilled the criteria were participated in this study during February 2012. The
data was analyzed using the Statistical Package for Social Sciences, version 16 for Windows. Frequency
distributions, cross-tabulation and chi-square tests were calculated at a 5% (p = 0.05) level of statistical
significance. Descriptive and inferential statistics, such as frequencies, tables and percentages were used
during the data analysis and the preparation of data summaries.
As stated in chapter three a total of 81 respondents were interviewed, using a structured questionnaire and
all of the participants responded. During the pilot study that had been conducted prior to the main study,
12 questionnaires were used. Based on the preliminary results being obtained from the pilot study, it was
concluded that the questionnaire was used friendly and without errors, and no adjustments were made.
4.2 DATA ANALSIS AND PRESENTATION
4.2.1 Descriptive Data
4.2.1 SECTION A: Basic demographic information
The basic demographic information which was collected included gender, age and departments. Results
are presented in table 4.1 below.
2
Table 4.1: Basic demographic characteristics of respondents.
VARIABLES DESCRIPTON FREQUENCY PERCENTAGE

1 GENDER
Male 50 61.7
Female 31 38.3
Total 81 100
2 DEPARTMENT
Nursing 41 50.6
Public Health 12 14.8
CLS 15 18.5
Pharmacy 13 16.0
Total 81 100
3 RESPODENT‟S AGE
20-22 57 68.7%
23-25 24 28.9%
26-27 2 2.4%
Total 100%
83
Table 4.1 shows the basic demographic characteristic of the respondents who participated on the study
categorized in to three variables namely, gender difference, age and departments.
Variable 1: Gender
With reference to gender of respondents who participated in the study, from a total of 81 participants
61.7% (n=50) were males and the remaining 38.3% (n=31) were female. The graphical presentation of
this gender difference in this study also can be seen from the figure below.
70 61.7%
60 50
50
38.3%
40 31
30
20
10
0
GENDER Male Female
FREQUENCYPERCENTAGE
Fig 4.1 shows gender proportion of respondents.
2
Variable 2: Department
With regard to the departments, the respondents were from four degree program departments of the
college namely nursing, public health, pharmacy and clinical laboratory science and as it can be seen in
the above table 4.1 from the total respondents 50.6% (n=41)are nursing students, 18.5%(n=15) are
CLS,16.0%(n=13) are pharmacy and 14.8% (n=12) are public health students. The graphical presentation
of the frequency of the departments can be seen from the below figure 4.2.
60
50.6%
50 41
40
30
18.5%
14.8% 15 16
20 13
12
10
0
Fig 4.2 Shows frequency of the students based on the departments.
4.2.1 Section B: Knowledge of students about mental illness.
The outcomes of participants‟ responses to questions about their knowledge of mental illness are
represented in this section as follows:-
Variable 3: How much do you know about mental illness?
2
100.00% 87.80% 93.30%

90.00%
80.00% 69.20%
70.00%
58.30%
60.00%
50.00% 41.70%
40.00%
30.80%
30.00%
20.00%
12.20%
10.00% 6.70%
0% 0% 0% 0%
0.00%
nursingPublic healthpharmacyCLS
GoodLittlenone
Fig 4.3 Shows the proportion of students with the correct responses to the question
“How much do you know about mental illness?”
From the Respondents: 87.8% of nursing students ,41.7% of public health , 30.8% of pharmacy and
6.7% of CLS answered they have good knowledge. the remaining 12.2% of nursing, 58.3% of phel,
69.2% of phar and 93.3% of CLS answered that they know little about mental illness.no body said I
don‟t have knowledge on mentl illness.
Variable 4: what is the source of your knowledge?
Table 4.2 Shows the proportion of answers given to the source of knowledge about mental illness.
Nursing Public health Pharmacy CLS

Mental health 100% 100% 0% 0%
education
Internet 48.8% 58.3% 38.5% 46.7%
Books 100% 100% 69.2% 13.3%
Mass media 0% 0% 0% 0%
Others 31.8% 41.7% 76.9% 26.7%
2
10100%0% 10100%0%
100%
90% 76.90%
80% 69.20% Fig, 4.4 shows the
70% 58.30% proportion of
60% 48.80%46.70%
41.70% students with
50% 38.50%
31.80%26.70% respect to the
40%
30% 13.30% sources of their
20% 0%0% 0%0%0%0% knowledge.
10%
0%
Mental Internet Books Mass others
health education media
nursingPublic healthpharmacyCLS
All of the nursing and public health students (100%) responded that they gotfrom mental health course
and 48.8% of nursing, 58.3% of public health , 46.7% of pharmacy and 50% of CLS got from internet and
All of the nursing and public health students (100%), 69.2% of pharmacy and 13.3% of CLS got from
text books and none of the students responded that mass media as a source. And 31.8% of nursing,
41.7% of Public health, 76.9% of Pharmacy and 26.7% of CLS answered that they got their knowledge
about mental illnesses from other sources.
Table 4.3 Shows Variables from 5 to 15 _ below.
3
Variables Nursing Public CLS Pharmacy p-value

Health
5. Mention the 34.1% 25% 2% 23.1% 0.000
types of mental
illness.
6. What are the 61.0% 50.0% 40.0% 46.2% 0.898
causes for mental
illness?
7. Like medical
problems most 92.9% 91.7% 60.0% 91.3% 0.091
mental illness can
be cured
8. Is the
hospitalization for 97.6% 91.7% 73.3% 61.5% 0.003
treatment of
mental illness
effective?
9. Can a person
who recovered 100% 83.3% 86.7% 92.3% 0.095
from mental illness
continue his
occupation?
10. Can homecare
help in recovery of 100% 100% 93.3% 92.3% 0.271
mentally ill
person?
11.Are you aware
of some physical 100% 75.0% 53.3% 91.7% 0.000
symptoms (like
pain) in mentally ill
persons without
any physical
cause?
12. Mental illness 100% 91.7% 100% 84.6% 0.049
only affects adults.
13. If a known
psychiatric patient 70.7% 83.3% 73.3% 84.6% 0.679
murders
somebody, is he/she
not criminally
responsible?
14. How many
psychiatric 100% 91.7% 53.3% 76.9% 0.000
hospitals do we
have in Eritrea?
15. A mentally ill
person is qualified 97.6% 58.3% 66.7% 84.6% 0.002
for casting vote.
3
Table 4.3 Shows the proportion of students with the correct responses to the knowledge questions.
Variable 5: Mention the types of mental illness?
40.00% 34.10%
30.00% 25% 23.10%
20.00%
10.00%
0.00%
2%
NursingPublic HealthPharmacyCLS
Fig 4.5 Shows Proportion of students with the correct responses to the question,
“What are the types of mental illness?”
As shown in table 4.3 and the above figure 4.5 the proportion of the students to answer all the given 5
types of mental illness namely schizophrenia, depression, mania. Epilepsy and drug addiction as mental
illness was only 34.1%, of Nursing students 25% of Public Health , 23.1% of pharmacy and 2% of CLS
students answered correctly with a significance of p- value 0.000.
Variable 6: What are the causes for mental illness?
70.00% 61.00%
60.00% 50.00% 46.20%
50.00% 40.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Nursing Public Pharmacy CLS
Health
Fig 4.6 Shows the proportion of students with the correct responses to the question.
“What are the causes for mental illness?”
From the Respondents: 61% of nursing students ,50% of public health , 46.2% of pharmacy and 40%
of CLS answered correctly to the above question “ What are the causes for mental illness?” as mental
3
illness is caused by biological and psychological factors, Family problems, hereditary and some other
medical conditions. The remaining students did not answered correctly to the causes of mental illness.
Variable 7: Does most mental illness can be treated like the medical problems?
1 92.90% 91.70% 91.30%

0.8
0.6 60.00%
0.4
0.2
0
NursingPublic HealthPharmacyCLS
Fig 4.7 Shows the proportion of students with the correct responses to the question,
“Does most mental illness can be treated like the medical problems?”
As it can be seen from table 4.1 and the above figure 4.5; 92.9% of the Nursing students ,91.7% of
public health , 91.3% of pharmacy, 60% of CLS answered “ yes” that most mental illness can be treated
like the medical problems correctly with p-value of 0.091.The remaining said ” no.”
Variable 8: Is hospitalization for treatment of mental illness effective?
97.60% 91.70%
1
0.8 61.50% 60.30%
0.6
0.4
0.2
0

Health
“Is hospitalization for treatment of mental illness effective?”
As shown in the above figure 4.5 majority of the nursing students which is 97.6% ,Public health students
91.7%, pharmacy students 61.5%, CLS 60.3% responded “ yes” the question “Is hospitalization for
treatment of mental illness effective?” the remaining students answered “no”, that hospitalization is not
effective to threat mentally ill.
Variable 9: Can a person who recovered from mental illness continue his occupation?
3
1.2
100%
1 92.30% Fig 4.9 Shows the
83.30% 86.70%
proportion of
0.8 students with the
correct responses to
0.6
the question
0.4
“Can a person who
0.2 recovered from
mental illness
0 continue his
occupation?”
Nursing Public Health Pharmacy CLS
As shown in the above figure 4.6; all of the Nursing students (100%), 83.3% of Public Health, 92.3% of
pharmacy and 86.7% of CLS students responded “ yes” to the above question with a p- value 0.095. the
remaining said “no”, that an individual who recovered from mental illness cannot continue his/her
occupation.
Variable 10: Can homecare help in recovery of mentally ill person?
100% 100%
1
Fig 4.10 Shows the
0.98 proportion of
students with the
0.96
93.30% correct responses to
92.30%
0.94 the question
0.92
“Can
0.9 homecare help in
recovery of
0.88
Nursing Public Health Pharmacy CLS mentally ill
person?”
6. Can homecare help in recovery of mentally ill person?
As it can be observed
from fig 4.7 all of the Nursing students (100% ) and Public Health (100%) but 92.3% pharmacy and 93%
of CLS students responded “yes” and the remaining said “no” with a significance level of p- value
0.271.
3
Variable 11: Are you aware of some physical symptoms (like pain) in mentally ill persons without
any physical cause?
100%
1 91.70%
0.9
0.8 75.00%
0.7
0.6 53.30%
0.5
0.4
0.3
0.2
0.1
0
Nursing Public Health Pharmacy CLS
“Are you aware of some physical symptoms (like pain) in mentally ill persons without any physical
cause?”
As shown in the above figure 4.8 most of nursing students (100%),public health 75% , pharmacy 91.7%
and CLS 53.3% answered “yes” and the remaining said “no” with a p-value of 0.0
Variable 12: Does Mental illness only affects adults?
100%
80%
60%
40% 100% 91.70% 84.60%82%
20%
0%

Health
“Does Mental illness only affects adults?”
When respondents were asked, “Does Mental illness only affects adults?”,as it can be seen from figure
4.9 most of the students responded “no”, that mental illness not only affects adults but also children with
3
a proportion of : Nursing (100%) , Public Health 91.7%, pharmacy 84.6%, CLS 82% and the remaining
8.3% of public health students,15.4% of pharmacy and 18% of CLS students answered “yes”, that
mental illness only affects adult but nobody ( 0%) from the nursing students answered “yes”.
Variable 13: If known psychiatric patient murders somebody does he/she is not criminally
responsible?
95.70%
1 89.30% 84.60%
73.30%
0.8
0.6
0.4
0.2
0

Health
“If known psychiatric patient murders somebody does he/she is not criminally responsible?”
As it can be shown from the above figure 4.10 ,95.7% of the Nursing students, (89.3%) of Public Health
( 84.6% pharmacy and 73.3% of CLS students answered “ yes” to the question number 9 but the
remaining students said “no”, that he/she is criminally responsible.
Variable 14: How many psychiatric hospital/s do we have in Eritrea?
100% 91.70%
1 76.90%
53.30%
0.5
Fig 4.14 Shows the proportion of

students with the correct responses to the question “How many psychiatric
hospitals do we have in Eritrea?”
3
As shown in figure 4.10 all of the Nursing students (100%), Public Health (91.7%), pharmacy (76.9%)
and CLS (53.3%) responded that there is only one psychiatric hospital in Eritrea .the remaining answered,
some of them “I don‟t know” and some of them said there are two psychiatric hospitals.
Variable 15: Does a mentally ill person be qualified for casting vote.
97.60%
1 84.60%
0.8 66.70%
58.30%
0.6
0.4
0.2
0
NursingPublic HealthPharmacy CLS
“Does a mentally ill person qualified for casting vote?”
As shown in the above figure 4.1 most of the Nursing students (97.6%), Public Health (58.3%), pharmacy
( 84.6%) and CLS (66.7%) answered “ no” with a p- value 0.002.The remaining respondents said yes
that mentally ill have the right to vote.
3
4.2.1 SECTION C: Attitude of students toward mental illness.
Scores of attitude between departments.
Nursing Public Health CLS Pharmacy p-value
Attitude on 24.71 (±3.035) 23.67 20.93 21.33 (±2.891) 0.000

Integrating (±5.158) (±4.061)
people with
mental illness
to the
community
Whatleys 19.61 (±2.756) 19.58 17.80 18.46 (±4.095) 0.001

Social Distance (±3.288) (±3.144)
Scale
Attitude on 44.51 42.75 39.93 38.92 (±3.252) 0.225

Understanding (±3.8480) (±6.298) (±3.731)
and Tolerance
of Mental
Illness.
Total Score 84.89 (±9.48)
Table 4.4 Shows Mean and Standard deviation of attitude of students towards mental illness based
on their departments.
Nursing Public Health CLS Pharmacy
Attitude on 24.71 23.67 20.93 21.33 (±2.891)

Integrating (±3.035) (±5.158) (±4.061)
people with
mental illness
to the
community
Table 4.4.1 Shows Mean and Standard deviation of a questioner measuring Attitude on Integrating
people with mental illness to the community of students towards mental illness in specific
Departments.
3
The average score mean and standard deviation of students responded correctly from the total score of 35
for 7 questions in which sum of Means and standard deviation responses to individual items on the 5
linkert scales are shown in the above table. In general, responses of Nursing students were 24.71
(±3.035),Public Health23.67 (±5.158),CLS 20.93 (±4.061) and Pharmacy 21.33 (±2.891) of mean and
standard deviation respectively which revealed favorable attitudes toward mental illness in which their
score were above 21 except CLS students .
Attitude on 44.51 42.75 39.93 38.92 (±3.252) 0.225

Understanding (±3.8480) (±6.298) (±3.731)
and Tolerance
of Mental
Illness.
Table 4.4.2 Shows Mean and Standard deviation of the questioner measuring Attitude on
Understanding and Tolerance of Mental Illness in students with specific Departments .
Table 4.4.2 shows the sum of the results of mean and standard deviation of respondents to the 11
questions with a total score of 55 based on Attitude on Understanding and Tolerance of Mental Illness in
which respondents answered: Nursing 44.51 (±3.8480), Public Health 42.75 (±6.298) ,CLS39.93
(±3.731) and pharmacy 38.92 (±3.252) of mean and standard deviation respectively from the total score
of 55 with p-value of 0.225 which is not significant. Generally respondents have very good attitude.
Whatleys Social 19.61 19.58 17.80 18.46 (±4.095) 0.001

Distance Scale (±2.756) (±3.288) (±3.144)
Table 4.4.3 Shows Mean and Standard deviation of attitude of students towards mental illness in
specific Departments and total score.
The table above shows response of students based on Whatley‟s Social Distance Scale in which it
contains 8 item questions with a scale of 3 and total score of 24,respondents were Nursing 19.61
(±2.756),Public Health19.58 (±3.288) which was very good attitude, however CLS17.80 (±3.144) and
Pharmacy18.46 (±4.095) that revealed only good attitude.
The total score of students towards attitude 84.89 (±9.48) shows students have good attitude towards
mental illness.
3
4.3 inferential results
Correlation between attitude and knowledge
Nursing Public Health CLS Pharmacy

r=0.218, p=0.000 r=0.557, p=0.049 r= -0.177, r= -0.012, p=0.968
p=0.528
Overall coefficient r=0.406, p=0.000
Table 4.4.4 shows correlation of knowledge and attitude of students with in the departments.
Nursing and Public Health students have positive correlation of knowledge and attitude in which weak
and moderately positive correlation respectively for each. Pharmacy and CLS students have good
knowledge, but negative attitude as it was indicated by the results which shows a negative correlation of
CLS (moderately negative correlation) and Pharmacy students (strong negative correlation)
Score of knowledge between departments.

Score (±SD) 16.02 (±1.423) 15.17 (±2.29) 12.20 (±2.21) 14.62 (±1.805) ANOVA,
p=0.000)
Total score 14.96 (±2.261)

(±SD)
Table 4.4.5 shows the scores of knowledge in terms of mean and standard deviation of the students
in the departments.
As it is shown in table 4.4.5 Nursing students scored the highest followed by Public Health students then
Pharmacy and at last CLS.
4.3 Discussion
This is the first study that had been performed on the knowledge and attitudes of college students towards
mental illness in Eritrea. In the literature study, it was shown that lack of knowledge and negative
attitudes towards mental illness with avoidance behavior toward mentally ill person were considered as
stigma which hinders the health seeking behavior of the mentally ill. So that the first objective of the
research was to identify whether Stigmatizing behavior about mental illness exists among the students or
not. To determine this objective the researcher used the outcomes of the knowledge and attitude
questions.
In the assessment of knowledge, students were asked about their knowledge on the causes, types,
treatments of mental illness, rights of mentally ill and some other knowledge related questions.
4
On the types of mental illness, as it was presented on data analysis and presentation the proportion of the
students to answer all the given 5 types of mental illness namely schizophrenia, depression, mania,
Epilepsy and drug addiction as mental illness was only 34.1%, of Nursing students 25% of Public Health,
23.1% of pharmacy and 2% of CLS students answered correctly with a significance of p- value 0.00. In
comparison to a national survey done in Great Britain 2011, on the adult non health professionals on the
same question 73% of the respondents answered correctly, the students knowledge on the types of mental
illness was generally very poor, but comparatively it was better in nursing students followed by public,
pharmacy and CLS. It was interesting to learn from this research outcome that the theoretical classes and
clinical exposure of students (Nursing) to score the highest than other departments. As acknowledged by
World Health Organization (Issa et al., 2008:43) that greater education leads to greater openness about
mental illness. Structured teaching program is an effective tool to increase student‟s knowledge on mental
illness. The poor outcome could be due to the reason that most of the respondents thought that epilepsy
and drug abuse are not types of mental illness (especially nursing students who scored poor result on the
these types of mental illness ), for Public health students the insufficient credit and duration of the course
could be the causes of this outcome. In pharmacy students who have taken only pharmacotheraptics and
CLS students who have not taken the course at all, it is obvious to score low results on the types of mental
illness. This problem can enhance to the continuation of stigma in both the students and the community.
The people with mental illness especially those having epilepsy and drug addiction may remain
unrecognized, and as a consequence of this there will not be improvement on the health seeking behavior
of the mentally ill people.
According to Gureje et al, 2006, improved knowledge about causes of mental illness may lead to
improved overall knowledge about mental illness and promote supportive attitudes to the mentally ill.
Hence the students were asked to answer four scientifically proved causes of mental illness, such as
psychological and biological factors, family problems, hereditary and other medical conditions to
determine their knowledge. The responses were not satisfactory that all the respondents in department
wise scored below the expected. Although nursing students scored greater than 50% the other
departments scored below. Comparatively as in the types of mental illness responses nursing students
scored higher score followed by public health ,pharmacy and CLS students (61%, 50%, 46.2% and 40%
respectively), this implies the students have less knowledge on the causes of mental illness. The
difference between nursing and public health seem to be related with the duration of the mental health
course they took as100% of the sources of knowledge of the nursing students is from mental health
course, but in public health 100 % of the students said their knowledge was mental health course. Both
pharmacy and CLS students who said mental health course was not source of their knowledge scored the
lowest results. Students were also asked to answer if visitation of the evil spirit, curse, and mystic
influences are causes of mental illness to determine if their knowledge is similar with the community‟s
knowledge because, it is uncommon to see or to heard that the community believes the causes of mental
illness to be the super natural power, Visitation of the evil spirit, Curse, and mystic influences. Proudly no
one of the students answered from the above as the causes of mental illness. This knowledge may result in
changing the knowledge of our community and the mentally ill in the causes of mental illness which in
turn results reduction in the greater use of traditional healers, delay in recognition of the problem at early
stage and poorer compliance with medication. Jorm, 2000, found that, beliefs by psychiatric patients in
supernatural causes were associated with greater use of traditional healers and poorer compliance with
medication.
4
Gureje et al, 2006, reported that belief that mental illnesses are treatable, can encourage early treatment
seeking, and promote better outcome. Understandably to this respondent were also asked about the
effectiveness of psychiatric hospitals in treating mentally ill individuals, the effectiveness of home care
for mentally and above all if mental illness can be treated. The result shows: As it can be seen from table
4.1 and the above figure 4.5; 92.9% of the Nursing students ,91.7% of public health , 91.3% of
pharmacy, 60% of CLS answered “ yes” that most mental illness can be treated like the medical
problems correctly with p-value of 0.091.The remaining said ” no.”
According to the WHO report in 2004 and the state of Eritrea MOH policy and guidelines on mental
health 2011, even though the introduction of mental health at community level is not a far future yet we
do have only one centralized psychiatric hospital (St. Marry Neuro-Psychiatric Hospital, Sembel) which
is located in Asmara and one community residential facility in Mai-Temenay north west part of Asmara.
From the knowledge questions the easiest but most of them missed question was asked. Hence students
were asked about the availability of mental health services in Eritrea as, “How many psychiatric
hospital/s do we have in Eritrea?‟ and as it can be seen from table 4_ only 53.3% of the CLS, 76.9% of
pharmacy and 91 .7% of the public health students answered correctly that there is one psychiatric
hospital in our country the remaining answered some of them “I don‟t know” and some of them “two”,
but all of the nursing students (100%) answered correctly. Some of them “I don‟t know” and some of
them said there are two psychiatric hospitals. This shows that except the nursing students the other are
alittle bit not familiar with the mental health services delivered in our country. This is due to the reason
that they have not clinical experience especially for those CLS and Pharmacy and also they may be
disinterested to know about mental health. But the (100%) response of to the correct answer Nursing
students could be due to their clinical experience. This knowledge of the students may affect the
knowledge of the community as the students are going to be assigned in different part of Eritrea no far
more time as health professionals with more expectation to achieve a great improvement in the health care
system of the country. However this knowledge is not sufficient to inform the mentally ill people or their
families were to go for better health care and it may not improve the traditional healing complications.
As it was presented in figure-4 students were also asked about their knowledge on the presence of mental
illness in children
Based on Attitude on Integrating people with mental illness to the community the researchers founded
that the total average score mean and standard deviation of students responded correctly from the total
score of 35 for 7 questions in which sum of Means and standard deviation of respondents to individual
items on the 5 likert scales was taken . In general, responses of Nursing students were 24.71 (±3.035)
which indicates very good attitude, Public Health23.67 (±5.158) good attitude, CLS 20.93 (±4.061) good
attitude and Pharmacy 21.33 (±2.891) good attitude of mean and standard deviation respectively which
revealed favorable attitudes toward mental illness in which their score were above 21 from 35 except
CLS students scored 20.93 this result indicates
Based on Attitude on Understanding and Tolerance of Mental Illness revealed the sum of the results of
mean and standard deviation of respondents to the 11 questions with a total score of 55 based on Attitude
on Understanding and Tolerance of Mental Illness in which respondents answered: Nursing
44.51(±3.8480), Public Health 42.75 (±6.298) ,CLS39.93 (±3.731) and pharmacy38.92 (±3.252) of mean
4
and standard deviation respectively with p-value 0.225 which is not significant. Generally the respondents
have very good attitude. Brunt D, Hansson L, Leufstadius C, Sandlund M (2009) et al conducted a study
on attitudes towards mental illness among health care students as a follow up study after completed
clinical placement. The aim of the study was to examine the changes in attitudes towards mental illness
after theoretical education and clinical placement among students from university program preparing for
different kinds of health professions. The result showed that the attitudes toward mental illness in general
had changed in a less stigmatising direction after the clinical placement. Study concluded that the clinical
placement included in the university program to some extent could affect attitudes in a de-stigmatizing
direction, possibly because of the interaction with persons suffering from mental illness and experienced
supervisors
As shown in the above figure 4.5 majority of the nursing students which is 97.6% ,Public health students
91.7%, pharmacy students 61.5%, CLS 60.3% responded “ yes” the question “Is hospitalization for
treatment of mental illness effective?” the remaining students answered “no”, that hospitalization is not
effective to threat mentally ill
As it can be observed from fig 4.7 all of the Nursing students (100% ) and Public Health (100%) but
92.3% pharmacy and 93% of CLS students responded “yes” and the remaining said “no” with a
significance level of p- value 0.271.
4
CHAPTER FIVE
5. CONCULUTION AND RECOMMENDATIONS
5.1 CONCULUTION
Generally nursing and public health students had very good knowledge and good attitude . Hence stigma
is not a great concern especially for nursing students but it existed in pharmacy and CLS students.
Nursing students who had long clinical and theoretical experience was found to have the best knowledge
and attitude followed by public health students who had short period theoretical experience, but not
clinical exposure in mental health. Pharmacy students who had taken only psychopharmacotheraptics and
CLS students who had not taken any mental health course at all had less knowledge and attitude
comparing the other. However the students had un satisfactory knowledge and attitude on the causes of
and in identifying the types of mental illness. The researcher therefore concluded that the more the
edicational experience the more will be the knowledge and attitude of the students. Additionally it was
observed that the more knowledge and attitude can be induced by more effective theoretical and clinical
educational experience. Understandably then in CLS and Pharmacy students there is a needs for mental
health education I n order to improve their knowledge and attitude in a better way. More over it was
found that improved attitude is associated with good knowledge.
5.2 RECOMMENDATIONS
As it was explained in the literature review, the more highly educated the person, the greater the
recognition of mental illness behaviors. However, even more relevant than amount of education is type of
education. Individuals in the more humanistic types of professions (e.g., lawyers, social workers, artists,
teachers, nurses and other health professionals) are more likely to seek psychiatric assistance than other
professionals such as business executives, computer specialists, accountants, and engineers.(C.
Towensend,2008:31). Therefore the researchers strongly recommended to the authorized personnel of
ACHS to introduce the basic mental health education for the remaining CLS and Pharmacy students in
their curriculum in the way that can improve their knowledge and attitude toward mental illness. For
Public Health students to achieve more better knowledge and attitude the amore credit hour is needed,
because they are the one who can provide health education to the public and also the Nursing students
who have very close contact with patients should have the best knowledge about mental illness. Therefore
the mental health instructors should teach the students focusing on the causes and treatment of mental
illness and in the way that can reduce their stigma in order to provide the needed care by patients and to
reduce community stigma.
The Student Affairs of ACHS should take measures to maintain equilibrium of good knowledge and
positive attitude the students by introducing basic mental health courses and even minimal clinical
practice or other conferences on mental health to the students who are continuing their education to
become productive for changing attitudes of the public by educating and advocating them.
It is advisable to recommend to the Asmara college of health Sciences administration to introduce un

updated books containing basic concepts about psychiatric diseases (mental illnesses) types of ,it‟s
4
causes, it‟s treatments , behavior or clinical manifestations of the different mental illnesses in the college
library and they should be available and sufficient for all the students.
The MOH in collaboration with MOI has to be strengthened on enlightening the students and
communities knowledge on mental health by introduce a program on mental health education in the mass
media like for the usual information on medical surgical problems doctors on studio in Eri-TV, Radio
numa and like the other topics of health issue presented at the Haddas Eritrea News Paper every
Wednesday.
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18.Corrigan, P.W. & Watson, A.C. 2002. Understanding the impact of stigma on
people with mental illness. World Psychiatry.
19. De Vos, A.S., Strydom, H., Fouche, & Delport, C.S.L. 2005. Research
at grass roots for the social sciences and human service professions, 3rd ed.,
Hatfield, Pretoria: South Africa.Elise
20. Hugo, C.J., Boshoff, D.E.L., Traut, N.Z. & Stein, D.J. 2003.
Community attitudes towards and knowledge of mental illness in South
Africa. MRC Unit on Anxiety Disorders, University of Stellenbosch: South
Africa. doi: 10.1007/s00127-003-0695-3.
21. Issa, B.A., Parakoyi, D.B., Yussuf, A.D. & Mussa, I.O. 2008. Caregivers‟
knowledge of etiology of mental illness in a tertiary health institution in
Nigeria. Iranian Journal of Psychiatry and Behavioral Science, 2(1):43-49.
22. Jorm, A.F., Angermeyer, M.C. & Katschnig, H. 2000. Public knowledge of
and attitudes to mental disorders: Cambridge University Press.
23. Jorm, A.F., Mackinnon, A., Christensen, H. & Griffiths, K.M. 2005. Structure of
4
beliefs about helpfulness of interventions for depression and schizophrenia:
results from a national survey of the Australian public. Soc psychiatry psychiatr
epidemiol, 40:877-883, doi 10.1007/soo127-005-0991-x.
24. Sadock, B.J. & Sadock, V.A. 2007. Synopsis of psychiatry:
behavioral sciences / clinical psychiatry. 10th ed. New York : U.S.A.
25. World Health Organization. 2001. Burden of mental and
behavioral disorders. Geneva : WHO.
4
ANNEXE
Questionnaire for Final Year Degree Students in Asmara College of Health Sciences(ACHS)
CONSENT: This questionnaire has been designed as per senior research paper titled as “The Knowledge,
and attitude of Final Year Degree Students of Asmara College of Health Sciences (ACHS) towards
Mental Illness‟‟ by BSN(nursing degree) students (Batch-6: Year-4, Semester-2 and Academic-Year of
2011/2012):
This questionnaire provides no specific identification of the respondent. It has to be known that, the
identifying parameters mentioned in the (A) section below is only included for analytic purposes. Your
cooperation is of high value and is thus politely requested. As a respondent you have the right to leave
this questionnaire only before you start to answer a single question. If you agree to respond to this
questionnaire, please feel free to put your signature in the space provided below:
Respondent‟s signature:
(A) Anonymous Respondents Identification
Sex: Age: Department code: Year:
(B) Questions measuring Knowledge about mental illness.
Instruction: For the following questions please put only one thick ( ) in the provided space where
the answer is( strongly agree, agree, slightly agree, slightly disagree, disagree, strongly disagree) for the
first part and (agree, disagree or not sure) for the second part. Here, it seems advisable to remind you of
not discussing any of the questions with any other person for it is your honest opinion that is needed and
highly reliable..
1. How much do you know about mental illness?
a) good
b) little
c) none
2. from where did you get the knowledge?
a) mental health course
b) internet
c) mass media
d) text books
e) others
4
3. Which one of the following is mental illness?
3.1 Depression
3.2 Schizophrenia
3.3 Manic depression
3.4 Drug addiction
3.5 Epilepsy
4.) What are the causes for mental illness?
4.1) Visitation of the evil spirit [ ]
4.2) Curse [ ]
4.3) Mystic influence [ ]
4.4) Excessive faith in power of saint & priest [ ]
4.5) Heredity [ ]
4.6) Biological & Psychological factors [ ]
4.7) Family problem [ ]
4.8) some other medical conditions [ ]
5 .Like medical problems most mental illness can be cured.
5.1 yes
5.2 No
6.) Is the hospitalization for treatment of mental illness is effective?
6.1) Yes [ ]
6.2) No [ ]
7) Can a person who recovered from mental illness continue his occupation?
7 .1) Yes [ ]
7.2) No [ ]
8)Can home care help in recovery of mentally ill person?
4
8.1) Yes [ ]
8.2) No [ ]
9. There are some physical symptoms (like pain) in mentally ill

persons without any physical cause.
9.1) yes [ ]
9.2) No [ ]
10. Does mental illness only affects adults.
10.1) Yes [ ]
10.2) No [ ]
11. If a known psychiatric patient murders somebody, does he/she is not criminally responsible?
11.1 Yes []
11.2 No [ ]
12. How many psychiatric hospital/s do we have in Eritrea?
12.1) One [ ]
12.2) Two [ ]
10.3) Three [ ]
13) Is mentally ill person qualified for casting vote?
13.1) Yes [ ]
13.2) No [ ]
5
Questions Agree Disagree Not sure
1) Depression is mental illness.
2) Schizophrenia is mental illness.
3) Manic depression is mental illness.
4) Drug addiction is mental illness.
5) Prolonged grief can cause depression.
6) Alzheimer‟s disease is mental illness.
7) Epilepsy is mental illness.
8) There are some medical conditions that

can cause mental illness.
9) Like medical problems most mental

illness can be cured.
10) There are some physical symptoms (like

pain) in mentally ill persons without any
physical cause.
11) Mental illness only affects adults.
12) Mentally ill individuals have the right to

vote.
13) If a known psychiatric patient murders

somebody, he/she is not criminally
responsible.
14) There are three psychiatric hospitals in

Eritrea
15) A victim of sexual assault has high

probability of developing PTSD (post
traumatic stress disorder)
5
C :Questions measuring attitude of students.
Table 1: attitude on Understanding and tolerance of mental illness.
Questions Strongly Agree Neutral Disagree strongly

agree disagree
1.We have a responsibility to provide the

best possible care for people with mental
illness
2.It is easy to recognize someone who once

had a serious mental illness.
3.Most mentally ill persons haven‟t the

ability to tell right from wrong.
4.Increased spending on mental health

services is a waste of money
5.Virtually anyone can become mentally ill
6.Mentally ill people are not intelligent.
7.Most mentally ill people don‟t care how

they look.
8.We need to adopt a far more tolerant

attitude toward people with mental illness in
our society
9.Mental illness is nothing to be ashamed

of.
10.As far as possible, mental health services

should be provided through community
based facilities
11.A mentally ill person is in no position to

make decisions about even everyday living
problems.
5
Table 2. Attitude on integrating people with mental illness into the community.
Questions Strongly Agree Neutral Disagree Strongly

agree disagree
1.People with mental illness are far less of a danger than

most people suppose
2.The best therapy for many people with mental illness is

to be part of a normal community‟
3.Residents have nothing to fear from people coming into

their neighborhood to obtain
mental health services
4.People with mental health problems should have the

same rights to a job as anyone else
5.Mental illness is an illness like any other‟
6.No-one has the right to exclude people with mental

illness from their neighborhood
7.Mental hospitals are an outdated means of treating

people with mental illnesses.
5
Table 3: Questions measuring attitudes based on Whatley’s Social Distance Scale.
Questions Agree Disagree Not sure
It is best not to associate with people who

have been in mental hospitals
It is wrong to shy away from people who

have mental disorders.
It would bother me to live near a person who

has been in a mental hospital.
I would not ride in a taxi driven by someone

who had been in a mental hospital.
I would rather not hire a person who had

been in a mental hospital.
Schoolteachers who have been in mental

hospitals should not be allowed to teach.
I would be against any sister of mine

marrying a man who had been to see a
Psychiatrist about mental problems.
If I needed a babysitter, I would be willing to

hire a woman who had been in psychiatric
hospital.
Please write your comments or suggestions about the questionnaire if you have problem in understanding
of the questions and give the number of the question/s. Are these questions appropriate to be asked for
final year degree
students? Are they sufficient to evaluate the knowledge and attitude of students about mental illness?
continue
your comments on the back space.
THANK YOU FOR YOUR COOPERATION.

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Knowledge and Attitude of students towards mental illness 1

ASMARA COLLEGE OF HEALTH SCIENCE

Title KNOWLEDGE AND ATTITUDE OF ASMARA COLLEGE OF HEALTH SCIENCES

Aman Shishay 08/014

Merhawi Teklemichael 08/086

Teklu Tsegai 08/158

Tesfaalem Tewelde 08/159

Mr. MOHAMMED HAMID M.Sc. PSYCHIATRIC NURSING

Mr. N. ARASU MANI M.Sc. PSYCHIATRIC NURSING

Table of contents pages

1.3 Problem statement.............................................................................................................................2

1.4 Significance of the

3.1 Study area...........................................................................................................................11

3.2 Study population….................................................................................................................11

3.3 Study design……………………………………………………………………………………

3.4 Sample design…...................................................................................................................v

3.5 Data analysis…......................................................................................................................11

3.6 Ethical consideration................................................................................................................12

List of Tables and Figures

Table 4.1:................................................Basic demographic characteristics of respondents

Fig 4.1...................................................................................................................shows gender proportion.

Table 4.2……………………………… Shows the proportion of answers given to the source of

“What are the causes for mental illness?”

“Is hospitalization for treatment of mental illness effective?”

“Can homecare help in recovery of mentally ill person?”

“Does Mental illness only affects adults?”

Table 4.4………………………………… Shows Mean and Standard deviation of attitude of students

Table 4.4.1….....................................Shows Mean and Standard deviation of a questioner measuring

Table 4.4.5…..........................................................shows the scores of knowledge in terms of mean and

APA : American Psychiatric Association

B.Sc.: Baccalaure Science

HMIS: Health Management Information System

MOH: Ministry Of Health

WHO: World Health Organization

SPSS: Short Package for Statically Storage

PHNP: Public Health Nursing Practitioner

PHCH: Public Health and Clinical Sciences

MLT: Medical Laboratory Technician

M.Sc.: Masters Science

et al. : and others

UoA: University of Asmara

1.1 BACKGROUND INFORMATION

1.1.1 BACKGROUND INFORMATION ON MENTAL ILLNESS

1.2 OPERATIONAL DEFINITIONS

1.3 PROBLEM STATEMENT

The study can be used as base line for further research.

1.5 Research question

towards mental illness.

1.7.1. General objectives.

1.7.2. Specific objectives

2.1 Concepts of Mental Health and Illness

2.2 Mental Health Knowledge

2.2.1 The Effect of Adequate Knowledge

2.2.2 The Effect of Inadequate Knowledge

2.3 Attitude Toward Mental Illness

2.3.1 The Effects of Attitude towards Mental Illness

3.1 OVER VEIEW

3.2 STUDY AREA:

3.2.1 Background information

Diploma: General Nursing and midwifery (RN) (3 year program)

Degree: B.Sc. in Pharmacy (5 year program)

Diploma: pharmacy technician (2 year program)