RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE
ANNEXURE-II
Proforma for registration of subject for dissertation
1. / Name of the Candidate and Address /Mrs. SUJATHA
I Year M.Sc. NursingAl-Kareem College of Nursing
GULBARGA – 585 105
2. / Name of the Institution / Al-Kareem College of Nursing
Barey Hills, near Adarsh Nagar,
SEDAM ROAD, GULBARGA – 585 105
3. / Course of Study and subject / M.Sc. Nursing
OBSTETRICS AND GYNAECOLOGICAL Nursing
4. / Date of admission / 30.06.2012
5. / Title of the Topic / A Study to assess the effectiveness of STRUCTURED TEACHING PROGRAMME ON CERVICAL CANCER AND HPV vaccination towards prevention of cervical cancer among adolescent girls STUDYING IN SELECTED PU COLLEGES AT GULBARGA.
INTRODUCTION
Adolescents in regarded as a unique phase of human development and the parents of near future, the health of adolescents is development on condition in the family, school, community, places of recreation and worship. It their needs are not addressed the infirmities will show up in the adult population in future1.
The term adolescence is derived from the Latin word “adolescere” meaning to grow, to mature. Age group between 10 to 19 years. It is considered as a period of transition from childhood to adulthood. They are no longer children yet not adults. It is characterized by rapid physical growth, emotional and psychological changes2.
The cervix is the lowest portion of the uterus. Normally the cervix has stopped growing by puberty, but its cells will continue to divide to replace those that die of injury or old age. Sometimes an abnormal cell may arise which later on divides out of control. This will them form a tumor. Cervical cancer start in just one single cell, but this cell quickly divides to form many similar cancer cells, which continues to grow. Eventually, if not cured, these cells push the normal cells out of the way, grow into a large tumor and spread to another parts of the body. Leading to fatal complication.
Cancer is the second common cause of death in the developed countries next to the cardio vascular diseases. In Europe and North America, approximately one in five die of cancer. According to WHO 50 million deaths are occurring annually in the world3.
As the human life span is increasing in India, more cases of cancer are observed. Approximately 500,000 new cases of cancer occur every year in India. According to Dr. D.J. Jussawalla founder secretary of Indian cancer society “Cancer is one of the major cause of the death today in India and is advancing in rank year by year4.
In the united states 11,000 cases of cervical cancer were diagnosed in the year 2007 2,80,000 women die annually worldwide and 5,00,000 cases are diagnosed annually 74% of HPV occurs between the ages of 15 & 24, that means if a young woman were immunized before she became sexually active, vaccine would cover her through most if not all of her more valuable years5.
The figures given by Indian cancer society state that about 1.5 million people suffer from cancer at any point of time in India. In other countries, like India, access to screening is limited due to lack of awareness of women on HPV vaccination in preventing cervical cancer. Cervical cancer is treated by hysterectomy (removal of the uterus). If the cancer has spread beyond the uterus, then aggressive chemotherapy is also used. Inspite of chemotherapy 33% of treated women will relapse or die within 5 years following the treatment6.
6. Brief resume of the intended work
6.1 Need for Study
About 4,93,000 new cases of cervical cancer occur world wide each year India’s cervical cancer age-standardized incidence rate of 30.7 per 1,00,000 is more than 300% higher than rates in the United State and other countries including United Kingdom and Canada7.
International agency for research on cancer studies are now detecting HPV DNA is virtually all cervical cancers. A study was conducted on adolescents (60) and young adults were evaluated. The study aimed to assess the knowledge of HPV and attitude towards HPV vaccination. A convenience sample of 60 women between 15 &28 years old was obtained, knowledge about HPV among this group was limited, with only 8.3% of those 15-17 years old and 34.5% of those 18-28 years old having heard of HPV others also have found low knowledge of HPV 10% of these women heard about HPV at school and schools need to play a major role in this education8.
This study motivated the investigator to do research in this area and also investigator specially mentions adolescent group because the chance of HPV is more once girl becomes sexually active as it spread through skin-to-skin contact.
A national study was conducted to assess perceptions about the role of HPV vaccine, and knowledge of cervical cancer. Parents of children aged 8 to 18 were asked questions on vaccine & knowledge on cervical cancer of the 1,350 respondents, over 70% (73.8%, 95% confidence internal 71.9% - 75.7%) reported they intended their daughter to be vaccinated against HPV. In this study, cultural background, religious beliefs and educational background were not predictors of parents intention to have their daughters vaccinated9.
A national study was conducted to assess the knowledge of obstetricians gynecologists and pediatricians on HPV vaccination. A self-administered questionnaire was mailed to all obstetricians /gynecologists and pediatricians and to a random sample of family physicians in British Columbia. Overall, 28% of physicians scored = 6 on 9 knowledge questions. The mean score was higher than that of family physicians (3.8) or pediatricians (3.2)10.
However, most intended to recommend HPV vaccine. 95% felt that vaccine should be given before the onset of sexual activity. 80% felt that best age for vaccination was <14 years over all, 88% of Canadian physicians surveyed intend to recommend the vaccine if it was publicly funded and 84% if patients had to pay for it.
6.2 Review of Literature:
A study was done on knowledge and attitudes about human papilloma virus pap smears and cervical cancer among young women in Brazil, objective of the study was to assess the knowledge and attitudes about HPV. A questionnaire was administered to 204 women aged 16-23 years, attending a public clinic, data were gathered on socio demographic characteristics, knowledge, attitudes related to HPV 92% women reported current / previous sexual activity, 42% perceived themselves at high risk of acquiring a sexually transmitted diseases, 67% did not know HPV can cause cancer / warts. Their findings recommend for greater HPV education of the public and health care practitioners10.
A study was done by dept of cancer epidemiology cancer institute, China to assess knowledge and attitudes about HPV and HPV vaccines among women living in metropolitan and rural regions of China. They undertook a population-based survey, which was designed to assess the women’s knowledge about HPV and their acceptability to the vaccines 15% of women reported to have ever heard of HPV, this knowledge differs by rural (9.3%) and metropolitan areas (21.6%) also by education. Most (84.6%) participants are willing to be vaccinated if HPV vaccine became available to them11.
In August 2002 a national survey was conducted with the aim of assessing Mexican physician’s knowledge and attitudes about the human papillomavirus and cervical cancer. A self administered questionnaire by using x² tests for analysis. 80% of respondents know that virus is the principle cause of cervical cancer, nearly all respondents through women should be informed that HPV causes cervical cancer. The study concluded that Mexican physicians support patient education on the HPV-cervical cancer link12.
A study was done by department of obstetrics and gynecology to assess women’s knowledge regarding the role of human papilloma virus in cervical intraepithelial neoplasia. Descriptive statistics and logistic regression analysis were used to identify significant demographic factors associated with the women’s preference for incorporation of HPV testing in their follow-up. 58% of the women rated their concern level as being 6 or more while 15% ranked their concerns as maximal at 10. interms of knowledge about HPV, 75% of the women had no or very minimal knowledge of the role of HPV in cervical intraepithelial neoplasia13.
A study was done to assess toward HPV vaccination among parents of adolescent girls in Mysore, India participants has been selected by conducting an outreach camp in community and after each presentation interested community members were invited to take part in focus group discussion. Each discussion lasted between 60 and 90min. an experienced qualitative research scientist trained the staff in qualitative research methods and adapted a focused group design. Most parents in the sample felt that their daughters were unlikely to become sexually active before marriage. Most participants felt that adolescent girls should be vaccinated between the ages of 15 and 18 years14.
6.3 Statement of the problem:
“A Study to assess the effectiveness of STRUCTURED TEACHING PROGRAMME ON CERVICAL CANCER AND HPV vaccination towards prevention of cervical cancer among adolescent girls STUDYING IN SELECTED PU COLLEGES AT GULBARGA”.
6.4 Objectives of the study:
The objectives of the study are to:
1. Assess the knowledge regarding cervical cancer and HPV vaccination towards the prevention of cervical cancer among adolescents by pre-test knowledge score in a selected pre university colleges at Gulbarga.
2. Administer structured teaching programme on cervical cancer and HPV vaccination among adolescents studying in selected PU colleges at Gulbarga.
3. Evaluate the effectiveness of structured teaching programme on cervical cancer and HPV vaccination among adolescents by post-test knowledge score.
4. Determine association between the pre-test knowledge score of adolescents regarding cervical cancer and HPV vaccination with selected socio-demographic variables.
6.5 Operational definition of the term:
Evaluate- It refers to the findings of the value of a structured teaching programme on knowledge of adolescents regarding cervical cancer and HPV vaccination towards the prevention of cervical cancer .
Effectiveness: It refers to the desirable changes brought about by the structured teaching program as measure in terms of significant knowledge gain in the post test and graded as adequate knowledge, moderately adequate knowledge and inadequate knowledge.
Structured teaching program: In this study, it refers to the time bounded teaching program in English materials, prepared by the investigator regarding various aspects of cervical cancer and HPV vaccination towards the prevention of cervical cancer .
Cervical cancer – It refers a type of cancer that effects the female- Genital part i.e. cervix.
HPV – It refers to a vaccination which prevents occurrence and transmission of HPV virus.
Adolescents girls: It refers to the girls with an age between 16-18 years.
PU Colleges: It refers to the students who are studying in class between 1st & 2nd year.
6.6 Assumptions:
The study is based on the following assumptions:
1. The knowledge of adolescents regarding cervical cancer and HPV vaccination can be assessed.
2. The structured teaching programme is an accepted teaching strategy that can enhance the knowledge of adolescents regarding cervical cancer and HPV vaccination.
3. Adequate knowledge on cervical cancer and HPV vaccination may reduce the mortality and morbidity rates of adolescents.
6.7 Hypothesis:
H1- The mean post test knowledge scores of the adolescents regarding cervical cancer and HPV vaccination is significantly higher than their mean pre-test knowledge scores.
H2- There is a significant association between the mean pre-test knowledge scores of adolescents regarding cervical cancer and HPV vaccination and the selected socio-demographic variables.
6.8 Delimitations:
The study is delimited to:
1. Students who are studying in class between PUC 1st & 2nd year with an age between 16-18 years.
2. Selected pre university colleges at Gulbarga.
3. Assessment of knowledge of samples only as the correct responses given to the items in the structure knowledge questionnaire.
7. Materials and methods:
7.1 Sources of data:
The sources of data are from adolescents of age between 16-18 years from selected pre university colleges belonging to the classes PUC 1st & 2nd year at Gulbarga.
7.1.1 Research design:
One group pre-test post-test design is adopted for the study.
7.1.2 Research approach:
Pre-experimental approach is adopted for the study.
7.1.3 Settings:
The study will be conducted at selected pre university colleges at Gulbarga.
7.1.4 Population:
In the study the population consist of the Students who are studying in class between PUC 1st & 2nd year with an age between 16-18 years at selected pre university colleges at Gulbarga.
7.2 Methods of data collection:
7.2.1 Sampling techniques:
Non, probability purposive sampling is adopted for the study.
7.2.2 Sample size:
50 adolescents will be included in the study.
7.2.3 Inclusion criteria:
The study includes adolescents who are-
a. Studying in selected pre university colleges.
b. Willing to participate in the study.
c. Available at the time of study.
d. Able to communicate in English.
7.2.4 Exclusion criteria:
The study excludes adolescents who are-
a. Sick during data collection.
b. Students who have attended any seminar, work shop on heat stoke within 6 months.
c. Not able to read and write in English Language.
d. Not willing to participate in the study.
7.2.5 Instrument intended to be used:
A structured knowledge questionnaire will be prepared to assess the knowledge of adolescents regarding cervical cancer and HPV vaccination. After reviewing the relevant literature and counselling with guide and experts from various fields obstetrics and gynaecological nursing. After structured teaching programme on cervical cancer and HPV vaccination among adolescents, the gain of knowledge is assessed.
7.2.6 Data collection method:
Data will be collected by the investigator himself prior to the study written permission will be obtained from the concerned authority. Further consent will be taken from the parents or guardians and adolescents regarding this willingness to participate in the study. Pre-test knowledge among adolescents on cervical cancer and HPV vaccination in selected pre university colleges, Gulbarga, will be done by administering structured knowledge questionnaire. Structured teaching programme will be administered for adolescents on cervical cancer and HPV vaccination in selected pre university colleges, Gulbarga. Investigator will evaluate the effectiveness of structured teaching programme by administering same structured questionnaire in the post test. The proposed period of data collection will be Oct 2013.