Questionnaire designing and validation on Dadhi Sevana in Kaphaja Kasa

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[Find the meaning and references behind the names: Sri, Guna, Hassan, Sanjeev, Anjali, Guru, Mala, Rasa]

REVIEW ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 103 Questionnaire designing and validation on Dadhi Sevana in Kaphaja Kasa Anjali Sanjeev 1 , Gopikrishna S 2 1 Final year Post Graduate Scholar, Department of Roga Nidana and Vikruti Vijnana, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India. 2 Professor and Head of Department, Department of Roga Nidana and Vikruti Vijnana, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India. I NTRODUCTION Dadhi (Curd) by its nature has; Madhuraamlarasa (sweetish sour taste), Amlavipaka (sour post digestion taste), [1] Guru (heavy to digest), Ushnavirya [2] (hot in potency) and is Abhishyandi (coats over the channels carrying Dosha, Dhatu and Mala). Predominant taste of Dadhi is Amla Svadu and it possesses Grahi and Address for correspondence: Dr. Anjali Sanjeev Final year Post Graduate Scholar, Department of Roga Nidana and Vikruti Vijnana, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India. E-mail: anjalisanjeev 93@gmail.com Submission Date: 15/07/2021 Accepted Date: 19/08/2021 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CCby-NC-SA increases Agni and produces Shopha according to Acarya Harita. The attributes of Dadhi varies according to inoculation time for fermentation, type and nature of milk used. Dadhi belongs to Amla Skanda (group of sour drugs) and it is one among the Vicitra Pratyarabdha Dravya (a Dravya which does not act as per Rasa Panchaka ); as these Dravyas are having the capability of producing both positive and negative impact on health. On the basis of the Panchabhuta composition, Dravya do not have structural similarity among the constituents. Another concept is which can be considered here is VikrutiVishama Samaveta – there is structural similarity but exhibit special pharmacological action. Dadhi Rasa, Guna, Veerya, Vipaka are differs hence it is Vicitra Pratyarabda Dravya. M ATERIALS AND M ETHODS Questionnaire developing based on classical reference on properties of Dadhi, Dadhi Sevana Niyama, [3] A B S T R A C T Consumption of Dadhi (curd) has a role in the formation of Kaphaja Kasa . It acts as a Viprakrista Nidana (distant cause) and as a Vyabhichari Nidana (weak cause) for the causation of disease. Dadhi being Madhura, Amla Rasa, Guru, Snigdha, Abhishyandi Guna, Ushna Veerya and Amla Vipaka and having Kaphakara property. Samanya Nidana of Kaphaja Kasa is intake of Guru, Abhishyandi, Madura, Snigdha Guna Aharas . And also, Dadhi is one among the Kapha Prakopa Karana Ahara explained by Madhavakara . To make Ayurveda easily acceptable, as per the current trends in research, a review of previously proved fundamentals of Ayurveda in line with currently followed method of research is essential to achieve easy application in field of clinical research. Five step processes of designing and validation of questionnaire ensure a research tool for clinical research. Thus, validations of Questionnaire are based on Dadhi Sevana . Due to Samanya Vishesha Siddhanta, Samana Guna acts as a Vruddhi Karana , also one who doesn’t follow Dadhi Sevana Niyamas , hence it shows risk factor in the formation of Kaphaja Kasa. Key words: Questionnaire Designing and Validation, Dadhi Sevana, Kaphaja Kasa

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[Find the meaning and references behind the names: Mark, Good]

Anjali Sanjeev et al. Questionnaire designing and validation on Dadhi Sevana in Kaphaja Kasa ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 104 followed by validation by methods of research. Basically, validation of questionnaire involves Five Steps 1. Preparation of questionnaire 2. Expert validity – taking the suggestions of subject experts for Content validity, to check the content of questionnaire, this is done by experts or authority persons 3. Construct validity – checked by Reliability tests 4. Face validity - Pilot study 5. Final reforming of questionnaire. R ESULT AND DISCUSSION Validation of Questionnaire for reliability and consistency carried out with the following steps; 1 Preparation of questionnaire 2 Expert validation 3 Cronbach‟s alpha and Principal Component Analysis 4 Pilot Study 5 Final reforming the Questionnaire. 1) Preparation of the Questionnaire A preliminary list of items related to Dadhi [4] and its mode of intake with duration in seasonal as well as daily routine and Dadhi Sevana Niyama were prepared according to classical Samhitas and same was converted into questions and two versions of questionnaires are prepared i.e., in English and Kannada language. This was followed by preliminary version of questionnaire with seventy-one items. The prepared questionnaire comprised of five Domains with Duration, Quantity, Types, Mode/Adjuvent, and Symptoms. The items in the questionnaire were developed in such a way that it was understood and easily completed by patients aged between 18-60 years and it was designed to be self-administered. The respondents were given the option for recording their responses in the form of “Regularly = 5 -10 times a week, Frequently = 2-4 times per week, Sometimes = 1-2 times in 2 weeks, Occasional = once in a month and Never‟ with Duration= time of year of practicing these habits, by recording a check mark in the respective column provided for the purpose. 2) Expert validation Expert validation was conducted to explore opinions about the positive and negative aspects of questionnaire and give expert suggestions. Ten experts were given the questionnaire containing seventy-one questions with option as Essential, Useful but not essential, not necessarily graded as 2, 1, 0 respectively for each question and their suggestions were noted. Cronbach alpha scale was tested for seventy-one questions as a whole. Two in domain 1- ‘Duration’, Three in domain 3 - ‘Types’, Two in Domain 5- ‘Symptoms’ removed. Thus, total seven question got deleted and sixty-four questions were finalized based on results of suggestions of experts and cronbach‟s alpha. The data analysis was done using the software 'Statistical Package for Social Sciences', Version 23 (SPSS IBM). 3) Cronbach’s alpha [5] Cronbach alpha is a measure of Internal Consistency means how closely related to a set of items are as a group. It is a measure scale reliability, while validating the scales, value of alpha greater than 0.7 was accepted, and value of alpha in between 0.8 to 0.9 is having a good consistency, Here the Cronbach alpha is 0.822 which means it is having a good consistency, those value of Alpha greater than Cronbach's coefficient alpha, corresponding item were deleted. For expert validation Cronbach alpha value was 0.822, seven questions were removed, two from duration (midnight and early morning curd intake) , three from types of curd intake and two from symptoms was removed. For Pilot study Cronbach alpha scale tested for seventy-one questions as a whole. Alpha value was 0.821, which is acceptable. Table 1: Showing Reliability Statistics (Cronbach alpha) Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items 0.822 0.821 64

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Anjali Sanjeev et al. Questionnaire designing and validation on Dadhi Sevana in Kaphaja Kasa ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 105 Principle Component Analysis and Cohens kappa Principle Component Analysis as well as cohens kappa could not able to elicit due to small sample size and less items present in the questionnaire. 1) Pilot Study The self-administered questionnaire was distributed to 30 in-patients of Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, for pilot study during the month of February- March 2020. Patients were given 24 hours’ time to complete the questionnaire. Cronbach alpha scale tested for sixty-four questions as a whole. 2) Final reforming the Questionnaire Final questionnaire contains sixty-four, the questionnaire also contains a copy of confidentiality agreement and brief history of patient. Confidentiality agreement stating the purpose of the study and assuring strict confidentiality of the respondents and the respondents were also asked to furnish demographic details about their age, gender etc. After pilot study on thirty patients, Cronbach's Alpha value was 0.821 considered to be acceptable. All the items were significant and acceptable. Validated Dadhi Sevana questionnaire is presented in Table 1. Table 2: Showing validated Dadhi Sevana Questionnaire. [6,7] Instructions to fill Regularly (R) 5-10 times a week Frequently (F) 2-4 times per week Sometimes (S) 1-2 times in 2 weeks Occasional (O) once in a month Never (N) Never Duration (D) Since when you are practicing these habits Item no. Questions R F S O N D I. Domain: DURATION 1. What is the frequency of Curd intake? 2. Usual time of curd intake? Morning (6:00 a.m-12:00 p.m) 3. Afternoon (12:00 p.m- 4:00 p.m) 4. Evening (4:00 p.m-7:00 p.m) 5. Night (7:00 p.m-12:00 a.m) 6. Usual season of curd intake? Winter (Mid november- Mid january) 7. Cold, Dew (Mid January- Mid march) 8. Spring (Mid March- Mid July) 9. Summer (Mid May- Mid July) 10. Rainy (Mid July- Mid September) 11. Autumn (Mid September- Mid November) II. Domain: QUANTITY 12. What is the amount of Curd intake? Less than 25 ml 13. 25 ml- 50 ml 14. 50 ml-75 ml 15. 75 ml-100 ml 16. 100 ml-200 ml 17. More than 200 ml

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[Find the meaning and references behind the names: Honey]

Anjali Sanjeev et al. Questionnaire designing and validation on Dadhi Sevana in Kaphaja Kasa ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 106 III. Domain: TYPES 18. What type of Curd do you use? Homemade cow curd 19. Homemade buffalo’s curd 20. Packed curd 21. Which Flavor of curd you use? Sweet 22. Sour 23. Yogurt 24. Shrikhand 25. Formed curd IV. Domain: MODE/ADJUVENT 26. Mode of intake of curd? Plain curd 27. With Sugar 28. With Salt 29. With Pickle 30. With Dal 31. With Honey 32. With Milk 33. With Amla powder 34. After meals 35. Do you consume curd with following? Rice 36. Chappati 37. Vegetable Salad 38. Fish 39. Milk 40. Heated curd 41. Ushna Dravyas 42. Common food items Lassi 43. Rabadi 44. Jelabi 45. Dahi vada 46. Curd rice 47. Dahi puri 48. Mangalore buns V. Domain: SYMPTOMS 49. Do you have following symptoms after curd intake? Cough 50. Cough with Sputum expectoration 51. Difficulty in breathing 52. Sneezing /cold 53. Heaviness of chest 54. Excess Sleep 55. Itching 56. Excess salivation 57. Decreased digestion 58. Hoarseness of voice 59. Will these symptoms decreases after stopping curd? Cough

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[Find the meaning and references behind the names: Williams, Deepika, Nil, Med]

Anjali Sanjeev et al. Questionnaire designing and validation on Dadhi Sevana in Kaphaja Kasa ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 107 60. Cough with Sputum expectoration 61. Difficulty in breathing 62. Sneezing /cold 63. Heaviness of chest 64. Do you refrigerate curd? CONCLUSION Questionnaires are the most commonly used tool in survey research. Questionnaires should produce valid and reliable demographic variable measures. A questionnaire is valid if what it measures is what it had originally planned to measure. Information scattered in Ayurveda text on particular fundamental principles needs to be compiled and a method has to be devised for its application. One such method is questionnaire designing. Hence designing of questionnaire and its validation is of paramount importance in Ayurveda Anusandhana . These selfreport scales, which are usually presented in questionnaire form, are one of the most used instruments in psychology and observational studies, and thus it is important that the measures be constructed carefully, while also being reliable and valid. The way that a question is framed can have a large impact on how a research participant will answer the question. The vocabulary of the questions should be very simple and direct, sensitive questions which are very personal to the patients should be framed well and consciously. Order of questions should be arranged in such a way that respondent feel interest in answering and to catch the respondent’s attention. Then reliability test should be carried based on response of subjects. REFERENCES 1 Acharya YT. Sushruta Samhita of Sushruta. Varanasi: Choukhambha Surabharati Prakashana. 2003; 202. 2 Acharya YT. Commentary by Dalhana on Sushruta Samhita of Sushruta. Varanasi: Choukhambha Surabharati Prakashana. 2003; 5: 202 3 Acharya YT. Caraka Samhita of Agnivesga. Varanasi: Choukhambha Surabharati Prakashana. 5 th ed, reprint 2007;p 60. 4 Susruta. Susruta Samhita, Nidandhansangraha Commentary of Dalhana and Nyayachnadrika Panjika commentary on Nidana Sthana of Gayadasacharya, edited by Yadavji trikamji. Varanasi: Chaukamba Sanskrit Sanasthan. 2010;p 659. 5 https://stats.idre.ucla.edu/spss/output/principal components/ 6 M Monier Williams. A Sanskrit English Dictionary. New Delhi: Bharatiya Grantha Nikethan Publishers. 1 st ed, Reprint, 2007. 7 Agnivesha, Charaka, Dridabala, Acharya YT. Charaka samhitha with Ayurveda deepika commentary by Chakrapanidutta on Charaka Samhita of Agnivesha. Varanasi: Chaukamba Sanskrit Sansthan. Chikitsasthana; Kasachikitsitham: Chapter 18, Verse 29- 30, reprint ed, 2014;p 541. ******************************* How to cite this article: Anjali Sanjeev, Gopikrishna S. Questionnaire designing and validation on Dadhi Sevana in Kaphaja Kasa. J Ayurveda Integr Med Sci 2021;4:103-107. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2021 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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Ushnavirya, Amlarasa, Kaphaja Kasa, Pilot study, Cronbach's alpha, Expert validation, Samanya Vishesha Siddhanta, Guru guna, Content validity, Construct validity, Self-administered questionnaire, Principal component analysis, Samanya Nidana, Questionnaire Validation, Face Validity, Internal Consistency, Dadhi Sevana, Amla Vipaka, Cronbach alpha, Demographic detail, Statistical package for social science, Abhishyandi guna.