A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING

PROGRAM ON THE LEVEL OF KNOWLEDGE REGARDING BENEFITS

OF AYUSHMAN BHARAT YOJANA AMONG NURSING STUDENTS OF
SELECTED NURSING COLLEGE OF DAMOH (M.P) IN THE YEAR 2025.

RESEARCH WORK

RESEARCH PROJECT SUBMITTED IN THE PARTIAL FULFILLMENT OF

THE REQUIREMENT FOR THE DEGREE OF THE BACHELOR OF
SCIENCE IN NURSING OF MADHYA PRADESH MEDICAL SCIENCE
UNIVERSITY JABALPUR (M.P) 2025

RESEARCH GUIDE
MR. SALOM RAJ
(ASSISTANT PROFESSOR)
RESEARCH BY
PRIYANKA GUPTA
KANCHAN KUMARI
ROSHNI AHIRWAR
SHIVANJALI VERMA
SHARON LAL

CHRISTIAN MEDICAL AND TRAINING CENTRE COLLEGE OF

NURSING DAMOH (M.P) FORWARD TO MADHYA PRADESH MEDICAL
SCIENCE UNIVERSITY JABALPUR (M.P) 2024-25
 CERTIFICATE BY THE PRINCIPAL/HEAD OF THE INSTITUTION

This is to certify that dissertation “ A study to assess the effectiveness of

planned teaching program on the level of knowledge regarding benefits of
Ayushman Bharat Yojana among nursing students of selected nursing
college of Damoh (mp) in the year 2025.

is a Bonafede work of Miss Priyanka Gupta, Miss Kanchan Kumari, Miss

Roshni Ahirwar, Miss Sharon lall, Miss Shivanjali Verma B.sc nursing 4 th year
CMTC college of nursing Damoh submitted in a partial fulfillment of the
requirement of the degree of bachelor of science in nursing from Madhya
Pradesh Medical Science University Jabalpur.

DATE

PLACE: Damoh (M.P.)

Signature of principal

Dr. PRASHANSA NATHAN KUMAR

PRINCIPAL

Christian Medical &Training Centre

Christian Medical &Training Centre

 CERTIFICATE BY THE RESEARCH GUIDE

This is to certify that dissertation “A study to assess the effectiveness of

planned teaching program on the level of knowledge regarding benefits of
Ayushman Bharat Yojana among nursing students of selected nursing
college of Damoh (M.P.)”

is a Bonafede work of Miss Priyanka Gupta, Miss Kanchan Kumari, Miss

Roshni Ahirwar, Miss Shivanjali Verma, Miss Sharon Lal B.sc nursing 4th year
Christian Medical & Training Centre college of nursing Damoh submitted in a
partial fulfillment of the requirement of the degree of bachelor of science in
nursing from Madhya Pradesh Medical Science University Jabalpur.

DATE
PLACE: Damoh (M.P.)

Signature of Guide

MR. SALOM RAJ

M.Sc. MEDICAL SURGICAL NURSING
(ASSISTANT PROFESSOR)
Christian Medical &Training Centre
College of Nursing Damoh (M.P)
 DECLARATION OF THE CANDIDATE

We hereby declare that the Christian Medical & Training Centre Damoh (M.P)
shall have the right to preserve, use and disseminate this thesis in print or
electronic format for academic/research purpose.

Date:
Place: Damoh (M.P.)

Miss. PRIYANKA GUPTA

Miss KANCHAN KUMARI
Miss ROSHNI AHIRWAR
Miss SHIVANJALI VERMA
Miss SHARON LAL
ACKNOWLEDGEMENT
 ACKNOWLEDGE

“THIS IS THE DAY LORD HAS MADE WE WILL REJOICE AND BE GLAD IN IT”
We are heartily grateful to my almighty God who strengthened, accompanied and blessed us
throughout the study. On completion of this project with a sense of immense relief and
satisfaction, we would like to express heartfelt gratitude to all those who have assisted us and
inspire me to achieve this goal. It is a privilege and pleasure for us to express our sincere
gratitude to the patron body of Christian Medical & Training Centre, college of nursing.
Damoh to facilitate an adequate environment for study. We consider our proud privilege to
express our indebtedness to Dr. Prasansha Nathan Kumar, Principal of Christian Medical &
Training Centre. college of nursing, who acted as an anchor during my academic period. Her
timely support and continued encouragement accelerated my pace towards the
accomplishment of my goal.

We have to express our gratitude to our guide Mr. Salom Raj (Assistant Professor),
Christian Medical & Training Centre college of nursing. We are grateful to them for having
consented to be our guide for the suggestion and the time spent in guiding us for study. We
owe special thanks to all the faculty members of Christian Medical & Training Centre
College of Nursing, Dr. Vinit Singh Ph.D. (N) C.H.N. (Vice Principal), Dr. Stephi Grove
Massey Ph.D. O.B.G (Professor), Mr. Salom Raj (Assistant Professor) for their valuable
suggestions, constructive criticism and help whenever we approached them. Our sincere
thanks to our study subjects without those content and co- operation this study would not
have seen the light of day. A word of commendation is for Mrs. Nandini Agarwal (Librarian)
for her immense help in providing relevant literature and books and made the computer
available for us and also helped us to use the internet for our research purpose and helped us
to obtain the review of literature. Words of acknowledgement would remain incomplete if we
do not express our sincere and deep sense of indebtedness to our parents for their constant
support and encouragement throughout the research project. We wish to thank all our friends
and colleagues who have been a source of encouragement and immense support at times
when it was needed.

Thanking you …

Priyanka Gupta, Kanchan Kumari, Roshni Ahirwar, Shivanjali Verma, Sharon Lal
ABSTRACT
 ABSTRACT

STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of planned teaching program on the level of

knowledge regarding benefits of Ayushman Bharat Yojana among nursing students of
selected nursing college of Damoh (M.P) in the year 2025”

OBJECTIVES:

● To assess the knowledge regarding Ayushman Bharat –(PMJAY) among nursing students.

● To assess the pre test and post test knowledge about Ayushman Bharat Yojana among
nursing students.

● To assess effectiveness of structured teaching Programmes regarding Ayushman Bharat

(PMJAY)among nursing students.

● To determine the association between pre and Post- test knowledge score regarding
Ayushman Bharat PMJAY with selected demographic variables among nursing students.

METHODOLOGY

In The Study One Group pre and post-test design was used to assess the knowledge of
planned teaching program among the Nursing Students of College of Nursing at Damoh
regarding benefits of Ayushman Bharat Yojana, the setting was in Christian Medical &
Training Centre at Damoh, the sample were drawn by convenient sampling techniques and
the sample size were 60 students. The tools are 35 structured knowledge questionnaires
administered to each sample.

MAJOR FINDINGS

1. The maximum number of nursing students is 60. majority of nursing students 16(26.67%)
to the age group of 18-20 years and 44(73.33% ),to the age group of 20-25 years,0(0%) to age
group of 25-30 years , 0(0%) to the age group of above 30 years.
2.Most of nursing students 17 (28.3%) were male and remaining nursing students 43(71.7%)
were female .

3. Most of the nursing students 30(50%) were Hindu and 0(0%) were muslim, 30(50%) were
christian and remaining nursing students 0(0%) were others.

4. Most of the nursing students 42 (70%) have previous knowledge about ABPMJAY.

5. Maximum nursing students 18(30%) do not have any knowledge about ABPMJAY.

6. Most nursing students 18(42.86%) gained knowledge about ABPMJAY from the Internet,
and maximum nursing students 14 (33.33%) have gained knowledge from Newspaper,
2(4.76%) have gained knowledge from Television and 8(19.05%) were others.

7. It was concluded that a planned teaching programme on knowledge regarding “Benefits of

Ayushman Bharat Yojana’’ which was provided, and has given complete information and
improved the knowledge of nursing students regarding Benefits of Ayushman Bharat Yojana.

8.It was observed that their pre-test knowledge regarding Benefits of Ayushman Bharat
Yojana showed that.

9. Majority in the present 33(55% ) nursing students had poor grades ,27(45%) nursing
students got average grades ,0(0%) nursing students had good grades .

10.After intervention given to the nursing students in the post-test of the same questionnaire
was grade 01(1.67%) nursing students got a poor grade, 14(23.33%) nursing students got
average grade ,and 45(75%) nursing students got a good grade.

11.It was concluded that a planned teaching program on knowledge regarding Benefits of
Ayushman Bharat Yojana was provided and given complete information and improved the
knowledge of nursing students.

CONCLUSION

After the detailed analysis, this study leads to the following conclusion. Those members did
not have 100% knowledge regarding Benefits of Ayushman Bharat Yojana. They required
further education and information because all of them needed to enhance their knowledge on
Ayushman Bharat Yojana.
 TABLE OF CONTENT

CHAPTER CONTENT PAGE NO.

I INTRODUCTION

Introduction about ABPMJAY

Background of the study
Need of the study
Statement of the problem
Objectives
Hypothesis
Assumptions
Operational definition
Delimitation
Summary

II REVIEW OF LITERATURE

III RESEARCH METHODOLOGY

Introduction
Research approach
Study area
Research design
Variable
Study tool
Setting
Sample size
Methods of data collection
Study period
Criteria for sample collection
Tools or instrument
Data collection method
Summary
IV DATA ANALYSIS AND
INTERPRETATION
Statistical analysis
Objective of the study Hypothesis
Organization of findings.

V DISCUSSION, SUMMARY,
CONCLUSION, RECOMMENDATION,
AND NURSING IMPLICATIONS OF
THE STUDY, LIMITATION

VI BIBLIOGRAPHY

VII APPENDICES
 LIST OF TABLES

TABLE NO. TABLE PAGE NO.

1 4:1 Distribution of study participants with

regard to demographic variables

2 4:2 Pre-test percentage of knowledge

regarding the Benefits of Ayushman Bharat
Yojana among nursing students.

3 4:3 post-test percentage of knowledge

regarding benefits of Ayushman Bharat
Yojana among B.Sc. Nursing students.

4 4:4 pretest and post test level of knowledge

score among the BSC nursing 3rd year and
GNM nursing 3rd year students.

5 4:5 comparison of mean score between

pretest and post test of knowledge among
BSC nursing 3rd year and GNM nursing 3rd
year students

6 4:6 association of knowledge score with

selected demographic variable

7 4:7 association of level of knowledge

regarding ABPMJAY in relation to

participants age
8 4:8 association of level of knowledge
regarding ABPMJAY in relation to
participants gender

9 4:9 association of level of knowledge

regarding ABPMJAY in relation to
participants religion

10 4:10 association of level of knowledge

regarding ABPMJAY in relation to
participants previous knowledge about
ABPMJAY

11 4:11 association of level of knowledge

regarding ABPMJAY in relation to
participants source of knowledge
 LIST OF THE FIGURES

TABLE TABLE PAGE NO.

NO.

1 Line diagram percentage depicting distribution of the study

participants concerning age

2 diagram percentage depicting distribution of the study

participants concerning gender

3 diagram percentage depicting distribution of the study

participants concerning religion

4 diagram percentage depicting distribution of the study

participants concerning previous knowledge

5 diagram percentage depicting distribution of the study

participants concerning source of knowledge

6 diagram depicting pre test and post test mean score among
B.Sc nursing 3rd year and GNM nursing 3rd year students

7 distribution of pre test and post test score of knowledge

among BSc nursing 3rd year and GNM nursing 3rd year
students

8 depicting total mean score

9 diagram showing association levels of knowledge and age

category

10 diagram showing association between levels of knowledge

and gender category

11 diagram showing association of religion

12 diagram showing association between previous knowledge
and level of knowledge

13 diagram showing association between knowledge from

gained from and level of knowledge
 CHAPTER I

INTRODUCTION
 INTRODUCTION

“Thought PM AYUSHMAN Bharat's health infrastructure mission on the entire

ecosystem for services from treatment to critical research will be created in every corner
of the country.”

-PRIME MINISTER NARENDRA MODI

Ayushaman Bharat Yojana has interrelated components: health and Wellness centres (HWCs)
and Pardhan Mantri Jan Arogya Yojana (PMJAY). Pardhan Mantri Jan Arogya Yojana
(PMJAY) is the national health protection scheme introduced on 23 September 2018 by the
government of India, targeting poor, socio-economically weaker, and disadvantaged families.
providing health insurance to economically weaker sections.it is a centrally sponsored
scheme funded by the union government and the state that offers services to 50 crore people
with the world's largest government-sponsored health care program. The study was initiated
to assess the knowledge and utilization of the Pradhan Mantri Jan Arogya Yojana, Ayushman
Bharat (PMJAY-AB) scheme among the eligible families of the selected rural community
Damoh.

Ayushman Bharat Programme is India's most definitive step toward the promotive,
preventive, curative, palliative, and rehabilitative aspects of universal health coverage.
adapting a continuum of care approach, Ayushman Bharat is being implemented through two
interrelated components viz health and wellness centered (HWCS)to provide primary care
and Pradhan mantri Jan Arogya Yojana for providing financial protection for accessing
hospitalization care and poor and vulnerable families identified in the 2011 social economic
and cast census.

1.​ Setting up-1.5lakh health and wellness Centre (HWCs) to provide for
non-communicable diseases and maternal and child health services.
2.​ Providing health coverage up to Rs.5 lakh per family per year for secondary and
tertiary care hospitalization to around 10.74 crore poor and vulnerable families

3.​ (Approx 50 crore individuals) under Ayushman Bharat Pradhan Mantri Jan Arogya
Yojana (AB-PMJAY).

Under (AB- PMJAY), which was launched on 20/9/2018 the entitled beneficiary families get
annual defined benefit cover of Rs.5 lakh per family on a family floater basis. This cover is
able to take care of almost all secondary care and most of tertiary care procedures. There is
no restriction on family, specifically girl child and senior citizens, to get coverage and there is
no limit on family size under this scheme.a digital health record is a health ID under a
ABDM.

The Ayushman Bharat scheme is funded by the central government only. and the funding is
shared between the Centre. and the state Government. The ratio of contribution towards
premium between the Centre and states is 60:40 in all states and the 3 Himalayan states
where the ratio is 90:10 within the upper limit for the Centre.

The nurse acts as an educator, collaborator, advocate, counselor, and case finder in planning
and implementing national health schemes. For every successful government health-related
scheme nurses act as a front-line workers to deliver the services to make the schemes
accessible to all. Hence it is essential to assess the healthcare personnel's knowledge before
implementing any health-related scheme. Training and educational sessions can be planned
based on the assessment to bridge the knowledge gap.

Nursing staff working in hospitals are key personnel with whom patients and their attendants
come in direct contact. Most of the patients and their relatives are unaware of the benefits of
Ayushman Bharat Yojana and how they can be potential beneficiaries of this scheme. So, it is
the responsibility of the staff nurses to make them knowledgeable regarding this scheme. But
to make patients and relatives aware, firstly staff nurses should be equipped with the
information regarding Ayushman Bharat Yojana. So, it becomes mandatory to assess the prior
knowledge of staff nurses regarding this scheme, and if there is a lack of information, they
will be provided an information booklet so that they can deliver accurate knowledge to the
patients and their relatives and by this, all the beneficiaries can be facilitated by this scheme.

According to the latest National Health Profile (NHP) data, despite an increase in healthcare
expenditure in India since 2019, public expenditure on medical services is among the lowest
in the world. As per the Organization for Economic Co-operation and Development (OECD),
India's total healthcare spending is 3.6% of GDP. According to the Indian Consumer
Economy 360 survey, the average medical expenditure in India is about 9,373. High
out-of-pocket expenditure makes health care services inaccessible to a significant proportion
of Indian households. The financial constraints are the limiting factor among the population
who did not avail medical care. Most of the urban or rural population overcome their health
expenditure by taking bank loans or by selling their assets. The health profile report released
by WHO in 2014 states that in India because of high out-of-pocket expenditure annually
about 3.2% of Indians fall below the poverty line and also three-fourths of Indians spend their
entire income on health care and purchasing drugs.

In order to facilitate UHC, the Indian government has launched an ambitious healthcare
scheme called “Ayushman Bharat.” The Ayushman Bharat scheme essentially has two
components: Pradhan Mantri Jan Arogya Yojana (PMJAY) and Health and Wellness Centers
(HWCs). The ( PMJAY) is a publicly financed health insurance scheme for the
socioeconomically deprived rural and selected occupational categories of the urban
population. It aims to cover 100 million households and approximately 500 million people of
the country, which roughly accounts for 40% of the total population. The benefits package
under the (PMJAY) includes cashless treatment up to 500,000 rupees for each family every
year on a family floater basis. Around 1,350 medical and surgical procedures are included
under the scheme which is claimed to include almost all secondary and most of the tertiary
care procedures. It allows the beneficiaries to avail free services from either public or an
impanelled private hospital. All pre-existing diseases are also covered, and the hospital is not
allowed to charge any fee and 104 is the helpline no. of ayushman bharat scheme and 14555
is the helpline no. for ayushman bharat yojana.

BACKGROUND OF THE STUDY

There is a global consensus to aim for universal health coverage (UHC). The main objectives
of (UHC) agenda are to improve the access to quality healthcare while ensuring financial
protection. Publicly funded health insurance (PHFI) has been promoted as a model to achieve
(UHC) in many low- and middle-income countries (LMICs), including India. In 2018, the
central government of India launched a national PFI scheme known as the Ayushman Bharat
- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). It replaced the earlier national PFI
scheme known as Rasthriya Swasthya Bima Yojana (RSBY), which was in operation for a
decade.both government and provide hospitals can Treatment be availed under the ayushman
bharat scheme.

The AB- PMJAY covers 100 million poor households with an assured annual sum of half a
million Indian rupees (around 6,000 US dollars) for hospitalization care. It provides

seventeen times larger financial cover than RSBY did. AB-PMJAY covers a wide range of

services for secondary and tertiary inpatient care. AB-PMJAY covers around 1400 services,
comprehensively covering treatment, surgeries and other procedures, medicines and
diagnostics, pre-operative and post-operative care, food, and accommodation. Like RSBY,
the services under (AB-PMJAY) are expected to be completely free for the enrolled persons
and cashless at the point of care. Under AB-PMJAY, state governments empanel a mix of
private and public hospitals to provide a package of inpatient services at preDefined prices.
The contracting of private hospitals is a key me-sure to expand access for the poor
households to a wide-range of inpatient care services, as the scheme aims to remove the
financial barrier by making the services free. The main objectives of providing health
insurance to poor families.

The coverage under ( AB-PMJAY) is funded completely by the government. Ensuring access
to quality services is an important objective under the UHC agenda. The (AB-PMJAY) also
includes it as a key objective. However, there also is no information available on the effects
of (AB-PMJAY) on the quality dimension of services. The existing evidence on (PFHI) in
India has shown its limited success in financial protection, though the evidence has been
mixed on its role in increasing utilization. A few quantitative studies are available on
AB-PMJAY, but all of those have covered its early days. A cross-sectional study covering
200 beneficiaries of (AB-PMJAY ) in two states in April 2019 showed that patients incurred
out-of-pocket expenditure (OOPE) in private hospitals. Another cross-sectional study
involving data collection from six states in 2019–2020, almost a year after the launch of
AB-PMJAY, found that the patients able to utilize the scheme were 21% less likely to
inculcate strophic expenditure (CHE) than others. The above-mentioned study reported that
(AB-PMJAY)did not result in increased utilization of inpatient care. An evaluation of
(AB-PMJAY) was conducted in Chhattisgarh state in 2019 after the scheme had completed its
first year of implementation; that study was based on repeated cross-sections of household
surveys before and after the launch of AB-PMJAY. It showed that (AB-PMJAY ) was not
able to improve access or financial protection for hospitalizations.

Since then, the policymakers at the national level have made changes in an important aspect
of the design of the benefit package under AB-PMJAY. The prices in which hospitals get
reimbursed for services were revised upwards using evidence from a large costing study
conducted by national-level government research institutions. The increased prices became
applicable in January 2020. The current study was aimed at examining the effectiveness of
(AB-PMJAY) in improving access, quality, and financial protection after the above measures.
The timing of this evaluation was significant as it happened after a substantive period of
full-fledged implementation of the scheme. The study was expected to add to the evidence
base for improving the policy and practice of (AB-PMJAY) and such publicly funded health
insurance schemes aimed at universal health coverage.

Over the last few decades, the world’s eyes have been on India as its economy has been one
of the top three fastest-growing economies of the world. However, despite making
remarkable strides in several sectors, India is still classified as a Lower Middle-Income
Country (LMIC) according to the World Bank classification of countries based on per capita
GDP, mostly due to its inconsistent socio-economic and health indicators.

Statistics show that more than 20 per cent of India’s population still lives under $1.9 per day
(2011 PPP). According to a World Bank projection, by 2021 more than 34% of India’s
population will be in the age group of 15-35 years. This rich demographic dividend enables
India to be highly optimistic about a sustained economic growth for a few more decades
before a higher dependency ratio sets in. However, the perceived benefits of the higher
demographic dividend are threatened by the epidemiological transition in India which is
currently facing the unique situation of a “triple burden of disease.” As the mission of
eradication of major communicable diseases remains unfinished, the population is also
bearing the high burden of non-communicable diseases (NCDs) and injuries. This leads to an
overall rise in the demand for health care over a prolonged period of time.

However, with a total population of more than 1.3 billion people, the supply side of adequate
and affordable healthcare in India is found wanting. Figures show an overwhelming tilt
towards health care services in the private sector which cater to nearly 70% of all visits for
health care needs in India and have 50% of total hospital beds. But, individually most
providers in the private sector are very small (with less than 25 beds). They are also
unregulated, with varying standards of quality of care and are mostly situated in large metros
or urban neighbourhoods leaving a great deficit of health services for the underprivileged
population of India.

health care system. Over the last two decades, the Government of India’s overall expenditure
on health has remained stagnant at about 1.2% of its GDP (Source: National Health
Accounts, 2015). Of its total expenditure on health, India spends only 21% from the
Government revenue and as high as 62% from out-of-pocket expenses (Source: National
Health Accounts, 2015). Thus, it has been deduced that increasing health care needs, coupled
with high out-of-pocket expenditure, is a leading cause of poverty in India. Not only does it
keep people poor, but it also pushes nearly 6 crore Indians back into poverty each year. The
following graph depicts this situation clearly by comparing the OOP to total expenditure on
health in two decades. india health spending patterns image

In the past, there have been several efforts by the Central and various State Governments to
strengthen demand side financing by launching various Government-funded health insurance
schemes. The Rashtriya Swasthya Bima Yojana (RSBY) was launched with an annual cover
of INR30,000 per family at the central level which catered mostly to secondary care
hospitalisation while many State schemes catered to tertiary care conditions. However, these
schemes worked independently of the larger health care system in the country and resulted in
further increasing the fragmentation of risk pools. Additionally, none of these schemes had
any linkage with primary health care.

To address these challenges, the Government of India took a two-pronged approach under the
umbrella of Ayushman Bharat. HWCs will provide services related to maternal and child
health ,communicable disease and non communicable disease.The first component of this
strategy was disease prevention and health promotion to curb the increasing epidemic of
non-communicable diseases. This was to be ensured through upgradation of the existing
network of Sub-centres and Primary Health Centres to Health and Wellness Centres (HWC).
Nearly 150,000 HWCs are to be set up in the country over the next few years which will
work towards reducing the overall disease burden and hospitalisation needs of the population.

The second component was the launch of the Pradhan Mantri-Jan Arogya Yojana (PM-JAY)
which aims to create a system of demand-led health care reforms that meet the immediate
hospitalisation needs of the eligible beneficiary family in a cashless manner thus insulating
the family from catastrophic financial shock. In the long run, the PM-JAY, through its system
of incentives, aims to expand the availability of its services. With greater demand, the private
sector is likely to expand in the unserved areas of Tier-2 and Tier-3 cities. For public
hospitals, PM-JAY will provide an incentive to prioritise poor patients and shall provide
means to generate additional revenue for strengthening their infrastructure and filling their
service gaps. PM-JAY has subsumed the existing RSBY and also works in convergence with
various State Government funded health insurance/ assurance schemes.
Because of its scope, PM-JAY is the world’s largest health insurance/assurance scheme that
offers a health cover to nearly 12 crore poor families which comes to a staggering 55 crore
Indians that form 40% of its bottom population. It is fully funded by the Government and
provides financial protection for a wide variety of primary, secondary and tertiary care
hospitalisations. The prime objective of PM-JAY is to reduce catastrophic out-of-pocket
health expenditure by improving access to quality health care for its underprivileged
population. More details on its evolution, planning, eligibility and state wise implementation
are discussed ahead.

NEED OF THE STUDY

Ayushman Bharat Yojana is one of the world's largest publicly funded health insurance
schemes. It is crucial to evaluate its impact and effectiveness in achieving its objectives.
Research studies are needed to:

●​ Assess the scheme's reach and coverage among the target population.
●​ Evaluate its impact on healthcare utilization and out-of-pocket expenditure.
●​ Identify challenges in implementation and suggest improvements.
●​ Measure its contribution towards achieving Universal Health Coverage (UHC) and
Sustainable Development Goals (SDGs).

LAHARIYA C. SHARMA AIN 2018

Ayushman Bharat is one of the biggest schemes of its nature in the world. With this scheme,
the government is trying to provide not just health insurance but health assurance. It is a
holistic service that begins with prevention, moves to procedures, and includes post-treatment
care. It has the potential to bring millions out of disease-related poverty. Considering the
ever-increasing population and rising diseases, it is a mammoth task. Overcoming many
implementation challenges should remain the single focus of the government. The scheme
requires further integration of private and public services. Data is the backbone of such a
movement. A strong IT infrastructure and data capture are essential, particularly to avoid
fraud. A sound implementation with suitable safeguards can change society for the better.

SANDEEP BHARDWAJ MARCH 2019

 The research focuses on assessing the awareness levels of self-employed individuals, such
as auto drivers, cab drivers, and skilled artisans, regarding government-sponsored health
insurance schemes in the Kalyan-Dombivli Municipal Corporation (KDMC) area. The study
involved a sample survey of 100 respondents to understand their inclination towards the
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). The findings indicated
varying levels of awareness among the target groups, highlighting the need for increased
outreach and education about the benefits of the (AB-PMJAY) scheme.

DR. SHREEKUMAR MENON AND DR. VISHAL 7 JULY 2020

The current study is the first to evaluate the performance of (AB-PMJAY) in improving the
quality of inpatient care. Patient satisfaction was found to be unrelated to whether the patient
was enrolled under (AB-PMJAY) or not. An earlier survey that covered the care of older
adults reported that 23.6% of those utilizing inpatient care in Chhattisgarh were dissatisfied
with the quality, and the proportion remained similar in the current study. The length of stay
was not associated with(AB-PMJAY )but mainly with the type of hospital utilized. An earlier
study had also shown that hospitalizations in private hospitals in India tend to be longer. It
seems that private hospitals have the incentive to prolong hospitalizations so as to charge
more from the patients. The (AB-PMJAY )has not been able to effect a change in this pattern.

The current study found that enrollment under (AB-PMJAY) had reached around 90% of the
population in the state. This represents an improvement from the days preceding the scheme,
when the enrollment under PFHI was around 60%. However, the study found that enrollment
under AB-PMJAY did not result in increased utilization of inpatient care. An earlier study
done in the same state after one year of AB-PMJAY’s implementation had reported the same
conclusion. A study covering six states also reported a similar finding regarding the effect of
(AB-PMJAY)on utilization. A fundamental purpose of (AB-PMJAY )was to provide financial
protection for inpatient care. The current study found that enrollment under (AB-PMJAY)did
not reduce OOPE or protect the patients from catastrophic expenditure for hospitalization. In
our study, the mean OOPE incurred by patients enrolled under this scheme was INR 23,691,
which was quite high when compared to the mean annual non-health consumption
expenditure of households (INR 97365). Among those using private hospitals, 45.4%
incurred CHE25 (at the 25% threshold) in 2022, and an earlier study in the same state
reported that the proportion was 39.4% in 2019 after one year
of(AB-PMJAY)implementation. The proportion of inpatients in the private sector incurring
CHE25 was 32.1% in 2014 when the RSBY scheme was in operation and 27.6% in 2004
when no PFHI scheme was in operation. This shows that despite the introduction of PFHI
schemes and the expansion of their coverage through AB-PMJAY, there has been a rising
trend in catastrophic health expenditure in private hospitals. The current study shows that
AB-PMJAY could not make the private hospitals affordable for the patients enrolled under its
cover. Utilizing public hospitals offered better protection from OOPE, irrespective of
enrollment under health insurance. A study in 2019 showed that enrollment under
(AB-PMJAY) was not able to make an impact on financial protection. At that time, the
empaneled private hospitals had contended that the prices at which they got reimbursed under
(AB-PMJAY) were inadequate. A large costing study was carried out nationally in 2019 to
decide the reimbursement rates according to rigorous evidence. It resulted in an upward
revision of reimbursement rates for 61% of the services covered in the (AB-PMJAY) benefit-
package. In addition, AB-PMJAY had several advantages over its predecessor national PFHI
scheme, called RSBY. The annual sum assured per family enrolled under (AB-PMJAY) was
seventeen times larger than the RSBY. The population coverage, i.e., the enrollment was also
larger in (AB-PMJAY) than earlier schemes. The number of empaneled hospitals had also
increased, at least in urban areas. The above changes were not successful in making
(AB-PMJAY) effective in financial protection. The inability of PFHI in ensuring financial
protection for hospital-care is consistent with other studies in India. A study of
(AB-PMJAY)in the first year of its implementation had reported a minor effect of
(AB-PMJAY) in reducing OOPE with a 21% lower chance of CHE for those who were able
to utilize the scheme. Looking at the findings of the above study alongside the current
evaluation, it seems that many of those enrolled under (AB-PMJAY) may be unable to
receive the benefit of AB-PMJDY when they get hospitalized. And those who are able to
access the benefit of AB-PMJDY may be getting a minor discount in payment.

Why does PFHI remain ineffective in providing financial protection in the Indian context?
The current study found that the mean OOPE for utilizing private hospitals remained around
ten times larger than that of public hospitals. As found by other studies, utilizing private
hospitals was the main determinant for incurring high OOPE or catastrophic expenditure. The
current study showed that the same pattern persisted four years after the full roll-out of
AB-PMJAY. This failure seems to be related to the existing problem of ‘double-billing’ and
overcharging by private providers under PFHI schemes in India. ‘Double billing’ refers to a
fraudulent practice whereby a hospital takes cash payments from a patient while also
claiming reimbursement for the same service from the government’s PFHI scheme. The
private hospitals were taking copayments from the patients even though their empanelment
contracts specifically prohibited such a practice. The present study showed that even after
implementing the increased prices, contracting was ineffective in ensuring that the private
hospitals adhered to the agreed prices. The persistent failure of (AB-PMJAY) and other PFHI
schemes in the Indian context suggests that further research is needed to develop alternative
policies for UHC.

Our study has several strengths, and it covers a lot more ground in comparison to the existing
evaluations of AB-PMJAY. The study is not based on a single cross-section but involves two
annual waves of data collection. It has a large sample of around 15,000 individuals in each
wave, representative of a state with a population of 30 million. The state chosen has been a
leading implementer of (AB-PMJAY) and has around 90% of its population enrolled under
the (PFHI) scheme. The study was conducted after four years of implementation of the
(AB-PMJAY) and thereby provides the first evaluation beyond its early days. The study is the
first to evaluate (AB-PMJAY) on the quality of inpatient care and used two different
measures for that. The methodology is robust as it confirms the results using multiple
analytical methods, including those addressing potential endogeneity. Earlier studies on PFHI
in India had another limitation: they could not take into account the severity of illness while
analyzing the variations in OOPE. The current study is able to overcome that limitation by
including the perceived severity of the illness.

Another strength of the study is the robustness of the analytical methods used. The
multivariate regression analysis offered the advantage that its results were easy to interpret
intuitively. It also shed light on the determinants contributing to OOPE(out of pocket
expenditure), such as provider ownership. Repeating the regressions using the IV approach
was useful in addressing any potential endogeneity. The PSM was useful in confirming the
main findings on the effect of public health foundation of India on matched groups of
enrolled and non-insured individuals.

Several policy lessons emerge from our findings. Our study shows that coverage under a
health insurance scheme may not guarantee financial protection. One set of policy measures
can be focused on improving the design and implementation of AB-PMJAY. The share of
private hospitals in service provision under the scheme needs to be reduced. The contracting
of private providers can be limited to services that are difficult to provide through the public
sector. The renewal of contracts with providers should be based on their track record of
adhering to the contracts. Contracting a smaller number of private providers can perhaps
make it easier for government regulators to monitor provider behavior and enforce the
contractual conditions. If the public sector starts providing the necessary range of services, it
can reduce its dependence on private providers. Introducing gatekeeping through public
sector hospitals may also help in reducing unnecessary medical procedures in the private
sector. There is a need to learn from the experiences of other LMICs in implementing PFHI
schemes. Another set of policy changes should be focused on measures beyond AB-PMJAY.

It has to be realized that health insurance schemes cannot be sufficient to ensure financial
protection, and additional strategies are needed for achieving the goals of universal health
coverage. Improving affordable access to essential medicines and diagnostics and
strengthening primary health care are examples of such measures.

- VISHNUPRIYA SRIEE GV, G RAKESH MAIYA IN APRIL 2021

A tough time during COVID-19 due to weak healthcare infrastructure. India is one of the
developing countries that managed the health crisis with scarce resources but also provided
relief to many other countries. Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana
(PMJAY) provides health assurance cover of up to Rs. 5 Lakh per year per family for
secondary and tertiary healthcare hospitalizations. The beneficiary families have been
identified based on select deprivation and occupational criteria in rural and urban areas,
respectively, according to the SECC 2011 database, covering 10.74 crore families,
comprising 50 crore people. This study reviews Ayushman Bharat for inclusive health
insurance in India. Papers published in Scopus and Google Scholar have been reviewed.

PRIYANKA C, A.S PANDEY DC AND TIWARI 19 NOVEMBER 2022

The main aim of Universal Health Coverage (UHC) is to ensure that individuals and
communities can access the healthcare they require without any financial constraints. To
achieve UHC, the Ayushman Bharat scheme has been launched by the government of India.
In Karnataka, PMJAY has been integrated with the pre-existing Arogya Karnataka scheme
and collectively called Ayushman Bharat Arogya Karnataka. This study was conducted to
assess the awareness, coverage, and utilization of the Ayushman Bharat scheme. The study,
which involved 1,027 individuals, found that 65% of the participants were aware of the
Ayushman Bharat scheme, which was comparatively lower than the results of a survey
conducted by the National Health Authority, where awareness in the state of Tamil Nadu was
80%. Another study conducted by Saveetha Medical College found that among 300
households, 77.33% were aware of the Ayushman Bharat scheme. Our study also found that
awareness of the Ayushman Bharat scheme among lower-income groups was slightly lower.

DR, GIRISH JANUARY 2023

This paper explores the processes and the role of economic evidence (i.e ,. cost,
cost-effectiveness and/or HTA evidence) that went into designing and pricing of packages
included in PM-JAY HBP. Our findings suggest that the recent HBP revisions have made
greater use of empirical economic evidence in comparison with the earlier versions, but there
is still a lot of ground to be covered in relation to the application of cost-effectiveness or HTA
evidence in HBP designing. Costing evidence from a variety of sources including the
national-level costing (CHSI study) has played an increasing role. The role of HTA and
cost-effectiveness analysis was introduced recently, and its application was also very limited
even in the most recent phase of revisions. At the same time, the capacity to generate and use
economic evidence is still limited and there exists a significant gap in the skills of NHA and
SHA staff in the application of cost-effectiveness and/or HTA evidence.

It is widely recommended that decisions on HBP design should include HTA evidence
consisting of the findings on clinical effectiveness, safety, cost, cost-effectiveness, budget
impact analysis, etc. Benefits packages designed using economic evidence have been argued
to provide the best value for money. Lack of coherence between the package design and
resource availability for its implementation can jeopardise the sustainability of any health
insurance scheme. In contrast, our survey respondents rated the importance of expert opinion
as an important factor for selecting intervention as part of packages, while other crucial
factors such as economic evidence and budgetary constraints were ranked lower. Further, for
setting package rates, expert opinion from clinicians and stakeholder consultations were both
seen to play a significant role and were considered more important relative to economic
evidence. In the absence of good-quality research and data, this may be a more pragmatic
choice, however, to ensure that experts take transparent decisions, it is important to make use
of deliberative processes and ensure experts are uniformly informed with the best available
evidence including economic evidence.
Potential barriers or challenges faced during incorporating HTA or economic evidence into
HBP at PM-JAY included the lack of availability of high-quality, timely HTA evidence and
inadequate capacity to understand the use of HTA evidence. The capacity to analyse and use
the available data within PM-JAY officials is also limited. Our key informants recognised the
need to recruit trained health economists and HTA specialists at the NHA. They also
mentioned that staff workshops on health economics could only serve a limited supporting
function. Regarding the available evidence, the pace of HTA evidence generation does not yet
match the need. The HTA In, the regulatory body for the conduct of HTA studies in India, has
completed only 26 studies while HBPs have over 1900 packages. At the same time, the
capacity to generate and use economic evidence is still limited.

Such capacity constraints are not unique to India alone. Similar studies to assess the use of
HTA evidence have been undertaken in other low/middle-income countries as well. In
Nigeria, the researchers assessed stakeholders’ capacity needs and perspectives on the use of
HTA and priority setting for Universal Health Coverage (UHC). The study concluded that
HTA is a valuable tool for designing benefits packages, clinical guidelines and service
improvement. However, the availability of local data to support such decisions was
considered to be inadequate.

While the lack of good evidence is a hindrance, this has not stopped the NHA from moving
forward with efforts to systematically update and revise the benefits packages. The findings
here provide important lessons for other countries on how processes can be initiated and
therefore drive the change necessary to improve the evidence one step at a time. For example,
following the launch of PM-JAY, the Government of India funded the nationally
representative cost study to help inform package rates. Furthermore, efforts have been made
to use HTA for designing HBP 2022 (although for now limited to specific oncology
packages), and, more recently, a special unit—HeFTA—has been set up within the NHA to
ensure the use of HTA evidence for making decisions that provide best value for money.
Recognising the urgent need for expedited evidence synthesis in the context of PM-JAY, the
HeFTA unit was established to accept nominations for HTA appraisal of proposed
interventions for inclusion in the HBPs from a wide range of stakeholders, including both
public and private organisations.

- DEEPSHIKHA SHARMA, AKASH DEEP SINGH CHAUHAN JUNE 2024

STATEMENT OF THE PROBLEM

A PRE-EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAM ON THE LEVEL OF KNOWLEDGE REGARDING BENEFITS
OF AYUSHMAN BHARAT YOJANA AMONG NURSING STUDENTS OF SELECTED
NURSING NURSING COLLEGE OF DAMOH (M.P) IN THE YEAR 2025.

OBJECTIVES

●​ To assess the knowledge regarding Ayushman Bharat –(PMJAY) among nursing

student
●​ To assess the pre test post test knowledge about ayushman bharat (AB-PMJAY)
among nursing student
●​ To assess effectiveness of structured teaching programmes regarding Ayushman
Bharat (PMJAY)among nursing students.
●​ To determine the association between pre and Post test knowledge score regarding
Ayushman Bharat PMJAY with selected demographic variables among nursing
students.
HYPOTHESIS

H0 - There will be significant difference in the knowledge and perception scores of nursing
student

H1-There is a significant improvement in knowledge scores after the teaching program.

H2-there is a significant positive correlation between the post test knowledge scores and
perception scores of nursing students.

H3-The mean posttest knowledge and perception scores of nursing students will be
significantly higher than their mean pretest scores after the structured teaching program on
ayushman bharat yojana .

ASSUMPTION

-A structured teaching program can improve the knowledge and perception of nursing
students.

-knowledge and perception regarding health schemes can be measured objectively through a
structured questionnaire.
OPERATIONAL DEFINITION

Assessment- it may have to assess the level of knowledge of the Ayushman Bharat Yojana
among selected community areas.

Knowledge- it refers to information regarding the Ayushman Bharat Yojana in rural areas.

Effectiveness – the degree to which something is successful in producing a desired result.

Planned teaching program – a structured teaching plan prepared by the invigilator to

improve the knowledge of AB-PMJAY.

Health- health is a state of complete physical, mental, social, and spiritual well–being and
not merely the absence of disease or infirmity.

Ayushman Bharat Yojana- AYUSHMAN BHARAT YOJANA is a program which aims to

provide a service to create a healthy, capable, and contented new India.

PMJAY -Pradhan Mantri Jan Arogya Yojana is a health insurance Scheme providing
financial protection for secondary and tertiary healthcare.

DELIMITATION

-The sample size is limited to 30.

-The study is delimited to the students of the selected college.

SUMMARY

This chapter introduces the Ayushman Bharat Yojana, a national health scheme launched to
provide free health insurance to low-income families. As future healthcare providers, nursing
students must be well-informed about such schemes to promote them effectively in the
community.

The chapter highlights the need to improve their knowledge and perception through a
structured teaching program. It includes the problem statement, objectives, hypotheses,
assumptions, and delimitations of the study.
 CHAPTER II

REVIEW OF LITERATURE
 REVIEW OF LITERATURE

LAHARIYA, 2018

describes the pathway established by the PMJAY yojana and gives an overview of all the
terms and conditions of the scheme. The main health issues that promote the development of
this policy are outlined in the opening paragraph of this article, along with the requirement
for funding and adjustments to account for inflation and growth. It discusses the plan being
looked at for creating 150000 health and wellness centers by the year 2022 to provide
complete primary health care. A SWOT analysis of ABP and how it seeks to offer financial
protection for secondary and tertiary level hospitalization as part of the National Health
Protection Scheme( NHPS ).

Swagata Yadawar, 2018

found that there are regional disparities in health facilities in the county. According to her,
West Bengal has only 10.6% Ayushman beneficiaries and 588 hospitals are empanelled.
While in Delhi it is only 6% and 510 private hospitals are impaneled and this scheme in India
needs more consciousness and stipulates generations. India is the lowest spender on health
services and needs to increase on healthcare. The government has started an insurance-based
Ayushman Bharat scheme for healthcare for poor people (2018, Yadawar).

Manjuram Mannuru, 2018

study recognized some clauses which ought to be amended to improve the quality and
accessibility of the yojna. He observed that OPD is not covered in this scheme and the
beneficiary can avail the benefit from impaneled hospitals only. As per the clause, the claim
should be settled within 15 days but sometimes it takes more time to settle. He suggested that
for some unrelenting ailments, OPD should be allowed with medicines. For any emergency,
the beneficiary should visit the nearest hospital, and the reimbursement policy should be there
in non-impaneled hospitals also (2018, Mannuru)

ANGELL ETAL, 2019

analysis and gives crucial replication suggestions and a path ahead for the successful and
speedy implantation of the AYUSHMAN BHARAT PROGRAMME. The design and
execution of ABP must be done currently from the start to be effective and efficient in
producing the intended results. The initiative might be a step toward reforming the Indian
health care system and moving India closer to achieve universal health coverage if
completely implemented and reinforced with other interference.

GUPTA, 2019

reviewed that the research based on AB-PMJAY provides a crucial analysis of the full
scheme and all of its parts in a single document. This work was authorized by the PMJAY
office from the government's perspective, it offers insightful information on demands and
application of the policy. This political article also discusses shortcomings of the nation's
decentralized healthcare system which was set up by previous administrations, and how it has
been rectified. This document serves as the foundation for all review papers and information
disseminated to the public.

Suneela Garg , 2019

discovered that this research focuses more on the constraints of the healthcare system and the
system's deficiencies in combating the COVID-19 Pandemic. Additionally, it discusses how
the system may be made better all-around and in connection to handling the epidemic and
also what steps may be made to strengthen present healthcare systems so that they are
better prepared to manage any pandemic crises that may happen in the future

Mita Choudhury and Pritam Datta, 2019

observed that the number of private hospitals impaneled by an insurance company in India is
large as compared to private hospitals impaneled by the government. And the success of
Ayushman services in India is chiefly reliant on the endowment of insured healthcare services
through private hospitals only. (2019, Choudhary, Datta).

Blake J. Angell, Shankar Prinja, Anadi Gupt, Vivekanand Jha, and Stephen, Jan 2019
They analyzed some challenges in healthcare insurance (PMJY). One challenge is the lack of
hospitals in the village area. Corruption in doctor training and investments. Careful
monitoring is required in quality control and health systems. Private hospitals can play a
major role in the success of this scheme because the numbers of public and government
hospitals are less as compared to Private hospitals. (20129, Angell,1, Prinja, Gupt, Jha and
Jan). Manjuram Mannuru, 2018, His study recognized some clauses which ought to be
amended to improve the quality and accessibility of the yojna. He observed that OPD is not
covered in this scheme and the beneficiary can avail the benefit from impaneled hospitals
only. As per the clause, the claim should be settled within 15 days but sometimes it takes
more time to settle. He suggested that for some unrelenting ailments, OPD should be allowed
with medicines. For any emergency, the beneficiary should visit the nearest hospital, and the
reimbursement policy should be there in non-empanelled hospitals also (2018, Mannuru).

Yogita Bhatia, 2019

She emphasized universal health coverage and stated that we need to improve the primary
health system in India. We need to increase the medical facilities and health centers at the
village level. If we compare our medical facilities with other countries, then we are far behind
and we are in vast need of medical infra and facilities. There is an immense need to work in
this field. (Bhatia,2019)

Vipin Jain, Vivek D. Singh, and Khushboo, 2019

Conducted a study among 150 residents of the Moradabad region (U.P.) by using a cluster
convenient sampling method. The finding of the study reveals that the demographic variables
have some relationship and correlation with PMJAY – AB awareness. The demographic
factors such as gender, age, marital status, religion, education qualification, occupations &
income status were tested with the awareness regarding PMJAY-AB. The study concluded
that very old people (above 60 yrs) have the highest awareness of PMJAYAB and the young
generation (20-30 yrs) has the lowest awareness regarding this government Yojana. Further,
residents between the age bands of 31-60 years have moderate awareness. Except for age
groups, no other variable (education qualification and income) makes any association with an
awareness level of PMJAYAB Yojana.

Saxena, 2019

conducted a study in 14 hospitals in Gujarat and Madhya Pradesh. In addition, a household

survey with 100 beneficiaries was carried out by each state. The PMJAY system was shown
to have required out-of-pocket payments from about 27% of recipients. Beneficiaries from
Gujarat (89%) reported "zero payment" at a higher rate than those from Madhya Pradesh
(57%), and from public hospitals (80%) than from private hospitals (66%). In Madhya
Pradesh, OOP payments were more common among patients in private hospitals. They also
explained any out-of-pocket expenses. diagnostic For treatments, pre-operative many
hospitals demand money because they worry that the patient cannot be admitted if the results
are unfavorable. Before admitting a patient, several private hospitals require that they
complete this at a public hospital

SHARMA, 2020

emphasizes the circumstances under which ABP helped the nation throughout this epidemic.
The government of India decides to cover COVID-19 testing and treatment under PM-JAY.
This action gave Sharma. (2020) emphasizes the circumstances under which ABP helped the
nation throughout this epidemic. The Government of India has decided to cover COVID-19
testing and treatment under PM-JAY. This action gave the bottom 40% of the population
access to free diagnostic testing in private labs and free illness treatment in hospitals
(including private) impaneled under the program. The decision to offer free COVID testing
and treatment as part of the PM-JAY was accelerated in response to the increasing incidence.
The study details all of these situations when PM-JAY helped with COVID-19 testing and
therapy. The report also focuses on the potential implementation-level drawbacks of this
pandemic plan

Suneela Garg , 2020

under the Ministry of Health & Family Welfare emphasize the necessity for upgrading the
present healthcare schemes post-COVID-19, to not only recover from the pandemic's
consequences but also to prepare ourselves for any similar scenarios that may occur in the
future. It focuses on how AB-PMJAY should be improved to make sure that it is ready to
meet any surge of medical needs during health emergencies or pandemics. Healthcare staff
and the public healthcare system should have a dedicated epidemiology division with
trained personnel and technology to ensure that the country is adequately prepared in
the event of a future pandemic

Bhaduri Soham, 2020

emphasized that, in addition to programs for free testing, treatment, and transportation, the
pre-existing infrastructure and basis of the program served as a framework for managing the
present outbreak. Ayushmann Bharat provides a comprehensive healthcare package that
covers over 1500 secondary and tertiary medical treatments. The plan was already
pre-equipped with complete packages to cope with such a sickness on a broad scale
population of ours before COVID-19 was officially proclaimed a pandemic. This was
highlighted when the NHA offered free treatment for the infection. Also, the manner of
functioning demonstrates the scheme's adaptability in handling an unexpected situation. This
can be appreciated in terms of flexibility given to states for modifying health care; as noted
above under Testing and Treatment of COVID-19.

Nagarkar, 2020

discusses how the lockdown has had a significant impact on the family economics of elderly
persons who live in rural regions and work as agricultural workers and daily wage earners.
They lack social security protections, and many are not covered by the Ayushman Bharat
insurance plan. The majority of them are dependent on minimal government and volunteer
assistance, which occasionally slips their minds. While the younger generation is working in
major centers, a sizable number of senior individuals are left behind in the rural areas.

Radhika Bhanja and Koel Roychowdhury, 2020

have assessed the performance of India in achieving sustainability in all arenas by 2030. This
study highlights that at the sub-national level, some states have performed well in the index
while the rest of the states need to focus on developing the quality of life of their people and
providing infrastructure services and utilities to both their rural and urban counterparts.

Dash U, 2020

evaluated the degree of awareness throughout the scheme's first implementation phase in
2019 across three states: Bihar, Haryana, and Tamil Nadu. It was found that the primary
source of information was the PM-JAY letter received by households. In Bihar, only 9.84%
of beneficiaries were aware of the PM-JAY program, while in Haryana, 12.41% had
awareness. In Tamil Nadu, where PM-JAY was integrated with the pre-existing state
program, 59% of beneficiaries were aware of the program

Kranthi, 2020

conducted a cross-sectional study on the awareness and readiness of healthcare workers in a

tertiary care hospital in Rishikesh, India, during implementation of the Pradhan Mantri Jan
Arogya Yojana scheme. The study found that faculty members scored considerably higher on
awareness than senior residents, and it also made clear how important it is to hold PMJAY
training for hospital stakeholders
Pugazhenthi, 2020

conducted a study on awareness of the PMJAY scheme in the Thanjavur district of Tamil
Nadu. They assessed various details about the scheme among 200 beneficiaries and found
that awareness regarding coverage was 65%, awareness regarding grievance redressal was
15% and awareness regarding PM Arogya Mitra was 21%. They concluded that there was a
partially higher degree of awareness recorded for the scheme's coverage amount than for the
monitoring of the scheme's execution, which was followed by the grievance redressal
system's operation. The degree to which the beneficiaries are aware of the various
components of the program will determine the system's overall performance

Garg, 2020

conducted three repeated cross-sectional studies in Chhattisgarh. They used two of the cross
sections of the (NSS) year 2004 when there were no publicly funded health insurance (PFHI)
schemes and in 2014, during the operation of the older Publicly Funded Health Insurance
scheme, primary data was collected in 2019 to cover the first year of PM-JAY
implementation and it was used to make the third cross-section. It found that the incidence of
catastrophic health costs did not go down with enrollment in PMJAY or other PFHI programs

Sriee, 2020

conducted a cross-sectional survey in 2020 among 300 residential units in the Thiruvallur
district of Tamil Nadu revealed that only about 42.33% of the 300 households were receiving
benefits from the Ayushman Bharat. Only 10% of the Ayushman Bharat scheme-eligible
households have incurred additional costs for medical care in the last year, out of the 47.24%
of homes that are covered by the program. Medical costs could have put 39.88% of
households without access to the Ayushman Bharat scheme in a difficult financial position.
They added that households covered by the health insurance program had a smaller financial
burden from medical expenses. Currently, this program does not include the middle class of
society. Therefore, many families may become impoverished because of significant or
unforeseen medical costs
Gautam Priya, 2021

discovered that the technique made a ready-made kit for detecting COVID-19 accessible.
The costs and kinds of this package were to the Indian Council for Medical Research's
requirements (ICMR). The impaneled centers were instructed to test beneficiaries for
COVID-19 based on a competent physician's prescription (as per ICMR standards) at
laboratories deemed by the National Accreditation Board for Testing and Calibration of
Laboratories (NABL), which has defined real-time assay to test COVID-19. They were also
advised to adhere to testing methods established by the Ministry of Health and Family
Welfare, Government of India (MoFHW), and state governments. The standards and their
revised updates can be observed in the communications of the NHA to the impaneled
institutions.

Vishnu PriyaSriee G.V1, G. Rakesh Maiya, 2021

Conducted a cross-sectional study to assess the Coverage, utilization, and impact of the
Ayushman Bharat scheme among the rural field practice area of Saveetha Medical College
and Hospital. Simple random sampling was done to choose the 300 study participants and
data was collected using a semi-structured questionnaire. Descriptive statistics were
presented in frequency tables and graphs. The study found that out of 300 households, only
about 42.33% of the households were covered under the Ayushman Bharat scheme. Among
the covered households, only 47.24% had availed the scheme in the past 1 year. Around
39.88% of the households did not have the Ayushman Bharat scheme and faced financial
burdens because of the increasing expenditure on health care.

Gaikar Vilas B, 2021

observed the public health schemes in Maharashtra and reflected that growth in public
expenditure boosts direct health outcomes. However, it is necessary to provide health
facilities to all the cities and villages as it is known that real India lies in villages.

Sriee and Maiya, 2021

This was a cross-sectional study based on 300 samples for data collection. The findings
revealed that the financial burden of healthcare expenses is lower in the households covered
under health insurance schemes but due to lack of sufficient awareness, the utilization of the
scheme among many respondents is not satisfactory. The annual report (2021-22) of
PM-JAY provides the vision & mission, salient features, institutional structure, and
implementational models of the PM-JAY that present an overview of the scheme.

Joseph, 2021

conducted a secondary analysis using cross-sectional administrative program data for 30

Indian states that were made available to the public on the PM-JAY webpage. They
discovered that, of all the facilities enrolled in the plan (N = 20,257) in 2020, the majority
(56%) were in the public sector, followed by private for-profit facilities (40%) and private
not-for-profit organizations (4%). The study found that five states (Karnataka 14.9%, Gujarat
13.3%, Uttar Pradesh 13.3%, Tamil Nadu 11.5%, and Rajasthan 10.4%) made up more than
60% of the PMJAY facilities. 40% of the facilities had two to five specialties, and 14% had
21 to 24 specialties. The study found that most of the hospitals that are part of the scheme are
in states that have already tried to set up public health insurance programs. Rajiv (2021)
conducted a qualitative examination of the obstacles and enablers to the private hospitals in
Kerala's Pradhan Mantri Jan Arogya Yojana Empanelment. It was shown that

Social commitment and an increase in patient flow were the main facilitators for private
hospital empanelment in the system. Because there aren't enough claim rates, hospitals must
cut back on the quality of care because of a lot of patients, the government doesn't want to do
anything about it, and hospitals have had bad experiences in the past [10]. Dash U et al.
(2020) evaluated the degree of awareness throughout the scheme's first implementation phase
in 2019 across three states: Bihar, Haryana, and Tamil Nadu. It was found that the primary
source of information was the PM-JAY letter received by households. In Bihar, only 9.84%
of beneficiaries were aware of the PM-JAY program, while in Haryana, 12.41% had
awareness. In Tamil Nadu, where PM-JAY was integrated with the pre-existing state
program, 59% of beneficiaries were aware of the program [11]. Kranthi et al. (2020)
conducted a cross-sectional study on the awareness and readiness of healthcare workers in a
tertiary care hospital in Rishikesh, India, during the implementation of the Pradhan Mantri
Jan Arogya Yojana scheme. The study found that faculty members scored considerably
higher on awareness than senior residents, and it also made clear how important it is to hold
PMJAY training for hospital stakeholders. Pugazhenthi (2020) conducted a study on
awareness of the PMJAY scheme in the Thanjavur district of Tamil Nadu. They assessed
various details about the scheme among 200 beneficiaries and found that awareness regarding
coverage was 65%, awareness regarding grievance redressal was 15% and awareness
regarding PM Arogya Mitra was 21%. They concluded that there was a partially higher
degree of awareness recorded for the scheme's coverage amount than for the monitoring of
the scheme's

Pandey, 2021

A recent study was done in this regard and based on the UTA UT model revealed that the
implication of service adoption theory with the above-mentioned model will surely enhance
the universal health care system of India. Primary data was collected through hospital visits
and patient interaction along with the medical personnel of this field. The research was
conducted in the light of adoption challenges that Ayushman Bharat was facing regarding
slower service adoption of this free mass healthcare system.

Rajiv, 2021

conducted a qualitative examination of the obstacles and enablers to the private hospitals in
Kerala's Pradhan Mantri Jan Arogya Yojana Empanelment. It was shown that social
commitment and an increase in patient flow were the main facilitators for private hospital
empanelment in the system. Because there aren't enough claim rates, hospitals must cut back
on the quality of care because of a lot of patients, the government doesn't want to do anything
about it, and hospitals have had bad experiences in the past

Pugazhenthi V, 2022

examined the performance of government-funded health insurance schemes (GFHIS)

prevailing presently in India along with states. The results showed that the southern states
like Tamil Nadu, Kerala, and Goa are performing better than the other states and Union
Territories (UTs). It emphasized the goal of quality and timely care to the needy poor also.
The report of WHO (2022) emphasized the need to establish a global knowledge repository
for health insurance experiences that will be of great value. It acknowledged PM- JAY as a
milestone for India in its journey towards UHC. The convergence between centers and states
is the epicenter in driving up the success of the scheme. However, it accolades the creation
of the National Health Authority (NHA) as par with global standard practice.
 CHAPTER III

METHODOLOGY
 CHAPTER III
METHODOLOGY
This chapter describes the methodology adopted in the investigation of the presence.

According to Polit and Beck's methodology, the steps, procedures, and strategies for
gathering and analyzing data in a research investigation are outlined.

This chapter outlines the methodology employed in the study. It includes the approach,
research design, variables, population, setting, sample, sampling techniques, sample size,
criteria for sample selection, tools or instruments, and data collection.

RESEARCH APPROACH

In this study, a quantitative research approach was adopted. The purpose was to measure the
effectiveness of a structured teaching program on knowledge about Ayushman Bharat Yojana
(PMJAY) among nursing students.

STUDY AREA

The present study was conducted in a selected nursing college located in Damoh District,
Madhya Pradesh (M.P.), India.

RESEARCH DESIGN

The study used a pre-experimental one-group pre-test and post-test design, which involves:

➢​ Administering a pre-test to assess baseline knowledge,

➢​ Implementing a structured teaching program as an intervention,
➢​ Conducting a post-test to measure the change in knowledge.

VARIABLE

1. independent variable - planned teaching program.

2. dependent variable - knowledge score of nursing students regarding Ayushman Bharat

Yojana.

STUDY TOOL

The data was gathered using a pretested semi-structured questionnaire. Data collection was
done by house-to-house visit, and the head of the family, or in his absence, the eldest adult in
the household, was interviewed using a semi-structured questionnaire. The questionnaire
consisted of details regarding sociodemographic characteristics, awareness, and coverage of
the Ayushman Bharat scheme, health care expenditure in the past 1 year, utilization of the
Ayushman Bharat scheme, and their impact on their family.

SETTING

Setting refers to the area where the studies are conducted. The researcher needs to design
where the intervention will be implemented and where the data will be collected.

(pilot and jungle, 1990)

The study was conducted at a selected nursing college in Damoh district, Madhya Pradesh,
where nursing students are enrolled in various programs.

SAMPLING SIZE

a part or subset of the population selected to participate in a research study. Samples were
college students who are pursuing a bachelor`s degree and diploma students at College of
Nursing, Damoh [M.P.]. The sample size was 60 students.

METHOD OF DATA COLLECTION

Written permission was obtained from the prior of the nursing college at Damoh, MP. The
data collection was done in 2 days at a college of nursing data was collected from 60 samples
that fulfilled the inclusion criteria. The written consent of the participants was obtained
before data collection, and assurance was given to the study participants that the
confidentiality of data would be collected from the sample. The questionnaire was
administered to 60 individuals of nursing students. The average time taken for fondling the
question was about 15-20 minutes. The investigations include the data collection, processed
by thanking the respondents for their participation and cooperation. The investigator did not
face any difficulty in collecting the data from the respondents since they were cooperative
and willing to participate in the study.

SAMPLING TECHNIQUE

The study used a non-probability purposive sampling technique. Students were selected based
on their availability, willingness, and relevance to the topic.
CRITERIA FOR SAMPLE SELECTION
INCLUSION CRITERIA

​ Nursing students who are willing to participate

​ Student present during the entire study period
​ A student studying in a selected nursing college
EXCLUSION CRITERIA

​ Adults who are not present at the time of data collection

​ Students who have already undergone formal teaching about the Ayushman Bharat
Yojana.

TOOLS OR INSTRUMENTS
The tools used for the study are a structured knowledge questionnaire.
Section A: It consists of demographic variables
Section B: questionnaires related to knowledge regarding AB-PMJAY.
Each correct answer carried 1 mark.
Score interpretation:
Good knowledge: 19-30
Average: 12-18
Poor: 0-11

DATA COLLECTION METHOD

Formal written permission was taken from the principal of the Christian Medical Training &
Center College of Nursing Damoh (m.p) to conduct the research among selected nursing
students for conducting the research work. Verbal permission was taken from the college
faculty after explaining the purpose of the study and ensuring the confidentiality of the
information.

SUMMARY

This chapter explained the methodology for this study. It includes a research approach,
variables, study area, research design, variable, study tool, setting, sample size, sampling
method of data collection, study period, sampling technique, criteria for sample selection,
tools or instruments, and data collection method.
 CHAPTER IV

DATA ANALYSIS AND

INTERPRETATION
 CHAPTER - IV
DATA ANALYSIS AND INTERPRETATION

Data analysis is the systematic organization and synthesis of research data and testing the
research hypothesis using those data. Interpretation is the process of making sense of the
results of a study and examining their implications (Polit & Beck, 2004).

STATISTICAL ANALYSIS
This section deals with the analysis and interpretation of data collected from 60 students of
the B.sc Nursing and GNM nursing 3rd year in nursing college, The findings are based on
pre-experimental

OBJECTIVES

●​ To assess the knowledge regarding Ayushman Bharat(PMJAY) among nursing

students.
●​ To assess the pre-test and post-test knowledge about Ayushman Bharat (AB-PMJAY)
among nursing students.
●​ To assess the effectiveness of a structured teaching programme regarding Ayushman
Bharat (PMJAY) among nursing students.
●​ To determine the association between pre and post-test knowledge scores regarding
Ayushman Bharat PMJAY with selected demographic variables among nursing
students.

HYPOTHESIS

H0 - There will be a significant difference in the knowledge and perception scores of nursing
students.

H1-There is a significant improvement in knowledge scores after the teaching program.

H2- There is a significant positive correlation between the post-test knowledge scores and
perception scores of nursing students.

H3-The mean post-test knowledge and perception scores of nursing students will be
significantly higher than their mean pretest scores after the structured teaching program on
Ayushman Bharat Yojana.
 SECTION - I
Table 4:1 DISTRIBUTION OF STUDY PARTICIPANTS WITH REGARD TO
DEMOGRAPHIC VARIABLES

SL No. DEMOGRAPHIC FREQUENCY PERCENTAGE

1. VARIABLE(AGE) %

a. 18 – 20 year 16 26.67%

b. 20- 25 year 44 73.33%

c. 25 -30 year 0 0%

d. Above 30 year 0 0%

2 DEMOGRAPHIC FREQUENCY PERCENTAGE

VARIABLE (GENDER) %

a. Male 17 28.30%

b. Female 43 71.70%

c. other 0 0%

3 DEMOGRAPHIC FREQUENCY PERCENTAGE

VARIABLE (RELIGION) %

a. Hindu 30 50%

b. Christian 30 50%

c. Muslim 0 0%

d. Other 0 0%

4 Previous knowledge about FREQUENCY PERCENTAGE

ABPMJAY %

a. Yes 42 70%

b. No 18 30%

5 Source of knowledge of the FREQUENCY PERCENTAGE

ABPMJAY %

a. Newspaper 14 33.33%

b. Internet 18 42.86%

c. Television 2 4.76%

d. Others 8 19.05%
FIGURE 4:1 = LINE DIAGRAM PERCENTAGE DEPICITING DISTRIBUTION OF
THE STUDY PARTICIPANTS CONCERNING AGE.

Regarding the age of students,0(0%)of them were 25-30 years,0(0%)of them were 30 above
,16(26.67%) of them were 18-20 years ,44(73.33%)of them were 20-25 years.
FIGURE 4:2 = DIAGRAM PERCENTAGE DEPICTING DISTRIBUTION OF THE
STUDY PARTICIPANTS CONCERNING GENDER.

regarding the gender of students, 17(28.3%) of them were male, 43(71.6%) of them were
female
FIGURE 4:3 = DIAGRAM PERCENTAGE DEPICITING DISTRIBUTION OF
THE STUDY PARTICIPANTS CONCERNING RELIGION.

regarding to religion of the student 30(50%) of them were hindu ,30(50%) of them were
christian
FIGURE 4:4 = DIAGRAM PERCENTAGE DEPICITING DISTRIBUTION OF THE
STUDY PARTICIPANTS CONCERNING PREVIOUS KNOWLEDGE.

Regarding the previous knowledge of the students, 42 (70%) were yes, of which 18 (30%) of
them had no previous knowledge.
FIGURE 4:5 = DIAGRAM PERCENTAGE DEPICITING DISTRIBUTION OF THE
STUDY PARTICIPANTS CONCERNING SOURCE OF KNOWLEDGE.

Regarding to previous knowledge gained from, 14 (33.3%)of them were newspapers, 18

(42.8%) of them were the internet, 2 (4.7%) of them were television,08 (19.05%) of them
were others.
 SECTION-II

Assess the pre-test and post-test level of Knowledge regarding the Benefits of Ayushman
Bharat Yojana among nursing students.

PART - A

Table 4:2 = Pre-test percentage of knowledge regarding the Benefits of Ayushman Bharat
Yojana among nursing students.

N=60

Component Number of Min-Max score Knowledge score

questions

Mean score Mean%

pre-test 30 0-30 11.93 39.77%

PART - B

Table 4:3= post-test percentage of knowledge regarding benefits of Ayushman Bharat Yojana
among B.Sc. Nursing students.

N=60

Component Number of Min-Max score Knowledge score

questions

Mean score Mean%

post test 30 0-30 20.75 69.16%

FIGURE 4:6 = diagram depicting pretest and post-test mean score among B.Sc nursing and
GNM nursing students.

The pre-test knowledge score among bsc nursing 3rd year and GNM nursing 3rd year
students is 11.93 (39.77%) and the post test knowledge score among bsc nursing 3rd year
and GNM nursing 3rd year students is 20.75 (69.16%).
 SECTION - III
TABLE 4:4 = PRE-TEST AND POST-TEST LEVEL OF KNOWLEDGE SCORE
AMONG THE BSC NURSING 3RD YEAR AND GNM NURSING 3RD YEAR
STUDENTS.

N=60

S. Knowledge level Pre-test Post-test

No.
NO. % NO. %

1. Poor 33 55% 01 1.67%

2. Average 27 45% 14 23.33%

3. Good 0 0% 45 75%

FIGURE 4:7 = DISTRIBUTION OF PRETEST AND POST TEST SCORES OF

KNOWLEDGE AMONG BSC NURSING 3RD YEAR AND GNM NURSING 3RD
YEAR STUDENTS.
TABLE 4:5 = COMPARISON OF MEAN SCORE BETWEEN PRETEST AND POST
TEST OF KNOWLEDGE AMONG BSC NURSING 3RD YEAR AND GNM
NURSING 3RD YEAR STUDENTS.

N=60

Component Group Mean Mean Mean % Standard T-value Significance

difference deviation

Pre-
test 11.93 39.77% 2.90 Significance
Knowledge P=
level 8.82 14.75 0.00000000
Post- 69.16% 01
test 20.75 3.61 P<0.05

FIGURE 4:8 = DEPICTING TOTAL MEAN SCORE.

TABLE 4:6 ASSOCIATION OF KNOWLEDGE SCORE WITH SELECTED
DEMOGRAPHIC VARIABLES.

N=60

Demographic Levels of knowledge p- SIGNIFICANCE

variables DF value
poor Average good

Age

(a) 18 – 20 years 5 11 0
6 P=0.71 P>0.05
(b) 20- 25 years 18 0
26
(c) 25 -30 years 0 0 0

(d) Above 30 years 0 0 0

Gender

(a) Male 8 9 0
4 P=0.98 P>0.05
(b) Female 23 20 0

0 0 0
(c) other

Religion

(a) Hindu 14 16 0 P=0.00

6 000000 P>0.05
(b) Muslim 0 0 0 01

16 0 0
(c) Christian ​
0 14 0
(d) Other
Previous knowledge
about ABPMJAY

(a) Yes
26 16 0 2 P=0.00 P>0.05
(b) No
4 14 0 001

Source of
knowledge of the
ABPMJAY

(a) Newspaper
12 16 0 6 P=0.13 P>0.05
(b) Internet ​ 13 8 0

(c) Television 1 2 0

(d) Others 2 6 0
 TABLE 4:7

ASSOCIATION OF LEVEL OF KNOWLEDGE REGARDING ABPMJAY IN RELATION

TO PARTICIPANTS AGE.

N=60

Demographic Poor Average good DF P - value SIGNIFICANCE

variables

Age

(a) 18 – 20 years 5 11 0
6 P=0.71 P>0.05
(b) 20- 25 years 26 18
0
(c) 25 -30 years 0
0
(d) Above 30 0 0
years 0
0

FIGURE 4:9 DIAGRAM SHOWING ASSOCIATION LEVELS OF KNOWLEDGE

AND AGE CATEGORY.
 TABLE 4:8
ASSOCIATION OF LEVEL OF KNOWLEDGE REGARDING ABPMJAY IN
RELATION TO PARTICIPANTS IN GENDER.

N=60

Levels of knowledge df P - value SIGNIFICANCE

Demographic
Variables
poor average good

Gender

(a) Male 8 9 0
4 P=0.98 P>0.05
(b) Female 23 20 0

(c) other 0 0 0

FIGURE 4:10 DIAGRAM SHOWING ASSOCIATION BETWEEN LEVELS OF

KNOWLEDGE AND GENDER CATEGORY.

The above table shows,for the sex group the sex group the `P`value is less than 0.5(not
significance).Hence, the value of X² is at the 5% level of sign
 TABLE 4:9

ASSOCIATION OF LEVEL OF KNOWLEDGE REGARDING ABPMJAY IN RELATION TO

PARTICIPANTS RELIGION.

N=60

Demographic Level of knowledge p- significance

variables df value
poor average good

Religion

(a) Hindu 14 16 0 6 P=0.00

00000 P>0.05
(b) Muslim 0 0 0 001

(c) Christian ​ 16 14 0

0 0 0
(d) Other

FIGURE 4:11 DIAGRAM SHOWING ASSOCIATION OF RELIGION.

 TABLE 4:10
ASSOCIATION OF LEVEL OF KNOWLEDGE REGARDING ABPMJAY IN
RELATION TO PARTICIPANTS PREVIOUS KNOWLEDGE ABOUT ABPMJAY.

N=60

Demographic variables Level of knowledge

df p- Significance
poor average good value

Previous knowledge about

Ayushman Bharat Yojana

(a) Yes 26 16 0 2 P=0.0 P>0.05

0001
4 14 0
(b) No

FIGURE 4:12 DIAGRAM SHOWING ASSOCIATION BETWEEN PREVIOUS

KNOWLEDGE AND LEVEL OF KNOWLEDGE.

The above table shows, based on the previous knowledge on Ayushman Bharat Yojana, the
`P` value is less than 0.05(not significant). Hence, the value of X2 is at 5% level of and
significance. There is no association between the previous knowledge and the level of
 TABLE 4:11
ASSOCIATION OF LEVEL OF KNOWLEDGE REGARDING ABPMJAY IN
RELATION TO PARTICIPANTS SOURCE OF KNOWLEDGE.

N=60

Demographic Level of knowledge P-value

variables df Significance
poor average good

Source of knowledge of
the Ayushman Bharat
Yojana

(a) Newspaper 12 16 0 6 P=0.13 P>0.05

(b) Internet ​ 13 8 0

(c) Television 1 2 0

(d) Others 2 6 0

FIGURE 4:13 DIAGRAM SHOWING ASSOCIATION BETWEEN KNOWLEDGE

FROM GAINED FROM AND LEVEL OF KNOWLEDGE.
 CHAPTER V

DISCUSSION, CONCLUSION, NURSING

IMPLICATION, LIMITATION,
RECOMMENDATION
 CHAPTER V

DISCUSSION, SUMMARY, CONCLUSION

RECOMMENDATION, IMPLICATION, AND LIMITATION

This chapter presents a discussion summary and conclusion of the study, as well as its
implications for nursing and healthcare services, followed by its limitations. This chapter
ends with suggestions and recommendations for future research in this field.

PROBLEM STATEMENT:-
A PRE-EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED
TEACHING PROGRAMME ON KNOWLEDGE REGARDING BENEFITS OF
AYUSHMAN BHARAT YOJANA AMONG NURSING STUDENTS OF SELECTED
NURSING COLLEGE IN DAMOH (M.P)

OBJECTIVES OF THE STUDY:-

●​ To assess the knowledge regarding Ayushman Bharat(PMJAY) among nursing

students.
●​ To assess the pre-test and post-test knowledge about Ayushman Bharat (AB-PMJAY)
among nursing students.
●​ To assess the effectiveness of a structured teaching program regarding Ayushman
Bharat (PMJAY) among nursing students.
●​ To determine the association between pre- and Post-test knowledge scores regarding
Ayushman Bharat PMJAY with selected demographic variables among nursing
students.
HYPOTHESIS
H0 - There will be significant difference in the knowledge and perception scores of nursing
students

H1-There is a significant improvement in knowledge scores after the teaching program.

H2- There is a significant positive correlation between the post-test knowledge scores and
perception scores of nursing students.
H3-The mean posttest knowledge and perception scores of nursing students will be
significantly higher than their mean pretest scores after the structured teaching program on
Ayushman Bharat Yojana.

MAJOR FINDINGS OF THE STUDY:

1. The maximum number of nursing students is 60. majority of nursing students 16(26.67%)
to the age group of 18-20 years and 44(73.33% ), to the age group of 20-25 years,0(0%) to
age group of 25-30 years, 0(0%) to the age group of above 30 years.

2. Most of the nursing students, 17 (28.3%), were male, and the remaining nursing students
43(71.7%) were female .

3. Most of the nursing students 30(50%) were Hindu and 0(0%) were muslim, 30(50%) were
christian and remaining nursing students 0(0%) were others.

4. Most of the nursing students 42 (70%) have previous knowledge about ABPMJAY.

5. Maximum nursing students 18(30%) do not have any knowledge about ABPMJAY.

6. Most nursing students, 18(42.86%) gained knowledge about ABPMJAY from the
Internet,and maximum nursing students 14 (33.33%)have gained knowledge from
newspapers, 2(4.76%)have gained knowledge from Television and 8(19.05%) were others.

7. It was concluded that a planned teaching programme on knowledge regarding “Benefits of

Ayushman Bharat Yojana’’ which was provided, and has given complete information and
improved the knowledge of nursing students regarding Benefits of Ayushman Bharat Yojana.

8.It was observed that their pre-test knowledge regarding Benefits of Ayushman Bharat
Yojana showed that.

9. Majority in the present 33(55% ) nursing students had poor grades ,27(45%) nursing
students got average grades ,0(0%) nursing students had good grades .

10. After intervention given to the nursing students in the post-test of the same questionnaire
was grade 01(1.67%) nursing students got a poor grade, 14(23.33%) nursing students got
average grade, and 45(75%) nursing students got a good grade.

11.It was concluded that a planned teaching program on knowledge regarding Benefits of
Ayushman Bharat Yojana was provided, and given complete information and improved the
knowledge of nursing students.
SUMMARY:

The summary includes discussion, objective, conclusion, recommendation and nursing

implications,etc. Research has adopted various strategies to improve the planned teaching
method.The present study was conducted to evaluate the level of knowledge regarding
Benefits of Ayushman Bharat Yojana among nursing students. In order to achieve the
objectives of the study, a study was adopted. Convenience sampling technique was used. The
sample size of the students is 60 nursing students in Christian Medical & Training Centre at
Damoh (M.P).

The main focus of the study is to evaluate the level of knowledge regarding Benefits of
Ayushman Bharat Yojana among nursing students. The conceptual framework adopted for
study was modified. A pre-experimental study was used. A convenient sampling technique
was adopted. The study was conducted at Christian Medical & Training Centre, Damoh, M.P.
An extensive review of literature, professional experience and expert advice helped the
investigator to design the methodology.The population of the study was nursing students
studying in Christian Medical & Training Centre Damoh M.P.

A pre experimental and inferential statistics was used for description, comparison and
association, it was found that the P value was statistically significant. This showed that after
using the chi-square test there was no .

CONCLUSION
After the detailed analysis, this study leads to the following conclusion.

Those members did not have 100% knowledge regarding Benefits of Ayushman Bharat
Yojana. They required further education and information because all of them needed to
enhance their knowledge on Ayushman Bharat Yojana.

IMPLICATIONS
The findings of the present study has several implications in the field of Nursing education,
Nursing Practice.Nursing administration and Nursing research.

NURSING PRACTICE
India is a developing country. Nurses play an important role in early direction and provide
knowledge of Benefits of Ayushman Bharat Yojana among nursing students in which
effective teaching strategies helps to evolve health education.
Effective teaching strategy should be adopted to improve the level of knowledge, Benefits of
Ayushman Bharat Yojana.

NURSING EDUCATION
Today more emphasis is given on continuous programs. The study also implies that the
nursing students have knowledge regarding Benefits of Ayushman Bharat Yojana. Education
is the key component to update and improve the individual knowledge. In the present
scenario, knowledge on benefits of Ayushman Bharat Yojana is deficient among the Nursing
students of Christian Medical & Training Centre Damoh M.P. Hence there is a need to
include these components into the present curriculum prescribed by INC.

NURSING ADMINISTRATION
Nursing administrators are the key person to plan, organize and conduct in-service education
programs. Nurse administration's support should be necessary to conduct and evaluate health
education programs. They can help to improve the knowledge of the nursing students under
training by providing various teaching programs and conferences. They are in a key position
to organize, implement and evaluate educational programs which will help to improve
knowledge as well as to meet the needs and accelerate the standards of nursing students,
necessary support should be provided for policy making and regulation.

NURSING RESEARCH
The main goal of the nursing research is to improve the level of knowledge of nursing
students through the implementation of evidenced based practice. The study provides
baseline data for conducting other research studies.The study will be a motivation for the
researchers to conduct similar studies on a large scale. The study will be a reference to the
research scholars.

RECOMMENDATIONS
The basis of the findings of the study following recommendations have been made for study:

The study can be conducted in a larger sample to generalize findings.

It can be conducted to find out the effectiveness of different teaching modules on Benefits of
Ayushman Bharat Yojana.
CHAPTER VI

BIBLIOGRAPHY
 CHAPTER VI
BIBLOGRAPHY

1. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and Progress Towards Universal
Health Coverage in India: A Commentary. National Institutes of Health, 2019.

2. Chellaiyan, Vinoth Gnana, Hanitha Ravi, and Neha Taneja. Pradhan Mantri Jan Arogya
Yojana – Ayushman Bharat. Indian Journal of Community Health 32, no. 2 (April - June
2020).

3. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and its impact on
utilization, quality and financial protection for inpatient care: a study of four years of
implementation in India. BMC Health Services Research, 2024.

4. Awareness and Utilization of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
Scheme (AB-PMJAY) in Urban and Rural Beneficiaries of Gautam Buddha Nagar. National
Institutes of Health, 2024.

5. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and its impact on
utilisation, quality and financial protection for inpatient care: a study of four years of
implementation in India. National Institutes of Health, 2024.

6. A study on the utilisation of Ayushman Bharat Arogya Yojana among patients who
received treatment for covid-19 in a tertiary care hospital in Central India.
ScienceDirect.com.

7. Carrin G, James C. Key performance indicators for the implementation of social health
insurance. Appl Health Econ Health Policy. 2005;4(1):15–22.

8. McGill E, Er V, Penney T, Egan M, White M, Meier P, et al. Evaluation of public health

interventions from a complex systems perspective: a research methods review. Soc Sci Med.
2021;272: 113697.

9. Trivedi MI, Saxena A, Shroff Z, Sharma M. Experiences and challenges in accessing

hospitalization in a government-funded health insurance scheme: evidence from early
implementation of Pradhan Mantri Jan Aarogya Yojana (PM-JAY) in India. PLoS ONE.
2022;17(5): e0266798.
10. Saxena A, Trivedi M, Shroff ZC, Sharma M. Improving hospital-based processes for
effective implementation of government-funded health insurance schemes: evidence from
early implementation of PM-JAY in India. BMC Health Serv Res. 2022;22(1):1–13.

11. Furtado KM, Raza A, Mathur D, Vaz N, Agrawal R, Shroff ZC. The trust and insurance
models of healthcare purchasing in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
in India: early findings from case studies of two states. BMC Health Serv Res. 2022;22(1):1–

12. Ramesh M, Wu X, He AJ. Health governance and healthcare reforms in China. Health
Policy Plan. 2014;29(6):663–72.

13. Alawode GO, Adewole DA. Assessment of the design and implementation challenges of
the national health insurance scheme in Nigeria: a qualitative study among sub-national level
actors, healthcare and insurance providers. BMC Public Health. 2021;21(1):1–12.

14. Haeder SF, Weimer DL. You Can’t Make Me Do It: State Implementation of Insurance
Exchanges Under the Affordable Care Act. Public Adm Rev. 2013;73(s1): S34-47.

15. Chandra S. India’s Development Tug-of-War: Which side will win? Organisation for
Economic Co-operation and Development.

16. Government of India. Gross State Domestic Product (GSDP) at Constant Prices for States
and UTs from 2011–12 to 2021–22 [Internet]. Open Government Data (OGD) Platform India.
2022. Accessed 19 May 2023.

17. Balabanova D, Mills A, Conteh L, Akkazieva B, Banteyerga H, Dash U, et al. Good

health at low cost 25 years on: lessons for the future of health systems strengthening. Lancet.
2013;381(9883):2118–33.

18. Hoelscher K, Miklian J, Vadlamannati KC. Hearts and mines: a district-level analysis of
the Maoist conflict in India. Int Area Stud Rev. 2012;15(2):141–60.
JOURNALS

1. Bertram RM, Blase KA, Fixsen DL. Improving programs and outcomes: implementation
frameworks and organization change. Res Soc Work Pract. 2016;25(4):477–87.

2. Nilsen P. Making sense of implementation theories, models and frameworks. Implement

Sci. 2015;10(1):1–13.

3. Nilsen P, Bernhardsson S. Context matters in implementation science: a scoping review of

determinant frameworks that describe contextual determinants for implementation outcomes.
BMC Health Serv Res. 2019;19(1):1–21.

4. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting
qualitative research. Acad Med. 2014;89(9):1245–51.

5. Seward N, Hanlon C, Hinrichs-Kraples S, Lund C, Murdoch J, Taylor Salisbury T, et al. A

guide to systems-level, participatory, theory-informed implementation research in global
health. BMJ Glob Heal. 2021;6(12): e005365.

6. Palinkas LA, Mendon SJ, Hamilton AB. Innovations in mixed methods evaluations. Annu
Rev Public Health. 2019;40:423–42. Joseph J, Sankar HD, Nambiar D. Empanelment of
health care facilities under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB
PM-JAY) in India. PLoS ONE. 2021;16(5): e0251814.

7. Morton M, Nagpal S, Sadanandan R, Bauhoff S. India’s largest hospital insurance program

faces challenges in using claims data to measure quality. Health Aff. 2016;35(10):1792–9.

8. Khetrapal S, Acharya A, Mills A. Assessment of the public-private-partnerships model of a

national health insurance scheme in India. Soc Sci Med. 2019;243: 112634.

9. Meghani A, Rodríguez DC, Peters DH, Bennett S. Understanding reasons for and strategic
responses to administrative health data misreporting in an Indian state. Health Policy Plan.
2022;38:150.

10. Nagulapalli S, Rokkam SR. Should Governments engage health insurance intermediaries?
A comparison of benefits with and without insurance intermediary in a large tax funded
community health insurance scheme in the Indian state of Andhra Pradesh. BMC Health Serv
Res. 2015;15(1):1–9.
11.Chhabra S, Smith O, Tandon A, Ulep V. Nuts and Bolts of the Chief Minister’s
Comprehensive Health Insurance Scheme (CMCHIS): A Case Study from Tamil Nadu World
Bank Team. 2019.

12. Cotlear D, Nagpal S, Smith O, Tandon A, Cortez R. Going Universal: How 24

Developing Countries are Implementing Universal Health Coverage Reforms from the
Bottom Up. Washington, DC; 2015.

13. Garg S, Tripathi N, Ranjan A, Bebarta KK. Comparing the average cost of outpatient care
of public and for-profit private providers in India. BMC Health Serv Res. 2021;21(1):1–9.

14. Hooda SK. Decoding Ayushman Bharat from a political economy perspective. Economic
Polit Wkly. 2020;55(25):107.

15. Sriram V, Hariyani S, Lalani U, Buddhiraju RT, Pandey P, Bennett S. Stakeholder

perspectives on proposed policies to improve distribution and retention of doctors in rural
areas of Uttar Pradesh, India. BMC Health Serv Res. 2021;21(1):1–16.

16. Gilson L, Schneider H, Orgill M. Practice and power: a review and interpretive synthesis
focused on the exercise of discretionary power in policy implementation by front-line
providers and managers. Health Policy Plan. 2014;29:iii51-69.

17. Meghani A, Rodríguez DC, Bilal H, Tripathi AB, Namasivayam V, Prakash R, et al.
Examining policy intentions and actual implementation practices: how organizational factors
influence health management information systems in Uttar Pradesh, India. Soc Sci Med.
2021;1(286): 114291.

18. Maurya D, Ramesh M. Program design, implementation and performance: the case of
social health insurance in India. Health Econ Policy Law. 2019;14(4):487–508.
INTERNAL REFERENCE

https://www.myscheme.gov.in/schemes/ab-pmjay

https://mera.pmjay.gov.in

https://www.india.gov.in/spotlight/ayushman-bharat

https://abdm.gov.in

​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​
 CHAPTER VII

ANNEXURE
​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​
​ ​ ​ ​ ​
 TOOL FOR DATA COLLECTION
DEMOGRAPHIC DATA
SECTION-A
1. Age

(a) 18 – 20 year

(b) 20- 25 year ​

(c) 25 -30 year

(d) Above 30 year

2. Gender

(a) Male

(b) Female

(c) other

3. Religion

(a) Hindu

(b) Muslim

(c) Christian ​

(d) Other ​

4. Previous knowledge about

(a) Yes

(b) No

5. Source of knowledge of Ayushman Bharat Yojana

(a) Newspaper

(b) Internet ​

(c) Television

(d) Others
 QUESTIONNAIRE RELATED TO ABPMJAY
SECTION -B

1. What is the main objective of the Ayushman Bharat scheme?

(a) Providing free education to the poor
(b) Providing free healthcare to all citizens
(c) Providing health insurance to economically weaker sections
(d) Employing unemployed youth

2. How much health insurance coverage is provided under the Ayushman Bharat scheme?
(a) 2 lakh per family per year
(b) 3 lakh per family per year
(c) 5 lakh per family per year
(d) 10 lakh per family per year

3. Who are the beneficiaries of the Ayushman Bharat scheme?

(a) Only government employees
(b) Only income taxpayers
(c) Poor and vulnerable families identified in the 2011 Socio-Economic and Caste Census
(d) All citizens

4. In which hospitals can treatment be availed under the Ayushman Bharat scheme?
(a) Only government hospitals
(b) Only private hospitals
(c) Both government and private hospitals (that are empaneled under the scheme)
(d) None of these
5. What are the two main components of the Ayushman Bharat scheme?
(a) Pradhan Mantri Jan Dhan Yojana and Pradhan Mantri Awas Yojana
(b) Pradhan Mantri Jan Arogya Yojana and Health and Wellness Centers
(c) MGNREGA and National Food Security Act
(d) None of these

6. What type of treatment is covered under the Ayushman Bharat scheme?

(a) Only primary care
(b) Only secondary care
(c) Primary, secondary, and tertiary care
(d) None of these

7. Which of the following statements about the Ayushman Bharat scheme is correct?
(a) This scheme is implemented only in urban areas
(b) There is no limit on family size under this scheme
(c) Pre-existing diseases are not covered under this scheme
(d) This scheme is only for women

8. What is the helpline number for the Ayushman Bharat scheme?

(a) 100
(b) 102
(c) 104
(d) 108

9. What is the main objective of the Ayushman Bharat Scheme?

a) To provide free healthcare services to all citizens
b) To provide health insurance to poor families
c) To improve healthcare facilities in rural areas
d) To provide medical education to underprivileged students
10. What is a key component of the Ayushman Bharat Scheme?
a) National Health Mission
b) National Health Insurance Scheme
c) Ayushman Bharat Health Account
d) All of the above

11. What is the annual health insurance coverage under the Ayushman Bharat Scheme?
a) 1 lakh
b) 2 lakh
c) 5 lakh
d) 10 lakh

12. What is the helpline number for Ayushman Bharat Yojana?*

a) 14556
b) 14557
c) 14555
d) 14554

13. Ayushman Bharat Yojana is a flagship scheme of which ministry?

a) Ministry of Health and Family Welfare
b) Ministry of Rural Development
c) Ministry of Finance
d) Ministry of Women and Child Development

14. PM-JAY is also known as:

a) National Health Mission
b) National Digital Health Mission
c) National Health Protection Scheme
d) None of the above
15. Who is eligible for PM-JAY?
a) All Indian citizens
b) Government employees
c) Families identified based on SECC 2011 data
d) Senior citizens above 60 years

16. Health and Wellness Centres (HWCs) focus on:

a) Primary healthcare
b) Tertiary care
c) Specialized surgeries
d) Medical research

17. What is a Health ID under ABDM?

a) A unique health insurance number
b) A digital health record for individuals
c) A government-issued identity card
d) A medical prescription

18. Can a beneficiary under PM-JAY avail of treatment in any hospital?

a) Yes, in any hospital in India
b) Yes, but only in government hospitals
c) Yes, but only in impaneled hospitals
d) No, treatment is only available in specific states

19. Is there any age limit for availing benefits under PM-JAY?
a) Yes, only for senior citizens
b) Yes, only for children below 10 years
c) No, there is no age limit
d) Yes, only for adults between 18 and 60 years
20. Ayushman Bharat aims to achieve:
a) 100% literacy rate
b) Universal Health Coverage
c) Zero Poverty
d) 100% employment

21. PM-JAY covers:

a) Only primary healthcare
b) Only secondary and tertiary healthcare
c) Both primary and secondary/tertiary healthcare
d) Only preventive healthcare

22. The Ayushman Bharat scheme is funded by

a) State governments only
b) Central government only
c) Both Central and State governments
d) Private organizations

23. Which of the following is a key feature of PM-JAY?

a) Cashless treatment at the impaneled hospitals
b) Free medicines for all
c) Free transportation to hospitals
d) Financial assistance for medical education

24. HWCs are envisioned to be the first point of contact for

a) Specialized medical care
b) Primary healthcare
c) Emergency medical services
d) All of the above
25. Ayushman Bharat is a step towards achieving
a) Sustainable Development Goals (SDGs)
b) Millennium Development Goals (MDGs)
c) Both SDGs and MDGs
d) None of the above

26. The focus of Ayushman Bharat is on

a) Curative care only
b) Preventive care only
c) Both preventive and curative care
d) Rehabilitative care only

27. PM-JAY beneficiaries can access treatment at

a) Any hospital in India
b) Only government hospitals
c) Only impaneled private hospitals
d) Both the government and the impaneled private hospitals

28. HWCs will provide services related to

a) Maternal and child health
b) Communicable diseases
c) Non-communicable diseases
d) All of the above

29. ABDM will help in

a) Improving healthcare delivery
b) Reducing healthcare costs
c) Enhancing patient experience
d) All of the above
30. Ayushman Bharat is a scheme for
a) Providing employment opportunities
b) Improving healthcare access and affordability
c) Promoting digital literacy
d) Developing infrastructure
 ANSWER KEY OF “ABPMJAY”

QUESTION NO. ANSWERS QUESTION NO. ANSWERS QUESTION NO. ANSWERS

1 C 11 C 21 b
2 C 12 C 22 b
3 C 13 a 23 a
4 C 14 C 24 b
5 B 15 C 25 a
6 C 16 a 26 C
7 b 17 b 27 d
8 C 18 C 28 d
9 b 19 C 29 d
10 d 20 b 30 b
Q1 Q2 Q3 Q4 Q5 Q5

1 B B C B B

2 A B C B B

3 A B C A D

4 A B A A A

5 B B C B D

6 B B A B A

7 B A C A A

8 A B C B A

9 B B A B D

10 A B C A D

11 A B A A A

12 A B A A D

13 B B A A A

14 A B A B A

15 B A C A A

16 B B A B B

17 B B A A D

18 B B C A A

19 B B A B A
20 B A A A B

21 B A C A C

22 A A A B B

23 B A C A D

24 A B C A A

25 B A C B A

26 B A C A D

27 B B A B C

28 B B C A B

29 B B A A A

30 A B A A A

31 B A A A A

32 A B A A B

33 A B C B A

34 B A A B B

35 B A A A B

36 B A A A A

37 B A C A A

38 B B C B B

39 A B C A B

40 B B A B B
41 B B C A B

42 B B A A B

43 B B A A B

44 B B A A A

45 B B A A A

46 B A A B B

47 A B A A A

48 B B A A A

49 B A C A A

50 B B A A B

51 B B A A A

52 B B C A A

53 B B C A B

54 B B C B A

55 B A A A B

56 B B C A B

57 B A A A A

58 B B A A A

59 B B C A B

60 B B C A B
SR
N Pre-Test
O. TOTAL

1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 1 0 1 1 0 13

2 1 1 1 0 1 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 1 0 0 1 1 0 0 1 14

3 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 1 0 0 1 0 1 1 12

4 1 1 1 1 1 0 1 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 1 15

5 1 1 1 1 0 1 1 1 1 1 1 0 0 1 1 0 0 0 1 1 0 0 1 0 0 1 1 0 1 0 18

6 1 1 1 0 0 0 1 0 1 0 1 0 1 0 0 0 0 0 0 0 1 1 0 1 0 0 1 1 0 1 13

7 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 9

8 1 0 1 1 0 0 0 0 0 1 1 0 1 0 0 0 1 0 0 1 0 0 0 1 0 0 1 0 0 1 11

9 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 1 1 1 1 12

10 1 1 1 1 0 0 1 0 0 1 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 13

11 1 1 1 0 1 0 1 0 1 0 1 0 1 1 0 0 0 0 1 1 0 1 0 0 0 1 0 0 1 1 15

12 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 0 1 0 0 1 1 0 0 1 0 1 0 0 0 0 17

13 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 1 0 1 0 17

14 0 0 1 1 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 1 0 0 1 11

15 1 0 1 1 1 0 1 0 1 1 1 1 0 1 1 0 1 0 0 1 0 0 0 0 0 1 0 0 0 1 13

16 1 1 1 1 1 0 0 0 1 0 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 11
17 0 1 1 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 0 1 8

18 0 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 0 0 0 0 0 1 0 0 1 0 1 0 16

19 1 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 1 0 0 10

20 0 1 0 1 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 9

21 1 0 1 1 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 1 0 0 1 0 1 1 0 1 1 0 9

22 1 0 0 0 1 0 1 0 1 0 1 1 0 0 0 1 1 0 0 0 0 0 0 1 0 0 1 0 1 1 12

23 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 1 0 1 1 0 10

24 1 1 1 1 0 0 1 0 1 1 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 13

25 1 1 1 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 1 1 1 1 1 0 0 1 0 1 0 0 13

26 1 1 1 0 1 1 1 0 1 1 1 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 1 0 1 1 16

27 1 0 0 0 1 0 1 0 1 1 1 1 0 0 0 0 1 0 1 1 0 1 0 1 0 1 0 1 1 0 12

28 1 1 1 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 1 0 1 1 16

29 1 1 0 0 1 0 1 0 1 0 0 0 0 0 1 0 0 0 1 0 1 1 1 1 1 1 1 1 1 1 12

30 1 1 1 1 1 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 1 13

31 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 1 1 1 1 0 9

32 1 1 1 0 0 0 0 0 1 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 10

33 1 1 0 0 0 0 1 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 1 1 1 1 13

34 1 0 1 1 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 12

35 1 0 1 0 1 0 1 1 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 1 0 1 0 1 0 10

36 0 1 0 0 0 1 0 0 1 1 0 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 1 0 1 11

37 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 1 0 1 1 6
38 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 1 1 0 8

39 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 1 1 0 1 9

40 1 1 1 1 0 0 1 0 0 1 0 0 1 0 1 0 1 0 0 0 0 1 1 1 1 0 1 0 1 0 15

41 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 9

42 1 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 8

43 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 1 1 0 1 0 0 0 1 1 1 0 1 1 1 8

44 1 0 1 0 1 0 1 0 1 1 1 0 0 1 1 0 1 1 1 1 0 0 1 0 0 0 1 0 0 1 16

45 0 0 0 0 0 0 1 1 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 1 0 1 1 0 6

46 0 0 0 0 0 1 1 0 0 0 1 0 0 1 1 1 0 1 0 1 0 1 0 0 0 1 1 0 1 1 13

47 0 0 0 0 0 0 1 0 1 0 0 1 0 1 1 1 0 1 0 1 0 0 1 1 0 1 1 1 0 1 10

48 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 6

49 1 1 1 0 0 0 1 0 1 1 1 1 1 1 0 0 1 0 1 1 0 0 0 0 0 1 1 1 0 0 13

50 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 7

51 1 1 0 0 0 0 0 1 0 1 1 0 1 0 1 0 0 0 0 1 0 0 0 1 1 1 0 1 0 1 10

52 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 1 1 1 13

53 1 0 1 1 1 0 0 1 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 10

54 0 1 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 1 11

55 0 1 0 1 1 0 1 0 0 0 0 1 0 1 0 1 1 0 0 1 0 0 0 0 0 1 0 1 1 0 10

56 1 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 11

57 1 1 1 1 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 1 10

58 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 1 0 0 0 1 1 0 1 1 0 1 0 9
59 1 1 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 8

60 1 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 1 0 1 9

716
S.
N POST-TEST
MAX
o MARKS

1 1 1 1 1 1 1 0 1 0 1 1 2 1 1 0 1 1 1 1 1 1 0 1 0 1 1 1 0 0 1 30

2 1 1 1 1 1 1 1 1 0 1 1 1 0 0 1 1 1 1 1 1 1 0 0 1 1 0 1 0 0 1 30

3 1 0 1 1 1 0 1 0 1 1 1 1 0 1 1 1 0 0 1 1 1 1 1 0 0 1 0 1 1 0 30

4 1 1 0 1 1 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 0 1 1 1 1 0 1 0 1 1 30

5 1 0 1 0 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 0 0 1 0 1 0 30

6 1 1 1 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 1 1 0 1 1 30

7 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 1 1 0 1 30

8 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 30

9 1 1 1 1 1 0 1 1 1 1 0 1 0 1 1 0 1 1 1 1 1 1 0 0 1 1 0 0 30

10 1 1 1 1 1 0 1 1 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 1 1 0 1 30

11 1 1 1 1 1 0 1 1 1 0 0 1 1 0 1 0 1 0 1 1 1 1 1 1 0 1 1 1 0 30

12 1 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 1 0 0 1 1 1 1 1 1 0 1 1 1 1 30

13 1 1 1 1 1 1 1 1 1 1 0 1 0 1 0 1 0 1 0 1 0 0 1 30

14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 30

15 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 30

16 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 30

17 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 30

18 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1 30

19 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 30
20 1 1 1 1 1 1 1 1 1 1 1 0 0 1 0 30

21 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 30

22 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 0 30

23 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 1 30

24 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 30

25 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 0 30

26 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 30

27 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 30

28 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 30

29 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 30

30 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1 30

31 1 1 1 1 1 1 1 1 0 0 1 1 30

32 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 0 30

33 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1 30

34 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 30

35 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 0 1 30

36 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 30

37 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 0 1 30

38 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 30

39 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 0 1 30

40 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 30
41 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 30

42 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 1 30

43 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 30

44 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 0 1 30

45 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1 30

46 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 30

47 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 30

48 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 0 30

49 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 30

50 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 1 30

51 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 30

52 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 30

53 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 30

54 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 30

55 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 0 30

56 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1 1 30

57 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1 30

58 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1 0 30

59 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1 30

60 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 30

1800