A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PRIMARY PREVENTION OF FEMALE INFERTILITY IN TERMS OF KNOWLEDGE
AND SELF-REPORTED PRACTICE AMONG EARLY ADULTHOOD GIRLS IN SELECTED COLLEGE
AT SALEM
A Dissertation submitted to
The Tamilnadu Dr. M.G.R. Medical University, Chennai-32 In partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
BY
Reg. No: 301721202
OBSTETRICS AND GYNECOLOGICAL NURSING SHANMUGA COLLEGE OF NURSING
24, SARADA COLLEGE ROAD, SALEM-636007
OCTOBER - 2019
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PRIMARY PREVENTION OF
FEMALE INFERTILITY IN TERMS OF KNOWLEDGE AND SELF-REPORTED PRACTICE AMONG EARLY ADULTHOOD
GIRLS IN SELECTED COLLEGE AT SALEM
APPROVED BY DISSERTATION COMMITTEE
Clinical Specialty Guide : __________________________________
Prof. M.Jansi Rani M.Sc(N),
HOD of Obstetrics and Gynaecology Nursing Salem- 636007.
Professor cum Principal : ___________________________________
Prof. Dr. S. ANNAM, M. Sc (N).,Ph.D(N)., Principal
Shanmuga College of Nursing, Salem- 636007.
Viva Voce & Date:
1. Internal Examiner:
(Signature with Name)
2. External Examiner:
(Signature with Name)
OCTOBER - 2019
DECLARATION BY THE CANDIDATE
I Ms.VIDHYA.R, hereby declare that this dissertation entitled
“A study to assess the effectiveness of structured teaching programme on primary prevention of female infertility in terms of knowledge and self-reported practice among early adulthood girls in selected college at Salem.” has been prepared by me under the guidance and direct supervision of Prof. Dr.S.Annam, M.Sc(N), Ph.D(N)., Professor cum principal and Prof.M.JANSI RANI, M.Sc(N), HOD of Obstetrics and Gynaecology Nursing, Shanmuga College of Nursing, Salem as the requirement for the partial fulfilment of MASTER OF SCIENCE IN NURSING degree under The Tamilnadu Dr. M.G.R Medical University, Chennai-32. This dissertation represents independent work of mine, which has not been previously formed and this will not be used further award of any degree/ diploma.
Place : Salem R. VIDHYA,
Date : October 2019 II Year M.Sc(N) Student, Shanmuga College of Nursing, Salem - 636007
CERTIFICATE BY GUIDE / HOD AND PRINCIPAL This is to certify that the dissertation entitled “A study to assess the effectiveness of structured teaching programme on primary prevention of female infertility in terms of knowledge and self- reported practice among early adulthood girls in selected college at Salem” is a bonafide work done by Ms.R. VIDHYA, Shanmuga College of Nursing, Salem, in partial fulfillment of the university rules and regulations for the award of MASTERS OF SCIENCE IN NURSING degree under our guidance and supervision during the academic year 2018-2019.
Name & Signature of the
Clinical Specialty Guide : _______________________________
Name and Signature of the
Professor cum Principal : _______________________________
CERTIFICATE FOR PLAGIARISM
This is to certify this dissertation work tilted a study to assess the effectiveness of structured teaching programme on primary prevention of female infertility in terms of knowledge and self-reported practice among early adulthood girls in selected college at Salem, of the candidate Ms. Vidhya with registration number 301721202 for the award of M.Sc(N) Master Degree programme in the branch of Obstetrics and Gynaecology Nursing. I personally verified the plagiarism detector website for the purpose of plagiarism. I found that the uploaded thesis file contains from introduction to conclusion page and result shows 8% of plagiarism in the dissertation.
Guide & Supervisor with seal
ACKNOWLEDGEMENT
“Trust in the lord with all your heart, and lean not on your own understanding; in all your ways acknowledge him,
and he shall direct your paths”
First and foremost I am thankful to the God Almighty, for his abundant blessing and grace all throughout my life and for strengthening me with all the needs required for the accomplishment of this study.
I express my gratitude to our chairman, Dr. P.S. Panneerselvam, M.S, M.N.A.M.S, F.I.C.S, F.A.I.S., for allowing me to undertake the M.Sc(N), Programme and providing me with valuable guidance and support in completion of my thesis.
I extend my heartful thanks and gratitude to our correspondent Mrs. Jayalakshmi, M.A., for providing valuable support and encouragement for my study.
I take privilege to express my sincere thanks and deep sense of indeptness to Medical Director Dr. Prabushankar, M.S., M.R.C.S and Administrative Director Dr. Priyadharshini D.C.H., DNB., for the support, encouragement and providing the required facility for the successful completion of the study.
It’s my pleasure to express my heartfelt gratitude and sincere thanks to Prof. Dr. S. Annam, M.Sc(N)., Ph. D(N)., Professor cum Principal, Shanmuga College of Nursing, Salem, for her guidance, Suggestions, support and motivation which enlightened my path to complete the study successfully.
I extend my gratitude and sincere thanks to Prof. Dr. C. Kavitha, M.Sc(N)., Ph. D(N)., Vice Principal, Department of Child Health Nursing, Shanmuga College of Nursing, Salem, without whom this study would not have moulded in this shape. Her rich professional experience and efficient guidance, valuable advices, inspiration, expert guidance helped me to step cautiously in the right direction till the fraction of the study.
My heartfelt thanks to Prof. M. Jansi Rani, M.Sc(N), HOD of Obstetrics and Gynaecology Nursing for her deep involvement, rich valuable suggestions and continuous guidance given for the completion of this study. I would also like to express sincere gratitude to Prof. Selvaraj, M.Sc(N).,HOD, Department of Mental Health Nursing and class coordinator for his constant motivation, ever helping and encouraging words which helped me to complete my study successfully.
I honestly pay my sincere thanks to the entire Faculty of Shanmuga College of Nursing for their timely support and co-operation, specially I would like to thanks Mrs.Sivashankari, M.Sc(N)., Associate Professor, Department of Obstetrics and Gynaecology Nursing, for support and motivation throughout my study.
I gracefully appreciate the efforts of experts who have contributed their valuable suggestions in validating the tools and independent variable.
My sincere gratitude to Principal of Government Arts and Science College, Salem-7 and Padmavani Arts and Science College for Women, Salem for allowed to conducting data collection for their co operation and concern.
I extend my sincere thanks to study participants for their kind co operation and willingness to participate in the study.
I extend my thanks to Mr. Mani M.Sc, M.Phil, Assistant Professor, department of bio-statistic, for the valuable execution of the statistical analysis of this study and, K.Prabu, P.G Assistant in English Government Higher Secondary School, Jallypudur for English editing of the content.
My sincere thank to my dear and lovable friends Ms. Meena, Ms.Anbarasi, Mrs. Seetha and Mrs.Geethakumari for their intensive support, suggestions and valuable assistance in ways big and small. They have helped me directly and indirectly towards completion of this study.
My special thanks to the librarian of Shanmuga College of Nursing for providing me the reference activity throughout the study.
I take this opportunity to express my sincere appreciation and love to my parents Mr.Rajendran and Mrs. Vijaya without whom I could have ever reached on this position. They are the quarry of my courage and my constant motivator, whose wise words showered the seeds of confidence in me to face the obstacles during my study period. I would like to express my deepest thanks to my loving brother Mr.Vinoth. Their prayers support and encouragement was the driving force for me throughout this experience.
I take this opportunity to express my unconditional thanks to very special people of my life Mr.A. Silambarasan, and his family for their prayers, support, motivation and encouragement throughout the study.
There are still others to whom I am indebted. Words don’t seems to be enough, when I need to express my heartily thanks for their help, motivation, guidance and prayers. My sincere gratitude to all for their co operation they have showed for the completion of this study.
R.VIDHYA
RESEARCH ABSTRACT
Ms. Vidhya.R*, Prof. Dr.S.Annam** and Prof. M.Jansi Rani***.
*M.SC(N) II Year student, **Principal, ***Professor, OBG Department Shanmuga College Of Nursing, Salem at the time of doing study in October 2019.
ABSTRACT: Background: Infertility is the inability to become pregnant even after one year of unprotected sex. Primary infertility is that where a woman has not conceived even once in her life time. Infertility is becoming more and more a social issue in today’s world. Being a problem which exist from the past, its magnitude is increasing day by day. In Tamil Nadu according to statistics of 2013 approximately 3.58% of the estimated population has reported impaired fertility. The major risk factors of infertility are poor nutrition, excessive coffee intake, lack of exercise, obesity, irregular menstruation. Therefore this study is aimed to promote knowledge and practice on primary prevention of female infertility through structured teaching programme among early adulthood girls. Methodology: A quantitative evaluative research approach, quasi-experimental pre-test post-test with control group design was used. The study was conducted in government arts and science college Salem for experimental group and padmavani art and Science College for women Salem for control group. After getting permission, 100 samples were selected, 50 in each group by non-probability purposive sampling technique. The demographic variables and knowledge was assessed with structured knowledge questionnaire from sample after obtaining informed written consent. The tools used were structured questionnaire to assess the level of knowledge on primary prevention of female infertility and checklist to assess the self-reported practice. Pre-test was conducted on day 1 to assess the knowledge and self-reported practice from each group. Followed by pre-test STP on primary prevention of female infertility was administered to experimental group with 10samples in a group for about 30 minutes. Then post-test on knowledge and self- reported practice was conducted from 7th and 14th day. At last booklet was issued to all the samples in both the group for their future reference. Findings: The findings shows the mean post-test II score in knowledge and self reported practice on primary prevention of female infertility was significant at p<0.05 level. There was no significant association between the pre-test levels of knowledge on primary prevention of female infertility with their selected demographic variables Conclusion:
The study proves that structured teaching programme on primary prevention of female infertility was effective in improving the knowledge and practice among early adulthood girls.
Keywords: effectiveness, knowledge, practice, structured teaching programme on primary prevention of female infertility, early adulthood girls.
*********************************************************************
Introduction: Infertility is the inability to become pregnant even after one year of unprotected sex. Primary infertility is that where a woman has not conceived even once in her life time. Secondary infertility is one where woman has conceived at least
once irrespective of the pregnancy outcome. Infertility is becoming more and more a social issue in today’s world. Being a problem which exist from the past, its magnitude is increasing day by day. The major risk factors of infertility nutrition, excessive coffee intake, lack of exercise, obesity, irregular menstruation. Students of early adulthood group are the future parent’s. They should have a thorough knowledge regarding infertility, risk factors and the causes there by recognizing the prevention of infertility by lifestyle modified on for their better future.
Statement: A study to assess the effectiveness of structured teaching programme on Primary prevention of female infertility in terms of knowledge and self-reported practice among early adulthood girls in selected college at Salem.
Objectives: 1.To prepare and validate the information booklet on primary prevention of female infertility among early adulthood girls. 2. To assess and compare the mean pre-test and post-test knowledge score on primary prevention of female infertility among early adulthood girls within and between experimental and control group.
3.To assess and compare the mean pre-test and post-test self-reported practice score on primary prevention of female infertility among early adulthood girls within and between experimental and control group. 4. To associate the pre-test level of knowledge score on primary prevention of female infertility with selected demographic variable such as age, dietary pattern, exercise, body mass index, menstrual cycle in experimental group.
Hypotheses: (level of significant p<0.05): H1: There is a significant difference in the mean post-test knowledge score on primary prevention of female infertility among early adulthood girls in between experimental and control group.H2: There is a significant difference in the mean post-test self-reported practice score on primary prevention of female infertility among early adulthood girls in between experimental and control group.H3: There is a significant association between the pre-test level of knowledge on primary prevention of female infertility among early adulthood girls and their selected demographic variable - age , dietary pattern, exercises, body mass index, menstrual cycle.
Methodology : 1. Structured teaching programme on primary prevention of female infertility:
The structured teaching programme is a formal teaching programme which is given in 50 samples of experimental group about 30 minutes at government arts and science college Salem by lecture cum discussion with roller board, PowerPoint, booklet. It consists of general information regarding female infertility and prevention which includes diet, exercise, body mass index and relaxation. 2. Knowledge on primary prevention of female infertility: It means the awareness of early adulthood girls regarding general information and prevention of female infertility which is assessed by structured questionnaire. The score were interpreted as 75-100% adequate, 51-74%
moderate, 0-50% inadequate. 3. Self-reported practice on primary prevention of female infertility: in this study the practice refers to the self-reported practice of primary prevention of female infertility which is assessed by checklist which consists
of 20 statements. Each statement has two options (yes/no). Total score were interpreted as 75-100% as adequate practice, 50-74% as moderate practice and 0-49%
inadequate practice.
Conceptual frame work utilized in this study was Imogene’s king’s goal attainment theory,a quantitative evaluative research approach; quasi-experimental pre- test post-test with control group design was used. The study was conducted in government arts and science college Salem for experimental group and padmavani art and Science College for women Salem for control group. After getting permission 100 samples were selected, 50 in each group by non-probability purposive sampling technique. Initially the researcher got permission from concerned authority. The demographic variables and study variables were assessed through questionnaire method from each group after obtaining informed written consent. The tools used were structured questionnaire to assess the level of knowledge on primary prevention of female infertility and checklist to assess the self-reported practice. On day 1 Pre- test was conducted to assess the knowledge and self-reported practice from each group. On day 2 STP on primary prevention of female infertility was administered to experimental group at a time 10samples for about 30 minutes. Then post-test on knowledge and self-reported practice was conducted on 7th and 14th day.
Findings: Section-I: Demographic variable: In experimental group out of 50 samples, in majority, 18(36%) of them 24-25 years of age group, 29 (58%) were unmarried, 26(52%) were III year undergraduates, 23(46%) of them sedentary workers , 31(62%) were belongs to joint family , 28(56%) of them living in urban area, 20(40%) of them had family income of 10000-20000 rupees per month , 31(62%) were not having family history of female infertility, 50(100%) of them were non-vegetarian, 15(30%) of them were taking broiler chicken , 43(86%) of them preferred junk food, 19(38%) of them taking junk foods at weekly once, 35(70%) belongs to normal weight, 43(86%) of them not followed regular exercise, 30(60%) of them had regular menstrual cycle.
In control group out of 50 samples, in majority, 17(32%) of them 24-25 years of age group, 38 (76%) were unmarried, 30(60%) were III year undergraduates, 18(36%) of them heavy workers , 27(54%) were belongs to nuclear family , 25(50%) of them living in urban area, 21(42%) of them had family income of < 10000 rupees per month , 25(50%) were not having family history of female infertility, 50(100%) of them were non-vegetarian, 15(30%) of them were taking fish , 43(86%) of them preferred junk food, 17(34%) of them taking junk foods at weekly once, 35(70%) belongs to normal weight, 44(88%) of them not followed regular exercise, 28(56%) of them had regular menstrual cycle.
SECTION-II: ANALYSIS OF PRE-TEST AND POST-TEST LEVEL OF KNOWLEDGE SCORE ON PRIMARY PREVENTION OF FEMALE INFERTILITY AMONG EARLY ADULTHOOD GIRLS AMONG EXPERIMENTAL AND CONTROL GROUP
Figure-4.1: The cylindrical diagram shows the percentagewise distribution of samples based on the pre-test and post-test knowledge scores among experimental and control group on primary prevention of female infertility.
Figure-4.1 depicts during pre-test in experimental group 46(92%) samples had inadequate knowledge level, 4(8%) samples had moderate knowledge, in control group 47(94%) samples had inadequate knowledge, 3(6%) samples had moderate knowledge. During post-test -I in experimental group 50(100%) samples had moderate knowledge, in control group 46(92%) samples had inadequate knowledge, and 4 (8%) samples had moderate knowledge. After post-test I reinforcement was given to the experimental group. During post-test-II in experimental group 7(14%) samples had moderate knowledge, 43(86%) samples had adequate knowledge level, in control group 46(92%) samples had inadequate knowledge level, and 4(8%) samples had moderate knowledge.
Table 4.1: Comparison of mean pre-test and mean post-test knowledge scores among the sample within and between experimental and control group on primary prevention of female infertility.
n1-50; n2-50 Pre test Post-test 2 Paired t test
pre-test and post test 2
Mean SD Mean SD
Control group 14.6 3.55 15.34 4.25 1.56 NS
Experimental group 14.84 3.59 37.36 2.83 34.19*
Un paired t test 0.34 NS 30.47*
*significant at p< 0.05 level; NS- Not significant; Paired t49=2.00, unpaired t98=1.98
0 20 40 60 80 100
Pre test 1st post test 2nd post test
pre test 1st post test 2nd post test
46(92%) 0 0 47(94%) 46(92%) 46(92%)
4(8%) 50(100%) 7(14%) 3(6%) 4(8%) 4(8%)
0 0 43(86%) 0 0 0
Percentage of Samples
Experimental group Control group
Inadequate Moderate Adequate
LEVEL OF KNOWLEDGE SCORE ON PRIMARY PREVENTION OF FEMALE INFERTILITY
Table 4.1 shows that the mean post-test II knowledge score in control and experimental group was 15.34 and 37.36 respectively. The calculated unpaired t value was 30.47 which was higher than the table value at p<0.05 level. Hence the research hypothesis H1 was accepted and null hypothesis H0 (1) was not accepted. It showed that the structured teaching programme on primary prevention of female infertility was effective in improving the knowledge on primary prevention of female infertility.
The above findings were supported by Ms. Remya Raj (2016) who conducted on study assess the effectiveness of structured teaching programme on knowledge regarding infertility on degree students in selected colleges at Bangalore in view to develop an information booklet. The sample consisted of 60 women selected through simple random sampling technique and allotted 30 each in control and experimental group. The result revealed that estimated mean differences between intervention and control group shows that the mean post-test knowledge scores of 18.3 in experimental group and 14.2 in control group revealed that the groups’
knowledge were significant. These finding shows that the health care package was effective in increasing the knowledge among infertile women on management of infertility.
Section-III Analysis of pre-test and post-test self-reported practice scores on primary prevention of female infertility of among experimental and control group
SELF REPORTED PRACTICE SCORE ON PRIMARY PREVENTION OF FEMALE INFERTILITY
Figure -4.2: Frequency and percentage distribution of samples on self-reported practice of primary prevention of female infertility.
Figure -4.2 shows that in pre-test in experimental group 49(98%) samples had inadequate practice level, 1(2%) sample had moderate knowledge, in control group 49(98%) sample had inadequate practice, and 1 (2%) sample had moderate practice.
0 20 40 60 80 100
Pre test 1st post test
2nd post test
pre test 1st post test
2nd post test
49(98%) 13(26%) 2(4%) 49(98%) 48(96%) 48(96%)
1(2%) 18(36%) 10(20%) 1(2%) 2(4%) 2(4%)
0 9(38%) 38(76%) 0 0 0
Percentage of Samples
Experimental group Control group
Inadequate Moderate Adequate
During post-test -I in experimental group 18(36%) sample had moderate practice, 13(26%) had inadequate practice, 19(38%) had adequate practice, in control group 48(96%) samples had inadequate practice, 1(2%) samples had moderate practice.
After the post-test I reinforcement was given to the experimental group .During post- test-II in experimental group 10(20%) samples had moderate practice, 38(76%) samples had adequate practice level, 2(4%) samples had inadequate practice, in control group 48(96%) samples had inadequate practice level, and 2(4%) samples had moderate practice.
Table 4.2: Comparison of mean, SD, paired mean difference, paired “t” value of pre-test and post-test practice score on primary prevention of female infertility among samples within and between experimental and control group.
n1-50; n2-50 Group Pre test Post-test 2 Paired t test pre-
test and post test2
Mean SD Mean SD
Control group 5.98 2.17 5.9 2.21 0.197 NS Experimental group 5.84 2.21 16.9 2.77 23.67* Un paired t test 0.319 NS 21.88*
*significant at p< 0.05 level; NS- Not significant; Paired t49=2.00, unpaired t98=1.98
Table 4.2 shows that the mean post-test II self-reported practice score in control and experimental group was 5.9 and 16.9 respectively. The calculated unpaired t value was 21.88 which was higher than the table value at p<0.05 level.
Hence the research hypothesis H2 was accepted and null hypothesis H0 (2) was not accepted. It showed that the structured teaching programme on primary prevention of female infertility was effective in improving the self-reported practice on primary prevention of female infertility.
Section-IV: Chi- square association between pre-test level of knowledge on primary prevention of female infertility and age among samples in experimental group.
There is no significant association between the level knowledge and self-reported practice on primary prevention of female infertility among early adulthood girls and their selected demographic variables (age, dietary pattern, exercise, BMI) in experimental group.
Limitation: 1. Generalization of the study was limited to the samples only. 2. After post-test no teaching was given to control group. 3. Assessed the self-reported practice on primary prevention of female infertility among early adulthood girls by using self-reported checklist only.
Conclusion: The present study findings and reviews were indicated that structured teaching programme on primary prevention of female infertility is more effective among early adulthood girls in order to improve their knowledge regarding prevention of female infertility. It also helps to improve their practices which promote healthy lifestyle and reducing the incidence of female infertility among early adulthood girls.
References:
1) D.C.Dutta. D.C Dutta,( 2001.) “Text book of Gynaecology, 5th edition, Calcutta, New Central Agency (p), Publications.
2) Kelly-Weeder S, & O'Connor A (2006) ; Modifiable risk factors for impaired
fertility in women: what nurse practitioners need to know; Journal of American Academy of Nurse Practioner.
3) Ms. Remya Raj (2016) “A study to assess the effectiveness of structured teaching programme on knowledge regarding infertility on degree students in selected colleges at Bangalore in view to develop an information booklet” Unpublished thesis.
4) Gretchen Garbe Collins and Brooke V. Rossi (2015). The impact of lifestyle modifications, diet, and vitamin supplementation on natural fertility abstract retrieved from pubmed.
INDEX CHAPTER
NO CONTENTS PAGE
NO
I INTRODUCTION 1-15
1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9
Need for the study
Statement of the problem Objectives
Hypotheses
Operational definitions Assumptions
Delimitations
Ethical considerations
Conceptual frame work based on modified Imogene’s king’s goal attainment Theory
Summary
4 6 6 7 7 9 9 10 10 15
II REVIEW OF LITERATURE 16-23
2.1 2.2 2.3 2.4 2.5
Studies related to prevalence of infertility among women
Studies related to prevention of infertility among women.
Studies related to knowledge of risk factors assessment on Infertility in early adulthood.
Studies related to self-reported practice assessment on Infertility in early adulthood.
Studies related to modified Imogene’s king’s goal attainment Theory.
Summary
16 18 19 21 23 23
III RESEARCH METHODOLOGY 25-35 3.1
3.2 3.3 3.4 3.5 3.6 3.6.1 3.6.2 3.7 3.8 3.9 3.10
Research approach Research design Variables under study Setting of the study Population
Sample
Criteria for sample size
Sampling technique and sample size
Development, interpretation, validity and reliability of tool
Pilot study
Data collection procedure Plan for data analysis Summary
25 25 26 27 28 28 29 29 29 32 33 34 35 IV DATA ANALYSIS AND INTERPRETATION 36-58 4.1
4.1.1 4.1.2
4.1.3
Presentation of data
Description of demographic variables of the sample Analysis and comparison of pre test and post test knowledge score on primary prevention of female infertility among samples
Analysis and comparison of pre test and post test self reported practice score on primary prevention of female infertility among samples
36 38 44
48
4.1.4 Association of selected demographic variables with pre test level of knowledge on primary prevention of female infertility among experimental group Summary
51
58
V DISCUSSION 59-64
VI
V
SUMMARY, MAJOR FINDINGS,
IMPLICATION, RECOMMENDATIONS AND CONCLUSION
65-76
REFERENCES 77-81
ANNEXURES i - xcv
LIST OF TABLES
TABLE
NO TITLE PAGE
NO 4.1
Frequency and percentage distribution of
demographic variables of samples 38
4.2
Comparison of mean pre-test and mean post-test knowledge scores among the sample within and between experimental and control group on primary prevention of female infertility.
46
4.3
Comparison of mean pre-test and mean post-test self-reported practice on primary prevention of female infertility among sample within and between experimental and control group
50
4.4
Chi-square association between pre-test level of knowledge on primary prevention of female infertility and their age among samples in experimental group
53
4.5
Chi-square association between pre-test levels of knowledge of primary prevention of female infertility and their dietary pattern among the samples of experimental group.
54
4.6
Chi-square association between pre-test levels of knowledge of primary prevention of female infertility and their exercise among the samples of experimental group.
55
4.7
Chi-square association between pre-test levels of knowledge of primary prevention of female infertility and their BMI among the samples of experimental group.
56
4.8
Chi- square association between pre-test levels of knowledge of primary prevention of female infertility and their menstrual cycle among the samples of experimental group.
57
LIST OF FIGURES
FIGURE
NO TITLE PAGE NO
1.1 Conceptual framework based on Imogene’s
king’s goal attainment model 14
3.1 Schematic representation of the research
design 24
4.1
Analysis of pre-test and post-test level of knowledge score on primary prevention of female infertility among early adulthood girls among experimental and control group.
45
4.2
Analysis of pre-test and post-test self- reported practice scores on primary prevention of female infertility of among experimental and control group.
48
LIST OF ANNEXURES
ANNEXURE
NO TITLE PAGE
NO I Letter seeking permission to conduct
research study i
II Letter seeking experts opinion for content
validity of the tool and independent variable iii III List of experts validating the tool and
independent variable iv
IV Evaluation criteria for content validity of the
tools and independent variable v
V Percentage of agree / disagree (validation of
tools) xxvii
VI Content validity certificate xlviii
VII Final tool xlix
VIII Independent variable- structured teaching
programme lxv
IX Plagarism Report xciii
X English editing xciv
XI Consent form ( English) xcv
1
CHAPTER – I INTRODUCTION
“An ounce of prevention is worth a pound of cure”
(Benjamin Franklin) Women‟s health involves women‟s physical, emotional, social, cultural, political, economic, and spiritual wellbeing. Every women should be provided with the opportunity to achieve, sustain, and maintain health, as defined by that women herself to her full potential. The determents of women‟s health begin even before birth, their effects accumulating from one age and stage of development to the next women bears the greatest biological burden of reproductive health problems, gender compounds the burden of disease at all stages of life span.
(World health organization)
Reproduction is the gift of God to all living creations. God created this world for all his living creations to reproduce and fill and flourish it.
Each human, on his birth is gifted a life. And each new day is added to his life not only to live but to bring out offspring‟s of him and double the happiness of him. Reproduction is that process where a living organism with the union of another of its own kind produces a new young one.
Fertility, according to the Longman Dictionary of Contemporary English, refers to the condition or state of being fertile, that is being able to produce many young, fruits or seeds. (Reproductive health journal)
Fertility plays a vital role in a woman‟s life. In our tradition fertility is the most important part of marital life. The feeling of being conceived is wonderful, and the mother is bound with joy on the first kick of her child in utero. Loss of this precious aspect, indeed results in stress.
2
With so much of technological advancements and other newer inventions in the field of science, reproduction is still a dream to many women.
Infertility is the name of this name of this dream. (Moultrie TA)
Infertility is the inability to become pregnant even after one year of unprotected sex. Both men and women contribute to this threat. It is broadly classified into two types, Primary infertility and secondary infertility. Primary infertility is that where a woman has not conceived even once in her life time. Secondary infertility is one where woman has conceived at least once irrespective of the pregnancy outcome. Infertility is a global health issue. It is not a newly emerging issue; it has its crux from the olden days. It is a pre – existing problem and a threat to the social integration of Families. (D.C.Dutta, 2008)
Infertility is becoming more and more a social issue in today‟s world. Being a problem which exist from the past, its magnitude is increasing day by day. The impact of this problem contributes a lot to the disharmony among young couples
The worldwide over all prevalence of primary infertility is developed countries in 3.5-16.7 and in developing countries is 6.9 -9.3.
World Fertility Survey and others estimated rates of infertility in South Asia, such as 4% in Bangladesh, 6% in Nepal, 5% in Pakistan and 4% in Sri Lanka. One estimate of overall primary and secondary .infertility in South Asia, on the basis of women at the end of their reproductive lives in the age group 45-49 years, suggests an infertility rate of approximately 8% in India, 10% in Pakistan, 11% in Sri Lanka, 12% in Nepal and 15%
in Bangladesh. (Perry.E.Shannon)
India is a country with a billion plus population, and every minute a child is born. It stands second next to China in population. But, statistics shows that childlessness is around 2.5% in India. In India the prevalence
3
of primary infertility is 3.9-16.8. A child is born a minute, but either to a same family or to a family where already there are extra pols. Even with population explosion now, on the long run there may be families who do not have off springs, to carry their genes and names. And of course it is a social issue in our culture. Even the small family norms have stated “we two ours one “stressing at least one for a family.
(Singh S, Badaya s. 2012)In Tamil Nadu according to statistics of 2013 approximately 3.58% of the estimated population has reported impaired fertility. (S Shamila 2014 )
Infertility is not merely a health problem; it is also a matter of social injustice and inequality. Present day lifestyle, food habits, environmental exposures to toxins along with hereditary predisposition for metabolic syndrome like obesity, hyperlipidaemia, diabetes and hypertension and stress has contributes to common problem faced by today female population. Today every problem has a solution or at least prevention. Early detection or at least prevention of its modifiable factors can contribute to some degree to the reduction of this infertility.
Early adulthood girls have lack of knowledge and negative lifestyle practice towards risk factors of female infertility. The researcher has a pivotal role in creating awareness among adolescent girls about risk factors of female infertility and lifestyle modification. Hence the researcher felt that structured teaching programme package was an effective teaching strategy to impart knowledge and self-reported practice among early adulthood girls regarding primary prevention of female infertility.
4
1.1 NEED FOR THE STUDY
Offspring are very important to all young couples. Their future depends on children. Family plays an important role in the experiences of the infertile couple. Economic consequences are a particular distressing factor. There is a need for psychological counselling in the treatment of infertile couples in which every part of the world they reside. It should be realized that in developing countries, despite overpopulation, unwanted childlessness is an important social and economic burden that needs attention. (Mandal, 2014)
The experienced social sufferings of women due to childlessness are difficulties in concerning integration into the family-in-law and their powerless status in the community without children. Health of the future citizens depends on the care given to them. Today between 1000 couples more than six couples face difficulties in conceiving. The major risk factors of infertility are poor dietary pattern, lack of excessive, coffee intake, exercise, obesity. This affect the early adulthood generation and later leads to infertility. By Promoting a good life style can reduce the incidence of infertility. (Subhash B Thakre et.al. 2014)
Mahoney D conducted a study with prospective quantitative designs on Infertile overweight and obese women with polycystic ovary syndrome at an infertility practice com Lifestyle modification intervention among infertile overweight and obese women. Tools were used by pelted questionnaires to assess diet and exercise practices. Body mass index and weight measurements were obtained on participants at study onset and completion of intervention. Menstrual history was assessed by interview. The result shows that a mean weight loss (p = .005) of 7(±5) pounds although a 5% weight reduction did not occur.
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Mean daily calorie (p = .005), fat (p = .006), and carbohydrate intake (p= .014) were significantly reduced. Frequency in brisk walking exercise significantly increased (p = .024). Menstrual cyclist improved by 50%
among prior amenorrhea. An evidence-based lifestyle modification guideline could prove to be a cost effective intervention for infertile women with who desire pregnancy.
Esmaeilzadeh S, Delavar MA etal (2014) a retrospective epidemiologic study was conducted characteristics of urban and rural women related to infertility to determine the prevalence to infertility and self-reported cause of infertility and identify the factors associated with infertility. A total of 1,140 women aged 20-45 years were selected using cluster sampling. Of these 1,140 women, 59 (5.2%) (CI 4.2, 6.2) were voluntarily childless. remaining 1,081 women, 913 (84.5%) (CI 82.5, 86.5) reported no difficulties in having children, and the remaining 168 (15.5%) (CI 13.5, 17.5) experienced difficulty conceiving at some stage in their lives. The prevalence of ever having primary infertility was 4.3%
(CI 2.3, 6.3). The most frequently self-reported causes of infertility in this study were ovulation problems (39.2%). Infertile women were significantly more likely to have a higher age at marriage, lower education ,higher body mass index long-term health problems , a partner who smoked , and past history of tubal or ectopic pregnancy. These risk factors may help inform reproductive health clinics and primary healthcare centres about factors associated with infertility.
Nurse being one of the key members of the health team, play an important role in creating awareness on prevention of infertility. The researchers felt that, the study is very significant; since increase in prevalence rate of infertility is more. By assessing the knowledge, the researchers can help the early adulthood to reduce the rate of infertility in future.
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Degree students are early adulthood group and the future parent‟s.
They should have a thorough knowledge regarding infertility the risk factors and the causes there by recognizing the prevention of female infertility by lifestyle modification for their better future. If they are aware of infertility they can avoid infertility in future and can bring their off springs.
1.2 STATEMENT OF PROBLEM
A study to assess the effectiveness of structured teaching programme on Primary prevention of female infertility in terms of knowledge and self-reported practice among early adulthood girls in selected college at Salem.
1.3 OBJECTIVES
1. To prepare and validate the information booklet on primary prevention of female infertility among early adulthood girls.
2. To assess and compare the mean pre-test and post-test knowledge score on primary prevention of female infertility among early adulthood girls within and between experimental and control group.
3. To assess and compare the mean pre-test and post-test self- reported practice score on primary prevention of female infertility among early adulthood girls within and between experimental and control group.
4. To associate the pre-test level of knowledge score on primary prevention of female infertility with selected demographic variable such as age, dietary pattern, exercise, body mass index, menstrual cycle, in experimental group.
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1.4 HYPOTHESES: Level of significant at P<0.05
H1: There is a significant difference between the mean post-test knowledge score on primary prevention of female infertility among early adulthood girls between experimental and control group.
H2: There is a significant difference between the mean post-test practice score on primary prevention of female infertility among early adulthood girls between experimental and control group.
H3: There is a significant association between the pre-test level of knowledge on primary prevention of female infertility and the selected demographic variable in experimental group.H3 (a): between experimental group and their age.H3 (b): between experimental group and their dietary pattern .H3(c) between experimental group and their exercise.
H3 (d): between experimental group and their body mass index .H3 (e)
between experimental group and their menstruation.
1.5 OPERATIONAL DEFINITIONS 1.5.1 Effectiveness
It refers to the improvement in early adulthood knowledge and self- reported Practice on primary prevention of female infertility. It mainly refers to before and after administration of structured teaching programme on primary prevention of female infertility. The knowledge is assessed by structured questionnaire and self-reported practice with the help of checklist.
a). Knowledge on primary preventions of female infertility:
It is the state of knowing, understanding, and acquiring information on primary prevention of female infertility. It was measured
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by structured knowledge questionnaire on primary prevention of female infertility. It contains multiple choice questions and each correct answer carries 1 mark. The total score were converted into percentage and interpreted as follow 75-100% adequate knowledge, 51-74% moderate knowledge and 0-50% inadequate knowledge.
b). Self-reported Practice on primary prevention of female infertility:
Self-reported practice is the individual‟s own report about their activities related to specific area. In this study it was assessed by self- reported practice on primary prevention of female infertility among early adulthood girls which was collected by researcher by using checklist. Each statement has two options, yes or No and each correct options carries 1 score. The total score was converted in to percentage and interpreted as fallows 75-100% adequate practice, 51-74%
moderately practice, 0-50% inadequate practice.
1.5.2 Structured teaching programme on primary prevention of infertility:
It is prepared to assess the effectiveness of structured teaching programme on knowledge and practice on primary prevention of female infertility and its helps to create awareness on prevention of female infertility. The structured teaching programme was planned for 30 minutes about its meaning, definition, risk factors, signs and symptoms and prevention of female infertility. Teaching was given by lecture cum discussion with roller board and PowerPoint followed by clarification of doubts. On 14th day after the post-test assessment the booklet was distributed to all the samples for their future reference.
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1.5.3. EARLY ADULTHOOD
It refers to early adulthood girls who are in between the age of 20 to 26 years. It includes unmarried and married women not having children in final year under graduate and post graduate course.
1.5.4. PRIMARY PREVENTION OF FEMALE INFERTILITY It refers to the measures taken to prevent female infertility among early adulthood girls and refers to the act or intervention to the onset of the female infertility. The measures are diet, exercise, relaxation, maintaining ideal body weight.
1.6 ASSUMPTIONS
1. Most of the early adulthood girls are having inadequate knowledge and interested to know about the primary prevention of female infertility.
2. Structured teaching programme may be an effective tool for creating awareness on knowledge and practice on primary prevention of female infertility.
3. By teaching about primary prevention of female infertility, the adulthood girls knowledge and certain lifestyle practice may be modified to prevent female infertility.
1.7. DELIMITATIONS
1. Study is delimited to 100 samples.
2. Data collection period is delimited to six weeks.
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1.8. ETHICAL CONSIDERATIONS
1. Written permission was obtained from human ethical committee of Shanmuga Institute of Medical Science, Salem.
2. Written permission was obtained from the Principal of Government Arts and Science College and Padmavani Arts and Science College for Women.
3. Informed written consent was obtained from the samples who are enrolled in the study.
4. All information was kept confidential and used only for the present study.
1.9. Conceptual Framework based on modified Imogene’s King’s goal attainment theory
Conceptual frame work is group of concept and set of proposition that spells out the relationship between them. Conceptual frame work place several interrelated roles in the progress of science. The overall purpose is to make findings meaningful and generalizable. Conceptual frame work facilitates communication and provides a systemic approach to nursing research, education, administration, and practice. The conceptual frame work selected for this study is based on Imogene‟s King‟s goal attainment model. The theory focuses on interpersonal systems and reflects king‟s belief related to the practice of nursing and is differentiated from that of other health professional by wants nurses to do with and for the individual. The major elements in the theory of goal attainment theory are seen in the interpersonal systems in which two people who are usually strangers, come together in a health care organization for help and be helped to maintain a state of health that permits functioning in roles.
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King‟s goal attainment theory is relevant for the present study to evaluate the effectiveness of structured teaching programme on primary prevention of female infertility in terms of knowledge and self-reported practice among early adulthood girls in selected college at Salem. The concepts of the theory are perception, action, and interaction. These concepts are interrelated in every nursing situation. These terms are deigned as concepts in the conceptual frame work.
The main concepts of Imogene‟s king's open system are:
Communication:
According to king, communication is the process whereby information is given when from one person to other either directly or indirectly or in the written world. In this study it refers to the communication between researcher and the sample.
Perception:
It is each person‟s representation of reality. It is a process in which data obtained through the sense and from memory are organized interpreted and transpired. In this study, the interacting persons are researcher and the samples. Researcher identifies that samples have lack of knowledge and practice on primary prevention of female infertility.
Judgement:
Researcher decides that teaching about primary prevention of female infertility to unmarried and married who are not having children.
The samples can identify the sources to gain the knowledge and the practice on primary prevention of female infertility.
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Action:
It refers to the activity to achieve goal what the individual perceives. In this study it is mutual goal setting to prevent female infertility .Researcher prepares the structured teaching programme on primary prevention of female infertility. Samples show willingness to participate in the study.
Mutual goal setting:
It is a process that leads to goal attainment. It is a dynamic and systematic process by which goal directed choice of perceived alternatives is made and acted upon by samples to answer a question and attain the goal. In this study, the researcher willing to educate samples regarding primary prevention of female infertility. Samples participate in the teaching learning programme with regard to primary prevention of female infertility.
Reaction:
Reaction is the individual plan together and moves towards goal attainment. In reaction the researcher collects demographic variables and performs pre-test to assess the level of knowledge on primary prevention of female infertility among early adulthood girls.
Interaction:
It refers to the perception and communication between a person and the environment or between two are more persons. In this study the investigator administers structured teaching programme on primary prevention of female infertility. Researcher does follow up on 7th and 14th days to ensure the knowledge improvement. Sample responds to structured teaching programme and participated well.
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Transaction:
It is the process in which, human beings communicate with the environment in order to achieve the goal directed by human behavior. In this stage the researcher plans to assess the effectiveness of structured teaching programme on primary prevention of female infertility among samples. The effectiveness was identified by conducting post-test through which the improvement of knowledge and self-reported practice and also the comparison was done with the pretest scores.
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Reassessment (not included in this study)
FICTURE-1 CONCEPTUAL FRAME WORK BASED ON MODIFIED IMOGENES KINGS GOAL ATTAINMENT THERORY (1997) APPLIED ON PRIMARY PREVENTION OF FEMALE INFERTILITY IN TERMS OF KNOWLEDGE AND SELF REPORTED PRACTICE AMONG EARLY ADULTHOOD GIRLS..
R E S E A R C H E R
S A M P L E S
PERCEPTION: The early adulthood girls has less knowledge and practice about primary prevention of female infertility.
JUDGMENT: Need to create
awareness about primary prevention of female infertility.
ACTION:preparing structured teaching programme on primary prevention of female infertility.
ACTION: shows willingness to participate in the study.
JUDGEMENT: need to improve the knowledge and practice of early adulthood girls on primary
prevention of infertility.
PERCEPTION: Need to improve knowledge and practice on primary prevention of female infertility.
Researcher The researcher
recognizes and plans to do STP about primary prevention of female infertility.
Samples:
Willing to participate in structured teaching programme on
primary prevention of female infertility.
Pre test:
1. Collection of demographic variables.
2. Assess the knowledge on primary prevention of female infertility with structured knowledge questionnaire.
3. Assess the
practice on primary prevention of female infertility with checklist.
Intervention:
Providing structured teaching programme on
primary prevention of female infertility.
Post test 1.Reassess the knowledge level on primary prevention of female infertility.
2.Reassess the practice towards the primary prevention of female infertility.
Goal attained Adequate and moderate level of knowledge and practice about primary prevention of female infertility.
MUTUAL GOAL SETTING
REACTION INTERACTION TRANSACTION
Goal not attained Adequate and moderate level of knowledge and practice about
primary prevention of female infertility.
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SUMMARY
This chapter dealt with introduction about the primary preventions of female infertility among early adulthood, need for the study, statement of the problem, objectives of the study, hypotheses, operational definitions, assumptions, ethical consideration, delimitation and conceptual framework.
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CHAPTER II
REVIEW OF LITERATURE
Good research does not exist in vacuum. Research finding should be an extension of previous knowledge and theory as well as guide for future research activity. In order to build an existing work, it is essential to understand what is already known about a topic. A thorough review of literature provides a foundation upon which to raise new knowledge.
The reviews of literature are arranged under following headings:-
Section 2. 1: Studies related to prevalence of infertility among women.
Section 2. 2: Studies related to prevention of infertility among women.
Section 2.3: Studies related to knowledge of risk factors assessment on Infertility in early adulthood.
Section 2.4: Studies related to self-reported practice assessment on Infertility in early adulthood.
Section 2.5: Studies related to modified Imogene‟s king‟s goal attainment Theory.
Section 2.1: studies related to prevalence of infertility among women Paul C. Adamson, Karl Krupp etal (2013) conducted a study on Prevalence& correlates of primary infertility among young women in Mysore, India. The baseline data were collected between among 897 sexually active women, aged 15-30 years. in these samples personnel interviewed participants using standardized questionnaires and data regarding socio-demographics, behavioral and reproductive health characteristics were collected. Logistic regression was used to examine factors associated with primary infertility. The results revealed that mean age of the women was 25.9 years (range: 16-30 years) and the prevalence
