A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING SELECTED HOME REMEDIES FOR DYSMENORRHEA AMONG ADOLESCENT GIRLS IN SELECTED PRE UNIVERSITY COLLEGE AT TUMKUR”

PERFORMA FOR REGISTRATION OF SUBJECT FOR THE

DISSERTATION

SUBMITTED BY

NIJAMOL.S

OBSTETRIC AND GYNECOLOGY

2010-2012

SRI SIDDHARTHA COLLEGE OF NURSIN

AGALKOTE, B.H. ROAD

TUMKUR

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

1. / NAME OF THE CANDIDATE & ADDRESS / MS.NIJAMOL.S
I YEAR M.Sc NURSING
SRI SIDDHARTHA COLLEGE
OF NURSING, AGALKOTE,
TUMKUR
2. / NAME OF THE INSTITUTION / SRI SIDDARTHA COLLEGE OF NURSING,B.H ROAD,TUMKUR
3. / COURSE OF THE STUDY & SUBJECT / MASTER DEGREE OF NURSING
OBSTETRIC &GYNECOLOGY
4. / DATE OF ADMISSION / 20 MAY 2010
5. / TITLE OF THE TOPIC / "A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING SELECTED HOME REMEDIES FOR DYSMENORRHEA AMONG ADOLESCENT GIRLS IN SELECTED PRE UNIVERSITY COLLEGE AT TUMKUR”.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“God, who foresaw your tribulation, has specially armed you to go through it, not without pain but without stain” C.S Lewis

Adolescence is a time of moving from the immaturity of childhood into the maturity of adulthood. Period of life from puberty to adulthood characterized by marked physiological changes, development of sexual feelings, efforts toward the construction of identity, and a progression from concrete to abstract though.1

Menarche expresses normal, regular menstruation that lasts for a few days, but anywhere from 2to 8 days is considered normal.2The average blood loss during menstruation is 35 milleliters with 10-80 ml considered normal. Menstruation can be defined as a periodic physiologic discharge of blood mucous and other cellular debris from the uterine mucosa.3

Many women experience menstrual problem specially adolescent girls.After the menarche the period may be irregular. . Systemic symptoms of nausea, vomiting, diarrhea, fatigue, fever, uterine cramps andheadache are fairly common.The uterine cramps, also referred to as dysmenorrhea.4

Dysmenorrhea is defined as difficult menstrual flow or painful menstruation. Dysmenorrhea is classified as primary or spasmodic and secondary or congestive.Primary dysmenorrhea is defined as menstrual pain not associated with macroscopic pelvic pathology. Secondary dysmenorrhea is defined as menstrual pain resulting from anatomic and/or macroscopic pelvic pathology. This condition is most often observed in aged women.5

Numerous women & adolescent girls suffer from severe dysmenorrhea everymonth. These cramps may be more painful because there is reduced blood supply to the myometrium.6 Significant home care treatment help to reduce the pain of dysmenorrhea.These measures are very effective than medication and gives pain relief benefit.

Most of the woman’s usedhome remedies for relieving the dysmenorrhea.Therefore,most of the home remedies for menstrual cramps are centered around dilating the blood vessels and easing the muscles. The home remedies for dysmenorrhea includes, hot application measures, exercise, diet, herbs and rest&sleep.7

“You don’t have to reach for that medicine bottle every time you want your cramps to go away. Instead, think about these home remedies – they just may make all the difference in the world.”

(Harritte Halepis)

6.1 NEED FOR THE STUDY

Dysmenorrhea refers to the occurrence of painful menstrual cramps of uterine origin and is a common gynecological complaint. The efficiency of conventional treatments such as non steroids is considerable,however the failure rate is still often 20-25%.Dysmenorrhea is the leading cause of short-term school absenteeism. It is associated with a negative impact on social, academic and sports activities of many female adolesent.8

About 80 percent of the time, cramps are part of the primary dysmenorrhea syndrome. Which is associated with back pain, headaches, nausea and vomiting, dizziness, and/or diarrhea accompany menstrual cramps. These symptoms may begin a day or so before the menstrual flow begins; they usually peak by the second day of flow. Many research studies states that nonmedical remedies be used in pain, is best treatment for cramps.9

The pain during menstruation, affects 40% to 95% of menstruating women, and has been reported as the most common causeof regular absenteeism among adolescents. In India the prevalence rate ranged from 1.7% to 97% in 106 studies, pelvic pain in UK reported were between 45% to97% for dysmenorrhea in community based studies and between 41% to 62% in hospital based studies. In India 2002 statistical studies reported that the rate of dysmenorrhea between 16.8% to 81%. There was substantial heterogeneity in forest plots and statistic was 98%.10

A study was conducted on the prevalence of dysmenorrhea among adolescent girls (101 girls in urban areas and 79 girls in rural areas) in Andrapradesh,India. This study concludes that the prevalence of dysmenorrhea is 54%. In this 53% girls in urban areas and 56% girls in rural areas. Sicknessand absenteeism 28% to 48%. Socio economic losses and perceived qualityof life losses are more prevalent among girls in urban area than girls in rural area.11.

For the year 2008 October, a study was conducted on the prevalence and severity of dysmenorrhea in India by Indian Physiological and Pharmacological department .The study subject was 107 female medical students.The study concludes that the prevalence of dysmenorrhea was 73.83%. Approximately 4.67% of dysmenorrhic subject had severe dysmenorrhea.Among female medical students who reported dysmenorrhea 31.67% and 8.68% were frequently missing college and classes’ respectively.12

From the above studies and statistical report states that the prevalence rate of dysmenorrhea in India was 81%, so further studies and healtheducation can essential for improvement of knowledge regarding the dysmenorrhea.

6.2 REVIEW OF LITERATURE

“To acquire knowledge, one must study; but to acquire wisdom, one must observe”.

Marylin Yos Sayant

A quasi- experimental study was conducted on the effect of systematic menstrual health education on dysmenorrhea among female adolescents in China.The study sample was 218 female adolescent girls randomly assigned to an experimental group and 237 subject to a control group.The intervention consisted of a three section health education programme and a dysmenorrheal self-care pamphlet.The study concluded that there is a significant increase in the experimental group members’ dysmenorrhea related knowledge and self care behavior.The findings of this study can serve as a guide to health care providers who want to design an effective systematic menstrual health education programme for female adolescent. 13

A descriptive study was conducted on the level of knowledge among adolescent girls regarding treatment of dysmenorrhea in Haryana, India. This study found that 5.3% consulted a physician for menstrual symptoms and 22% self treated with over-the-counter medicines, 52% reported self treatment and 7.7% used complementary medicines. The study conclude that there is poor access of awareness of available effective treatments &even about house hold and herbal remedies .14

A study was conducted on the level of knowledge among adolescent girls regarding effective treatment of dysmenorrhea, in Chicago. The study sample was 182 adolescent girls at the age 14-18 years to assess the prevalence, knowledge and morbidity .A multiple choice questionnaire was used to assess the knowledge.Of the study group 72.7% reported pain or discomfort, 58.9% reported decreased activity, and 45.6% reported school or work absenteeism.In dysmenorrhic sample 15.5% used as prescribed medication and only 14.7% used natural home treatment.The study concluded that there was substantial ignorance or misinformation among adolescent females regarding effective natural home management for dysmenorrhea.15

A cross-sectional descriptive study was conducted on the knowledge of primary dysmenorrheaand natural remedies in Nigeria.The sample for the study was 50 adolescent school girls.A pre-tested semi-structured questionnaire was used to collect the data.Findings reveled the adolescent had a knowledge deficit regarding dysmenorrhea and natural remedies.58% of respondents reported pain and majority used inappropriate methods to manage primary dysmenorrhea.The study conclude that school nurses are able to assist adolescent and their mothers in proper management of primary dysmenorrhea.16

A descriptive study was conducted on the prevalence of dysmenorrhea severity and its associated symptoms among adolescent girls in Gwalior,India.The study sample was nine hundred and seventy adolescent girls of age 15-20 years studying in the higher secondary school of Gwalior.Percentages,Chi-square test,test-retest method are used.In this study most of them 37.96% suffered regularly from dysmenorrhea severally.The study conclude that, three most common symptoms present on these days aretiredness, depression and inability to concentrate in workand symptoms on the day after the stoppage of menstruation is depression.The prevalence of dysmenorrhea in adolescent girls was found to be 79.67%.17

A descriptive study was conducted on the knowledge, attitude and consequences of menstrual health in urban adolescent females in Washington. The study sample was 35 adolescents age group between 12-21 years. Chi-square test is used for analysis of data. In the 91.5% of the respondents, 84.3% have premenstrual syndrome, followed by dysmenorrhea .The study conclude that the premenstrual syndromes and dysmenorrhea are prevalent medical disorders among urban adolescents. Only 2% of teenagers’ reports receiving information about menstruation from their health care provider, it is imperative that health care providers increase their anticipatory guidance regarding normal menstruation. This may aid in the prompt diagnosis and treatment of menstrual disorder and decrease their associated morbidities.18

An experimental study was conducted on the efficiency of heat-and steam- generating sheets for the relief of symptoms of dysmenorrhea among young women in Japan. Thesample for the study was 34 female university students.Heat-and steam-generating sheets generate moist heat will keep the attached to the lower abdominal or lumbar region once a day on 1st, 2nd, 3rd of menstruation consecutively.The study conclude that 63% of subjects felt relief of abdominal pain .19

A comparative study was conducted on the effect of ginger and ibuprofen on pain among adolescent girls with primary dysmenorrhea in Iran on September 2006 to February2007.The sample was 150 students with age group of 18 years and over. Students in the ginger group took 250mg of ginger powder four times a day for three days from start of their menstrual period.Members of other group received 400mg ibuprofen capsules, on the same protocol. The study concluded that ginger was effective than ibuprofenfor relieving pain in women with primary dysmenorrhea. No severe side effect occurred.20

An experimental study was conducted in Taiwan regarding Rose tea is a home remedy for dysmenorrhea. The study sample was 130 female adolescents were randomly assigned. 70 as experimental & 60 as control group. Pre-intervention and post-intervention data at 1 month,3 month and 6 month were gathered .The result shows compared with the control group, the experimental group perceived less menstrual pain, distress and anxiety and showed greater psychophysiology well being after the intervention. Findings suggest that drinking rose tea is a safe readily available and simple for dysmenorrhea.21

A study was conducted on the relationship among exercise, stress and primary dysmenorrhea among students’ nurses in Georgia. These studies consider primary dysmenorrhea from a biopsychosocial perspective in examining the leadership between physical exercise and menstrual pain. Stronger evidence indicates that exercise helps to relieve stress and elevates mood and that stress heightens menstrual discomfort. The study conclude that regular exercise reduce the stress and symptoms of dysmenorrhea.22

A cross-sectional study on self – treatment patterns among adolescent girls with dysmenorrhea was carried in urban academic medical center in Newyork.The subject for the study was 76 adolescent girls aged 19 years or younger with moderate to severe primary dysmenorrhea.Dysmenorrhea was moderate in 42%, severe in 58%, associated with nausea in 55%, and vomiting in 24%.Of those attending school 46% reported missing one or more days monthly due to dysmenorrhea.About 42% used natural home remedies such as sleeping and heat application.The study conclude that adolescents with moderate and severe dysmenorrhea reported high morbidity and girls used numerous natural home remedies shows reduction in dysmenorrhea.23

STATEMENT OF PROBLEM

“A study to assess the effectiveness of structured teaching programme on knowledge regarding selected home remedies for dysmenorrhea among adolescent girls in selected pre university colleges at Tumkur”.

6.3 OBJECTIVES OF THE STUDY:

  1. To assess the pretest knowledge regarding home remedies for dysmenorrhea among the adolescent girls.
  2. To assess the post test knowledge regarding home remedies for dysmenorrhea among the adolescent girls.
  3. To assess the effectiveness of structured teaching programme by comparing pre and post test score.
  4. To determine the association between pre-test and post test knowledge and selected demographic variable.
  5. RESEARCH HYPOTHESIS
  1. H1: The mean post test knowledge on home remedies for dysmenorrhea will be significantly more than mean pre test knowledge among adolescent girls.
  2. H2: There will be significant association between the knowledge of adolescent girls regarding home remedies for dysmenorrhea and selected demographic variable.

6.5OPERATIONAL DEFINITIONS:

In this study:

1.AssessIt refers to gathering information regarding knowledge of home remedies for dysmenorrhea.

2. Effectiveness:It refers to the extent to which the structured teaching programme is helpful in gaining knowledge regarding selected home remedies in dysmenorrhea.

3.Structured teaching programme: It is a systematically developed programme with teaching aids, design to impart knowledge regarding home remedies of dysmenorrhea on adolescent girls.

4.Knowledge: It refers toawareness of adolescent girls regarding home remedies for dysmenorrhea.

5. Selected home remedies: The selected home remedies refers to the treatment methods for dysmenorrhea such as hot application, aerobic pelvic and abdominal exercises, diet, herbs like rose, ginger and rest & sleep.

6.Dysmenorrhea: It is the cramping pain during the menstrual cycle.

7. Adolescent girls: In this study adolescent girls denoted the age group 15-19 years.

6.6 ASSUMPTIONS:

The study assume that

  1. The adolescent girls may not have adequate knowledge about home remedies for dysmenorrhea
  2. Structured teaching programme will improve the knowledge of adolescent girls regarding home remedies for dysmenorrhea
  3. The knowledge on home remedies for dysmenorrhea may have the relation with demographic variables.
  4. DELIMITATION:

Study is limited to the adolescent girls in the age group of 15 to 19 years in a selected pre-university college at Tumkur.

7. MATERIALS AND METHODS OF THE STUDY:

7.1 SOURCE OF DATA

The pre-university college students at an age group of 15-19 years in selected pre-university college at Tumkur.

7.2METHODS OF DATA COLLECTION:

Data will be collected by using structured questioner after obtaining prior permission from the authority.

7.2.1 TYPE OF STUDY/RESEARCH APPROACH

Quasi experimental study.

7.2.2 RESEARCH DESIGN:

One group pre and post experimental design is chosen for conducting the study.

7.2.3VARIABLES OF STUDY.

Dependent variable:Knowledge of adolescent girls regarding the home remedies for dysmenorrhea.

Independent variable: structured teaching programme on home remedies for dysmenorrhea.

Attributing variable: demographic variables such as age,education, class of the family, source of information, interval of menstrual cycle etc.

7.2.4SETTINGS

The study conducted in selected pre university College at Tumkur.

7.2.5 POPULATION

The population will comprise theadolescent girls in a selected preuniversity college.

7.2.6 SAMPLE

The adolescent girls who fulfill the inclusion criteria are consider as sample.

7.2.7 SAMPLE SIZE:

Sample size of the study is 60(n=60)

7.2.8 SAMPLING TECHNIQUE:

Random sampling technique will be used to select the samples.

7.2.9CRITERIA FOR SELECTION OF SAMPLE:

1. INCLUSION CRITERIA

  • Students who can read and write English.
  • Students at the age group 15-19 years.
  • Only female students.

2. EXCLUSION CRITERIA:

  • Pre-university students who are not available at the time of data collection.
  • Students who are not willing to participate in this study.

7.2.10 FOLLOW UP: Post test will be conducted after 1weeks of pre test.

7.2.11 COMPARISION PARAMETER:

Yes,the pre test and post test level of knowledge will be compared with in the group.

7.2.12DURATION OF STUDY:

The study planned to conduct with the time duration about 6 weeks.

7.2.13TOOL / INSTRUMENT:

A structured questionnaire will be prepared in such a way it will consist two parts. Section A: It consists of demographic profile of the student and parent.

Section B: Questionnaire: It consist of questions to assess the knowledge regarding selected home remedies for dysmenorrhea.

7.2.14 DATA COLLECTION PROCEDURE

  • Formal permission will be obtained from the authorities of selected pre-university college.
  • The investigator introduces self and purpose of the study
  • Consent will be obtained from the adolescent girls.
  • Pre test will be conducted for the adolescent girls.
  • Planned teaching programme will be administered to the adolescent girls
  • Conduction of post test after 1 weeks

7.2.15 PLAN FOR STATISTICAL ANALYSIS

The data obtained will be analyzed in terms of the objective of the study using descriptive and inferential statistics.

DESCRIPTIVE ANALYSIS

  1. Frequency and percentage analysis will be used to describe the demographic characteristics of adolescent girls.

2Descriptive analysis such as mean, range standard deviation and mean score percent will be used to assess the knowledge of home remedies for dysmenorrhea among adolescent girls.

INFERENTIAL STATISTICS

  1. Paired t - Test will be carried out to assess the statistical significance and compare the pre and post test knowledge score on home remedies for dysmenorrhea among adolescent girls.
  2. The Chi -Square analysis will be used to determine the association between knowledge and selected demographic variables.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE

CONDUCT ON PATIENTS OR OTHER HUMAN OR ANIMALS?

Yes, this study involves the intervention of structured teaching programme.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?