Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.  / Name of the candidate and address
(in block letters) / ALPHONSA J.
I YEAR M. Sc. NURSING
ATHENA COLLEGE OF NURSING
FALNIR ROAD
MANGALORE – 575 001.
2.  / Name of the Institution / ATHENA COLLEGE OF NURSING
FALNIR ROAD
MANGALORE – 575 001.
3.  / Course of Study,
Subject / M. Sc. NURSING
OBSTETRICAL AND GYNAECOLOGICAL NURSING
4.  / Date of Admission to the course / 17.05.2010
5.  / Title of the Topic
A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION BOOKLET ON THE KNOWLEDGE REGARDING FOETAL WELLBEING MEASURES AMONG PRIMIGRAVIDAS IN A SELECTED HOSPITAL OF MANGALORE.
6.  / Brief Resume of the Intended Work
6.1 Need for the Study
Technology and science have become the prominent components of obstetrical care. Technology can provide useful information about the status of pregnancy and condition of the foetus; however, it is imperative to balance technologic capabilities with responsiveness to the human needs of the women and her family. A variety of diagnostic techniques and monitoring parameters are used to evaluate foetal wellbeing, that is, the growth and health of the developing foetus as well as its ability to tolerate physiologic stress of pregnancy, labour and birth.1
Foetal development is a complex, and at times, mysterious process. Foetal surveillance techniques have dramatically affected the understanding of foetal anatomy, physiology and behaviour. The average duration of human pregnancy is 40 weeks or 280 days after the first day of the last menstrual period. During this period of pregnancy, foetal wellbeing can be assessed and monitored using a number of biochemical, physical, and physiologic surveillance techniques. Routine assessment of foetal wellbeing has included intermittent auscultation of foetal heart sound, measurement of fundal height and abdominal girth, maternal perception of foetal movements, ultrasonography, NST, maternal weight gain, antenatal check-up, routine blood tests, and urine tests.1
An exploratory study was conducted in Sweden to identify women’s expectations on antenatal care, preference regarding number of visits, and attitudes to continuity of midwife caregiver. Three thousand and sixty-one women participated in the study. The study found that 70% preferred to follow the standard schedule of antenatal visits, 23% preferred more, and 7% fewer visits. Most women (97%) considered continuity of midwife caregiver during pregnancy as most important.2
A quantitative study was conducted in Sovenga to assess the mother’s knowledge on foetal movements monitoring in 97 pregnant mothers selected by simple random sampling. The study found that 71% of mothers perceived foetal movements at 4-6 months whereas 7% perceived foetal movements only at 7-9 months of gestation. Fifty-two mothers (54%) have experienced both rolling and kicking movements whereas 36 (37%) only kicking movements. Five mothers (5%) experienced the rolling movements only and four mothers did not know which movements to monitor during pregnancy. Overall the study found that there was limited information on the importance of foetal movement monitoring in relation to perinatal outcome.3
A wide range of studies have shown that foetal wellbeing measures are important to assess the growth and development of foetus. Knowledge of mothers is an important contributing factor in reducing the foetal morbidity and mortality and for a better outcome. The investigator during her experience identified that primigravidas have less knowledge regarding foetal wellbeing measures.
The investigator’s experience and discussion with colleagues and experts helped her to realise the importance of information regarding foetal wellbeing measures. If primigravidas are educated about foetal wellbeing measures, the foetal mortality and morbidity can be reduced to some extent. Therefore, the investigator decided to distribute information booklet to primigravidas in a selected hospital of Mangalore.
6.2 Review of Literature
A cross-sectional study was conducted in Turkey to identify the association between the information given to pregnant women about foetal activity, level of maternal awareness of foetal activity, maternal concern about decreased foetal movement, and pregnancy outcomes. The sample consisted of 691 mothers with a singleton delivery and the tool used was a structured knowledge questionnaire. The study found that there was significant
association between receiving information about foetal activity with increased maternal awareness and maternal concern about decreased foetal movements. Low maternal awareness of foetal activity was associated with an increased risk of having a small for gestational age infant.4
A descriptive study was conducted in Egmore to assess the role of obstetric ultrasound in routine screening after 14 weeks for detection of congenital anomalies. The sample size was 1500 and they diagnosed 17 cases of major anomalies such as anencephaly-8, hydrocephaly-2, encephalocele-1, meningomyelocele-1, monster-1, bilateral hydro nephrosis-2, univentricular heart-1, achondroplasia-1. In 13 cases, pregnancy was terminated and 4 were allowed to continue pregnancy with information to parents about the anomalies of foetuses and with advice on necessary measurements postnatally. The study found that obstetric ultrasound is very useful for detecting congenital anomalies after 14 weeks.5
A descriptive study was conducted in Varanasi to assess the fundal height measurements as a simple method for antenatal screening of term low birth weight. The sample consisted of 147 women with uncomplicated pregnancy at term and their normal offspring. Offspring were weighed soon after birth and the mothers were subjected to anthropometry as well as haemoglobin and serum albumin estimation. The uterine fundal height and abdominal girth measurements were correlated with birth weight of the offspring. The fundal height was found to have higher positive correlation with birth weight than abdominal girth.6
A study was conducted in Uttar Pradesh to assess the effect of antenatal care utilisation on safe delivery in 300 low to middle income women who had given birth in last three years. Results showed that demarcating women’s antenatal care status based on a simple indicator – two or more visits versus less – masked a large amount of variation in care received. The study found that women with a relatively high level of care (at the 75th percentile of the score) were using trained assistance at delivery almost four times higher than women with a low level of care (at the 25th percentile of the score).7
A longitudinal study was conducted in Philadelphia among 221 pregnant women to examine the relationship of pre-pregnancy weight and pregnancy weight gain to functional status, physical symptoms, and physical energy. Functional status was measured by inventory functional status; physical symptoms by symptoms checklist; and physical energy by a one-item question; self-reported weight and height were used to calculate Body Mass Index [BMI]. Women were classified by pre-pregnancy BMI as underweight (19.8), normal weight (BMI=19.8-26.0), or overweight (BMI>26.0). The groups did not differ in weight gain by trimester, for an average total weight gain of 30.56 lb, with overweight women therefore gaining less weight on a percentage basis (M=16.87%) than women who were normal weight (M=23.58%) or were underweight. Women who gained more than the recommended amount of weight for their pre-pregnant weight group had a lower level of third trimester functional status than those who did not.8
6.3 Problem Statement
A study to assess the effectiveness of information booklet on the knowledge regarding foetal wellbeing measures among primigravidas in a selected hospital of Mangalore.
6.4 Objectives of the study
1.  To determine the pre-test and post-test level of knowledge of primigravidas regarding foetal wellbeing as measured by a structured knowledge questionnaire.
2.  To evaluate the effectiveness of an information booklet on foetal wellbeing as measured by a structured knowledge questionnaire in terms of gain in mean post-test knowledge score.
3.  To find the association between mean pre-test knowledge score and selected demographic variables (age, education, family income, area of residence and occupation).
6.5 Operational Definition
Knowledge: In this study, knowledge refers to the correct responses of the primigravidas on the items regarding foetal wellbeing as measured by structured knowledge questionnaire.
Foetal wellbeing measures: In this study, foetal wellbeing measures refers to the methods used to assess the growth and development of the foetus in uterus such as foetal movement count, ultrasonography, non-stress test, weight gain, abdominal girth, antenatal checkups, and routine blood test and urine tests.
Information booklet: In this study, information booklet refers to a written material which provides information regarding foetal wellbeing measures which is systematically organised and validated.
Effectiveness: In this study, effectiveness refers to the extent to which information booklet on knowledge regarding foetal wellbeing has its desired effects on primigravidas as measured in terms of gain in mean post-test knowledge score.
Primigravidas: In this study, primigravidas refers to the women who are pregnant for the first time and are in second / third trimester.
Variables under study
1.  Independent variable: Information booklet on foetal wellbeing.
2.  Dependent variable: Knowledge of primigravidas regarding foetal wellbeing.
3.  Extraneous variables: Age, education, family income, area of residence and occupation.
6.7 Assumptions
1.  Primigravidas will have some knowledge regarding foetal wellbeing.
2.  Information booklet is an accepted strategy in improving the knowledge.
3.  Primgravidas will be interested and willing to participate in the study.
6.8 Delimitations
The study will be delimited to:
·  Primigravida women of second/ third trimester who attend the antenatal OPD in a selected hospital of Mangalore at the time of data collection.
·  Generalisation is not possible due to small sample size.
6.9 Projected outcome (Hypotheses)
All hypotheses will be tested at 0. 05 level of significance.
H1: The mean post-test knowledge score of primigravidas regarding foetal wellbeing will be significantly higher than their mean pre-test knowledge score.
H2: There will be significant association between the mean pre-test knowledge score and selected demographic variables.
7. / MATERIAL AND METHODS
7.1 Source of Data
The data will be collected from primigravidas of second/third trimester.
7.1.1 Research Design
Quasi experimental one group pre-test post-test design will be used for the study.
O1 X O2
O1: Pre-test
X: Information Booklet
O2: Post-test
7.1.2 Setting
The study will be conducted in Government Lady Goschen Hospital, Mangalore, which is a maternity hospital with bed strength of 260 beds. The average antenatal mothers attending OPD is 100 per day.
7.1.3 Population
In this study population consists of primigravidas of second/ third trimester who attend the antenatal OPD of a selected hospital of Mangalore.
7.2 METHOD OF DATA COLLECTION
7.2.1 Sampling Procedure
Purposive sampling technique will be used to select the hospital and 30 antenatal mothers will be selected.
7.2.2 Sampling Size
The sample for the present study would consist of 30 primigravida women from a selected hospital at Mangalore.
7.2.3 Inclusion criteria for sampling
·  Primigravidas of second/third trimester in the selected hospital of Mangalore who are willing to participate in the study.
·  Women who can read or write Kannada, Malayalam or English.
7.2.4 Exclusion Criteria for sampling
·  Primigravida women of first trimester and multipara women in the selected hospital of Mangalore.
·  Women those who are not willing to participate in the study.
7.2.5 Instruments Intended To Be Used
The tool would consist of two sections:
Section I: Demographic proforma
Section II: Structured knowledge questionnaire to assess the knowledge of primigravida regarding foetal wellbeing.
7.2.6 Data collection method
Permission will be obtained from the concerned authority. The investigator will visit the OPD and 8-10 samples who meet the inclusion criteria will be selected per day as they wait for the doctor. The purpose of the study will be explained to the subjects and informed consent will be taken. Pre-test will be conducted with a structured knowledge questionnaire; this will be followed by administering the information booklet. The investigator will take down the contact address of the sample. They will be asked to come to OPD 7 days after pre-test and post-test will be conducted in the same way as the pre-test. This procedure will continue till data is collected from the desired sample (30).
7.2.7 Data Analysis Plan
Descriptive and inferential statistics will be used to analyse the data. Findings will be presented in the form of tables and figures. Demographic data will be presented in terms of frequency, percentage, mean and standard deviation. Association between pre-test mean knowledge score and selected demographic variables will be analysed using Chi-square test. Effectiveness of the information booklet will be analysed by using paired‘t’ test.
7.3 Does the study require any investigations or interventions to be conducted on mothers or other humans or animals? If so, please describe briefly.
No investigation or intervention will be conducted on sample. However, an information booklet will be given to the primigravidas.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Ethical clearance will be obtained from the ethical committee of college of nursing prior to the conduction of the study. Administrative permission will be obtained from the concerned authorities. Written consent will be obtained from the study sample and confidentiality will be maintained.
List of References
1.  Gabbe SG, Neibyl JR, Simpson JL. Textbook of obstetric normal and problem pregnancies. Philadelphia: Churchill Livingstone; 2002.
2.  Women’s expectations on antenatal care as assessed in early pregnancy. No. of visits, continuity of caregiver, and general content. [online]. Available from: URL:http://www.google/onlinelibrary.wiley.com/ [accessed on 29.09.2010].
3.  Maputle MS, Mothiba MT. Mothers’ knowledge of foetal movements monitoring during pregnancy in relation to perinatal outcome. [online]. Available from: URL: http://edo-hu-berline.de/oa/degruytes/jpm [accessed on 29.09.2010].
4.  Saastad E, Ahiborg T, Froen JF. Low maternal awareness of foetal movement is associated with small for gestational age infants. [online]. Available from: URL:http://www.ncbi.nih.gov/pubmed/ [accessed on 25-09-2010].
5.  Ratan P, Naseem S, Mathurmbal TS. Role of obstetric ultrasound in routine screening after 14 weeks for detection of congenital anomalies. Journal of Obstetrics and Gynaecology of India 1994 Jan; 95(6):11-2.
6.  Swain S, Agarwal A, Bhatia BD, Reddy DCS, Pandey S, Pandey LK. Fundal height measurement: A simple method for antenatal screening of low birth weight babies. Journal of Obstetrics and Gynaecology of India 1993 Jan; 23(8):28-30.
7.  Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India. [online]. Available from: URL:http://heapol.oxfordjournals.org/content/ [accessed 29.09.2010]
8.  Lorraine T, Karen MH, Jacqueline F. Pregnant weight and weight gain during pregnancy. JOGNN 1998 Nov;27(6):629-34.
8. / Signature of the Candidate
9. / Remarks of the Guide
10. / Name and Designation of
(in block letters)
10.1  Guide / Sr. SELINAMMA DEVASIA
ASSISTANT PROFESSOR
OBSTETRICAL AND GYNNAECOLOGICAL NURSING
ATHENA COLLEGE OF NURSING
FALNIR ROAD
MANGALORE.
10.2  Signature
10.3  Co-guide (if any)
10.4  Signature
11 / 11.1  Head of the Department / Mrs. ASHA. K. VARUGHESE
ATHENA COLLEGE OF NURSING
FALNIR ROAD
MANGALORE.
11.2  Signature
12. / 12.1 Remarks of the Chairman and Principal
12.2  Signature

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