RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. /NAME OF THE CANDIDATE AND ADDRESS
/ Ms. HIMA KUSUMA,ANURADHA COLLEGE OF NURSING,
SREEGANDHADAKAVAL,
HEGGANHALLI CROSS,
SUNKADAKATTE ROAD,
BANGALORE, KARNATAKA.
2. /
NAME OF THE INSTITUTION
/ ANURADHA COLLEGE OF NURSING,SREEGANDHADAKAVAL,
HEGGANHALLI CROSS,
SUNKADAKATTE ROAD,
BANGALORE, KARNATAKA.
3. / COURSE OF STUDY AND
SUBJECT
/ M.Sc. NURSING I YEARPEDIATRIC NURSING
4. / DATE OF ADMISSION TO
COURSE
/ 15TH MAY 20095 / TITLE OF THE TOPIC / A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF ADOLESCENCE REGARDING SEX EDUCATION IN A SELECTED SCHOOL OF BANGALORE.
6. /
BRIEF RESUME OF THE INTENDED WORK
INTRODUCTIONSex education is the acquisition of knowledge that deals with human sexuality. It consists of instruction on the development of an understanding of the physical, mental, emotional, social, economic and psychological phases of human relations as they are affected by sex.1
Sex education is a process whereby information is given or imparted to a group of young ones and which takes into account the development, growth, the anatomy and physiology of the human reproductive system and changes that occur from youth all through stages of adulthood.1
Adolescence has been described as a stage among human beings where a lot of physiological as well as anatomical changes take place resulting in reproductive maturity in the adolescents. Many adolescents manage this transformation successfully while others experience major stress and find them selves engaging in behaviours (e.g. sexual experimentation, exploration etc.) that place their well being at risk for Sexually Transmitted Diseases (STDs).1
Adolescence is the most important and sensitive period of one's life. According to the World Health Organization (WHO) Expert Committee, adolescence is defined as the period between 10 and 19 years, the second decade of life.2
News papers, Periodicals, journals and magazines often carry sensational stories of teenage sex escapades, Pregnancies, sexually transmitted diseases like gonorrhoea and syphilis most recently but more dangerous reported cases of Acquired immuned Deficiency Syndrome (HIV- AIDS), While the reports of expulsion pregnant students by school authorities were also common.11
Emergence of AIDS has focused everybody’s attention towards the role of sex education. AIDS and other sexually transmitted diseases (STDs) are common today, but many parents, teachers and students do not understand these diseases and their prevention. Young persons for variety of reasons such as development issues, peer pressure, social influences etc are becoming sexually active at earlier ages than ever before. However, this early sexual activity is often not accompanied by knowledge about its consequences. The absences or lack of sex education puts youth at risk for unplanned pregnancy and various STDs, it also results into phenomenon of unwanted mothers, which is common in Europe, Africa and America and is also being reported from India.4
The sex education given at the right age can prevent various STDs including the modern day pandemic of AIDS. However, this need is still not appreciated by various agencies involved. Owing to the effectiveness, acceptability and low cost, the school based sex education programme may become useful in reaching adolescents. Sex education hardly exists in India; it is the right time to under take it in a cautious yet a
needful manner so as to impart vital cognitive clues to the youngsters for safe behavior. After having decided from sex education, other questions emerge such as at what age it
should be initiated, which agency should impart it and what should be the duration and content of such education , all of which need to be addressed.4
Lessons about sex can happen anytime, anywhere and with anyone. Friends talking in the playground, family talking around the dinner table, a bizarre website you stumble across – all of these can be sex education moments. But that doesn’t mean what you’re learning is accurate, or that it will be helpful to you. For that, you need to make sure you’re getting good sex education. Whether you’re sixteen or ninety-six, you’re bound to have some questions and some concerns about sex, and you deserve to get answers that will help you. Which raises an important question; what makes for good sex education?3
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NEED FOR THE STUDY
Sex education is the significant need of the adolescent and preadolescent boys and girls. Adolescence is the period of transition from childhood to maturation. It is concerned mainly with rapid physical, physiological and sexual development. This sudden transformation along with exposure to influences of peers and print and electronic media makes the adolescent confused on knowledge, attitude and behaviour regarding sex.The adolescent is often anxious about nocturnal discharge of seminal fluid, size of the penis, or its shape and erection, size shape of breasts, menstruation, puberty changes and appropriate informations about sex and barrier of communication with parents enhance adolescents worry and anxiety.
Most adolescent practice masturbation for gratification of sexual desire and to obtain pleasure. This practice leads to intense guilt feeling and anxiety which make them run to quacks who induce treatment without any scientific and psychological approaches. So, the adolescents need emotion support and information regarding sexual concerns.5
National statistics shows that during December 2000, CDC statistics had 774,467 reported AIDS cases. Among them 4,061 cases were among the Adolescent (13 to 19 yrs of age )cases. Among these AIDS cases of adolescent, 50% occur in African Americans, 28% in Caucasians and 20% in Hispanics.18
India has more than 10 million pregnant adolescent mothers. One in six girls begin childbearing between the ages of 13 and 19 yrs. One source suggests that 44.7% of girls between the ages of 15 and 19 yrs in rural areas are married. Only 7.4% of married girls between the ages of 15 & 19 yrs use contraception. 68.7% of mothers under the age of 20 receive prenatal care from a skilled health worker and 41.6% give birth with assistance of a skilled birth attendant. India has a major proportion of approximately 80% 0f all induced are still performed illegally by private and untrained persons in unhygienic conditions. induce abortions account for more than 11% of maternal deaths, Significantly influence womans reproductive health.19
It is necessary that students who are to be given this education should be involved at every stage of decision making. Present study aims to identify the need and perception of students about sex education and also address to crucial issues mentioned above. Attempts have also been made to compare the responses of the students of two sexes as their responses are likely to be different upbringing different attitudes.4
It is essential to catch them young impart them knowledge regarding anatomy and physiology of reproductive system including promotion of safe sex practices and prevention of high risk behaviour by sex and AIDS. Education to secondary school children can be considered as the most effective way of combating AIDS, as school children are easily accessible.6
A study was carried out to promote the provision of reproductive health services to young people by exploring the attitudes and perceptions of university students in Shanghai, China, toward reproductive health. 243 students from 14 universities in Shanghai took part in our survey. Topics covered the demands of reproductive health-care services, attitudes towards and experience with sex, exposure to pornographic material, and knowledge on sexual health and sexually transmitted infections (STIs)/AIDS. The study demonstrated that out of the 5 067 students who provided valid answer sheets, 50.05% were female and 49.95% were male, 14.86% were medical students, and 85.14% had non-medical backgrounds. A total of 38.4% of respondents had received reproductive health education previously. The majority of students supported school-based reproductive health education, and also acquired information about sex predominantly from books, schoolmates, and the Internet. Premarital sexual behavior was opposed by 17.7% of survey participants, and 37.5% could identify all the three types of STIs listed in the questionnaire. Although 83.7% knew how HIV is transmitted, only 55.7% knew when to use a condom and 57.8% knew that the use of condoms could reduce the risk of HIV.14
A study was conducted to evaluate sexeducation.Results from a questionnaire are presented from 3314 Year 11students in 25 schools from non-metropolitan Britain. Over 70%answered that their sexeducation had included ‘a lot’or ‘some’ education on sexual intercourse, contraceptionandsexually transmitted diseases (STDs); 51% demonstrationof condoms; 45% personal morality; and 36% assertiveness trainingincluding ‘how to say no’. Teenagers' assessmentof sexeducation was varied but only the minority (44%) consideredit satisfactory. Over 70% said they thought teaching a widerange of topics should start in Year 8 ,
most(75%) wanted outside agencies involved in the teaching, (57%)did not want parents to provide ‘most of it’ and(70%) did not want it taught in single-sex groups. School wasthe most frequently specified source of ‘most helpful’information on contraception (38%) and STDs (45%). Teenagerswithin schools perceived to deliver above average input on contraceptionand STDs were more likely to cite school as their most helpfulsource of information. Increasing input was not associated withincreasing awareness of risks from STDs nor improved knowledgeof contraception. The questionnaire and reporting of comparativefindings back to the schools will allow an assessment of currentpractice and future change to sexeducation programmes.20
In the light of the above facts and evidences, the investigator observed that the rate of unwanted pregnancy and sexually transmitted diseases are among the adolescent group, Many of the adolescence were unaware of the life threatening complications .Despite of intense reach, there is still so much to be learned about life style modifications in adolescence sexual health. Pediatric nurses have more contact with the adolescence, thus they significant and unique contributions to educate the adolescence. They act as a facilitator and supporter in increasing the knowledge of the adolescence.
Hence , the investigator felt the need and importance of giving sex education to the adolescence which will be helpful in managing the good sexual life of adolescence by preventing their life from complications of unwanted pregnancies and the present prevailing STDs such as HIV/AIDS etc.
6.2
6.2.1
6.2.2
6.2.3
6.2.1
6.2.2
6.2.3 / REVIEW OF LITERATURE
Review of literature is the key step in research process. The typical purpose for analyzing a review existing literature is to generate research question to identify what is known and what is not known about the topic. The major goals of review of literature are to develop a strong knowledge base to carry out research and non research scholarly activity.
Review of literature from the present study has been divided into –
Studies related to knowledge of adolescence regarding sex education.
Studies related to attitude of adolescence regarding sex education.
Studies related to effectiveness of sex education on adolescence.
Studies related to knowledge of adolescence regarding sex education.
A study was carried out to investigate the perception, knowledge and attitude of adolescent urban schoolgirls towards sexually transmitted Infections (STIs), HIV/AIDS, safer sex practice and sex education. The self-administered questionnaire was completed by 251 female students from two senior secondary schools. The result indicates that more than one third of students in this study had no accurate understanding about the signs and symptoms of STIs other than HIV/AIDS. About 30% of respondents considered HIV/AIDS could be cured, 49% felt that condoms should not be available to youth, 41% were confused about whether the contraceptive pill could protect against HIV infection and 32% thought it should only be taken by married women. there is an immense need to implement gender-based sex education regarding STIs, and contraceptives in schools in India.7
A study was conducted to determine the Knowledge, risk perception of AIDS and reported sexual behaviour among students in secondary schools. A questionnaire survey was carried out among 1041 students in secondary schools and colleges in Tanzania to evaluate the relationship between HIV-risky sexual behaviour and anti-condom bias, as well as with AIDS-related information, knowledge, and perceptions. Self-reportedly, 54% of students (75% of the boys and 40% of the girls) were sexually active. The condom use rate was higher than previous reports. However, 30% of sexually active respondents did not always use condoms (Risk-1 behaviour) and 35% of those with multiple partners in the previous year did not always use condoms (Risk-2 behaviour). Students engaging in risky behaviour were aware of the risk, even though they failed to change their behaviour. Reasons for the AIDS epidemic among Tanzanian students and the importance of more effective AIDS education are also discussed.8
A study was undertook for detailed analysis of knowledge of correct condom use and consistency of use, as well as their covariates, among adolescents in Burkina Faso, Ghana, Malawi and Uganda using the data from the National Adolescent Surveys. As indicated by behaviour among young men, the extent to which adolescents use the condom consistently varies across countries. The proportion reporting consistent use of the method in the 3 months preceding the survey is 38% in Burkina Faso, 47% in Ghana, 20% in Malawi and 36% in Uganda. Other important predictors of consistent condom use are residence, education, living arrangement and exposure to mass media, specifically the radio and newspaper. This study demonstrated that policy and program can address to provide adolescents access to the kinds of information and service they need to achieve healthy sexual and reproductive lives.9
A study was conducted to examine public opinion on sex education in schools to determine how the public's preferences align with those of policymakers and research scientists. Randomly selected nationally representative sample of US adults aged 18 to 83 years (N = 1096). Support for 3 different types of sex education in schools: abstinence only, comprehensive sex education, and condom instruction. The study demonstrates approximately 82% of respondents indicated support for programs that teach students about both abstinence and other methods of preventing pregnancy and sexually transmitted diseases. Similarly, 68.5% supported teaching how to properly use condoms. Abstinence-only education programs, in contrast, received the lowest levels of support (36%) and the highest level of opposition (about 50%) across the 3 program options. Self-identified conservative, liberal, and moderate respondents all supported abstinence-plus programs, although the extent of support varied significantly. The study concluded that US adults, regardless of political ideology, favor a more balanced approach to sex education compared with the abstinence-only programs funded by the federal government. In summary, abstinence-only programs, while a priority of the federal government, are supported by neither a majority of the public nor the scientific community.10
Studies related to attitude of adolescence regarding sex education.
A study was conducted to investigate the disposition ofstudents and parents towards the inclusion of sex education in the school curriculum in CrossRiverState. Using a random sampling technique, 602 secondary school studentsand 180 parents from Calabar, were selected for the study. Data were collected withthe aid of self –administered questionnaireandanalysed using descriptivestatistical techniques.
The majority of the students (90.70%) and parents (93.89%) were in support of the inclusion of sex education in the school curriculum. They believed that the teaching of sex education would compliment efforts being made towards the control of HIV/AIDS. Based on the results of the study, some recommendations were generated.11
A survey was conducted among in-school and out-of-school but unmarried adolescents aged 10 to 19 in five locations in Tanzania. A questionnaire was used to collect information and to characterize sexual practices among these adolescents. The result from the survey is that about 32% of adolescents reported being sexually active; a higher proportion being males than females. The only inquired and reported sexual practices include vaginal sex, masturbation, oral and anal sex. About 15% of sexually active adolescents reported having multiple sexual partners. Significantly more males reported having multiple partners than females. Nearly 42% of sexually active adolescents reported having used a condom during most recent sexual act. Females reported older partners at first sexual act. From the study it is concluded that adolescents experience several sexual practices that include penetrative and non-penetrative. More males reported being sexually active than females. Despite adolescents reporting having multiple sexual partners, reported condom use during the most recent sexual act was low. We advocate for a more enhanced approach of reproductive health education that includes safer sex to adolescents without forgetting those in-schools.12
A study was conducted to determine the attitude of Filipino teens on relationships, love and sexuality. A questionnaire including topics on relationships,
love and sexuality was distributed to a target population of 4,000 Filipino students
from third year high school to third year college. Participants were obtained through multi-stage sampling of clusters of universities and schools. This paper concentrates on teens aged 13 to 18. The results of the study report that the students have obtained information about love and sexuality mainly from friends. However, they valued parents' opinion more than friends'. They revealed few conversations with their parents on these topics. A majority of them would like to have more information, mainly about emotion-related topics. Almost half of respondents were not aware that condoms are not 100% effective in preventing STIs or pregnancies. More girls, compared to boys, were sensitive and opposed to several types of sexism. The study concluded that there is room for further encouraging parents to talk more with their children about sexuality, especially aspects related to feelings and emotions in order to help them make better sexual choices. Indeed, teens wish to better communicate with their parents on these issues.13