A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME ON AWARENESS AND ATTITUDE REGARDING EARLY IDENTIFICATION
AND MANAGEMENT OF POLYCYSTIC OVARIAN SYNDROME AMONG ADOLESCENT GIRLS IN
SELECTED COLLEGES AT MADURAI
BY A.AARTHI
A dissertation submitted to the
Tamil Nadu Dr. M. G. R. Medical University, Chennai.
In partial fulfillment of the requirements for the degree of Master of Science in Obstetrics and Gynecological Nursing
UNDER THE GUIDANCE OF
Prof. Dr. MERLIN JEYAPAL., M.Sc (N).,Ph.D., Professor cum Vice Principal,
C.S.I. Jeyaraj Annapackiam College of Nursing and Allied Health Sciences,
Madurai-4 OCTOBER-2019
CERTIFICATE
This is to certify that the dissertation entitled “A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME ON AWARENESS AND ATTITUDE REGARDING EARLY IDENTIFICATION AND MANAGEMENT OF POLYCYSTIC OVARIAN SYNDROME AMONG ADOLESCENT GIRLS IN SELECTED COLLEGES AT MADURAI” is a bonafide work done by AARTHI.A, C.S.I. Jeyaraj Annapackiam College of Nursing, Madurai, submitted in partial fulfillment for the degree of Master of Science in Nursing.
Signature of the Principal
Prof. Dr. C. JOTHI SOPHIA, M.Sc (N)., Ph.D.,
College Seal
A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME ON AWARENESS AND ATTITUDE REGARDING EARLY IDENTIFICATION
AND MANAGEMENT OF POLYCYSTIC OVARIAN SYNDROME AMONG ADOLESCENT GIRLS IN
SELECTED COLLEGES AT MADURAI
Approved by the dissertation committee on
RESEARCH CO-ORDINATOR
Prof. Dr. C. JOTHI SOPHIA, M.Sc (N),Ph.D., Professor cum Principal,
C.S.I. Jeyaraj Annapackiam College of Nursing, Madurai-625004.
RESEARCH GUIDE
Prof. Dr. MERLIN JEYAPAL, M.Sc (N), Ph.D., Professor cum Vice Principal,
C.S.I. Jeyaraj Annapackiam College of Nursing, Madurai-625004.
MEDICAL GUIDE
Dr. VIMALA, M.B.B.S., D.G.O., Obstetrician and Gynecologist, City Hospital,
Madurai-625004.
A dissertation submitted to
The Tamil Nadu Dr. M. G. R. Medical University, Chennai.
In partial fulfillment of the requirements for the degree of Master of Science in Nursing
October-2019
CERTIFICATE OF THE EXAMINERS
This is to certify that the dissertation entitled “A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME ON AWARENESS AND ATTITUDE REGARDING EARLY IDENTIFICATION AND MANAGEMENT OF POLYCYSTIC OVARIAN SYNDROME AMONG ADOLESCENT GIRLS IN SELECTED COLLEGES AT MADURAI” is a bonafide work done by AARTHI.A, C.S.I. Jeyaraj Annapackiam College of Nursing, Madurai, submitted in partial fulfillment for the degree of Master of Science in Nursingfrom the Tamil Nadu Dr. M. G. R. Medical University, Chennai.
SIGNATURE OF THE EXAMINERS
:
1. External: 2. Internal:
Date: Date:
ACKNOWLEDGEMENT
“For Iknowthe plans I have for you…
Plans to prosper you and not to harm you, Plans to give you hope and a future”.
(Jeremiah 29:11)
I thank God Almighty for his abundant blessings, guidance, wisdom, courage, and strength, which helped me to complete the study successfully.
Some people grumble that roses have thorns; I am greatful that thorns have roses. There were many guiding and supporting hands in this journey, which made it easier. With immense joy and gratitude, I take this opportunity to acknowledge them.
I would like to express my respectful gratitude and hearty thanks to my research co-ordinator Prof. Dr. C. Jothi Sophia, M.Sc.(N),Ph.D., Principal, C.S.I. Jeyaraj Annapackiam College of Nursing, for her constructive guidance, inspiration, and motivational efforts which contributed towards the successful completion of this dissertation.
I extend my at most heartfelt thanks and gratitude to Prof. Dr. Merlin Jeyapal, M.Sc.(N)., Ph.D., Professor Cum Vice Principal, my guide, C.S.I. Jeyaraj Annapackiam College of Nursing, for her expertise guidance, prompt suggestions, encouragement, keen interest, constructive criticism and constant encouragement which made this study fruitful and successful. I consider it as my highest degree of privilege to have completed this study under her guidance and I owe her my deepest sense of gratitude.
I extend my sincere thanks to medical guide Dr. Vimala, M.B.B.S., D.G.O., City Hospital, for her valuable suggestions for this study inspite of her busy schedule.
It is my pleasure and privilege to express my deep sense of gratitude to Prof. Dr. K. Pricilla, M.Sc.(N), Ph.D., Medical and Surgical Nursing department, for
her prayer, guidance, motivation, support and valuable effort to complete this study. It
is very essential to mention that her wisdom and helping nature has made my research a lively and everlasting one.
It is my pleasure and privilege to express my deep seated gratitude and genuine thanks to our class coordinators Prof. Dr. Y. John Sam Arun Prabhu,
M.Sc.(N), Ph.D., Professor, Head of Community Health Nursing department and Mrs.P.Jeyajothi, M.Sc (N)., Assistant Professor, Medical and Surgical Nursing
department for their support to ensure the best quality of this piece of work. Their valuable suggestions, encouragement, timely and inspiring words will never be forgetten.
I would like to extend my heartful gratitude to Mrs.K.Amutha, M.Sc.(N), Lecturer, Faculty of Obstetric and Gynecological Nursing department for all the support and encouragement given to me throughout the study.
I owe my profound gratitude and sincere thanks to Prof. Dr. M. Davamani Christober Principal, American College at Madurai, for giving permission, support and suggestion to conduct my research study.
I owe my greatfulness to the panel of experts who validated my tool effectively.
My sincere thanks to Mr. Manivelusamy, M.Sc., M.Phil., for his excellent guidance in statistical analysis for this study.
I greatful to Mrs. Angelin Mannova, Librarian, C.S.I. Jeyaraj Annapackiam College of Nursing, Library faculty of CMC Vellore and Dr M.G.R. University for extending their support in collecting the literature for this study.
I wish to express my thanks to Mrs. Mercy Mary Arulmani. M.A, DCA., computer department staff.
I wish to express my heartful thanks to the study participants who extend their willingness during data collection without whom, this study would not be made possible.
I extend my sincere thanks to all the teaching and non-teaching faculty of C.S.I.
Jeyaraj Annapackiam College of Nursing.
I pay my gratitude to my charming friends Ms. Jemimah Ranjitha, Ms. Narmadha, Ms. Wincilin, Ms. Maglin Anusha, Ms. Evangelin and Mr. Jose Paul Rader who motivated and supported me to bring this work reality.
I am fascinated to express my affectionate thanks to my beloved mother Mrs. Jeyanthi, father Mr. Ananthan, mother-in-law Mrs. Parimala, father-in-law Mr. Ilangovan without whom it would have been impossible to complete this study and special love to my kind hearted husband Mr. Selvakumar for his passionate love and blessings. I feel my deep sence of gratitude and thanks to my cherished brother Mr. Dhivin, my beloved sister Ms. Madhi for upholding me through prayer, their love, care and devotion at every moment to accomplish the task very successfully.
Last but not least, I extend my thanks to all those who have directly or indirectly supported the study at various levels not mentioned here.
ABSTRACT
A study to assess the effectiveness of video assisted teaching programme on
awareness and attitude regarding early identification and management of polycystic ovarian syndrome among adolescent girls in selected colleges at Madurai for partial fulfillment of the requirements for the degree of Master of Science in Nursing to the Tamil Nadu Dr. M.G.R. Medical University, Chennai during the year 2019.
Background of the study:
Poly Cystic Ovarian Syndrome is the most common endocrine disorder in women of reproductive age. The disease affecting as many as 7 to 10 out of 100 women of child bearing age (15-45 years).
The objectives of the study are:
1. To assess the level of awareness regarding early identification and management of polycystic ovarian syndrome in experimental and control group.
2. To evaluate the effectiveness of the video assisted teaching programme on awareness and attitude regarding early identification and management of polycystic ovarian syndrome in experimental group.
3. To find out the association between the pretest level of awareness and attitude regarding polycystic ovarian syndrome with their selected demographic variable in experimental and control group.
The hypothesis of the study are:
H1: The mean post test level of awareness and attitude is significantly higher than the mean pretest level of awareness and attitude in experimental group.
H2: The mean post test level of awareness and attitude in experimental group is significantly higher than the mean post test level of awareness and attitude in control group.
H3: There is a significant association between pretest level of awareness and attitude regarding polycystic ovarian syndrome with their selected demographic variable in experimental and control group.
Methods:
Quasi- experimental pretest-posttest control group design was used to collect the data. A total of 60 students in American college at Madurai were selected as control group (n=30) and experimental group (n=30) through non-probability convenience sampling technique. Structured questionnaire and modified attitude scale regarding early identification and management of PCOS were used as the tool. Video teaching was telecasted to the experimental group. After seven days, posttest was done by using structured questionnaire and modified attitude scale.
Results:
The obtained data was analyzed by using descriptive and inferential statistics.
• In control group, pretest mean score of awareness was 11.43 ±3.07 the posttest mean score was 12.27±SD 2.65, the mean difference was 0.84. The obtained “t”
value was 1.85, which was not statistically significant.
• In experimental group, pretest mean score of awareness was 11.70 ±2.48 the posttest mean score was 21.03±SD 1.42, the mean difference was 9.33. The obtained “t” value was 29.90, which was statistically highly significant at p<0.001***level.
• In control group posttest mean score of awareness was 12.26±2.65. In experimental group posttest mean score was 21.03±1.42, the mean difference was 8.77. The obtained “t” value was 15.95, which was statistically highly significant at p<0.001***level.
• In control group, pretest mean score of attitude was 52.00 ±5.87 the posttest mean score was 53.27±SD 5.48, the mean difference was 1.26. The obtained “t” value was 1.92, which was not statistically significant.
• In experimental group, pretest mean score of attitude was 52.83±6.93 the posttest mean score was 73.77±SD 4.94, the mean difference was 20.93. The obtained “t”
value was 15.35 which was statistically highly significant at p<0.001***level.
• In control group posttest mean score of attitude was 53.27±5.48. In experimental group posttest mean score was 73.77±4.94, the mean difference was 20.50. The obtained “t” value was 15.20, which was statistically highly significant at p<0.001***level.
The present study findings concluded that, video teaching is effective by improving the awareness and attitude among adolescent girls.
Recommendation:
1. A prevalence study can be conducted among the college students on a large scale.
2. The same study can be done with one group pre test posttest design.
3. A similar study can be replicated on large sample to generalize the findings.
4. A comparative study can be carried out among the adolescent girls in rural and urban areas.
INDEX
Chapter No Contents Page No
I INTRODUCTION
Background of the study 1
Need for the study 8
Statement of the problem 17
Objectives 17
Hypothesis 17
Operational definitions 18
Assumptions 19
Delimitations 19
Projected outcomes 19
II REVIEW OF LITERATURE
Literature related to prevalence of Polycystic ovarian syndrome 20
Literature related to awareness and attitude regarding 27 polycystic ovarian syndrome
Literature related to effectiveness of video teaching on early 31 identification and management of PCOS
III RESEARCH METHODOLOGY
Research approach 38
Research design 39
Setting of the study 39
Variables 40
Population 41
Sample 41
Sample size 42
Sampling technique 42
Sampling criteria 42 Development of the tool 43 Description of the tool 43
Scoring procedure 44
Validity and reliability of the tool 45
Pilot study 45
Data collection method 46 Plan for Data collection 47
Plan for data analysis 48
Ethical consideration 48
IV DATA ANALYSIS AND INTERPRETATION 50
V DISCUSSION 77
VI SUMMARY, CONCLUSION AND RECOMMENDATION
Summary 87
Major findings of the study 89
Conclusion 94
Implications 94
Limitations 96
Recommendation 97
REFERENCES 98
APPENDICES
LIST OF TABLES
Table .no Title Page.no
1. A. 1 Frequency and percentage wise distribution of samples
based on their demographic variables.
52
2. B. 1 Distribution of samples based on level of awareness in control and experimental group.
56
2. B. 2 Distribution of samples based on level of attitude in control group and experimental group.
59
3. C. 1 Comparison of pre and post test mean score of awareness in control group.
61
3. C. 2 Comparison of pre and post test mean score of awareness in experimental group.
62
3. C. 3 Comparison of posttest mean score of awareness between the control and experimental group.
63
3. C. 4 Comparison of pre and post test mean score of attitude in control group.
65
3. C. 5 Comparison of pre and post test mean score of attitude in experimental group.
66
3. C. 6 Comparison of posttest mean score of attitude between the control and experimental group.
67
4. D. 1 Association between pretest level of awareness in experimental group with their selected demographic variables.
69
4. D. 2 Association between pretest level of awareness in control group with their selected demographic variables.
71
4. D. 3 Association between pretest level of attitude in experimental group with their selected demographic variables.
73
4. D. 4 Association between pretest level of attitude in control group with their selected demographic variables.
75
LIST OF FIGURES
Figure
No Title Page
No
1 Conceptual frame work 37
2 Schematic representation of research design 49
3 Distribution of samples based on the level of awareness in control and experimental group.
58
4 Distribution of samples based on the level of attitude in control and experimental group.
60
5 Comparison of posttest mean score of awareness between the experimental and control group.
64
6 Comparison of posttest mean score of attitude between the control and experimental group.
68
LIST OF APPENDICES
Appendix No Title
I Letter seeking permission for content validity II Certificate for content validity
III Letter seeking permission for conducting pilot study IV Letter seeking permission for conducting research study
V List of experts for content validity of the tool VI English editing certificate
VII Tamil editing certificate VIII Plagiarism certificate
IX Tool
Structured questionnaire on awareness of early identification and management of PCOS
Modified attitude scale regarding early identification and management of PCOS
X Structured teaching program on PCOS XI Photo gallery
CHAPTER - I
INTRODUCTION
1
CHAPTER-I INTRODUCTION
“Adolescent is a new birth, for the higher and more completely human traits are now born”
- G. Stanley Hall BACKGROUND OF THE STUDY
Life shrinks or expands in proportion to one’s courage. The best protection of any women can have is courage, because she has the power to create, and manifest the glory of God, though she posses within herself, which is expressed through when she becomes a mother. Becoming a mother is a natural phenomenon for the woman, sometimes it is blocked by physical and psychological problem. Naturally each female child is born with the capability of giving birth and she is physically prepared at puberty. Normally she attains puberty during her adolescence.
Adolescence is a period of transition from childhood to adulthood, a time of physiological, psychological, social and emotional adaptation. Adolescence is one of the most fascinating and complex transition in the life span: a time of accelerated growth and change. A time of expanding horizons, self-discovery, emerging independence and a time of metamorphosis from child to adulthood.
Now a day’s adolescence is being attracted to the current technological world and has greater impact on their life style in all aspects. So they need more guidance and care. Specifically, adolescent girls need more consideration in their health because the current gynecological problems are gradually arising and that stem up the girls to pass through their motherhood. Polycystic ovarian syndrome is one of the most growing gynecological and endocrinal problem, which is most common
2
among adolescent girls. It adversely affects their life process and leading them to infertility in later life, thus it prevents them to enjoy their motherhood and cause more stress throughout their life.
Adolescents and young women make up around forty percent of the population of India. The behavioral patterns established during these developmental period helps to determine the current health status and their risk for developing chronic diseases during adulthood. Early adult is a critical transitional period that includes biological changes of puberty and the need to negotiate key developmental tasks, such as increase independence and normative experimentation. During this period, the body changes and there will be the development of secondary sexual characteristics. Any differences of secondary sex characteristics can inversely affect the physical and emotional adaptation of the adolescent. The leading causes of illness, death among adolescents and young women are largely preventable. Health outcomes for adolescence and early adults are grounded in their social environment and are frequently mediated by their behaviors.
Gynecological diseases are fairly common but most of the women ignore the symptoms or they are unaware, until the problem really worsens. Now a days, one of the problems faced by adolescent girls are POLYCYSTIC OVARIAN DISEASE.
In recent times there has been a great emphasis on gynecological and obstetrical problems in the adolescent age group; the common problems in adolescents are associated with ovulation, menstruation and growth. This could be due to various etiological factors including polycystic ovarian syndrome and tumors of ovary. PCOS is the most common cause of amenorrhea in young girls. The amenorrhea with polycystic ovaries was first described in 1935 by Stein and
3
Leventhal. It is characterized as a disorder involving irregular menstrual cycles, infertility, obesity, and over production of testosterone. Few studies have shown that high insulin levels in the blood are common in PCOS and contribute to the over production of testosterone.
Alessandra Gambineri, Alma Mater Studiorum University of Bologna, Italy.
Conducted cross-sectional observational study among women with PCOS, followed from youth to middle age. A total of 255 women with PCOS were followed for at least 10 years (mean follow-up 16.9 years). Six women were diagnosed with diabetes at baseline, and another 42 women developed type 2 diabetes during the follow-up.
The incidence rate of type 2 diabetes in the study population was 1.05 per 100 person.
The age-standardized prevalence of diabetes at the end follow-up was 39.3%, which is significantly higher with respect to that of the general Italian female population of a similar age (5.8%). The likelihood of developing type 2 diabetes is significantly increased as BMI, fasting glucose, and glucose area under the curve at baseline increased and significantly decreased as sex hormone–binding globulin (SHBG) levels. The study demonstrated the risk of type 2 diabetes is markedly elevated in middle-aged women with PCOS and included BMI, glucose, and SHBG-circulating levels in the risk stratification.
Polycystic ovarian syndrome is an endocrine disorder which affect the adolescent girls. Polycystic ovarian syndrome is a condition in which the woman has an imbalance of female sex hormones. This may lead to changes in the menstrual cycle, cyst in the ovary, failure to conceive and other health problems. It is a common health problem among teenagers and young women. It affects 5% to 10% of women in their reproductive years.
4
Polycystic ovarian syndrome (PCOS) gets its name because of clusters of small, pearl size cyst in ovaries. These cysts are fluid filled bubbles called follicles that contain eggs that have not yet been released because of hormonal imbalance. A major cause of polycystic ovarian syndrome is a genetic disorder. The other causes are family history and abnormal gonadotropin secretion due to negative feedback of hypothalamus.
The primary underlying defect in PCOS remains unknown, but key features include insulin resistance, impaired gonadotropin dynamics and androgen excess.
PCOS can be described as an oligogenic disorder in which the interaction of a number of genetic and environmental factors determine the clinical, and biochemical phenotype. The genetic etiology of PCOS remains unknown. Studies in first-degree relatives of patient with PCOS shows that 24% of mothers and 32% of sisters are affected, and it has a major genetic association. Screening of an unselected population in the South Western United States showed 4% incidence of PCOS. Environmental factors implicated in PCOS (eg; obesity) can be exacerbated by poor dietary choices and physical inactivity. Infectious agents and toxins may also play a role. The reproductive and metabolic features of PCOS are sometimes reversible with lifestyle modifications such as weight loss and exercise.
It was observed that among PCOS about 43% had positive family history in first degree relatives. In the study done by Kashsar-Miller MD, Nixon C, Boots LR, seventy eight mothers and sisters were evaluated clinically. It was observed that 19(24%) samples were affected with PCOS. This shows that there is a genetic predisposition for PCOS. A study done by Joseph to identify the level of obesity, among those diagnosed with PCOS. The result revealed 50% were non-obese, 43%
cases were overweight, and 7% were obese. PCOS cases had higher waist to hip ratio
5
and higher BMI. BMI was significantly higher in cases confirmed with PCOS. In the study done by Joshi B et.al., in Mumbai, revealed that, 71.8% were non obese, 7.5%
were overweight, and 20.7% were obese.
PCOS involves primary defects in the hypothalamic pituitary axis, insulin action and ovarian function. PCOS has been linked to insulin resistance and obesity.
Insulin helps to regulate the ovarian function. The ovaries respond to excess insulin by producing androgens, which can lead to anovulation. Follicular maturation arrest is a hallmark sign that an ovarian abnormality exists.
A key sign of PCOS is irregular or missed periods because the hormonal effects on the ovaries can cause anovulation. Enlarged ovaries with numerous small cysts, irregular menstrual cycles, hirsutism, alopecia, acne, acanthosis, nigricans, and skin tags are the symptoms of PCOS. Although the signs symptoms are vary, the three most common factors associated with PCOS include ovulation irregularities, increased androgen levels, and cystic ovaries. Majority of the women have problems with ovulation and elevated androgen levels. Moreover, hirsutism, acne, and alopecia are directly associated with elevated androgen levels, and the prevalence of polycystic ovaries. The study conducted at Srinagar revealed that, in Indian Subcontinent, prevalence rates of PCOS are as high as 50%. It is responsible for 18% of infertility and 40% of hirsutism. A descriptive study revealed that metabolic syndrome was diagnosed in 46% of women with PCOS.
In Australia polycystic ovarian syndrome is 15.3% prevalent among urban women (Boyel and J.Norman, 2012). Alabama University (2014), reported that 6%
women were affected with polycystic ovarian syndrome in United States. A case control study in Iran revealed that obesity is the common feature and more calories,
6
fat were consumed by the women with polycystic ovarian syndrome. Ganie et.al.,(2010) conducted a study to review the different clinical endocrine manifestation of PCOS among adolescent girls. The result shows that 88% had oligomenorrhea, 65% had over weight 88% had hirsutism and menstrual disturbances. It is concluded that clinical manifestation of poly cystic ovarian syndrome adversely affects the lives of young married girls.
A meta analysis was conducted between the year 2006-2011. The total sample size was 19,226 women aged between 10-45 years. The prevalence of PCOS based on National institute of child health and human disease of the US was, 6.8% (95% CI:
4.11- 8.5), based on ultrasound was 4.41% (95%: 568-4.14). The prevalence of hirsutism was 13%, acne 26%, androgenic alopecia 9%, menstrual disorders 28%, overweight 21%, obesity 19% and infertility 8%.
If PCOS is suspected, a complete medical history, physical examination, blood tests, and a pelvic ultrasound should be performed.A medical history and physical examination provide the physician about unexplained weight gain, menstrual cycle abnormalities, male-pattern hair growth, skin changes, and elevated blood pressure (BP). During the assessment period, other potential causes associated with reproductive, endocrine, and metabolic dysfunction could be excluded. Physicians should rule out adrenal hyperplasia, Cushing syndrome, and hyperprolactinemia before a PCOS diagnosis is confirmed.
Few treatment approaches improve all aspects of the syndrome. The patient’s desire for fertility prevent her from seeking treatment despite the presence of symptoms. Treatment goals should include correcting anovulation, inhibiting the action of androgens on target tissues, and reducing insulin resistance.
7
A healthy lifestyle is one of the most important aspects of managing PCOS successfully. A healthy diet will ensure that the adolescent girls are getting an adequate intake of nutrients, vitamins and minerals. Healthy diet, avoid junk foods and regular exercise reduce the severity of PCOS. Weight reduction for obese patients with PCOS is beneficial in many ways. Weight loss helps to decrease androgen, luteinizing hormone (LH), and insulin levels. It also helps to regulate ovulation, thereby improving the potential for pregnancy.
Sunanda B, Sabitta Nayak (2016), conducted a descriptive study to assess the knowledge on the polycystic ovarian syndrome among 150 student nurses in Mangalore. The study revealed that 76% of the samples were with average knowledge and 10.7% with good knowledge regarding polycystic ovarian syndrome. The study concluded that source of information, consumption of junk food, dietary food patterns of the student were associated with their level of knowledge on PCOS.
Manita Dalal, Dr. Mrs. Molly Babu, Mrs. Sharda Rastogi, (2014), conducted a exploratory survey design to assess the knowledge and practice of women with polycystic ovarian syndrome among 275 women of 12-14 years age group women in New Delhi. The study revealed that prevalence of PCOS among women attended gynecology OPD of Safdarjung Hospital was found to be 10.09%. The knowledge and management of the women with PCOS was found to be inadequate with mean score of 12.1 out of 33. The study concluded that the knowledge was improved for women with Polycystic Ovarian Syndrome.
Pharmacological approaches for anovulation, is clomiphene citrate (Clomid, Sanofi). Initially, a dose of 50 mg/day for 5 days is given. If ovulation occurs but no pregnancy results, 50 mg/day for 5 days is continued for the subsequent cycles.
8
However, if ovulation does not occur after the first cycle, the dose may be increased to 100 mg daily for 5 days at least 30 days after the previous course of therapy.
Further treatment is not usually recommended after three courses of therapy;
however, up to six cycles may be attempted before further therapy is considered.
Clomiphene results in successful pregnancies. Twenty percentage of these pregnancies result in spontaneous abortions or stillbirths. Adverse effects include ovarian enlargement; ovarian hyperstimulation syndrome (OHSS); Multiple pregnancies; hot flushes; gastrointestinal (GI) distention, bloating, and discomfort.
The short-term complications of PCOS are menstrual irregularities, hyperandrogenism, insulin resistance and hyperinsulinemia, obstructive sleep apnea, dyslipidemia, oligo ovulation, anovulation and long-term complication includes endometrial hyperplasia, metabolic syndrome, cardiovascular disease and psychological disorders.
NEED FOR THE STUDY
In worldwide, PCOS affects between 8% and 20% of reproductive-age women. Because there is no universal definition of PCOS, the exact number of women in the United States with PCOS is unknown, but is thought to be approximately 5 million. Most women are diagnosed during their twenties or thirties.
It affect girls as young as 11 who haven't even had their first period. U.S. Scientists reported that the prevalence of Polycystic Ovarian Syndrome may be as high as 11.2% in girls of reproductive years. Among this group, adolescent girls make up a large part, perhaps as high as 50% of young girls suffer with polycystic ovarian disease (PCOS).
9
Polycystic ovarian syndrome is highly prevalent among adolescents. World wide it is estimated that 5-7% adolescent girls are affected with polycystic ovarian syndrome. (Pennsylvania University, 2011). A survey was conducted at national level in India. The aim was to determine the prevalence of PCOS and reported that 9-13%
women are affected with PCOS (National Institute of Health, 2011). A study was conducted at Dr. M.G.R. Medical University reported that 10% of reproductive group women were affected with polycystic ovarian syndrome at Tamil Nadu level.
As polycystic ovarian syndrome is the most common endocrinologic disorders during adolescence, there is always a need to investigate all new relevant data. The early recognition and prompt treatment of polycystic ovarian syndrome in adolescents is important to prevent long-term sequalae. More research is necessary in order to find answers too many clinical and theoretical aspects of the syndrome.
A study on teen and college girls in several colleges around India was done.
The study revealed that higher percentage of PCOS and there was around 36 % of increase cases of PCOS compared from a period of 2007-08.
A study conducted by the department of endocrinology and metabolism, AIIMS, showed that 20-25 per cent of Indian women of childbearing age are suffering from PCOS. While 60 per cent of women with PCOS are obese, 35-50 percent have a fatty liver. About 70 per cent have insulin resistance, 60-70 per cent have high level of androgen and 40-60 per cent have glucose intolerance. About 6 to 10% of girls were affected by PCOS and are even not aware of their presence. In a prospective study of 400 women of reproductive age revealed that 4% to 4.7% of white women and 3.4% of African American women had PCOS, a similar rate of 4% to 6% has been found in other populations.
10
Hoda Abdel, Azim Mohamed, Women’s Health and Obstetric Nursing Department, Egypt 2016, conducted the study among Faculty of Nursing at Minia university. Quasi experimental research design was adopted on ninety-six females.
Interviewing questionnaire and knowledge assessment tool (pre/post educational program) were used for data collection. After the educational program, majority (94.69%, 95.85%, 94.79%, 97.31%, 95.42%) of the samples have adequate knowledge regarding diagnosis, causes, risk factors, complications and management.
Majority 92.7% of the samples had good knowledge, 6.25% had average knowledge and only 1.04% had poor knowledge after educational program. Mean scores of posttest were significantly higher after educational program compared to their values at pretest (p < 0.001). Statistically significant difference was found between demographic characteristics such as age of the samples and family history with samples knowledge at pre-test (p < .02 and p < .05) respectively. Based on the results of the study it is concluded that, before utilization of educational sessions, most of the samples (84.4%) had poor knowledge regarding polycystic ovarian syndrome. After the educational sessions there was an enhancement of knowledge score on polycystic ovarian syndrome. It was found that the post-test score was significantly higher after educational program. The overall post-test mean score (54.66) was higher than the overall pretest mean score (25.5). It is concluded that, educational program is effective in improving the knowledge of adolescent girls.
Amal Alessa, et. al., faculties of Medicine (2017), Saudi Arabia, conducted the study to assess the level of knowledge on PCOS, and to identify the factors that influenced the awareness, improve health care and lower the treatment cost. A population-based cross-sectional study was conducted in Saudi Arabia. A 40 items research questionnaire targeted to a woman of reproductive age (aged 18-50). The
11
questionnaire included personal data, awareness and method of knowledge of PCOS, clinical presentation, risk, and complications. Total number of participants was 2000.
The level of awareness of PCOS was 56.7%. Among them 15.3% were diagnosed as PCOS and 21.3% have known about PCOS via internet, patient, doctors, and books, respectively. Among females, the majority were aware of symptoms pertaining to endocrine disorders and a healthy diet. In contrast, most of them were unaware of the relationship between it. The level of awareness of PCOS was significantly related to higher educational levels (P = 0.001), and women with college qualifications (P = 0.001). Area of residence, marital status, and diabetes mellitus had no major impact.
Mehwish Rizvi, et. al., Pakistan conducted a quantitative cross-sectional survey to evaluate the perception of patients with polycystic ovarian syndrome. This survey was conducted over a period of 8 months. The data were analyzed by SPSS and employed descriptive statistics and chi square tests. A total of 270 patients were available for their clinical data. Samples were asked regarding their understanding about the disease, majority of patients (55.6%) answered negatively. The patients who were diagnosed with polycystic ovarian syndrome are mostly young. The comprehension and awareness regarding the disease among the patients were generally found to be deficient. Equipping them with knowledge can lead to improve the quality of life.
Hansa et.al.,2016, the study conducted in a Semi Urban School of Sambalpur, India. It was identified that 78% students never heard of PCOS. In a study in Tertiary Care Hospitals of Pakistan revealed that 55.6% patients were found to be unaware about PCOS (Abbas et. al., 2014).
12
A comprehensive community-based study was done among 3,443 adolescent girls (15-18 years) to find out the prevalence of PCOS from 10 schools, Trivandrum.
Among them, 339 girls are with the symptoms of PCOS and they were under- nourished (37.6%), normal weight (51.2%), overweight (8.6%) and obese (2.6%).
Lack of awareness and lifestyle changes are considered to be the major leading factor.
Sonia Rawat, Gomathi B., Laxmi Kumar, Mahalingam V., Himalayan College of Nursing, SRHU, Dehradun, Uttarakhand, India 2017, conducted a study among ninety-four adolescent girls aged between 15 – 18 years were conveniently selected.
Data was collected by using Structured Knowledge questionnaire. The mean post-test knowledge score (22.55± 3.57) was higher than that of mean pre-test mean knowledge score (11.13± 3.32) and the mean difference was11.42. The calculated ‘t’ value was 23.45 which is higher than the tabulated value of 1.98 (df 93 at p< 0.05). So it was interpreted that structured teaching programme is effective in improving the knowledge of adolescent girls. The findings of the study revealed that STP was effective in enhancing the knowledge of adolescent girls on PCOS. Hence the study concluded that structured teaching programme had a great potentiality to increase the awareness on PCOS.
A retrospective study done among 58 preadolescent and adolescent girls to identify the age at the diagnosis of PCOS and to compare the risk factors. It revealed that PCOS may occur at a younger age in girls who develop early pubarche and thelarche. Therefore, the diagnosis and workup should be considered in young girls with the risk factors suggestive of PCOS.
A pilot study was done at Mohali among 20 teenage girls. The main research study was conducted among 200 teenage girls studying at selected schools of Mohali.
The results showed that majority of girls 123 (61.5%) had fair knowledge and only
13
one 1 (0.5%) had excellent level of knowledge. Only 35 (17.5%) girls had good level of knowledge. The mean score was 8.0 with standard deviation of 2.7 and median was 8.0 with minimum score of 3.0 and maximum score of 16.0. The findings showed that there was a lack of knowledge among teenage girls regarding PCOS. The researcher developed and administered an information booklet regarding PCOS.
Deeksha Kumari, Deepu Gupta conducted the study to assess and compare the knowledge and attitude among 25 nursing students regarding the polycystic ovarian syndrome before and after the administration of a structured teaching programme.
True experimental research approach with pre and post-test design was adopted.
Samples were selected by randomized sampling technique. The result revealed that the pre-test mean knowledge score of control group is 7.84 and post-test is 8.28. The pre-test mean knowledge score of experimental group is 7.44 and post-test is 12.6, whereas the mean pre-test attitude score of control group is 29.84 and post-test is 35 and pre-test mean score of attitude in experimental group is 30.48 and post-test is 32.72. The calculated ‘t’ value of control group is 1.17 and of experimental group is 5.002 which is considered to be significant. The ’ t’ value of control group is 0.62 and of experimental group is 2.98 which is considered to be significant. So, it is concluded that there was an improvement in knowledge and attitude regarding PCOS in experimental group.
A study was done to assess the effectiveness of planned teaching program on Polycystic ovarian syndrome in terms of knowledge and attitude among adolescent girls in selected higher secondary schools of Ahmedabad city. Sixty Adolescent girls were selected by using simple random sampling techniques. The pre-test was conducted using a structured knowledge questionnaire and summated Likert attitude scale. The planned teaching program was conducted. Seven days later post-test was
14
conducted using the same scales. Most of Adolescent girls had inadequate knowledge (76.67 %) and (23.33%) had moderately adequate knowledge in pre-test. But in post- test 48.33 % had moderately adequate knowledge, 50.00% had adequate knowledge and 1.66% had inadequate knowledge. Regarding the attitude of Adolescent girls 20%
had unfavorable attitude in pre-test. In post-test 55% had favorable attitude and 45 % had unfavorable attitude. Paired ‘t’ test was applied to compare pre-test and post-test mean and standard deviation. Knowledge and attitude level of Adolescent girls on Polycystic ovarian syndrome was statistically significant (p<0.05). This study demonstrated that planned teaching program on polycystic ovarian syndrome is effective in improving the knowledge and attitude level of adolescent girls.
Polycystic ovarian syndrome (PCOS) associated with multiple presentation in females although it is a common disorder but due to lack of knowledge females often delays in getting confirmation in diagnosis and treatment. To assess the knowledge about PCOS in young women, Cross sectional study was performed on 400 women with the age group of 18-30 years either studying in Colleges or working in Indore city. Among 400 participants, only 41% of the women were aware of the term PCOS.
46% of the subjects who were aware about the organ system involved in this disease.
Most of the people knew about this disorder through friends or relatives. 49% of the women knew about the various signs and symptoms associated with PCOS.
Pitchai, Sreeraj & Anil, 2016, the study done in Mumbai revealed that 32% of the sample feel anxious as they are not completely aware of PCOS. 19% felt depressed due to distorted body image and altered quality of life. It hindered their mental state due to hormonal alterations slipping them into depression. The study showed that among 34 PCOS patients 44.12% are sufferer of anxiety and 41.18% of depression.
15
A study was done to assess the effectiveness of Lifestyle Modification Package on knowledge and attitude regarding weight reduction among women with PCOS at Janet Nursing Home, Trichy. A quasi experimental one group pre test - post test design was used. Forty women with PCOS were selected by using Non probability convenience sampling technique. The Self administered knowledge questionnaire and 5-point Likert scale were used to assess the knowledge and attitude of the samples before and after providing Lifestyle Modification package. The statistical analysis revealed that, the calculated paired ‘t’ test value for knowledge (‘t’=22.07) and attitude (‘t’=19.74) had a significant difference between the pre and post test levels of knowledge and attitude of the women with PCOS at 0.05 level of significance. The correlation between the post test scores of knowledge and attitude regarding weight reduction was [‘r’ =0.8] which indicates that there was a positive and highly significant correlation. In chi square there was a significant association in the pre test levels of knowledge with Education, occupation and Previous source of information. There was significant association with Age of the women, Education, Occupation, and Previous source of information towards pre test level of attitude. The study finding showed that the Lifestyle Modification Package was effective in improving the knowledge of women with PCOS.
Arulmozhi, 2008 conducted the study to assess the effectiveness of video assisted teaching programme related to concepts of PCOS. Adolescent girls were selected as samples. The experimental group was selected from St. Fuscos matric higher secondary school, Madurai, and control group was selected from Tagore vidyalaya Matric higher secondary school Madurai. 100 adolescent girls were selected for the study by using convenient sampling technique among which 50 adolescent girls were in experimental group and 50 adolescent girls were in control group.
16
Teaching on concepts of PCOS was given with the help of power point presentation and video clips. Structured interview schedule was used to assess the knowledge and self reported practices related to concepts of PCOS. Data analysis were done according to the objectives of the study. Both the descriptive and inferential statistics were used.
RCH programme insist the women health from the adolescent period to have a healthy mother and the healthy future generation. Adolescent girls need to know about the reproductive system and reproductive Health.
PCOS is the most common endocrinologic disorders during adolescence.
There is always a need to investigate all new relevant data. Early recognition and prompt treatment of PCOS in adolescents is important to prevent the long term complications. From all the above studies the researcher found that adolescent girls have to obtain adequate knowledge regarding PCOS because they are the future mothers and they are the one to make the new generation. Lack of knowledge and the negative lifestyle attitude towards polycystic ovarian disease was found among college girls and they are not taking any measures to improve their lifestyles.
During my clinical experience in Gyneac OPD, I came across many adolescent girls diagnosed with PCOS. They had inadequate knowledge regarding prevention, early detection and treatment of polycystic ovarian syndrome. So I felt the need to assess and provide structured teaching program to the adolescent girls to impart the knowledge regarding polycystic ovarian syndrome.
As a gynecological nurse the investigator wants to know the level of awareness and attitude regarding early identification and management of polycystic ovarian syndrome among adolescent girls. So she has selected this study.
17 STATEMENT OF THE PROBLEM
A study to assess the effectiveness of video assisted teaching programme on awareness and attitude regarding early identification and management of polycystic ovarian syndrome among adolescent girls in selected colleges at Madurai.
OBJECTIVES
1. To assess the level of awareness regarding early identification and management of polycystic ovarian syndrome in experimental and control group.
2. To evaluate the effectiveness of the video assisted teaching programme on awareness and attitude regarding early identification and management of polycystic ovarian syndrome in experimental group.
3. To find out the association between the pretest level of awareness and attitude regarding polycystic ovarian syndrome with their selected demographic variables among adolescent girls in experimental and control group.
HYPOTHESIS
H1: The mean post test level of awareness and attitude is significantly higher than the mean pretest level of awareness and attitude in experimental group.
H2: The mean post test level of awareness and attitude in experimental group is significantly higher than the mean post test level of awareness and attitude in control group.
H3: There is a significant association between pretest level of awareness and attitude regarding polycystic ovarian syndrome with their selected demographic variables in experimental and control group.
18 OPERATIONAL DEFINITIONS ASSESS
In this study, it refers to an activity to decide the awareness and attitude of polycystic ovarian syndrome among adolescent girls in American college, Madurai.
EFFECTIVENESS
In this study, it refers to the significant gain in awareness and attitude regarding polycystic ovarian syndrome after video assisted teaching which was determined by pretest and post test awareness and attitude score.
VIDEO ASSISTED TEACHING
In this study, it refers to a multimedia teaching which is systematically organized by using video which was prepared by the investigator.
AWARENESS
In this study, it refers to the perception of the samples regarding PCOS which was assessed by a structured questionnaire.
ATTITUDE
In this study, it refers to the way of thinking and feelings regarding PCOS which was expressed in the form of statement assessed by modified attitude scale.
EARLY INDENTIFICATION AND MANAGEMENT OF PCOS
It refers to recognize someone or something. Management is the process of dealing with or controlling people.
19
In this study, it refers to the understanding of the samples regarding signs and symptoms, diagnostic evaluation, prevention, early identification, management and the prevention of complications of PCOS.
ADOLESCENT GIRLS
In this study, it refers to the female students above the age group of 18 years, who are studying B.Sc Maths in the American college.
ASSUMPTIONS
• PCOS is a common problem among women of reproductive age.
• The adolescent girls will not have basic knowledge about PCOS.
• The knowledge and attitude of students will influences their practices on the prevention and management of PCOS.
DELIMITATIONS
The study is delimited to
• Adolescent girls between the age group of 18-20 years.
• Data collection period is limited to 6 weeks.
• Samples are only from the American college.
PROJECTED OUTCOME
The findings of the study was help to identify the level of awareness and attitude regarding early identification and management of polycystic ovarian syndrome among college students. The development of video teaching programme was used to instruct the students to enable them to update and improve their knowledge on polycystic ovarian syndrome.
CHAPTER - II
REVIEW OF
LITERATURE
20
CHAPTER – II
REVIEW OF LITERATURE
A review of literature enables one to get an insight into the various aspects of the problems under the study. This involves the systematic, identification, location, and summary of written materials that contain information on a research problem.
This chapter deals with:
I. Literature review II. Conceptual framework
I. Literature review on the effect of video assisted teaching programme on polycystic ovarian syndrome under the following headings.
1. Literature related to prevalence of poly cystic ovarian syndrome.
2. Literature related to awareness and attitude regarding polycystic ovarian syndrome.
3. Literature related to effectiveness of video teaching on early identification and management of PCOS.
1. Literature related to prevalence of poly cystic ovarian syndrome
Ruiz P, Reyna R et.al., (2010) conducted a study to determines the prevalence of PCOS and related disorders in Mexican women. Samples were selected by prospective cross-sectional method. Menstrual cycles were recorded and hirsutism was graded. Pelvic ultrasound was performed and androgen levels
21
were measured. Samples were collected from a total of 150 female Mexican volunteers aged of 20-45 years. Nine of the 150 women were diagnosed with PCOS. According to NIH criteria the prevalence of 6.0% (95% CI: 1.9-10.1%) was found. The ultrasound morphology added one more patient, a prevalence of 6.6% (95% CI: 2.3-10.9%). The prevalence was higher in patients presented with oligoovulation, 9 had hirsutism and 7 of them had acne and 8 of the 10 patients had morphologic characteristics of PCOS.
Journal of American nurse Midwife (2010) explained that women who are overweight need to reduce weight by eating less and regular exercise. Loss of weight helps the body to use insulin better. Many women have periods every month and be get pregnant even if they only lose a small amount of weight. Weight loss can help to decrease the chance to have high blood pressure, a heart attack or a stroke.
Vause et.al., (2010) concluded that 5% to 10% weight loss can help to restore menstrual function, which lead to increased glucose tolerance and better body composition. Women with PCOS, who are overweight or obese, should initially attempt weight loss through exercise and dietary restrictions to become conceive.
Weight loss and dietary modification may also decrease the chance of type 2 diabetes mellitus, thromboembolism and cardiovascular disease.
Balakrishnan.S (2011) stated that PCOS is the most common diagnosis in women with the gradual appearance of irregular menstrual cycles from menarche, especially associated with weight gain and hirsutism. Progesterone challenge likely to produce a withdrawal bleed. Diagnosis can be made by ultrasonography.
22
Mittal.S and Upendra.S (2011) reported that obesity is also an important aim of the PCOS trial and is seen in 50% of women with PCOS. 80% of the obese women have insulin resistants. Weight loss can be achieved either by exercise, diet or both.
Weight loss of just 5-10% through diet or exercise restores the reproductive function in 55-100% of individual within the period of 6 months. Exercise helps in weight loss, improves insulin resistance and restores the reproductive functions.
Renoto pasquali, Elisabet stener-victorin Bulent, Yildiz and Antoni J, (2011) conducted to summarize the areas of investigation in polycystic ovarian syndrome and to stimulate further research in this area. The study revealed that potential areas of further research activity include the analysis of predisposing conditions that increase the risk of PCOS, particularly genetic background and environmental factors such as endocrine disruptors and lifestyle. The study concluded that there are several intriguing areas for future research in PCOS.
Padmalatha V, Nagarathna R et.al., (2011) conducted a study to find out the prevalence of PCOS among adolescents in Andra Pradesh, India .A total of 460 girls aged with 15 to 18 years were included. All the clinical examination was carried out. Out of 460 girls, one (0.22%) had oligo/amenorrhea with clinical hyperandrogenism, 29(6.30%) had oligomenorrhea with polycystic ovaries, one (0.22%) had polycystic ovaries with clinical hyperandrogenism and 11 (2.39%) had oligomenorrhea with polycystic ovaries. Thus 42 (9.13%) girls satisfied Rotterdam's criteria for PCOS. This study concluded that the Prevalence of PCOS in Andra Pradesh adolescents is 9.13.
Moran (2011) concluded that obesity, glucose intolerance, acne, excessive hair growth, amenorrhea and infertility are common reasons that women
23
initially seek care and ultimately diagnosed as PCOS. PCOS along with obesity and glucose intolerance can lead to the development of type 2 diabetes, hyperlipidemia and cardiovascular disease.
Mukherjee.GG and Samanta.J (2012) stated that PCOS has been recognized as one of the most common endocrinopathies. It affects 6-10% of women of reproductive age. Stein and leventhal (1935) explained that PCOS as a problem with oligomenorrhoea, hirsutism, obesity and infertility. The true pathophysiology of syndrome has been unfold with the endocrine, metabolic and cardiovascular complications. Diagnosis criteria are oligomenorrhoea, hyperandrogenism and poly cystic ovaries.
Shannon.M and Wang.Y (2012) concluded that PCOS is a congenital disorder that involves an excess of androgen production with clinical manifestations evident as early as puberty. The incidence rate is 7% to 8.7% in reproductive age women. The prevalence estimates vary according to the weight of women PCOS affect approximately 28% of women who are obese. The exact etiology for the development of hyperandrogenism is unknown. The prenatal environment also can influence the susceptibility of women to hyperandrogenism and PCOS. There is a evidence that prenatal exposure to androgens can cause PCOS and most often as a result of congenital adrenal hyperplasia.
Farland.C (2012) explained that about 40% of women have lack of ovulation which is the cause for infertility. PCOS who suffer from oligo or anovulation typically need treatment from a fertility specialist to seek conception.
PCOS is diagnosed when a women who met two of the following inclusions such
24
as oligo or anovulation, clinical or serum indications of hyperandrogenism and polycystic ovaries. Several different forms of treatment are available such as pharmacological, non- pharmacological and surgical interventions.
Samar Musmar, Asma Afanch, Hafsa Moalla, (2013) conducted a cross sectional study to assess the prevalence of polycystic ovarian syndrome among 137 female age group between 18-24 years in Nablus city in the north of west Bank. The study revealed that prevalence of PCOS was 7.3%. Clinical hirsutism was found among 27% of participants and 70% had idiopathic hirsutism. The study concluded that prevalence of PCOS in Palestine seems to be relatively high but similar to of other Mediterranean statistics.
Shawna B Christensen,MS, Mary Helen Black, Ning smith,, Maryia M, (2013) conducted a cross sectional study to assess the prevalence of polycystic ovarian syndrome in adolescents in Southern California. The study revealed that the prevalence of a confirmed diagnosis of PCOS was 0.5% and increased to 1.14% with undiagnosed cases. The study concluded that overweight and obesity were associated with higher odds ratio of PCOS in adolescents.
Zhang Q, Yang D, et.al., (2013) studied the prevalence of polycystic ovarian syndrome in India. A total of 16,886 women from 152 cities and 112 villages were included in the study. Community survey was taken by a questionnaire and samples had a physical and transvaginal ultrasound
examination. Blood samples were collected from a subsamples of women (n=3565) for analysis of metabolic markers and hormones. Based on the
Rotterdam PCOS criteria, they assessed hyperandrogenism (H), chronic anovulation(O) and polycystic ovaries (P). Following diagnosis, women with
25
PCOS were assigned to one of four different phenotypes. Finally, the prevalence and related risk of PCOS among Chinese women were estimated based on all the data sources. A total of 16,886 women were initially involved in the study and 15,924 were eligible participants then completed the study; the overall response rate was 94.3% (15,924/16,886). The prevalence of PCOS in the Chinese community population was 5.6% (894/15,924). The study concluded that there was Prevalence rate of PCOS in Indian adolescents is 9.13.
Agarwal R, Sharma S.et.al., (2013) conducted a Observational study, to investigate the prevalence of polycystic ovarian syndrome (PCOS) in adolescents and its association with obesity. The samples were 502 adolescents aged between 18-24year in London. The prevalence of a confirmed diagnosis of PCOS was 0.56%, which is increased to 1.14%. Compared with the normal/underweight girls, the odds ratios (OR and 95% confidence interval [CI]) for confirmed PCOS diagnosis were 3.85 (3.04-4.88), 10.25 (8.16-12.84), and 23.10 (18.66-28.61) for overweight, moderately obese, and extremely obese adolescents respectively.
Beena Joshi, Sarabani Mukherjee, Rama Vaidya (2014) conducted a cross sectional study to assess the prevalence of polycystic ovarian syndrome among 778 adolescents and young girls with the age group of 15-24 years in Mumbai. The study revealed that there is no community based prevalence data is available for this syndrome. The study concluded that PCOS is an emerging disorder during adolescents and screening could be provided to target the group for promoting healthy lifestyle and early interventions.
Swetha Balaji, Chioma Amadi, Satish Prasad, Jyoti Bala Kasav, (2014) conducted a cross sectional study to determine urban and rural differences in the
26
burden of polycystic ovarian syndrome, among adolescent girls in the age group of 12-19 years in Vellore, Tamilnadu. The study revealed that 18% of the participants were confirmed of having PCOS. The study concluded that participants diagnosed with PCOS was higher among urban participants while comparing to the rural participants.
Pratik Kumar Chatterjee, P. Prasanna Mithra, Raghul Pal (2014) conducted a cross sectional study to find out the epidemiological correlation among 100 patients with PCOS women in Karnataka. The study revealed that there was a significant differences in blood groups along with their age and BMI, family history of diabetes were also considered. The study concluded that early screening help for better management and prevention of further complications.
Chauhan S, Vaidya R. et.al., (2014) conducted a study to assess the prevalence of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India. 778 Samples were randomly selected from census block of Mumbai. The clinical, ultrasonography (USG), and biochemical investigations was done. Mild PCOS (oligomenorrhea and polycystic ovaries on USG) was the most common phenotype (52.6%). History of oligomenorrhea had a positive predictive value of 93.3% and negative predictive value of 86.7%.
Hyperinsulinemia (serum insulin >15 μlU/mL) was present among 19.2% of diagnosed PCOS cases. Obese girls with PCOS were more hirsute, hypertensive, and had significantly higher mean insulin and 2 hr post glucose levels compared with non obese PCOS.
Dr. Kalavathi, D. Biradar, Dr. Amrita N Shanmanrwadi (2015) conducted a descriptive study to determine the prevalence of PCOS among adolescent girls in
27
Bangalore. The study revealed that majority of the samples (76.2%) of adolescents were diagnosed as PCOS. Ultrasound report of the adolescents revealed that 30 of them were diagnosed as PCOS. This difference was statistically significant. The study concluded that early diagnosis and intervention will reduce the long-term health complications associated with PCOS.
Nitin Joseph, Aditya G.R.Reddy, Divya Joy, Vishakha patel, (2016), conducted a cross sectional study to assess the proportion of PCOS among 480 participants in Mangalore city at Karnataka state. The study revealed that 39 were already diagnosed with PCOS, 40 were at high risk and 401 were at low risk for PCOS. The study concluded that PCOS is a common disorder among young women and it was need to provide screening activities.
2.
Studies related to awareness and attitude regarding polycystic ovarian syndrome.Lucidi (2010) stated that life style modifications are considered first line treatment for women with PCOS, such as diet, exercise and weight loss. Women with PCOS and impaired glucose tolerance should start a comprehensive program diet and exercise to reduce their risk of developing diabetes mellitus. The diet emphasizes increased fibre, decreased carbohydrates.
Lawson KL, Pierson RA.et.al., (2010) conducted a study to assess the changes in knowledge, feelings, and daily health practices related to PCOS among participants. After taking part in a clinical research study, participants had increased knowledge and concern about the etiology and health consequences of PCOS, better lifestyle practices and improved health care satisfaction. Enhanced
28
knowledge of PCOS was positively associated with changes in concern, healthy dietary habits, activity levels and health care satisfaction. After the study, women felt empowered to participate in the management of their condition and communicate with their primary care providers.
Genton MG, Schattman GL. (2010) conducted a study to assess the descriptive measurements of patients perception and awareness of the polycystic ovarian syndrome. This study suggested that most women associated negative emotions with PCOS although the self-reported knowledge level for the disorder was high.
Barbin L et.al., (2010) conducted a study to determine knowledge and awareness in adolescents with polycystic ovarian syndrome(PCOS) and self perceived severity of illness affects their HRQL(health related quality of life). A sample of 97 adolescent girls were selected. The study results showed that adolescents with PCOS scored lower on subscales measuring general health perceptions, physical functioning, general behaviour and limitations in family activities. The study highlights that PCOS and perceived severity negatively affect the HRQL in adolescents. The study result suggested a need to develop interventions to reduce the distress in patients with polycystic ovarian syndrome (PCOS).
Jones.GI, Hall JM, Lashen HL, Balon. AH and Ledger WL (2011) conducted the qualitative study to explore health-related quality of the life among adolescents with PCOS in out-patient gynecology clinics in yorkshire, England. Overall PCOS has a negative impact on the health related quality of life of adolescent’s girls with
