The study results indicated that higher proportion of the caregivers were females and from middle-aged group (38-47) years. It specified that the females are mostly in priority for the caretaking of anyone in the family in developing country like Bangladesh. A study in Brazil reported that care of the person with disabilities is usually assigned to women as a result of their traditional role as caretaker for the home and family . There was decline in the percentage of caregivers with the increasing educational status. This is a clear indication that the caregivers who are educated were not interested for the role of caregiver. Regarding occupational status, it was noticed that most of the caregivers were housewife. Men are mostly exposed to the work or activities that make them vulnerable to SCI, while women generally do not go out to work and remain indoors . The relatives (kins/cousins) were also found to be involved as primary caregiver and wife of the male SCI individuals as well as mother of females were mostly engaged in caretaking amongst a family member, if the person were married.
Level of knowledge
The study findings demonstrated moderate level of knowledge among caregivers i.e. neither high nor low knowledge which showed insufficient information on prevention and care of PU. It is reported that the knowledge of caregivers regarding bedsore care was inadequate and practices were found to be incorrect . The caregivers had inappropriate information about prevention of complications resulting due to immobility . It is assumed that age group and educational background may be a factor related to this moderate level of knowledge while, the results showed that age and level of education had a highly significant relation. Supporting this explanation, a study on caregivers illustrated having higher level of education, had higher knowledge than those having lower levels of education . Furthermore, more than three quarter of the respondents are in age group (18-27) and (28-37). Since, this is the age of education and learning, thus might be the reason for the moderate level of knowledge. A study showed that age had a significant effect on knowledge score, the old age exhibited an excellent knowledge . Majority of the caregivers were housewife (69.3%), and they have some idea of the general care except specific knowledge on transfer and positioning. It seems they had more information on other aspects of general care rather than pressure ulcer care. A significant relation was observed between level of knowledge, age, sex, marital status and kin relationship respectively . Regarding relationship between caregiver and patient, it is predicted that if the patient were married, wife and mother were the primary caregiver and other family members were rarely involved in the caretaking. The related result was noticed where level of knowledge is statistically significant with area of residence, marital status and educational status of respondents .
Level of attitude
The results showed that greater quantity of caregivers had neutral level of attitude regarding the prevention and care of PU which indicates that caregivers were unaware of PU prevention and care, or they had no idea about preventing PU development. It is predicted that there might be relation between age and attitude. In contrast, additional analysis supported this statement. There was significant correlation between age and attitude. The female showed more positive attitude than male, while the house wife had positive attitude more than the other occupation . It was observed that large number of caregivers were of age group (38-47) years, being from middle age group it is possible that they understood the fact about the disability and were ready to compromise with the situation. Therefore, they might have had showed neutral attitude towards prevention and care of PU. Likewise, high proportion of the house wife (77.3%) presented with neutral attitude towards prevention and care of PU compared to other occupations. The possible reason behind this might be they did not have had other responsibilities rather than as a caregiver such as office work and family responsibilities. And being a house wife, they perform daily tasks in their houses which are also quite similar to the activities as a caregiver. The family members are the primary caregivers in most of the times during need of patient care . Regarding relationship between caregiver and patient, it also showed relation with attitude score. The wife of the SCI individuals showed higher neutral attitude (46.6%) regarding prevention and care of PU than others. This might be due to their relationship as it was observed that wife and mother were in priority of caregiving for married peoples with SCI. This may be the reason of showing neutral attitude rather than negative. The relationship and bonding between caregiver and the person with SCI reflect their interest in caregiving .
Level of practice
It was found that the caregiver’s practice regarding prevention and care of PU was at a moderate level. The level of knowledge and practice were equivalent to each other. In this study, caregivers’ practice was reflected by their knowledge. 95.1 % of PU can be controlled by having information on its preventive factors . The gender presented significant relationship with the practice level. A possible reason for explaining this moderate level of practice among gender may be because the females are mostly engaged in household chores as it was found that majority of the caregivers were housewife. This helps them to deliver moderate level of practice to the sufferers than the male caregivers. Educational status is a related factor for the moderate level of practice. It was observed that the caregivers with higher level of education showed higher practice. The similar significant relation was reported between level of practice, age, sex, marital status and kin relationship respectively . The academic status of caregivers had its effect on the quality of care .
Relationships between knowledge, attitude and practice
The study presented moderately positive significant relationship between knowledge and attitude regarding prevention and care of PU. Based on KAP model, the factor that could affect attitude is specific based knowledge. Subsequently, the findings of this study support the KAP model. This may be because caregivers’ attitude was influenced by age group, educational status and relationship between caregiver and patient. A study conducted in Pakistan, demonstrated that poor or appropriate knowledge was significantly associated with development of PU where level of knowledge was based on the training and occupation of the participants. Meanwhile, attitude and practice were also significantly associated with the increased level of knowledge . It showed that the caregivers who were wife of the SCI individual and in the active phase of life along with higher education demonstrated positive attitude. Therefore, knowledge in itself is related to caregiver’s development of attitude. According to the KAP model, changes in the knowledge and attitude of individuals can affect practice. In this regard, caregivers need further continuing education and training programs regarding prevention and care of PU that could influence positive attitude ultimately, leading to effective practice towards prevention and care of PU. Previous studies showed relationship between knowledge and attitude but not with the practice. The high level of knowledge shows a positive attitude, while there was no relation between the knowledge and practice score . There was a moderate, significant positive correlation between knowledge and practice regarding prevention and care of PU among the caregivers. These findings support the KAP model in which practice is influenced by knowledge. A study revealed that caregivers had unsatisfactory knowledge and inadequate performance, where training and educational program enhances knowledge and practice of caregivers . However, there was a little and non-significant relationship between attitude and practice regarding prevention and care of PU. The KAP model suggests that if attitude developed, they would reflect on practice. Hence, in this study, caregivers’ practice was not reflected by their attitude.
It is recommended that caregivers need up-dated knowledge and information about prevention and care of PU in order to improve their practice. It needs special attention for improving the support systems for persons with SCI during the acute rehabilitation and reintegration phases in Bangladesh. If adequate knowledge is provided to caregivers, then it will assist them to cope with the stress and develop positive attitude towards PU care which enhance the quality of life of themselves and the sufferer. The study presents the findings of KAP of caregivers towards prevention and care of PU in a rehabilitation setting. However, after discharged from the rehabilitation center the maximum number of deaths due to PU have occurred in home. In community settings, the KAP of the caregivers towards PU may be different. Therefore, it is suggested to conduct the study of KAP among caregivers towards prevention and care of PU in spinal cord injury patients, in the community to reveal the findings related to the prevention and care of PU at both levels.