RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE / MS. SIMRANDEEP KAUR M.SC. NURSING AECS MAARUTI COLLEGE OF NURSING, BANGALORE.2. / NAME OF THE INSTITUTION AND ADDRESS / AECS MAARUTI COLLEGE OF NURSING, No.99, NEAR AECS MAARUTI DENTAL COLLEGE, KAMMANHALLI, OFF B.G.ROAD,BANGALORE.560076
3. / COURSE OF THE STUDY AND SUBJECT / M.SC. NURSING 1st YEAR IN OBSTETRICS AND GYNECOLOGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 30.JUNE.2008.
5. / TITLE OF THE TOPIC / “EFFECTIVENESS OF STP ON SELECTED ASPECTS OF PRECONCEPTIONAL COUNSELING (PCC) AMONG WOMEN OF AGE GROUP 18-25 AT A SELECTED WOMEN’S COLLEGE,BANGALORE.’’
INTRODUCTION
Giving birth is one of the greatest honors which God gave to Woman, for this woman is respected everywhere. But state of pregnancy is associated with several complications most of which are avoidable, if care is taken before the time of conception only.
When a couple is seen and counseled about pregnancy, its course and outcome well before the time of actual conception it is called “preconception counseling”. It is a very new concept. It is based on the theory that all women of child bearing years should be pre-screened for health and risk potential before attempting to be pregnant so that she enters pregnancy with an optimal state of which would be safe both to herself and the fetus.
Components of Preconception care and counseling are1:-
1. Identification of high risk factors.
2. To maintain Base level health status
3. Healthy life style(e.g. diet, exercise, rest and sleep)
4. Diet supplements specially folic acid and iron
5. To cease substance abuse
6. Drugs used before pregnancy are verified and changed
7. screening and counseling for genetic disease
8. Immunization
9. Screening for STD/AIDS
More than half of the complications which arise during antenatal, intranatal and postnatal period can be avoided with good preconception counseling and care. Base line health status helps to bear and sustain pregnancy well and efficiently so the woman can overcome the pregnancy induced disorders in better way. This optimum level of health can be achieved by following healthy life styles like balanced diet, exercise regime and adequate rest and sleep. Blood is the only source with which the infant gets its nourishment so any disorders like anemia should be treated before the conception. Anemia can lead to complications during pregnancy and labor as it is seen that non-anemic women can withstand blood loss and cardiac variations more during labor. Folic acid should be taken four weeks prior to the conception upto twelve weeks of pregnancy. Neural tube defects can be avoided up to 70 percent.
There are 20 to 70 percent chances of perinatal mortality in cases if mother gets hepatitis or rubella infection during pregnancy. There is increased incidence of abortion, preterm birth and intrauterine death leading to fetal wastage. Good metabolic control before conception and in the early weeks of pregnancy may decrease the frequency of major anomalies. Poorly controlled diabetes is one of the causes of the infant mortality due to stillbirth, intrapartum asphyxia, and hyaline membrane disease. Women are urged to cease substance abuses also. Taking even one drink a day can greatly affect the growing fetus. It can lead to the condition called Fetal Alcohol Syndrome (FAS). FAS is one of the leading known preventable causes of mental retardation and birth defects.
6.0 BRIEF RESUME OF INTENDED WORK
6.1 NEED OF STUDY
Organogenesis is completed by the first trimester. As many as 30 percent of pregnant women goes for antenatal clinics after first trimester, it is often too late to advice because all the adverse factors may have already begun to exert their effects. So, most of the physicians and experts recommends that a woman visit her physician as soon as the woman plan to have a child, and optimally 3 to 6 months before actual attempts are made to conceive1. This time frame allows a woman to better prepare her body for successful conception and pregnancy, and allows her to reduce any health risks which are within her control.
According to a study it was found that 98 percent of all couples reported one or more risk factors. Many of these factors were related to an unhealthy lifestyle. Women with a low level of education reported more risk factors than women with a high level of education. There is a great need for preconception care and counseling as shown by the fact that almost all couples reported risk factors for which personal counseling was indicated2.
A study conducted regarding prevailing risk factors for adverse pregnancy outcomes during pregnancy and the preconception period reports that major health risks were reported by substantial proportion of women in the preconception period and were also reported in pregnant women. 54.5 percent of preconception women reported one or more of 3 risks factors (frequent drinking, current smoking and absence of HIV Test) compared with 32.0 percent of pregnant women4
India is a developing country where still 220 million people are under poverty line who hardly able to earns two meals a day can’t even think of nutrition, suffer from deficiency diseases. Out of other deficiency disorders anemia is most frequently found nearly 27.9 percent of non pregnant, 21.1 percent of adolescent girls and 52.3 percent of pregnant females are anemic6.
According to an article on march 03, 2005, there are 2.7 cases of NTD (Neural tube defects) per 1000 births in Chennai and 0.5-11 per 1000 births on an average in India. 2/3 of which are completely avoidable11.
Around 1000 to 5000 cases per year are there of FAS (Fetal alcohol syndrome) in India. FAS can result in mental retardation, defects of heart and organs, miscarriage, LBW, still births in new born and emotional behavioral problem in long run3.
The research study and working area created insight in investigator mind regarding complications of pregnancy and congenital malformation in children. Hence, the need is felt to help women to overcome the complications, so that she can have healthy pregnancy and healthy child.
This is a vital area of research for women health but that is not well studied. Hence, the investigator designed to study the effectiveness of structured teaching program on preconceptional counseling.
6.2 REVIEW OF LITERATURE
A study was conducted regarding knowledge and believes of women regarding preconception care and counseling. Out of 499 women, nearly all woman 98.6 percent realized the importance to receive information about pregnancy before conception. The vast majority of patients surveyed (95.3 percent) preferred to receive information about preconception health from their family physician. Only 39 percent of women could recall their physician ever discussing this topic9
A study was conducted to summarize the study on change in Trends in preconception awareness and behavior regarding folic acid for the period of ten years. Random-digit dialed telephone surveys were conducted of approximately 2000 women aged 18-45 years in that period. There was an increase in awareness from 52 percent to 84 percent in that period. Of all women surveyed , 19 percent knew folic acid prevented birth defects, from 4 percent in when compared to previous survey. Women who reported learning about folic acid from health care providers increased from 13 percent to 26 percent. Among women who were not pregnant at the time of survey, 31 percent reported taking a vitamin contain folic acid daily compared with 25 percent 12.
A study was conducted on practice and beliefs of primary care workers regarding preconception care. A number of lifestyle modification and medical interventions can be of benefit to maternal and neonatal health, when applied prior to conception. They agreed that advice about smoking, drug use, folic acid, genetic counseling, chronic disease, alcohol, and maternity care and screening for rubella, genital infection, hepatitis, HIV and cervical cytology were important. They felt that advice about diet, exercise, supplements, food safety, occupation hazards and benefits and screening for nutritional status were less important. They stated few had received any training on PCC since their qualification. The barriers to providing PCC included lack of resources and lack of contact with women planning to conceive10
In a study about knowledge, attitude and practices of preconception care in medical students and residents. 268(77 percent) of 347 responded. The most common education they reported receiving was about smoking cessation (71 percent) and the least was about folic acid supplementation (12 percent). Many participants reported providing smoking cessation in their practice (60 percent), though only about one third of respondents advise restricting alcohol intake. Few advising Calcium supplement (10 percent) or folic acid supplements 4 percent) 8
A study conducted regarding knowledge and awareness regarding preconception care. 100 convenience samples were screened regarding family planning services, domestic violence, nutrition and medical risk factors, medication use, appropriate counseling and use of referral services. They were interviewed before and after intervention (one hour lecture). The greatest improvement were noted in complete screening for medical factors (from 15 to 40 percent ), over the counter and prescription medication use (from 10 to 57 percent ) and nutrition (9 to50 percent ) 7.
STATEMENT OF THE PROBLEM
“A Study To Assess The Effectiveness Of Structured Teaching Programme On Selected Aspects Of Preconception Counseling(PCC) Among Women Of Age Group 18-25 at A Selected Women’s College, Bangalore.’’
6.3 OBJECTIVES
1 To assess the knowledge regarding preconception counseling among women of age group 18-25 at a selected women’s college, Bangalore.
2 To develop and implement a structured teaching program on knowledge regarding pre-conception counseling among women of age group 18-25 at a selected women’s college, Bangalore.
3 To find out the effectiveness of Structured teaching program on knowledge regarding preconception counseling (PCC).
4 To find out the association between knowledge and selected demographic variable.
6.4 OPERATIONAL DEFINITION
Assess - In this study it refers to the measurement of knowledge regarding Preconception counseling.
Structured teaching program – It is a planned instruction to impart knowledge on preconception counseling using relevant teaching method.
Knowledge - In this study it refers to correct responses of women on Preconception counseling.
Preconception counseling – It is the counseling given about pregnancy, its course and outcome well before the time of actual conception. Preconception counseling includes taking healthy diet, exercises, immunization, screening high risks, ceasing substance abuse.
Women - In this study it refers to females who are in reproductive age between 18 to 25 years who are studying at selected colleges.
6.5 HYPOTHESIS:
H1 - There is significant improvement in the knowledge scores of women regarding Preconception counseling after STP than before STP
H2 - There is a significant association between the knowledge andselected demographic variables
VARIABLES:
Independent variable In this study independent variable is structured teaching plan Dependent variable: In this study dependent variable is knowledge regarding Preconception counseling
Demographic variables: In this study demographic variables such as age, religion, parents education, family income, type of family, exposure to mass media .
DELIMITATION:
This study is limited to females aged between 18 to 25 years at a selected women’s college, Bangalore South.
7.0 MATERIAL AND METHODS:
7.1 SOURCES OF DATA: Women between the age group of 18-25 from selected colleges of Bangalore.
Research Approach: Experimental.
Research Design: Quasi-experiment design. One group pre-test post-test
Research Setting: The study will be conducted at a selected women’s college, Bangalore.
Population: The population of study comprises of females in reproductive age group of 18-25 year.
Sample: sample comprises of women of age group of 18-25 years studying in a selected women’s college, Bangalore.
Sample Size: study comprises of 100 women of 18-25 years
Sample Technique: sample will be selected by simple random sample technique.
Inclusion Criteria:
1. women who are in age group of 18-25
2. women who are students of selected women’s college.
3. women who are present at the time of data collection
4. women who are willing to participate
TOOL FOR DATA COLLECTION:
PART-A: Socio demographic profile prepared by investigator.
PART-B: Self administered questionnaire
7.2 METHOD OF DATA COLLECTION
A prior formal permission will be obtained from the college or institution authority for conducting the study. An infomal consent will be obtained from the subjects.The process of study will be explained to the subjects
METHOD OF DATA ANALYSIS:
The investigator will organize the data in a master sheet.
Frequencies and percentages for the analysis of data will be calculated.
Descriptive statistics: mean, mode, median, standard deviation.
Inferential Status: Chi square test to determine the association between demographic variables and knowledge level. Paired “t” will be used to draw the significant difference between pretest and post test knowledge scores
7.3 Does the study require any investigation or intervention to be conducted on patient and other human or animals? If so please describe briefly.
No. It is only educational research.
7.4 Has ethical clearance been obtained from institution?
Yes, permission will be taken from research committee of AECS Maaruti College of nursing.
Informed consent will be obtained from respective college authorities and subjects.
Primary confidentiality and anonymity will by guarded, scientific objectivity of the study will be maintained with honesty and impartiality.
8. LIST OF REFERENCES:
1. Dutta, D.C. Text book of Obstetrics, 6th Edition, 2004.New central book agency Pvt Ltd. Calcutta: P 103-4
2. Pendsey, S.P. Importance of preconceptional control of Diabetes in prevention of congenital malformations in the infants of Diabetic mothers.
3. Anderson, J.E, Ebrahim, S., Floyd, L., Atrash, H., Prevalence of risk factors for adverse pregnancy outcomes during pregnancy and the preconception period, United States. Maternal Child Health Journal, 2006 Sept;10: P 101-6
4. van Haeringen A, Neven A.K., Assendelft P. Preconception counseling in primary care:prevalence of risk factors among couples contemplating pregnancy. Paediatric Perinatal Epidemiology,2008 May;22(3):280-7.
5. Bierman J, Dunlop A.L., Brady C., Dubin C., Brann A., Promising practices in preconception care for women at risk for poor health and pregnancy outcomes. Maternal Child Health Journal. 2006 Sep;10(5):21-8.