A Study to Assess the Effectiveness of Stp on Mentural Hygiene and Practice Among Adolescent

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

1. NAME OF THE CANDIDATE : MS.SUKHDEEP KAUR

AND ADDRESS I YEAR M.Sc NURSING

CHINAI COLLEGE OF NURSING,

SAPTHAGIRIMANSION,

BHAANU NURSING HOME ROAD,

BOMMANAHALLI, BANGALORE-68.

2. NAME OF THE INSTITUTION : CHINAI COLLEGE OF NURSING,

BANGALORE -68

3. COURSE OF STUDY AND : MASTER DEGREE OF NURSING,

SUBJECT COMMUNITY HEALTH NURSING.

4. DATE OF ADMISSION TO : 15.06.2009

COURSE

5. TITLE OF THE TOPIC : “A STUDY TO ASSESS THE EFFECTIVENESS

OF STRUCTURED TEACHING PROGRAMME ON MENSTURAL HYGIENE KNOWLEDGE AND PRACTICE AMONG ADOLESCENT GIRLS STUDYING IN 8TH TO 10THSTANDARD IN SELECTED SCHOOL AT BANGALORE”.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“I Want to fly ______do not cut my wings.”

[2004, UNFPRA PROGRAMME]

In INDIA about 24%of total population belongs to adolescent period. The blossoming of adolescence in each generation is as fascinating a sight as the unfolding offspring each year predictable and repetitive. Adolescents belong to vital age group, not only because they are the entrant population to parenthood but also because they are threshold between childhood and adulthood. As they attempt to cross this threshold they face various physiological, psychological and developmental changes. The word ‘’Adolescent’’ is derived from the Latin word ‘adolescere’ which means to grow to maturity that indicate the defining features of adolescence. During puberty the physical changes occur which transform the body of child into that of an adult, changes in body size, and changes in body proportions.

Menstruation is a physiological phenomenon which is unique to females that begins in adolescence. Menstruation is also properly called menses (or) catamenia and more commonly a period of monthly flow. Menstruation is not an illness. It is a healthy, normal, mature process. The ages of onset is from 9-16 years and termination occurs approximately every 28days and last for about five days. Menstrual flow consists of blood, mucus, and tissue particles. Average blood loss is about three ounces. Factors that may alter the menstrual cycle are stress, fatigue, exercises, acute (or) chronic illness, and changes in climate. Personal hygiene to be followed during menstruation are to use sterile pads during early period of heavy flow, bathe daily for comfort and to feel fresh, keep perineal area clean from anterior to posterior, cotton under garments preferred. The most striking change in adolescent girls is the onset of menstruation, 3-5 days bleeding from the uterus once a month that will occur throughout the lifetime till menopause.The first menses is called “Menarche”. Menarche is the signal that sexual maturation of the young female has occurred and that the body is capable of supporting pregnancy. With onset of menstruation a girl becomes aware of her emerging identity as a female capable to reproduce. Her understanding and acceptance of her new identity will be greatly influenced by the feed back she receives from peers, educators and most importantly her parents. Menstruation occurs periodically throughout the child bearing years, except during pregnancy and lactation. The ages of onset of menstruation differ from person to person but seem to be affected by heredity, racial background and nutritional status.

Most of the girls receive their gynecological information from their mothers, religious books, older sister or a peer. However such information was generally given after menarche rather than before A study conducted in (2006) using qualitative research data and quantative survey revealed, that prior to menarche the knowledge about menstruation was deficient among the respondents and ten percent of women respondedants and reported various taboos related to menstruation. Hence there is a need to provide healthy family life education to the woman particularly the adolescent girls.Very few similar studies have been conducted in India which has explored the knowledge and practice areas. But the attitudinal aspects of menstruation have not been studied specifically.

Menstruation is still regarded as something unclean or dirty in Indian society. The reaction to menstruation depends upon awareness and knowledge about the subject. The manner in which a girl learns about menstruation and its associated changes may have an impact on her response to the event of menarche. Although menstruation is a natural process, it is linked with several misconceptions and practices, which sometimes result into adverse health outcomes.

Hygiene-related practices of women during menstruation are of considerable importance, as it has a health impact in terms of increased vulnerability to Reproductive Tract Infections (RTI). The interplay of socio-economic status, menstrual hygiene practices and reproductive tract infections are noticeable. Today millions of women are sufferers of Reproductive tract infections and its complications and often the infection is transmitted to the offspring during pregnancy.

Women having better knowledge regarding menstrual hygiene and safe practices are less vulnerable to Reproductive Tract Infections and its consequences. Therefore, increased knowledge about menstruation right from childhood may escalate safe practices and may help in mitigating the suffering of millions of women.

The social stigma attached to menstruation causes many girls and women to carryout dangerous hygiene practices. Lacking a platform to share menstrual hygiene problems, girls and women often suffer from discomfort and infection, avoiding urination during menstruation and using any kind of cloth available old (or) unwashed as an absorbent. These kinds of practices can lead to problems like infection, boils and itching but still girls are not visiting medical practitioners.

6.1 NEED FOR THE STUDY:

Today’s adolescents (24%) are tomorrow’s adults who are the strength of the nation. Today’s adolescent girls are our future homemakers. Most of the adolescents tend to be extremely unaware of their own body their physical well being and psychological change. Half of the adolescence age 12- 15 years residing in 9th to 12th standard do not know about menstruation until its onset.

Menstrual cycle has come to occupy an increasingly important place in discussions of woman’s health attention is again focusing on the impact of the onset of menarche. Studies of girl’s response to menarche have determined that it is a highly salient, intensely experience event and a turning point in female development. They also have demonstrated that more adequate preparation is associated with a more positive initial response .Despite a sense of being prepared and even excited about impending event, however, most girls still find menarche mildly stressful.

A study was conducted in (2007), due to lack of information on this natural phenomenon and culturally divergent beliefs and practices, rural adolescent girls in India often manage menstruation in an unsafe manner that leads to reproductive tract infections and other reproductive health problems.

The girls should be educated about significance of menstruation and development of secondary sexual characteristics, selection of sanitary menstrual absorbent and its proper disposal. So that she does not develop psychological upset and received education would indirectly wipe away the age-old wrong ideas and make her feel free to discuss menstrual matters without any inhibitions.

Menstruation and puberty hygiene is rarely discussed at home as well as schools; especially in the regions the current study was conducted. Due to some cultural and religious restrictions many young girls in this country lack appropriate and sufficient information regarding menstrual hygiene causing incorrect and unhealthy behavior during their menstrual period.

A study was conducted by James (2003) on, “knowledge and practice of menstrual hygiene” in Punjab. The main finding of the study was that adolescent school girls as a whole had an inadequate knowledge on menstrual hygiene.

A study was conducted by Kolf (2001), on “Understanding of menstruation in early adolescent girls”. Their explanation for menstruation reflected at best incomplete knowledge and more typically a variety of misconception or ignorance.

A study was conducted by Sreenivasa (1999), on “Knowledge and Attitude of adolescent girls regarding menstruation” showed that the emotional response of the majority of girls (60%) at the onset of menstruation.

The above studies and personal views of the investigator and her exposure to the surroundings in the form of relatives, neighborhood who faced certain problems in the aspect of menstruation and its crisis situation created an insight to conduct a study to assess the effectiveness of STP on menstrual hygiene and practice among adolescent girls in 8th to 10th standard in selected school at Bangalore.

6.2 REVIEW OF LITERATURE

Review of literature is a broad systematic and critical collection and evaluation of important scholarly published literature as well as unpublished materials. The review serves as an essential background for any research. [B.T.Basavanthappa, 2004]

A study was conducted by Dasgupta A, Sarkar. (2008) “Menstrual hygiene; how hygienic is the adolescent girls”. Menstruation and menstrual practices are still clouded by taboos and socio-cultural restrictions resulting in adolescent girls remaining ignorant of the scientific facts and hygienic health practices, which sometimes result into adverse health outcomes. A descriptive, cross-sectional study was conducted among 160 adolescent girls of a secondary school situated in the field practice area of Rural Health Unit and TrainingCenter, Singur, West Bengal, with the help of a pre-designed and pre-tested questionnaire. Data was analyzed statistically by simple proportions. Results shows Out of 160 respondents, 108 (67.5%) girls were aware about menstruation prior to attainment of menarche. Mother was the first informant regarding menstruation in case of 60 (37.5%) girls. One hundred and thirty-eight (86.25%) girls believed it as a physiological process. Seventy-eight (48.75%) girls knew the use of sanitary pad during menstruation. Regarding practices, only 18 (11.25%) girls used sanitary pads during menstruation. For cleaning purpose, 156 (97.5%) girls used both soap and water. Regarding restrictions practiced, 136 (85%) girls practiced different restrictions during menstruation. Conclusions: Menstrual hygiene, a very important risk factor for reproductive tract infections, is a vital aspect of health education for adolescent girls. Educational television programmes, trained school nurses/health personnel, motivated school teachers and knowledgeable parents can play a very important role in transmitting the vital message of correct menstrual hygiene to the adolescent girl of today.

A study was conducted by Rembeck G I, Moller .M. (2006). “Attitude and feelings towards menstruation and womanhood in girls at menarche”. To elucidate early adolescent girls' attitudes, thoughts and feelings towards menstruation and their bodies. METHODS: 309 12-y-old girls answered questionnaires. One part of the questionnaire dealt with thoughts and feelings towards menstruation. The other part dealt with thoughts and feelings towards menstruation and sex and ability to communicate on aspects of womanhood. The study reveals that Postmenarcheal girls were less positive towards menstruation than premenarcheal girls (p = 1 x 10(-6)). Many girls (43%) did not reaffirm the statement "I like my body" and almost one quarter stated being teased for their appearance. Many of the girls claimed that they had been called "cunt" (38%) or "whore" (46%). If called "cunt" or "whore", 17% stated that they felt alone, 76% felt anger and 50% were offended. Mothers were those with whom girls could most easily "chat" about their period. Sixty-seven per cent received information about menstruation from school nurses.

A study was conducted by Parwej.S, Kumar, AgarwalAK. (2005) “Experiences in relation to menstruation”. The study finding showed that most of the girls talked about how their menstrual bleeding makes they feel dirty and unclean and reported feelings of embarrassment and shame. During menstruation one was completely shocked; another reported that she was not allowed to enter in the temple and kitchen. Such prohibitions do induce feelings of isolation and shame in young girls.

A study was conducted by Ei-Gilany AH, Badawai K,(2005). “Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt”. This study among 664 schoolgirls aged 14-18 inEgypt, asked about type of sanitary protection used, frequency of changing pads or cloths, means of disposal and bathing during menstruation. Girls were selected by cluster sampling technique in public secondary schools in urban and rural areas. Data were collected through an anonymous, self-administered, open-ended questionnaire during class time. Use of sanitary pads may be increasing, but not among girls from rural and poor families and other aspects of personal hygiene were generally found to be poor, such as not changing pads regularly or at night, not bathing during menstruation. Lack of privacy was an important problem. But a large majority of girls said they needed more information.

A study was conducted by Shukla .S (2005). “working on menstruation with girls in Mumbai, India”. Menstruation is considered a polluting factor among Hindus. In many places menstruating girls and women are considered untouchable. Such attitudes and practices are unlikely to create a positive self image with in girls. Shukla found that girls and women teachers were very knowledgeable about the intricate system of taboos and sanctions that pertained to menstruation but had very little actual knowledge about the biological process of maturation and normal physiology. This is lack of factual information, compounded by the prevalence of myths, means that girls practical needs related to managing menstruation are often not appreciated (or) appropriately addressed, e.g. of the provision of adequate sanitary protection .Most girls are left to cope as they can with rags (or) other insufficient protection.

A study was conducted by Kirk .J, Sommer, M. (2005). “Menstruation and awareness; critical issues for girls education”. Lack of sanitary protection during menstruation is often mentioned as a barrier to girl’s regular attendance in school. In many poor families providing adequate clothing for the whole family can be a challenge. Insufficient (or) inadequate sanitary protection can be very embarrassing for a girl attending school during her monthly period.

A study was conducted by Bista,M.B(2004). “A review of research literature on girls education in Nepal”. Bista reports, local cultural expectations that menstruating women should remove themselves from public spaces has led to classes taught by female teachers being discontinued for several days at a time (or) to women teachers who continue to teach during menstruation being viewed negatively by the community not only does this disrupt the learning process, but it may simultaneously very negative messages about what is expected of women and girls.

A study was conducted by Trinoye OO, OPgunghomi A, Ajo AO. (2003) “Menstruation : knowledge, attitude and practices of students in Taiwan”. The purpose of the study was to explore gender differences in knowledge and attitudes towards menstruation among Taiwanese adolescents. This study was a secondary data analysis of a cross-sectional comparison study conducted in Taiwan. A total of 287 female and 269 male students at a junior high school participated in the study. The results showed that almost all the students had heard about menstruation and most of them had received menstrual information at school. However, their knowledge about menstruation was not accurate. Moreover, the male students expressed more negative attitudes towards menstruation than the female students.

A study was conducted by Turkan Turan (2003). “Determination of knowledge and practices about menstruation”. The data was collected using a 21-item questionnaire developed by the researcher based on information in the literature. The mean age of the girls included in the study was 12.88+0.94. More than half of the girls (52%) had begun menstruating and the mean age for menarche was 12.29+0.81. The majority (90%) had received information about menstruation but 10% had not. A significant difference was found between frequency of changing sanitary pads and the students' income status (p=0.001). As their income level decreased their frequency of changing pads decreased. In conclusion the children had a knowledge deficit about menstruation and education needs to be given at their schools and in their families.

A study was conducted by Rajashree R. Kamble (2001). “A study to access the knowledge and practice of menstruation and menstrual hygiene among school girls”. The findings of the study showed that 61.66%of the girls had an average knowledge regarding menstruation on menstrual hygiene and 87.66% of the girls followed correct practices.

STATEMENT OF THE PROBLEM:

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON MENSTURAL HYGIENE KNOWLEDGE AND PRACTICE AMONG ADOLESCENT GIRLS STUDYING IN 8TH TO 12TH STANDARD IN SELECTED SCHOOL AT BANGALORE”.

6.3 OBJECTIVES OF THE STUDY:

1.To assess the knowledge and practice on menstrual hygiene among adolescent girlsstudyingin 8thto 12th standard before and after structured teaching programme.

2.To evaluate the effectiveness of structured teaching programme in term of knowledge and practice on menstrual hygiene.

3.To determine the corelation between the knowledge and practice on menstrual hygiene among adolescent girls studying in 8th to 12th standard.

4.To determine the association between the knowledge and practice on menstrual hygiene among adolescent girls with their selected socio-demographic variables

6.4 HYPOTHESES OF THE STUDY:

H1:There will be significant increase in the knowledge and practice on menstrual hygiene among adolescent girls studying in 8th to 12th standard after structured teaching programme.

6.5. OPERATIONAL DEFINITIONS:

1. Knowledge: Refers to understanding of adolescent girl’s on menstrual hygiene as elicited by the structured questionnaire devised by the questionnaire.

2. Effectiveness ; it refers to determine the extent of significant knowledge gaion among among adolescent girls studying in 8th to 12th standard.