"A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAME (STP) ON KNOWLEDGE REGARDING REPRODUCTIVE HEALTH AMONG ADOLESCENCTS OF 15-19 YEARS STUDYING AT SELECTED PRE UNIVERSITY COLLEGES IN TUMKUR."
PERFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
SUBMITTED BY
Miss. BINDU .C. KURIAN
FIRST YEAR M. Sc (NURSING)
OBSTETRICAL AND GYNAECOLOGICAL NURSING
2009-2011
SRI SIDDHARTHA COLLEGE OF NURSING
AGALAKOTE, TUMKUR.
rajiv gandhi university of health science
bangalore karnataka
pErforma for registration of
subject for dIssertation
1. / NAME OF THECANDIDATE AND
ADDRESS / Miss. BINDU .C. KURIAN
FIRST YEAR MSC NURSING
SRI SIDDHARTHA COLLEGE OF NURSING
AGALAKOTE, TUMKUR.
2. / NAME OF THE
INSTITUTION / SRI SIDDHARTHA COLLEGE OF NURSING AGALAKOTE,
B. H. ROAD, TUMKUR.
3. / COURSE OF STUDY
AND SUBJECT / FIRST YEAR MSC NURSING
OBSTETRISCS AND GYNAECOLOGICAL NURSING
4. / DATE OF ADMISSION
TO COURSE / 8TH JUNE 2009
5. / TITLE OF THE STUDY / "A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAME (STP) ON KNOWLEDGE REGARDING REPRODUCTIVE HEALTH AMONG ADOLESCETS OF 15-19 YEARS STUDYING AT SELECTED PRE UNIVERSITY COLLEGES IN TUMKUR."
6.BRIEF RESUME OF THE INTENTED WORK
INTRODUCTION:-
"Social representations are ideas, thoughts, images, and the knowledge belongs to society and which shape individual consciousness"
{Augoustinos, 1995}
Adolescence is bounded by the advent of puberty at the lower end and the capacity to take on adult responsibilities at the upper end. In our society adolescents are 'neither fish or nor fowl', as the saying goes neither children nor adult1. On this way they may face troubles due to lack of right kind of information regarding their own physical and sexual development2. Increasing penetration of international mass media is changing the social values and shifting the standard of societal behavior from conservatism to liberal interaction with both sexes. Adolescents find themselves sand witched between a glamorous western influence, which arouses their curiosities and instincts, and stern conservatism at home, which strictly forbids discussion on sex. This dichotomy aggravates the confusion among adolescents3. Changes in social values may lead to increased premarital sexual activity, pregnancy and possibly child bearing among unmarried girl, apart from increasing incidence of abortion and STD's (4.5)
The world health organization (2003) defines adolescence is a period of life between age 10-19. Adolescence is a stage of developmental frustration, a bridge between childhood and adulthood. It involves progress from appearance of secondary sex characteristics (puberty) to sexual reproductive maturity. It is the stage of development of adult mental process and identity and transition from socioeconomic dependence to relative independence. So far the health system has been more specially targeted to infants, children below six years and pregnant women. There for, unmarried women and adolescent have been ignored by the government and health sector. It's only since 1996 that reproductive health programme has included adolescence health in its spectrum of package. Current world population is 6.798 Billon. Nearly half of the world population is under the age of 25. Despite this reproductive health needs are poorly understood and ill served. Adolescents often have poor information about reproductive health services, sex and sexuality etc (6,7)
While for many, adolescence is a time to learn and grow in nurturing environments, for others-especially those living in poverty-it is time of heightened risk. Many drop out of school to help with family survival or face violence, sexual abuse or HIV infection .Nearly half of (45percent) young women in India marry before age 18; legal age at marriage for a women. Contraceptive use is very low. Unplanned child bearing among adolescents in is not uncommon. 14% recent births were unplanned in 2006. Proportion that basically unchanged from that in 1993 ( 8,9).
Evidence shows that withholding information and services from young people only increases the likelihood of that if and sexual initiation occurs, it will be unprotected14. Young people require not only basic information about their bodies, preventing HIV, Sexually transmitted infections and pregnancy but also programmes that address gender equality, empowerment, rights and responsibilities and reproductive negotiation and decision making. The meaningful participation of adolescents in the design of programmes and laws and policies that affect their sexual and reproductive lives should be guaranteed10.
The male role has been gradually declining over the years largely due to the entire focus of these programmes being on women. The male belief that childcare is the exclusive domain of women or regarding STDs as women’s diseases or as shameful diseases has discouraged men participation.11
6.1 NEED FOR THE STUDY
International agreements affirm that adolescents have a right to age-appropriate sexual and reproductive health information, education, and services that enable them to deal positively and responsibly with their sexuality12
"While national strategies and programmes have focused on children and pregnant women, neither services nor research has focused on adolescents and their unique health information needs"13
Adolescent receive most of their information from peers which often lead to misinformation. Adolescent need structured formal and informal learning environment with age appropriate peers to address issues of sexuality14.
The importance of focusing adolescent girls and boys is; 15
about 25 percent girls in the 15-19 age groups have their first child before the age of 19 in India.
Pregnancy before age 18 carries many health risks. Teenagers are more likely to die in pregnancy or child birth than woman ages 20-24.
Adolescent account for fourteen percentages of abortion in India according to International Planned parenthood Federation.
Raising the mothers age at first birth from 18-23 could reduce population momentum over 40 percent according to United Nations Programme on HIV/AIDS.
Those under age 25 account for half of HIV infection India according to joint nations programme on HIV / AID
Adolescent reproductive and sexual programmes should take parents and community into confidence to build a supportive environment for the adolescents to exercise their choices. In the absence of such an integrated approach, there is a work with both boys and girls together so they appreciate sexual and reproductive processes in both sexes. These lead to proper understanding and exercise of sexual rights .The reproductive and sexual health of young men is important, and engagement with their experiences of gender and sexuality are essential because: In a patriarchal country like India, it is assumed that young men will one day be the leaders and decision makers within the family, Community and society.(15,16)
. The study is an intervention designed to improve the lives and prospects of young women in several slum areas of Allahabad. A baseline from these 1518 young men's and 1683 women's reproductive health knowledge indicated that; 17
39% and 97% girls are familiar with menstrual cycle.
88% of boys and 42% girls know about sexual intercourse and process of conception
6% of boys and 2% of girls know peak fertility period in a women's cycle
87% boys and 67% of girls can name at least one STD
44% boys and 55% of girls know that a married woman can get HIV from husband.
84% of boys and 32% of girls know that condom can prevent spread of HIV/AIDS.
A study of 500 adolescent boys and girls in Rural Maharashtra state in western India showed that18;
25% thought that menstrual blood was located in uterus.
51% of unmarried girls did not know that a baby delivered through vagina
6.2 REVIEW OF LITERATURE
- An experimental study conducted with pretest & posttest group on effectiveness of structured teaching programme in improving knowledge and attitude of school going adolescent on reproductive health among 200 adolescent students in Dhahran town of Nepal. All the subjects were divided into experimental and control group each comprising two subgroups of 50 boys and 50 girls. STP consisting of information on human reproductive system, was used as a tool of investigation for experimental group where as conventional teaching method was used for control group. Result of the study showed the mean pretest score of experimental group on knowledge of reproductive health was 38.83 and of the control group was 39.47. The same of the experimental group was after administration of structured teaching programme was (84.60+10.60) and of control group with conventional teaching method (43.93+10.08) was statistically significant (p<0.001). Researcher concluded that use of STP is effective in improving knowledge and attitude of adolescents on reproductive health19.
- A study was conducted to measure the effectiveness of a reproductive health education package in improving the knowledge of adolescent girls aged 15-19 years in Chandigarh. In one school, a nurse conducted 15 sessions for 94 students in three batches using conventional education approach. In another school she conducted sessions for a selected group of 20 adolescents who later disseminated the messages informally to their 84 classmates (peer education). Using a 70-item structured questionnaire the knowledge of 95 adolescents from conventional, 84 from peer, and 94 from control school were assessed before and one month after the last session. Change in the score in intervention and control groups was tested by ANOVA taking age and socio-economic status as covariates. . Reproductive health knowledge scores improved significantly after intervention in conventional education (27.28) and peer education group (20.77) in comparison to the controls (3.64). Conclusion of the study showing peer education and conventional education strategies were effective in improving the reproductive health knowledge of adolescent girls but peer strategy was less time consuming20.
- A reproductive health survey conducted among adolescents and young adults in Pakistan to assess the baseline sexual and reproductive health (SRH) SRH knowledge and to suggest interventions based on needs with regard to SRH promotion, so that the level of existing services should be upgraded. A cross sectional survey was conducted in 20 villages of Lahore, in which 400 young adults were interviewed using a semi structured questionnaire respondents were equally divided in gender in all villages using stratified random sampling. Result of the study was adolescents and young adults have some knowledge about SRH issues. Yet large majority need clarification on their concepts and perceptions. T. Research conclusion was life skills programmes to increase unmarried girl's cognitive skills & young man's involvement in such programmes is must21.
- An adolescent fertility survey was carried out in Uganda starting in 1988. This report presents data from household and individual questionnaires collected in Mabel District for the third phase in August 1990. 1357 adolescent and young adult respondents (15-24 years old) comprised the sample (146 urban males, 330 urban females, 356 rural males, and 525 rural females). . It was found that most of these young people were sexually active, and many initiated sexual activity before age 15 years. Most reported having received information about reproductive health, but few could identify the safe period in a woman's menstrual cycle. It is recommended that more educational programs be devised to counter the factors which will encourage high fertility in this population22.
- This study reports results from an evaluation of the Teen Web project, a multi-year, web-based health education intervention implemented in two urban settings: Nairobi, Kenya (N=1178 school students) and Rio de Janeiro, Brazil (N=714 school students). A quasi-experimental, school-based pre-test/post-test design was implemented at each study site to determine if easy access to web-based reproductive health information. Students in web-access schools completed one web-based module approximately every 6-8 weeks, and in return, had access to the Internet for at least 30 min after completing each module. . Most measures showed statistically significant differences between students in "web" and "comparison" conditions at post-test, but only about half of the differences were in the hypothesized direction. Future intervention should focus on teen's purposeful searching for health information when they are in personal circumstances of unmet health needs23.
- This study was conducted to analyze the degree of knowledge adolescents have on STD/AIDS prevention, transmission, signs, and symptoms, and to contribute with the elaboration of educational actions in the University Extension Program called Corporality and Health Promotion. The research counted on 1,087 adolescents (40% females, 60% males) and was carried out in three elementary and high schools located in the municipality of Embu. A structured, multiple choice questionnaire was applied. Result of the study was .92 percent of girls and 78percent of boys referred to the use of condoms, while 42 percent of girls and 43 percent of boys affirmed to wash their genitalia after the sexual relation; Regarding STD healing programs, 57percent females and 71percent males affirmed not to have any knowledge on the issue; 5percent of girls and 6percentof boys thought AIDS to be curable. In a general perspective, we can conclude that girls were more familiar with the study’s issues than boys. Results found here are strengthened by our conviction of the importance of sexual education, mainly on the reproductive health of adolescents24.
- . A study was conducted among adolescent girls of 16-19 years in Uduppi district Karnataka to determine the effectiveness of health education in improving knowledge regarding reproductive health. Sample size was 791 girls. Their awareness assessed immediately following intervention. Chi square test used for analysis. Result of the study showed significant improvement in knowledge after intervention from 14.4percent-68percent p<0.01 was observed regarding contraception. Knowledge regarding diet during pregnancy improved from 66percent-95percent. Conclusion of the study showed that education intervention program can bring about desirable change in knowledge among girls regarding reproductive health25.
- This review of literature reveals that there are many knowledge, attitude, and practice studies on adolescents and youth in relation to their reproductive health in India. The objective of the study is to develop a replicable model for provision of sexual and reproductive health services to college based youth in Thane district. In order to assess the awareness and views about reproductive health , baseline data of the proposed study has been collected. A self administered semi-structured questionnaire was used for the survey, which included 800 Male and 700 Female in age group 15-24 years. The result of the survey was students lacked scientific information and misconceptions are widespread on various reproductive health issues27.
- A study was conducted in Mumbai with the objective of understanding the KAP of adolescents and gate keepers on adolescent reproductive health issues, understanding the health seeking behavior of adolescents. Sample size was 600 adolescents would be surveyed equally from both genders of age group 10-19 years. Semi structured tool in local language used separately for boys and girls of 10-14 years old and 15-19 years old. Focus group discussion with various group revealed that knowledge of reproductive health was very poor among this population27.
10.A study was conducted on perspectives of adolescent boys 15-19 years on risk of unwanted pregnancy and Sexually Transmitted Infections in Kenya. Based on the qualitative data from eight focus group discussion with 90 boys indicated that despite of high knowledge of sexual risks, fear of HIV and awareness of protective value condom young men exhibit high risk behavior and blaming girls (girl's parents) for not protecting themselves. There is a clear need for educational programmes that confront male sexual norms, address issues of gender power relations, and promote communication skills, informed choice and sexual responsibility among boys as well as girls28.