RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.Name of the candidate and address / PADMAVATI .P. JM.Sc NURSING 1 YEAR
Dr. SYAMALA REDDY COLLEGE OF NURSING
#111/1 SGR MAIN ROAD,
MUNNEKOLALA,
MARTHAHALLI,
BANGALORE-560037.
2.Name of the Institution / Dr. Syamala reedy college of nursing
3.Course of study and subject / M.Sc nursing 1 year.
Pediatric nursing.
4. Date of admission to course / June 2009
5. Title of the study / A comparative study on assessment of level of knowledge and attitude regarding health needs among adolescents in the selected private and government PU colleges at Bangalore.
BRIEF RESUME OF THE INTENDED WORK
“Adolescent’s Health is Our Nation’s Wealth”
6.0. INTRODUCTION:
Adolescents are full of energy, have significant drive and new ideas. They are a positive force for a Nation and are responsible for its future productivity provided they develop in a healthy manner. Since mortality in this age group is relatively low the adolescents are considered to be healthy. However, Mortality is a misleading measure of adolescent health. In fact, the adolescents do have a range of health problems that cause a lot of morbidity as well as definite mortality. Adolescents in rural India, both boys and girls, consume fewer nutrients than the recommended daily intakes. More than 70 per cent of girls aged 10–19 years suffer from severe/moderate anemia and this high prevalence is a major contributing factor towards higher-age specific mortality.1
The estimated world’s total population by the year 2009 is 6.8 billion. Adolescents represent 20% of total world population and 85%of whom live in developing countries. India is the second most populous country in the world with total population of over 1081 million. Adolescents (10-19 years) form a large section of population – about 22.5 percent, that is, about 225 million. They are living in diverse circumstances and have diverse health needs. The total population of young people (10 – 24 Years) is approximately 331 million comprising nearly 30 percent of the total population of India.2
‘Adolescence’ comes from the Latin word, meaning “to come to maturity” a fitting description of this stage of life. It is a period of dramatic growth and development. It is the most critical developmental period, second only to childhood. Beginning of adolescence is related to the onset of puberty in most cultures, but there is a wide difference as to when it ends. The W.H.O (1996) defined adolescence as - progression from appearance of secondary sex characteristics (puberty) to sexual and reproductive maturity.3
The term “adolescence” has been associated with the transition from childhood to adulthood, encompassing the interval between puberty and marriage, and it has been evolved into a distinct period of biological clock. It is a period of physical and psychological changes associated with puberty, and a time of preparation for the roles, privileges and responsibilities of adulthood.4
During the puberty growth spurt, four important physical changes occur which transform the child’s body into that of an adult; changes in the body size; changes in the body proportion, the development of the primary sexual characters and the development of the secondary sexual characters. The girls/boys during puberty undergo not only physiological changes but also psychological changes and emotional conflict that is the landmark of adolescence.5
Many adolescent health problems result from the rapid physiologic changes that are taking place, the person’s reaction to those changes, and the stress, conflict and confusion that characterize adolescence. As a struggle with questions about identity, independence, career, sexuality, emotions, alteration in body size and appearance etc. could seem difficult, perhaps even impossible to some.
Adolescence itself is a period of growth and development that requires special attention to maintain and promote health and wellbeing. Certain social, cultural, economic and other factors can further compound the problem of a vulnerable group by predisposing them to various health risks. Though there were a lot of initiatives in the wake of the needs of adolescents, it was the International Conference on population development in Cairo in 1994, which brought about much of their reproductive health needs onto main stage. Hence, several countries that are signatories have drawn up a plan of action to strengthen the reproductive health services for them.6
In spite of definite health problems they may have, it is a common observation that adolescents do not access the existing services. In India there have not been any designated services for this age group so far, leading to substantial unmet service needs. Absence of friendly staff, working hours that are inconvenient to adolescents and lack of privacy and confidentiality have been identified as important barriers in accessing health services by adolescents and young people.7
Adolescents have unique health needs. Though seemingly the healthiest period in one's life, adolescence can be a time fraught with developmental anxieties, mental health issues and health compromise. As in other stages of life, physical, psychological and social factors all interplay to affect the health and well-being of adolescents. However, any adverse impact from these factors is more keenly felt by adolescents who are in a vulnerable stage of rapid growth and transition from childhood to adulthood. Adolescents are also prone to behaviors which affect their health and the reasons are cognitive immaturity, impulsiveness and aggressiveness, lack of appropriate information and knowledge, peer pressure, the desire to satisfy curiosity and to seek excitement, the false sense of invincibility and rebellion may account for these behaviors. Adolescents' special vulnerability and risk-taking health-compromising behavior underlies many of their health needs and problems. The health of adolescents is particularly dependent on their behavior, which in turn is heavily influenced by their environment. Adolescents of today are growing up within a more complex, permissive and materialistic society. Rapid societal changes over the last two decades in have challenged the traditional attitudes, values, standards and behavior.
Major Health needs of Adolescents are-Nutrition, exercise and physical activity, Sex education.
Nutrition can be defined as “food or nourishment needed to keep an organism growing, healthy and viable. It also refers to the process of providing or receiving food or other life-supporting substances.” Nutrition (also called nourishment or aliment) is the provision, to cells and organisms, of the materials necessary (in the form of food) to support life. Many common health problems can be prevented or alleviated with a healthy diet.8
Exercise is defined as “the physical activity that is planned, structured, and repetitive for the purpose of conditioning any part of the body. Exercise is utilized to improve health, maintain fitness and is important as a means of physical rehabilitation.” Physical activity promotion has been identified as a public health priority for the twenty-first century. Because physical activity is a behavioral intervention or lifestyle choice, promoting it is a complex activity that requires input of many professional groups to achieve success.9
WHO (World Health Organization) 2002 definition of Sexual health is: “Sexual health is a state of physical, emotional, mental and social well-being. In relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence.”10
Adolescents are the pillars of our future society. Our efforts in meeting their health needs and in raising the standards of their health can only be our gain, both for the present and for the future. Anticipatory care aiming at health promotion, early detection of health problems combined with a holistic and empathic approach are the cornerstones of enhancing the health of our adolescents.
6.1 NEED FOR THE STUDY:
Adolescence is a period of transition from childhood to adulthood. One fifth of the world’s population is represented by them. Development of knowledge and attitude takes place during this period, which can have lifelong effects on the individual, family and society. Changes in the pattern of thinking, attitude, relationships, moral standards and abilities take place in this period.11
There is growing concern about certain health problems presented by adolescents-such as drug abuse and with means for dealing with those problems. However, information is lacking on their general health status, behavior and attitudes, and medical care needs.
Research suggest that interventions integrating programs and expertise from health care, school and community-based settings can effectively increase adolescent’s prevention skills , improve their access to health care services , build adult motivation and support for adolescent prevention practices , and change physical environments and social norms to support healthy behavior. It is a globally acknowledged that adolescents in general, and out- of-school adolescents, in particular often lack access to health information, counseling, legal protection, as well as health care and other social services.12
A study conducted in 2007 states that adolescence is a phase of storm and stress and is the most vulnerable group to suffer various health problems, especially if they lack knowledge about reproductive health. Adolescents need extensive and supportive education programs to improve their awareness and thus reproductive health status.13
Adolescent reproductive health is a rights-based issue and we should include sexual and reproductive health from a “rights” perspective, regardless of issues such as age, sex, marital status and sexual preferences. The situation for adolescents entails understanding the needs of a youth who lives within certain social, cultural and religious contexts.14
Most of the Millennium Development Goals are highly relevant to the health and welfare of youth. Better adolescent health will directly contribute to achieving five of the eight internationally agreed-upon goals: reversing the spread of HIV/AIDS; reducing maternal deaths; reducing infant and child deaths; developing and implementing strategies for decent and productive work for youth; and reducing poverty. Adolescent's sexuality and related reproductive health and rights problems are sensitive issues. Globalization has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed.
Adolescents and young people are poorly informed about sexuality, reproductive health and the consequences of unprotected sex or drug use. In a 2004 survey in India, 80 percent of high school students said they had never participated in a course, nor in extracurricular activities related to HIV prevention. Access to essential health services is lacking in the Asia-Pacific region. For example, the coverage of voluntary counseling and testing services was less than 0.1 percent of the population (aged 15-49) in the region.15
A survey was carried out by the Family Planning Association of India to assess knowledge, behaviour and attitudes about sexuality among youth. Boys and girls from standard XI and XII were selected for the study. Results revealed that only 10 percent of boys’ parents could discuss issues like masturbation, night emission, sexual intercourse and other related matters with their sons. About 20 percent of girls’ parents were able to discuss sex-related issues with their daughters. According to both boy and girl respondents, friends and mass media play a major role in providing information on ‘sex related matters’. ‘Peers and older friends’ are another major source of information because they are easily available and accessible to young people. The study showed that boys felt more comfortable discussing sexuality with their friends, while girls were more comfortable with their mothers and elder sisters. This research reveals that the awareness about sexually transmitted infections (STIs) among both boys and girls is much lower than about HIV/AIDS, and that boys are more aware than girls. This indicates that there is a need to address issues on STIs while conducting programmes on HIV/AIDS. It is well established that sexually transmitted infections enhance the risk of HIV transmission by 5 to 10 times. This study corroborates the findings of other studies regarding the need for introducing sex education in schools. Adolescents lack correct and scientific knowledge about on sex education.16
Various studies conducted on knowledge, attitude and practice in the region reveal that the adolescents and young people are looking forward to receive the correct and scientific knowledge about their reproductive and sexual health. Keeping in view this reality efforts are being made in the region to create awareness among the adolescent under the heading of life useful education. However it majorly focuses on the reproductive health and very little attention given to the sexual health and sexuality education.
Proper food and good nutrition are essential for survival, physical growth, mental development, and productivity, health and wellbeing of adolescents. The rapid adolescence growth spurt places extra demand on nutritional requirements. Adolescent “growth spurt” results in a 50% increase in calcium, and 15% increase in iron requirement. Also adolescence is a time when a young people change their eating patterns and lifestyles and become susceptible to environmental influences. Inadequate nutrition in adolescence can potentially retard growth and sexual maturation.
A survey carried out in 2003 by the National Nutrition Monitoring Bureau(NNMB),India revealed that intake of most foods, except cereals, millets, roots and tubers, was below the Recommended Dietary Allowances(RDA)in all age and sex categories of adolescence. Consumption of protective foods such as green leafy vegetables, fruits, pulses and milk was grossly inadequate. Almost half of the adolescents of both sexes were not getting even 70% of their daily requirements of energy and a quarter of them were getting less than 70%of RDA of proteins. Malnutrition is seen in 30% of adolescent girls and 18%boys. 17
Under-nutrition among adolescent is more common in developing countries, especially in India. A study which was done on prevalence of under-nutrition among Adolescents in urban West Bengal ,reveals that the overall prevalence of under-nutrition was 28.60% The rates were significantly higher among boys (37.59%)compared with girls(19.43%).By this we can conclude that there is urgent need intervention strategy through community based nutritional awareness.18
Adolescent obesity has become a major health concern in India. An increased frequency of fast food restaurant dining is associated with higher intake of calories and calories from fat. A recent study was done to gain insight as to how food choices in a "simulated" fast food environment might be influenced by nutrition education in a group of adolescents.18