A QUASI-EXPERIMENTAL STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME
ON KNOWLEDGE AND ATTITUDE REGARDING MENSTRUAL HYGIENE AMONG RURAL ADOLESCENT GIRLS IN SELECTED
COMMUNITY AREA AT DINDIGUL DISTRICT
BY
S. SAVITHIRI
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
Obstetric and Gynecological Nursing
UNDER THE GUIDANCE OF
DR.PROF. MERLIN JEYAPAL. M.Sc (N),Ph.D HOD of Obstetric and Gynecological Nursing,
C.S.I Jeyaraj Annapackiam College of Nursing and Allied Health Sciences, Madurai-4
OCTOBER - 2020
CERTIFICATE
This is to certify that the dissertation entitled “A Quasi-Experimental Study to Evaluate the Effectiveness of Video Assisted Teaching Programme on Knowledge and Attitude Regarding Menstrual Hygiene Among Rural Adolescent Girls in Selected Community Area at Dindigul District” is a bonafide work done by Mrs. SAVITHIRI. S, 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, RN.RM.
Principal / Research Co-Ordinator,
CSI Jeyaraj Annapackiam College of Nursing, Pasumalai, Madurai.
College seal :
A QUASI-EXPERIMENTAL STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME
ON KNOWLEDGE AND ATTITUDE REGARDING MENSTRUAL HYGIENE AMONG RURAL ADOLESCENT GIRLS IN SELECTED
COMMUNITY AREA AT DINDIGUL DISTRICT
Approved by the dissertation committee on 05.02.2019
RESEARCH CO-ORDINATOR : ………...
PROF.DR.C.JOTHI SOPHIA, M.Sc(N).,Ph.D., Principal / Research Co-Ordinator,
CSI Jeyaraj Annapackiam College of nursing, Pasumalai Madurai-4
RESEARCH GUIDE ………..
PROF.Dr.MERLIN JEYAPAL. M.Sc (N), Ph.D HOD of Obstetric and Gynecological Nursing C.S.I Jeyaraj Annapackiam College of Nursing Pasumalai, Madurai-4
MEDICAL GUIDE ………...
Dr. ALICE JESINTHA, M.B.B.S, DGO., HOD of Obstetric and Gynecology,
Christian Mission Hospital, Madurai
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-2020
CERTIFICATE BY THE EXAMINER
This is to certify that the dissertation entitled “A Quasi-Experimental Study to Evaluate the Effectiveness of Video Assisted Teaching Programme on Knowledge and Attitude Regarding Menstrual Hygiene Among Rural Adolescent Girls in Selected Community Area at Dindigul District” is a bonafide work done by Mrs. SAVITHIRI. S, C.S.I Jeyaraj Annapackiam College of Nursing and Allied Health Sciences, Madurai, submitted in partial fulfillment for the degree of Master of Science in Nursing from the DR. M.G.R. Medical University, Chennai.
Signature of the Examiner:
1. External: 2. Internal
Date: Date:
ACKNOWLEDGEMENT
“A mother can understands what a child does not say”
- Mother Theresa The study project involved in this thesis requires the collaboration of many personal and I wish to thank everyone involved in the project.
First of all I am thankful to Lord Jesus for providing me strength to accomplish this task. I thank to God to bless and help me throughout the thesis work.
I am so grateful to incredible personality Prof Dr.C.Jothi Sophia, M.Sc (N) Ph.D., Principal, HOD Of Child health nursing, C.S.I Jeyaraj Annapackiam College of nursing , Madurai, for her continued support, interest, cheerful approach and her willingness to provide expert guidance and constructive suggestions to mould this study to the present form.
. I express my sincere thanks to my research Guide Prof. Dr. Mrs. Merlin Jeyapal, M.Sc (N).,Ph.D., Vice Principal HOD of Obstetric and Gynecological Nursing, for her constant support and valuable guidance and timely help rendered to me throughout this study. Her reassuring glands patience in reading draft after draft of every paper, encouragement and inspiring words will never be forgotten.
I deem, it is a great privilege to express my sincere gratitude and deep sense of indebtedness to my esteemed teacher Prof. Dr. Mr. Y. John Sam Arun Prabu M.Sc. (N). Ph.D., H.O.D of Community Health Nursing Department, for his excellent guidance, valuable suggestions, constant help, affectionate support and assistance from initial step for the completion of the study.
I express my gratitude to Mrs. P. Jeyajothi, M.Sc. (N), Asso.professor, PG Join coordinator Department, for her enthusiastic support and encouragement throughout the study.
I Would like to express my fervent gratitude and sincere thanks to my clinical guide Mrs.Amutha M.Sc (N)., for her encouragement and support.
I Wish to extend my thanks to Mrs.Priya Sahaya Kaviya, M.Sc.(N)., Lecturer, psychiatric department for her support and encouragement.
I extend a special thanks to Mrs. Angelin Mannova, Librarian, C.S.I Jeyaraj Annapackiam College of Nursing, and the librarians of Dr. M.G.R Medical University, Chennai and C.M.C Vellore for their help in locating appropriate search material.
My sincere thanks to Mr. Mani Velusamy, M.Sc., MPhil. Statistician for his excellent advice and support in analyzing and interpreting the data in the research.
I record my respect and thanks to all the participants of the study for their kind co-operation and participation without them the study is not possible.
I extent my sincere thanks to the entire faculties of C.S.I Jeyaraj Annapackiam College of nursing for their support and suggestions.
Though I cannot find adequate words to express my gratitude to my endearing parents Mr.Selvaraj and Mrs.Santhi, my beloved brother Mr. Nagaraj and my father–in-law Mrs.Pitchaimuthu and mother-in-law P.Vellaithai and all my relatives and friends for their support, unending love, financial support and prayers which made this study a dream come true.
I express my grateful thanks to my most precious husband Mr.P.Savadamuthu for his love and support at each and every moment made me to carry out this task very successfully.
A special note of gratitude to all my dear friends “EDELLWISE 2018” for Their prayers, encouragements, feedback and timely help.
Last but not least, I would like to extent my sincere thanks to every soul and well-wisher who helped me in the successful completion of the study.
ABSTRACT Introduction
Menstruation is the first significant milestone in the reproductive history of a women’s life. Menarche is a most important biological milestone in a woman’s life as it marks the onset of the reproductive phase of her life. Menstrual hygiene management is a problem for adolescent girls in developing countries, particularly poor facility for attending school. Poor water, poor sanitation and hygiene practice in schools, inadequate puberty education and lack of information in hygiene.
Management menstrual hygiene. Most of the girls experience to menstruation period shameful and uncomfortable. The aim of the study was to evaluate the effectiveness of video assisted teaching programme on knowledge and attitude regarding menstrual hygiene among rural adolescent girls in selected community area at Dindigul district.
The objectives of the study were to assess the exiting knowledge and attitude on menstrual hygiene among rural adolescent girls and the effectiveness of video assisted teaching programme on knowledge and attitude regarding menstrual hygiene among rural adolescent girls and to correlate the knowledge and attitude regarding menstrual hygiene among rural adolescent girls and to find the association between the knowledge and attitude regarding menstrual hygiene among rural adolescent girls and their selected demographic variable.
Methodology:
Quasi experimental one group pre test and post test research design was used.
The tool used for data collection was structured interview questionnaire and attitude scale to assess the level of knowledge and attitude regarding menstrual hygiene among rural adolescent girls who participated in the present study. The sampling technique adopted for the study was Non probability convenient sampling technique.
The sample size of the study was 60. In video assisted teaching programme was given on menstrual hygiene and to assess the knowledge and attitude among rural adolescent girls. The collected data were tabulated and statistically analyzed.
Result:
85% rural adolescent girls had inadequate knowledge in pre test, after video assisted teaching only 0% had inadequate knowledge in post test and 65% had adequate knowledge. and 35% had moderate knowledge. There was a significant improvement in mean post test knowledge score (51.78) in rural adolescent girls, (t value = 35.26, p<0.05), and Also 90% rural adolescent girls had poor attitude in pre test, after video assisted teaching 81.7% had good attitude and 18.3% had moderate attitude. There was an improvement in mean post test attitude score (33.5) (t value =39.38).,p<0.001). Which shows that there was a highly significant positive relationship between the post test level of knowledge and the post test level of attitude of adolescent girls. The obtained ‘r’ value was 0.349 is significant at 0.05 level.
Conclusion:
The finding of the study has aimed to assess the effectiveness of video assisted teaching programme upon knowledge and attitude on menstrual hygiene among rural adolescent girls. The study concludes that there is need to improve the level of knowledge and attitude of menstrual hygiene among rural adolescent girls .Therefore to educate, incorporate and to provide a realistic learning regarding menstrual hygiene among rural adolescent girl, video assisted teaching programme is needed to improve the knowledge and attitude of menstrual hygiene among rural adolescent girls.
Recommendation
Based on the findings of the study, the recommendations offered for future research were,
• A similar study can be conducted, replicated on a large sample size to generalize the study findings.
• A similar study can be conducted as comparative study between students studying in Government schools and private schools.
• A similar study can be conducted in the same setting by using post test only design.
• A similar study can be conducted with experimental research design having control group and experimental group.
• A longer period of intervention can be studied for more reliability and effectiveness
INDEX
CHAPTER No. CONTENTS PAGE No.
I INTRODUCTION 1-18
Background of the study 1
Significance and need for the study 7
Statement of the problem 15
Objectives of the study 15
Hypotheses 15
Operational definitions 16
Assumption 18
Delimitation 18
Projected Outcome 18
II REVIEW OF LITERATURE 19-38
Literature related to knowledge on menstrual hygiene among adolescent girls
19
Literature related to attitude on menstrual hygiene among adolescent girls
26
Literature related to video teaching programme In general
28
Conceptual frame work 36
III RESEARCH METHODOLOGY 39-46
Research approach 39
Research design 39
Setting of the study 41
Population 41
Sample technique 41
Sample size 41
Criteria for sample selection 41
Variables 42
Description of instrument 42
Scoring techniques 43
Development of intervention 44
Validity 44
Reliability 44
Pilot Study 45
Method of data collection 45
Ethical consideration 46
IV DATA ANALYSIS AND INTERPRETATION 47-83
V DISCUSSION 84-89
VI SUMMARY AND RECOMMENDATIONS. 90-96
Summary 90
Main finding 91
Implication 94
Limitation 95
Conclusion 96
Recommendation 96
REFERENCES APPENDIX
LIST OF TABLES
TABLE
No. TITLE PAGE
NO 1 Demographic variables of rural adolescent girls.
1.1 Distribution of rural adolescent girls on their demographic
variables such as age, religion and age of menarche. 48
1.2
Distribution of rural adolescent girls on their demographic variables such as type of family, dietary pattern and source of information.
52
1.3
Distribution of rural adolescent girls on their demographic variables such as educational status of student, father’s education and mother’s education
56
1.4 Distribution of rural adolescent girls on their demographic
variables such as occupational of parents and monthly income. 60 2 Existing knowledge and attitude of rural adolescent girls of
menstrual hygiene.
2.1 Distribution level of knowledge on menstrual hygiene among rural
adolescent girls. 63
2.2 Distribution level of attitude on menstrual hygiene among rural
adolescent girls. 65
3.
Effectiveness of video assisted teaching programme on menstrual hygiene regarding knowledge and attitude among rural adolescent girls.
3.1 Pre test level of knowledge on menstrual hygiene. 67 3.2 Post test level of knowledge on menstrual hygiene. 68
3.3 Pre test and post test level of knowledge on menstrual hygiene
among rural adolescent girls. 69
3.4
To evaluate effectiveness of video assisted teaching programme on menstrual hygiene regarding knowledge among rural adolescent girls
70
3.5 Pre test level of attitude on menstrual hygiene. 71 3.6 Post test level of attitude on menstrual hygiene. 72 3.7 Pre test and post test level of attitude on menstrual
hygiene among rural adolescent girls.
73
3.8 To evaluate effectiveness of video assisted teaching programme on menstrual hygiene regarding attitude among rural adolescent girls
74
4 Correlation between post test level of knowledge and attitude on menstrual hygiene among rural adolescent girls.
4.1 Relationship between post test level of knowledge and attitude on menstrual hygiene among rural adolescent girls.
75
5 Association of pre test level of knowledge and attitude with the selected demographic variables on menstrual hygiene among rural adolescent girls.
5.1 Association between demographic variables with pre test knowledge on rural adolescent girls such as age, religion and age of menarche.
76
5.2 Association between demographic variables with pre test knowledge on rural adolescent girls such as type of family, dietary pattern and source of information.
77
5.3 Association between demographic variables with pre test knowledge on rural adolescent girls such as educational status of student, father’s education and mother’s education
78
5.4 Association between demographic variables with pre test knowledge on rural adolescent girls such as occupational of parents and monthly income.
79
5.5 Association between demographic variables with pre test among rural attitude adolescent girls such as age, religion and age of menarche.
80
5.6 Association between demographic variables with pre test attitude on rural adolescent girls such as type of family, dietary pattern and source of information.
81
5.7 Association between demographic variables with pre test attitude on rural adolescent girls such as educational status of student, father’s education and mother’s education
82
5.8 Association between demographic variables with pre test attitude on rural adolescent girls such as occupational of parents and monthly income.
83
LIST OF FIGURES
FIGURE
No. TITLE PAGE
No.
2.1 Conceptual Framework 38
3.1 Schematic representation of research design 40
4.1 Age (in year) 49
4.2 Religion 50
4.3 Age at menarche 51
4.4 Type of family 53
4.5 Dietary pattern 54
4.6 Source of information 55
4.7 Educational status of student 57
4.8 Father’s educational status 58
4.9 Mother’s educational status 59
4.10 Occupational of parents. 61
4.11 Family monthly income. 62
4.12 Distribution level of knowledge 64
4.13 Distribution level of attitude 66
LIST OF ANNEXURES
APPENDIX NO TITLE
A Letter seeking and permission for content validity B Certificate of Validation
C Letter seeking permission for conducting pilot study D Letter seeking permission for research study
E List of experts for content validity of the tool F Certificate of English Editing
G Certificate of Tamil Editing H Plagiarism certificate
I Research Tool
J Video assisted teaching programme on menstrual hygiene
K Photo Gallery
CHAPTER I
INTRODUCTION
1
CHAPTER I INTRODUCTION
“Adolescents are not monsters. They are just people trying to learn how to make it among the adults in the world, who are probably not so sure themselves”
BACKGROUND OF THE STUDY
The term adolescent comes from the Latin word which means ‘to grow into maturity’. Marlow’s classification of adolescence includes early adolescence of 12-13 years; middle adolescence of 14-16 years and late adolescence of 17-21 years.
Adolescence is an important period in the life span of a human because the change brings about immediate effects on attitudes and behaviour. The transition period between childhood and adulthood is called adolescence. The main occurrences are the growth and development of a child and during this period, there is physical, psychological, and biological development. Group adolescent population occupies 1/5th of the world’s population and Indian population of 20.9% also falls into this age group.
The current population of India is 1.21 billion and among these people, about 253.2 million of the population lies between 10-19 years.
Menarche is an important biological milestone in a woman’s life as it marks the onset of the reproductive phase of her life. The average age at menarche is mostly consisting of the population, between 12 and 14 years of age. Unfortunately, due to lack of knowledge on menstrual hygiene and management, shyness and embarrassment the situation becomes worse for girls. Menstruation is a natural process but it is still a taboo in the Indian society as it is considered unclean and dirty.
2
Menstrual wastes are the wastes that are generated by a woman in her reproductive years. These wastes are produced during a menstrual period otherwise called menses, periods, or monthly bleeding or menstrual cycle. The menstrual cycle has three phases, i.e., follicular phase (proliferative), ovulation phase, and luteal phase (secretory). The menstrual cycle is regulated by hormones. In this process endometrium, the lining of the uterus gradually thickens and sheds off which causes bleeding that normally lasts for 3–5 days and in some cases up to 7 days. Menstruation sheds two-thirds of the endometrial lining. In addition to blood, menstrual fluid, mucus and vaginal fluid. The menstrual flow varies from woman to woman and may occur with more bleeding at the beginning of menses and may change throughout the cycle.
The colour of the menstrual fluid varies between red, bright red, dark brown and black.
Menstrual fluid may or may not have an unpleasant odour. Menstrual flow and differences in the colour of the blood also change day by day during the menstrual cycle period. Menstrual flow, duration and colour also change before menopause or during gynaecological problems like uterus cancers, hormonal imbalance, fibroids, polyps, and endometriosis. Increase in menstrual flow and excessive loss of blood through menstruation can cause anaemia.
Menstrual period developed their strategies to the women around the world.
Globally, these strategies mostly vary due to personal harassment, availability of resources, economic status, cultural and traditions beliefs, education status, and knowledge about menstrual hygiene and practice. Poor menstrual hygiene practice cause toxic shock syndrome, reproductive tract infections (RTI), and vaginal diseases.
Poor genital hygiene negatively affects adolescents’ health. Most girls are unaware and unprepared for menarche and menstrual hygiene practices as they are not informed about menstruation and due to this, the adolescent girls are mostly affected.
3
Menstrual hygiene management is poorly taken care in India. Increase in the area of public health is taken as the key intervention by government and non- governmental organizations. To understand the importance of menstrual hygiene management and practice, it as to be looked at from the wider perspective of women’s health. Poor hygiene has a comparatively high rate between 250 and 450 per 1,00,000 lives (UNICEF 2010) according to the United Nations Children’s Fund. Poor hygiene causes disease, mainly infection, related to a lack of hygiene which is widely spread throughout India. Hence necessary steps are taken to improve hygienic practices as well as the overall sanitation of Indians that aims at reducing the number of victims and people suffering from the current circumstances.
Menstrual hygiene management is a problem for adolescent girls in developing countries, particularly the girls attending poor facilitated schools. Unclean water, poor sanitation, unhygienic practice in schools, inadequate puberty education and lack of information are some of the needs that are ought to be corrected under menstrual hygiene management. Most of the girls experience discomfort and shame during their menstruation period. Qualitative studies report that girls fear and feel guilty from the leaking of blood and body odour, and lead them to absent themselves from school, with little quantitative data confirming this. Cultural taboos add to girls’ difficulties, preventing them from seeking help, and impose restrictions on their diet and activities when menstruating. Poor menstrual hygiene management causes infections in urinary and genital tracts. Recent international concern for menstrual hygiene management, spearheaded through work to improve WASH (water, sanitation and hygiene) in schools. It is been formed to focus on the need for dignitary, privacy, safety and effective menstrual hygiene management absorbents which are accessible and that
4
which pave way for improving the school WASH (water, sanitation and hygiene) environment. The latter includes separate toilets for girls, clean water, cleaning materials and safe disposal of soiled materials.
Women across India grow up remaining unaware of the real reasons for menstruation and the importance of menstrual hygiene. The taboo surrounding menstruation remains a part of their growing up and continues to their daughters.
Hence, the lack of awareness is carried forward via generations in India, says Supriya Khanna of Indian Council for Medical Research.
It has been seen in rural areas that two-three women of the same family use the same cloth during menstruation, after washing and drying it. This is extremely unhealthy and brings numerous health hazards. Sanitary napkins are still a luxury in rural areas and small towns. Even if available, women are discouraged from spending on sanitary napkins as old clothes or sand is thought to be good enough for something
‘dirty’ like menstruation, said Ms Sharma.
Menstruation is such a taboo subject that many women are ashamed even to seek medical advice if they face any health problems due to menstruation. Unhygienic menstrual conditions often result in women developing health problems which are further aggravated due to their inability to seek medical help on time, said Sahana Bhat, Co-founder of the NGO Sukhibhava which works in the field of menstrual hygiene.
“The myths and taboos surrounding menstruation need to be broken down effectively before schemes and incentives make their way to make life better for menstruating women,” said a Water Aid India official.
5
Conditions for menstruating women in India can only improve when awareness on menstrual hygiene is spread says IEC on menstrual hygiene. Swachh Bharat Abhiyan or any other state scheme must educate women across all ages on what menstruation is and why the taboos surrounding it do tremendous harm. Simultaneously, sanitary napkins must be provided to menstruating women to ensure that they do not fall prey to age-old unhygienic traditions of using cloth, soil or sand. It must be remembered that 88% of India’s menstruating women do not use sanitary napkins. Making sanitary napkins available to over 300 million women and ensuring that they do use these will be a herculean task, and can only be achieved with due cooperation from all stakeholders and proper coordination between them to improve the status menstrual hygiene in India.
From a ban on advertisements on sanitary napkins in 1990 to a full-fledged feature film, PadMan, based on a low-cost sanitary napkin entrepreneur in 2018, India has indeed come a long way. It was eight years back in 2010, when the Ministry of Health and Family Welfare launched the Freeday Pad Scheme, a pilot project to provide sanitary napkins at subsidized rates for rural girls. The scheme was launched in 152 districts across 20 states and sanitary napkins were sold to adolescent girls at the rate of Rs.6 per pack of six napkins by Accredited Social Health Activists (ASHAs). The estimated cost for the entire scheme was 70 crore.
A year later, the Union government launched the SABLA (Sponsored programme of the government of India) scheme across 2015 districts in the country.
The scheme aimed at improving health conditions for adolescent girls with menstrual hygiene as an important component. Two years later, under the then ongoing Nirmal Bharat Abhiyan, focus on menstrual hygiene was added as a key component of the sanitation mission. In 2014, the Union government launched the Rashtriya Kishor
6
Swashthya Karyakram which was aimed at improving the health and hygiene of an estimated 243 million adolescents. Menstrual hygiene was also included as an integral part of the programme.
Under the ongoing Swachh Bharat Abhiyan, menstrual hygiene has been given high importance. The Swachh Bharat (Gramin) guidelines explicitly state that funds allocated for information, education and communication (IEC) may be spent on bettering awareness on menstrual hygiene in villages. Adequate knowledge of menstrual hygiene and development of local sanitary napkin manufacturing units is encouraged by Swachh Bharat Mission (rural) and self-help groups are to help in propagating such efforts.
Menstrual hygiene is an integral part of ensuring better sanitation in rural villages. Construction of toilets in households and schools is integral to menstrual hygiene. Under the Swachh Bharat Abhiyan, the government is encouraging safe menstrual hygiene practices. Skill development and setting up of sanitary napkin dispensers and incinerators in schools and public toilets are a prime component of the Swachh Bharat Abhiyan, said Arun Baroka, Joint Secretary, Ministry of Drinking Water and Sanitation.
Recently, Union Minister for Drinking Water and Sanitation, Ms Uma Bharti said that sanitary napkin, similar to a toilet, is a right of every woman. Reiterating that menstrual hygiene was a key concern for the ministry, Ms Bharti at a recent press conference said that she spoke to Union Minister for Textile Ms Smriti Irani and Union Minister for Woman and Child Development Ms Maneka Gandhi on making affordable sanitary napkins available to women in rural areas.
7
In order to ensure holistic development of adolescent population, the Ministry of Health and Family Welfare launched Rashtriya Kishor Swasthya Karyakram (RKSK) on 7th January 2014 to reach out to 253 million adolescents - male and female, rural and urban, married and unmarried, in and out-of-school adolescents with special focus on marginalized and underserved groups. The programme expands the scope of adolescent health programming in India - from being limited to sexual and reproductive health, it now includes in its ambit nutrition, injuries and violence (including gender- based violence), non-communicable diseases, mental health and substance misuse. The strength of the program is its health promotion approach. It is a paradigm shift from the existing clinic-based services to promotion and prevention and reaching adolescents in their environment, such as in schools, families and communities. Key drivers of the program are community-based interventions like outreach by counsellors, facility- based counselling, social and behaviour change communication and strengthening of Adolescent Friendly Health Clinics across levels of care.
Adolescence often does not have the autonomy or the agency to make their own decision. RKSK (Rashtriya Kishor Swasthya Karyakram) takes cognizance of this and involves parents and community. Focus is on reorganizing the existing public health system to meet the service needs of adolescents. Under this a core package of services includes preventive, promotive, curative and counselling services, routine check-ups at primary, secondary and tertiary levels of care is provided regularly to adolescents, married and unmarried, girls and boys during the clinical sessions.
SIGNIFICANCE AND NEED FOR THE STUDY
Menstruation is a normal and healthy part of life for women. Roughly half of the female population, around 26 per cent of the global population are of the
8
reproductive age. Most women menstruate each month for about two to seven days.
Yet, as normal as it is, menstruation is stigmatized around the world.
A lack of information about menstruation leads to damaging misconceptions and discrimination and can cause girls to miss out on normal childhood experiences and activities. Stigma, taboos and myths prevent adolescent girls and boys from the opportunity to learn about menstruation and develop healthy habits.
“At UNICEF (United National Children’s Fund), we envision a world where every girl can learn, play, and safeguard her health without experiencing stress, shame, or unnecessary barriers to information or supplies during menstruation," said Sanjay Wijesekera UNICEF, Chief of Water, Sanitation and Hygiene. He also said, “Meeting the hygiene needs of all adolescent girls is a fundamental issue of human rights, dignity, and public health.”
The first period can be met with either celebration, fear or concern. For every girl, this signifies an important transition to womanhood - a time when they would benefit from the support of family and friends.
Many girls do not have a complete and accurate understanding of menstruation as a normal biological process. Educating girls before their first period and most importantly, boys on menstruation build their confidence, contributes to social solidarity and encourages healthy habits. Such information should be provided at home and school.
Poor menstrual hygiene can pose physical health risks and has been linked to reproductive and urinary tract infections. Many girls and women have limited options
9
for affordable menstrual materials. Providing access to private facilities with water and safer low-cost menstrual materials could reduce urogenital diseases.
Girls and women with disabilities and special needs face additional challenges with menstrual hygiene and are affected disproportionately with lack of access to toilets with water and materials to manage their period.
Many women and girls do not have access to materials to manage their menstruation, especially in times of emergency such as natural disasters and conflicts.
In emergencies, UNICEF (United National Children’s Fund) provides dignity kits to women and girls, which include sanitary pads, a flashlight and whistle for personal safety when using the toilet.
Globally, 2.3 billion people lack basic sanitation services and in the least Developed Countries, only 27 per cent of the population have a hand washing facility with water and soap at home. Managing periods at home is a major challenge for women and adolescent girls who lack these basic facilities at home.
About half of the schools in low-income countries lack adequate drinking water, sanitation and hygiene which are crucial for girls and female teachers to manage their period. Inadequate facilities can affect girls’ experience at school, causing them to miss school during their period. All schools should provide running water, safe and clean toilets for adolescent girls.
UNICEF is working with local communities, schools and governments to research and provide information about menstruation, promote positive hygiene habits and break down taboos. UNICEF also provides adequate facilities and supplies, including toilets, soap and water to schools in some of the poorest regions.
10
More than half of all adolescents globally live in Asia (UNICEF 2011). South Asia has the most number of adolescents around 340 million than any other region. It is followed by East Asia which has around 277 million. The census conducted at world level accounts for 2 billion women worldwide and in that adolescent's age group is nearly about 334 million.
India has the largest population (Indian times 2017) of adolescents in the world about 243 million aged between 10-19 years. Women & girls constitute half of the Indian population (UIS data 2017). There are over 355 million menstruating women and girls in India, many women still face barriers to a comfortable and dignified experience with menstrual hygiene management. According to 2017 census, Tamil Nadu has a population of 1.26 crore in adolescence. In Dindigul alone, there are 1,511,777 as female population. Despite rapid urbanization and the (census 2011) trend to migration to 8 cities. While 63.16% of the adolescents and nearly 58.80% of the youth living in the rural area.
355 million are the number of menstruating women in India, accounting for nearly 30 per cent of the country’s population. Menstruation continues to be a subject of gender disparity in India. Myths about menstruation are largely prevalent, forcing many girls to drop out of school early or be ostracized for the duration of their menstrual cycle every month. A 2014 report by the NGO (Non-governmental organization) Dasra titled “Spot On” found that nearly 23 million girls drop out of school annually due to lack of proper menstrual hygiene management facilities, which include the availability of sanitary napkins and logical awareness of menstruation. The report also came up with some startling numbers. About 70 per cent of mothers with menstruating daughters considered menstruation as dirty and 71 per cent adolescent girls remained unaware of menstruation till menarche. A 2014 UNICEF report pointed out that in Tamil Nadu, 79
11
per cent girls and women were unaware of menstrual hygiene practices. The percentage was 66% in Uttar Pradesh, 56% in Rajasthan and 51% in West Bengal.
Lack of awareness makes for a major problem in India’s menstrual hygiene scenario. Indian Council for Medical Research’s 2011-12 report stated that only 38 per cent menstruating girls in India spoke to their mothers about menstruation. Many mothers were themselves unaware about menstruation was, how it had to be explained to a teenager and what practices could be considered as menstrual hygiene management.
Schools were not very helpful either as schools in rural areas refrained from discussing menstrual hygiene. A 2015 survey by the Ministry of Education found that in 63% of schools in villages, teachers never discuss menstruation or how to deal with it hygienically.
In a city, a woman who is aware of menstrual hygiene availing a sanitary napkin is a normalized process. Not only are sanitary napkins available in pharmacies and grocery stores in cities, but they are also commercialized via advertisements so that they are treated as any other product. In rural areas, sanitary napkins are found with difficulty. Most girls rely on home-grown or other readily available material, the latter often being unhygienic and unsanitary. Only 2 to 3 per cent of women in rural India are estimated to use sanitary napkins. The lack of demand results in storekeepers not stocking up on sanitary pads. This results in women resorting to unhygienic practices during their menstrual cycle, such as filling up old socks with sand and tying them around waists to absorb menstrual blood, or taking up old pieces of cloth and using them to absorb blood. Such methods increase chances of infection and hinder the day- to-day task of a woman on her period.
12
Surveys by the Ministry of Health in 2002, 2005, 2008 and 2012 found out that most problems related to menstrual hygiene in India are preventable, that is caused due to low awareness and poor menstrual hygiene management. This resulted in the development of some serious ailments in adolescent girls. Roughly 120 million menstruating adolescents in India experience menstrual dysfunctions, affecting their normal daily chores. Nearly 60,000 cases of cervical cancer deaths are reported every year from India, two-third of which are due to poor menstrual hygiene.
Other health problems associated with menstrual hygiene like anaemia, prolonged or short periods, infections of reproductive tracts, as well as psychological problems such as anxiety, embarrassment and shame.
Sangeetha Balamurugan (2015) described the lack of Menstrual hygiene as an important risk factor for reproductive tract infections. Menstrual hygiene education given by television programs, trained school nurses, motivated school teachers, and educated parents can play an important role in passing through vital messages of correct menstrual hygiene education in adolescent girls. Increase in menstrual hygiene among the rural population will help in the improvement of women literacy and health education. Improvement of menstrual hygiene plays an important role in the prevention of reproductive tract infection and cervical cancer among women. Promotion of positive attitudes and knowledge towards menstruation and related problems should be taught to adolescent girls.
Bhavik Rana et al., say that nearly 70% of the adolescence have inadequate knowledge about menstruation and menstrual hygiene practice. Nearly half the adolescence have inadequate practice during menstruation. Health education should be given to all adolescent girls which will help them to gain adequate knowledge about
13
menstruation, menstrual hygiene and management. All adolescent girls should be encouraged to use sanitary pads for which these pads should be affordable to every woman of our society.
Poor menstrual hygiene management may cause reproductive tract infection, Bacterial vaginosis, polymicrobial syndrome, bacterial flora in the vagina in adolescent girls. The normal vaginal flora is dominated by hydrogen peroxide producing lactobacilli bacterial vaginosis. There is a reduction of lactobacilli with a simultaneous Gardnerella vaginalis, Pretovella species, Bacteroides species, Pepto streptococcus, Mycoplasma hominis, Ureaplasma urea, Mobil uncus species. As a girl progresses with poor menstrual hygiene, it causes the reproductive tract infections during her womanhood. Bacterial vaginosis has a higher risk during pregnancy outcomes like preterm birth, sexually transmitted infections and pelvic inflammatory disease.
Adhikari P et al., (2017) (68.9) in their study participants had a low level of knowledge about the source of menstruation. Correct knowledge and practice of menstrual hygiene can protect women suffering from the reproductive disease.
Unhygienic practices and social taboos followed during menstruation become the biggest cause of reproductive diseases.
Public health awareness programme should be promoted to educate about the physiological change of menstruation and proper hygienic practices, disposable sanitary pads. Improvement in such public programme promote menstrual hygiene knowledge and practice.
Sutanuka Santra (2017) says that about 32 women (20%) have no idea about menstruation before menarche. About 65% of women used sanitary pad and 30% used only cloth pieces whereas 5% used both pad and cloth piece. Prevalence of sanitary pad
14
use was significantly higher among those aged <25 years (p<0.05). With increasing literacy status as well as socio-economic status, use of sanitary pad was also found to be increased and this difference was statistically significant (p<0.05). About 42% of the cloth piece users involved in the practice of reusing the cloth piece. All those, who reused cloth pieces, washed the used cloth pieces with soap and water and 50% of them dried those under sunlight. All the women practice some kind of restriction during menstruation. About 4% of individuals did not take a regular bath during their bleeding period. Some women (37.5%) suffered from reproductive tract infection during or just after menstruation. Most of the study subjects (95.6%) disposed of used napkins in a municipal vat.
Nurses are responsible for giving adequate teaching to adolescent girls about menarche, menstruation, menstrual practice and female reproductive health. The knowledge that promotes positive ideas on physiological processes that are associated with sex should be taught. Knowledge combined with fact attitude towards menstruation will help adolescent girls to gain confidence and to ask questions confidently regarding this tabooed subject. There is evidence to demonstrate that knowledge intervention when planned and conducted by nurse education gives clients an idea about the whole process in different areas of health care.
Hence the researcher felt that there is a need for education to the rural adolescent girls regarding pubertal changes, menarche and menstrual hygiene and practice. So the present study is indented to determine the knowledge and attitude on menstrual hygiene among rural adolescents girls in selected community area around Dindigul.
15
STATEMENT OF THE PROBLEM
A quasi-experimental study to evaluate the effectiveness of a video-assisted teaching programme on knowledge and attitude regarding menstrual hygiene among rural adolescent girls in selected community area around Dindigul district.
OBJECTIVE
• To assess the existing knowledge and attitude on menstrual hygiene among rural adolescent girls.
• To determine the effectiveness of a video-assisted teaching programme on knowledge and attitude regarding menstrual hygiene among rural adolescent girls.
• To correlate the knowledge and attitude regarding menstrual hygiene among rural adolescent girls.
• To find the association between the knowledge and attitude regarding menstrual hygiene among rural adolescent girls and their selected demographic variables.
HYPOTHESIS:
H1: There is a significant difference between pre-test and post-test score on knowledge and attitude regarding menstrual hygiene among rural adolescent girls.
H2: There is a significant relationship between knowledge and attitude regarding menstrual hygiene among rural adolescent girls.
H3: There is a significant association between knowledge and attitude of their demographic variables.
16
OPERATIONAL DEFINITION ASSESS
This refers to the measurement of knowledge and attitude of menstrual hygiene among rural adolescent girls.
EFFECTIVENESS:
This term refers to the outcome of the video-assisted teaching programme measured in terms of knowledge score gained. The effectiveness was determined by using statistical tests and pre and post-test scores.
VIDEO ASSISTED TEACHING PROGRAMME :
A video-assisted teaching programme is a well-planned instruction to provide information to improve knowledge and positive attitude. In this study, it refers to a method of video-assisted teaching programme which was developed by the researcher and validated by the experts regarding menstrual hygiene among adolescent girls. The content of the video-assisted teaching includes reproductive organs, functions, changes during puberty, hormonal and behavioural changes during puberty, menstruation and menstrual cycle, menstrual hygiene and associated problems of menstruation. The timing of the video-assisted teaching programme was 30 minutes and the age group of the student who attended the programme were between11-21 years.
ADOLESCENT GIRLS:
This term refers to the rural girls who come under the age group of 11 to 21years.
KNOWLEDGE:
The term refers to the verbal response of the rural adolescent girls regarding menstrual hygiene to the structured interview schedule. The knowledge is measured in terms of knowledge scores. For the study, it was further classified into:
17
Inadequate knowledge : Refers to the knowledge score obtained by the respondent ranging from 0 -50%
Moderate Knowledge : Refers to the knowledge score obtained by the respondent ranging from 51-75%
Adequate knowledge : Refers to the knowledge score obtained by the the respondent ranging from 76-100%
ATTITUDE:
The term refers to the verbal response of the rural adolescent girls regarding menstrual hygiene to the attitude schedule. The knowledge is measured in terms of attitude scores. For the purpose of the study, it was further classified into:
Poor attitude : Refers to the attitude score obtained by the respondent ranging from 0-50%
Moderately level of attitude : Refers to the attitude score obtained by the respondent ranging from 51-75%
Good attitude : Refers to the score obtained by the
the respondent ranging from 76-100%
MENSTRUAL HYGIENE:
It refers to the maintenance of hygiene during the menstrual period which includes the use of clean pads, changing of soaked pads whenever necessary, proper disposal of used pads, perineal and personal hygiene with usual daily activities, exercise, diet and way of preventing discomfort and problems related to menstruation.
18 ASSUMPTION:
• Health education in groups promotes the knowledge and behaviour of the rural adolescent girls regarding menstrual hygiene.
• The verbal response during the interview of rural adolescent girls will represent their knowledge on menstrual hygiene.
• The video-assisted teaching programme is adequate to include knowledge and attitude regarding menstrual hygiene.
DELIMITATIONS OF THE STUDY
• The study is delimited to rural adolescent girls between the age group of 11-21 years.
• The study is delimited to rural adolescent girls who attain menarche.
• The data collection is limited to 6 weeks
• The evaluation of knowledge and attitude interventions is limited to a period of 7 days after the administration of Intervention.
PROJECTED OUTCOME
The study would reveal the effectiveness of video-assisted teaching programme on menstrual hygiene among rural adolescent girls. The results of the study would show that there is an increase in knowledge and attitude regarding menstrual hygiene among rural adolescent girls. The findings of the study might help the professionals in educating the rural adolescent girls about menstrual hygiene.
CHAPTER II
REVIEW OF LITERATURE
19
CHAPTER – II
REVIEW OF LITERATURE
'A great literature is chiefly the product of inquiring minds in revolt against the immovable certainties of the nation.’ - H. L. Mencken
Review of literature is an important step in the development of any research project. It helps the investigator to analyze what is known about the topic and to describe the methods of enquiry used in earlier work including the successes and shortcomings. It gives a broad understanding of the particular problem. It generally helps to put research problem in prospective or to identify gaps and weakness in the prior study to justify a new investigation.
Research and non-research literature related to the present study is reviewed and organized under the following headings.
• Literature related to knowledge on menstrual hygiene among adolescent girls
• Literature related to the attitude on menstrual hygiene among adolescent girls
• Literature related to the video-assisted teaching programme in general
LITERATURE RELATED TO KNOWLEDGE ON MENSTRUAL HYGIENE AMONG ADOLESCENT GIRLS
Zelalem Belayneh and Birhanie Mekuriaw (2019) conducted a cross- sectional study to assess the knowledge and menstrual hygiene practice among adolescent school girls, at southern Ethiopia in Gedeo. About 791 adolescent girls were randomly selected using a multi stage sampling technique from zone high schools. Data were collected using an interviewer-administered questionnaire. Knowledge of adolescent school girls regarding menstruation was evaluated using a series of 20 Likert scale questions. It resulted in 68.3% who had poor knowledge of menstruation. About
20
48.1% of school girls used absorbent materials, and 69.5% clean their external genitalia.
It had significantly associated with poor menstrual hygiene practice.
Pooja Chauhan, et al., (2018) conducted a cross-sectional study in the rural field practice area under the department of community medicine, at south India, to assess the knowledge, attitude, and practices about the menstrual cycle and factors influencing the same. Around 226 adolescent girls were included in the study. A pre- designed, pre-tested, and semi-structured questioner were used for collecting data by personal interview method. Overall, the knowledge about the menstrual cycle is very poor. Menstrual awareness was found in 35.8% of girls. Source of knowledge for most of the girls were mothers, followed by friends. 97% of them used sanitary pads.
Menstrual hygiene practices were found to be satisfactory but needed improvement in the disposal of menstrual waste. The conclusion is that the knowledge about the menstrual cycle is found to be very poor with schools playing and there is no role in its improvement. Schools need to be encouraged in imparting right information and encouraging girls to speak about it.
Tanvi Nitin Deshpandee, et al. (2018) conducted a community-based cross- sectional study to assess knowledge, beliefs, and sources of information regarding menstruation, and also to assess hygiene among them, at Krishna Institute of Medical Sciences, Karad, Maharashtra. About 100 adolescent girls participated in this study.
Data were collected by house-to-house survey in the community, and girls were asked questions using a predesigned, pretested questionnaire method. Researcher concluding that since the majority of the girls were school dropouts, knowledgeable parents play a vital role in implementing hygienic practices among adolescent girls. It is a strong belief that an educated woman is the first teacher of a family and that is why education of the mother and the adolescent girl is very important. But presently, as we live in a male-
21
dominated society, educating men about the basic needs of women of his family during menstruation will help in contributing towards a cleaner and healthier menstrual practices.
Anjali Mahajan, Kanica Kaushal (2017) have done a descriptive study to assess the knowledge and practice regarding menstrual hygiene among adolescent girls of Government School, at Shimla, Himachal Pradesh. About 100 adolescent girls were selected by convenience sampling technique. The data were collected by a self- administered, structured, pretested, closed-ended anonymous questionnaire method.
The knowledge was assessed with 20 multiple choice questions and for each correct response, a score of “1” (one) and for the wrong response, a score of “0” (zero) was given. The data on knowledge scores revealed that 29% had adequate knowledge about menstrual hygiene, 71% had inadequate knowledge about menstrual hygiene. The investigators improved general awareness about the cause of menstruation and the organs involved. Use of sanitary napkins was promoted and various schemes regarding menstrual health were briefed to the students. Thus, early awareness can prevent students from suffering from various reproductive tract infections.
Jesty Kuriachen and Sridevy (2016) had conducted an experimental study which was done with 100 adolescent girls from a community area based on the knowledge of menstrual hygiene. One group pre-test, the post-test experimental design was used. This study was conducted in a selected Government higher secondary school, at Kadirkamam, Pondicherry. The population of the study comprises of selected adolescent girls who are currently in their 9th standard at Pondicherry. The total sample of the study consists of 50 adolescent girls who are studying 9th standard. Convenient and Purposive sampling technique was used. A structured knowledge questionnaire was used for the data collection process. The study revealed that the knowledge and attitude
22
level in pre-test was inadequate but after the structured teaching programme the subjects had adequate knowledge and attitude in the post-test improved significantly.
Among the subject, there was a significant difference between pre-test and post-test knowledge and attitude score concerning different variables. Hence adolescent girls need awareness of menstrual hygiene.
Kartik Ramachandra, et al., (2016) did a cross-sectional study to explore the knowledge, practices and sources of information regarding menstruation and hygiene among adolescent girls in Bangalore. About 550 school going adolescent girls between the ages of 13-16 years participated in this study. Data were collected and a pre- designed, pre-tested, semi-structured questionnaire was used. This study showed that there is a need to provide education to equip them with skills regarding safe and hygienic practices and also to make appropriate choices to enable them to lead a healthy reproductive life and prevent the risk for reproductive tract infections. Furthermore, there is also a need to empower mothers and teachers to function as primary sources of information on menstruation including reproductive health as they are accessible to handle adolescent issues and facilitate referrals as the need arises.
Ruchi, Fartha Azmi (2016) had done a descriptive study on knowledge of the adolescent girls regarding menstrual hygiene in a school at Bahadrabad, Haridwar. The non-experimental quantitative research approach was used. The study population consisted of adolescent school girls and 40 samples were selected from Aarya Intercollege in Haridwar. Convenient sampling technique was used. Data collection was done through structured knowledge questionnaire. Descriptive and inferential statics were used for data analysis. This study concluded that only 25% of the adolescent have adequate knowledge about menarche and menstrual hygiene.
23
Rakesh Ninama et al, (2015) had done a community-based cross-sectional study on knowledge about menstrual hygiene. Study samples include adolescent girls of rural areas as well as. The study was conducted in lord Krishna school, Pioneers school and Eklavya school in Gujarat. About 100 adolescent girls were selected for the study. A pre-designed pre-test structured questionnaire was used. The study explained that about 70% of adolescent girls unaware of menstrual hygiene reason for menstruation. Nobody talks much about menstrual hygiene. It is assumed that knowledge regarding menstruation will come gradually by its own. Most of the adolescent are unaware of normal physiology change involved during menstruation.
Mothers play a vital role as a teacher imparting primary knowledge about menstrual cycle to adolescent. So a mother needs to be armed with proper and complete knowledge via formal and informal communications.
Kalpana Mandal (2011) conducted a study to evaluate the effectiveness video teaching program regarding menstrual hygiene to develop knowledge and practice regarding menstrual hygiene among school girls. About 100 rural girls were selected as a sample from the senior secondary of Delhi, Najaggarh Chawla. It was multistage sampling with the video teaching program. Survey approach and structure questionnaire were used to collect the data. It was identified that there was a deficit in knowledge regarding menstrual hygiene in school girls.
A community-based survey was conducted by Das Gupta (2010) on the basic needs of the adolescents in impoverished areas at Rawalpindi, Pakistan. The study revealed medical problems, especially during the menstrual period. 100% blind girls following poor hygienic practices during menstruation and amongst whom 15% were using sanitary pads and 60% reusing the cloths. After training, 100% gained knowledge
24
regarding basic care. So there is a need for the education of blind girls regarding menstrual hygienic practices.
Kuhanamhalli (2009) conducted a study in India. The study was conducted on 11 to 19-year-old girls attending a rural High school in Guntur district in Andhra Pradesh to assess knowledge and practices about menstrual hygiene. About 45% think menstruation is a physiology process. 55% of girls believe that hormones are responsible for menstruation. 50% think that menstrual bleeding originated from the uterus. Regarding the practices 10% used cloth during menstruation, 30% reused cloth, 20% disposed of the used cloth throughout. 60% took a special bath during menstruation. 30% of student's use of clean water wash the external genital area. Only 5% of student’s used water and soap. More than 50% restricted from household work and about 15% were restricted from attending school during menstruation.
Adams Hillard PJ (2009) conducted a study on menstruation in adolescent girls in clinical perspective with the aim to the development of knowledge, on development of pubertal, menarche, menstrual cycle, menstrual hygiene and practice.
It was a survey approach with a descriptive design. The study was conducted at the University of Cincinnati College of Medicine, the USA on 80 adolescent girls aged 11- 19 years. Pretest, post-test questionnaire was used to collect the data. The finding revealed that 70% were concerned about the discomfort in menstruation openly.
Geetha (2003) conducted a study on menstrual hygiene to evaluate the effectiveness of video teaching programme regarding menstrual hygiene on the knowledge and attitude. 50 girls were selected as a sample from corporation higher secondary school at Coimbatore. It was using continent sampling and data was collected from a structured questionnaire. Descriptive design survey was taken and analyzed by frequency and percentage distribution was done. This intervention increased the
25
knowledge and attitude of menstrual hygiene through an effective method of video teaching.
Hannah C H (2002) conducted a study to test the level of knowledge and practice between girls of 11 to 19 years regarding menstrual hygiene. It was found that 80% of the girls had inadequate knowledge about menstrual hygiene, and only 32%
practised menstrual hygiene period such as take bath and use hygiene material like sterile pads. A study to evaluate the educational teaching programme of lecture cum discussion was used. After adequate teaching, there was an improvement in the knowledge level and promise to maintain good practice. Effectiveness of teaching programme of menstrual hygiene was achieved.
Sangamitra E (2002) conducted a cross-sectional method of study. It was done on 200 students from 11-19 years. The study revealed that 80% had inadequate knowledge about dysmenorrhea, 70% received information from their relatives, mother and sister. 30% practised affected personal hygiene such as taking bath, using hygiene materials. 25% avoided normal physical activity and mild exercise. 45% takes bath on the 1st days and 51.5% took bath on or after 5 days.
Appaji (2002) conducted a study on menstrual patterns of adolescence girl in Nigeria with developing the aim of knowledge about menstrual hygiene pattern among adolescent girls. The study was conducted by interview questionnaires methods with 700 girls of the Obafemi Awolowo University, Nigeria, between the ages of 11 to 19 years. It was a survey approach with descriptive design and frequency and percentage distribution was also done. The study found that 70% had normal menstrual hygiene pattern, 45% had a normal menstrual pattern and 30% had dysmenorrhea.
26
LITERATURE RELATED TO ATTITUDE ON MENSTRUAL HYGIENE AMONG ADOLESCENTS GIRLS
Tanis B.C.&F.R.Rosendal (2011) conducted a study of orthodox Jewish girls about developing menstruation attitude and importance in recognizing cultural belief, especially in school girls. Questionnaires were answered by 200 students at the boarding of a Jewish school, study conducted at Israel. A survey approach descriptive design interview questionnaires were used. Frequency and percentage distribution were done. Findings showed that 80% of Jewish girls avoid physical activity such as preparation of food, not handling the holy book, not attending a common group cemetery during the menstruation.
Brooks-Gunn J, Ruble DN (2010) conducted a study in the development of menstrual-related knowledge and attitude beliefs and behaviours during adolescence with the aim of the importance of socialization and menstrual distress and negative menstrual attitude. It was a survey approach with a comparative design. 600 girls in grades marked the 1st and 2nd questionnaires which were cross-sectional and longitudinal. Correlation analysis indicates that girls learned menstrual hygiene practice and attitude.
Mohammed Presalani (2006) conducted a study to assess the knowledge and attitude of behaviour about menstrual hygiene and menstrual hygiene pattern of adolescent girls in a rural community area in Tehran. The aim of this study was a positive attitude and knowledge and attitude behaviour about menstrual hygiene. It was a video teaching program. Survey approach along with descriptive design was used.
Data collected from 200 Adolescent girls between the age group of 11-19 years.
Correlation and 'r' value were identified. The results show that adolescent girls need
27
proper nutrition, physical activities, personal hygiene, use of clean pads and medication based on physician prescription.
Chrisler JC (2003) conducted a study on attitude towards experience of menstrual hygiene in the U.S and India with aim of knowledge and level of attitude preparedness of menarche. A survey approach, comparative design and an attitude questionnaire were used. 70 American adolescents were involved in the study. The study was conducted at the Connecticut community area, New London, USA. Findings of the study revealed that Indian adolescents scored significantly higher than the American adolescents on the attitude subscales.
Mahr.E (2003) conducted a study on the perception of first menstruation intending to develop adolescent girls’ attitude. The study was relevant to the successful practice of menstrual hygiene. The study was conducted by the comparative design of collected sample from 500 adolescents of age 11-19 at the University of Berlin.
Germany survey approach descriptive using a structured questionnaire was used. A correlation was done and the study found that positive correlation suggested that adolescent girls require counselling.
Sveinsdottir.H (2002) conducted a study on the attitudes towards menstrual practice among Icelandic nursing students with their relationship with menstrual preparation and menstrual hygiene. The aim of the study was the collection of menarche of present menstrual hygiene practice. The sample size of 150 girls was taken. It was a survey approach and descriptive design that was used to collect data. Frequency and percentage distribution were done and the study found that 80% were convinced that menstruation influences the formation of menstrual attitudes.
Swenson. I & Havens B (2002) conducted a study on menarche and menstruation to develop hygiene and practice of menstruation and positive attitude
28
towards a menstrual cycle in physically and emotionally prepared. 50 adolescent girls were selected. Convenient sampling was used to select the samples. Structure Questionnaire was used for data collection. It was a survey approach and descriptive design. The study was conducted in Nigeria. An interview schedule questionnaire was used to collect the data. Chi-square analysis was done. The result confirms that there is no significant relationship between menarche and menstruation.
LITERATURE REVIEW ON VIDEO ASSIST TEACHING PROGRAMME IN GENERAL
Suganya S, Kamala K, Sridevi R (2020) a study was conducted to assess the effectiveness of video-assisted teaching programme on knowledge regarding benefits of Outdoor Play among School going children (11-13 years) in a selected Government School, at Karaikal. The objectives were to assess the level of knowledge regarding benefits of outdoor play among school-going children (11-13 years), to assess the effectiveness of video-assisted teaching programme on knowledge, regarding benefits of outdoor play among school-going children, to find the association between pretest level of knowledge regarding benefits of outdoor play among school-going children with selected demographic variables. Pre-experimental with one group pre-test and post-test design was used. 100 children (11-13 years) studying in NSC Bose higher secondary school, Karaikal were selected by using a convenient sampling technique.
Demographic data was collected and pre-test was conducted by using a checklist method to assess the students' knowledge regarding the benefits of outdoor play. The video-assisted teaching programme was given about the benefits of outdoor play. After 7 days post-test was conducted using the same checklist method. The results revealed that in the pre-test, 62% had inadequate knowledge, 38% had moderate knowledge and
