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A STUDY TO EVALUATE THE EFFECTIVENESS OF PRANAYAMA IN REDUCING CLIMACTERIC SYMPTOMS AMONG

PERIMENOPAUSAL WOMEN IN A SELECTED RURAL AREA AT COIMBATORE

BY

DONA JACOB

A DISSERTATION SUBMITTED TO THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN

PARTIAL FULFILLMENT OF REQUIREMENT FOR THE DEGREE OF

MASTER OF SCIENCE IN NURSING

APRIL 2012

A STUDY TO EVALUATE THE EFFECTIVENESS OF PRANAYAMA IN REDUCING CLIMACTERIC SYMPTOMS

AMONGPERIMENOPAUSAL WOMEN IN A SELECTED RURAL AREA AT COIMBATORE

APPROVED BY THE DISSERTATION COMMITTEE ON………

RESEARCH GUIDE ……….

PROF.DR. R. ANNAPOORANI., MA., DGS., M.Phil., Ph.D.,D.Sc (GERMANY),

PROFESSOR IN RESEARCH METHODS,

ANNAI MEENAKSHI COLLEGE OF NURSING, COIMBATORE.

CLINICAL GUIDE ……….

CAPT.PROF. KALPANA JAYARAMAN, M.Sc (N)., PRINCIPAL,

ANNAI MEENAKSHI COLLEGE OF NURSING, COIMBATORE.

MEDICAL EXPERT………

DR.S.PRAMILA, M.B.B.S., SENIOR CIVIL SURGEON,

GOVERNMENT PRIMARY HEALTH CENTRE, ARISIPALAYAM, COIMBATORE.

A DISSERTATION SUBMITTED TO THE TAMILNADUDR. M.G.R.

MEDICAL UNIVERSITY, CHENNAI, IN PARTIALFULFILLMENT OF REQUIREMENT FOR THE DEGREE OF

MASTER OF SCIENCE IN NURSING.

APRIL 2012

CERTIFIED THAT THIS IS THE BONAFIDE WORK OF

DONA JACOB

ANNAIMEENAKSHICOLLEGE OF NURSING, COIMBATORE, TAMILNADU.

SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING TO

THETAMILNADUDR.M.G.RMEDICALUNIVERSITY, CHENNAI.

COLLEGE SEAL:

CAPT.PROF. KALPANA JAYARAMAN, M.Sc (N)., PRINCIPAL,

ANNAI MEENAKSHI COLLEGE OF NURSING, COIMBATORE, TAMILNADU.

DEDICATION

DEDICATION

I dedicate this book to

The God almighty who blessed me to finish this work successfully.

I dedicate this book to my Parents,

Mr. Jacob. C. Varghese, &Mrs. Bala Jacob who made my life purposefuland meaningful and stood as a shoulder to cry upon.

I dedicate this book to,

My loving Sisters Mrs.Jasmu Jacob, Mrs.Jain Jacob,&Mrs.Shona Jacob, and Broher in Laws Mr. Sumesh Abraham, Mr. Sinu Paul and Mr. Thomas Zacharia , who have never failed to give me the caring support without which the completion of my study would have been at stake.

I dedicate this book to,

My Friends for their moral support and encouragement they have given to me to

complete this dissertation successfully .

ACKNOWLEDGEMENT

ACKNOWLEDGEMENT

I praise and thank the Lord Almighty for His blessings throughout this study.

With profound joy and gratitude, I acknowledge the help of those who involved in the successful completion of this endeavour.

My special thanks are to my study participants who extended their co- operation throughout my study period.

I honestly express my sincere thanks to Mr.M.PADMANABHAN, M.A., Correspondent of our college,for all the facilities, he has been provided to us at the institution and for giving me an opportunity to study in this esteemed institution.

I am extremely grateful to Our Principal and Clinical Guide, CAPT.PROF.

KALPANA JAYARAMAN, M.Sc (N)., Annai Meenakshi College of Nursing, Coimbatore whose excellent guidance, expert suggestions, encouragement and support helped me to tide over the hardships encountered during the study.

I am immensely thankful to our Vice Principal PROF. G. MAHALAKSHMI MSc (N)., Annai Meenakshi College of Nursing, Coimbatore for the valuable suggestions and corrections till the completion of the study.

I owe my sincere thanks to Research Guide PROF.DR.ANNAPURANI., MA., DSP., M.Phil., Ph.D.,D.Sc (GERMANY), Prof. in research methods, Annai Meenakshi College of Nursing, Coimbatore, for her excellent guidance.

I am pleased to convey my profound thanks to my Medical Guide expert Dr. S.PRAMILA,M.B.B.S, Coimbatore for his excellent guidance, expert suggestions,

encouragement and support that helped me to tide over the hardships encountered during the study.

I am pleased to express my sincere thanks to Mr.SENTHILKUMAR M.B.B.S, D.P.H. the Deputy Director of Public Health Coimbatore for permitting me to collect data from community centres.

My heartful thanks to Dr.V.KRISHNASAMY M.D.(Acu) for giving a special training on Pranayama with which I could train the perimenopausal women with climacteric symptoms and reduced the symptoms and enabled to finish my study successfully.

My sincere thanks to Dr. P.SALEENDRAN, Ph.D., for his invaluable help in statistical analysis.

I am thankful to my most respectful.PROF.M. MUMTAZ.M.Sc(N), Academic Director, Annai Meenakshi College of Nursing, for her esteemed guidance, keen interest, sustained patience, critical comments, constant availability

and continuous inspiration right from the planning phase till the completion of the thesis.

I am thankful to our M.Sc., (N) faculty Mrs.A.SAHAYAMARY.

M.Sc.,(N)Reader.,Mrs.DHANALAKSHMIMSc(N),Lecturer.,Mrs.PONNAMMAL M.Sc(N),Lecturer.,Mrs.MANAVALAM.MS.c(N)Lecturer,Mrs.BALAMANI,M.Sc (N),Lecturer.,Ms.EBENEZER,.MSc(N).,Lecture,Ms.SUTHANTHIRAKUMARI, M.Sc(N)., Lecturer, Mr.SATHISHM.Sc(N) Lecturer, Mrs.SIVAPRIYA.M.Sc(N) . Lecturer.,Ms.NITHYA.M.Sc(N).Lecturer.,Mr.CHINNACHADAYAN.M.Sc(N), Lecturer., Ms.JAYAVARUNANI.M.Sc.(N). Lecturer for their scholarly guidance, valuable suggestions, precise advice, inspiration and encouragement which madethestudy purposeful.

My special thanks are to the experts for their valuable suggestions and constructive comments.

¾ PROF. MRS. ESTHERJOHN,M.Sc (N)., Principal, Ganga College of Nursing Coimbatore.

¾ PROF. MRS. LATHA ,M.Sc(N)., Principal , RVS College of Nursing, Coimbatore.

¾ PROF. MRS.CHARMIJAYAPRIYA, M.Sc(N)., Principal, Texity College of Nursing, Coimbatore.

¾ ASSO. PROF. MRS.RENUKA, M.Sc(N)., ShriRamakrishna Colleg of Nursing, Coimbatore

¾ ASSO.PROF.MRS. RENUKA M.Sc(N). H.O.D (MATERNITY HEALTH NURSING) K.M.C.H., Coimbatore.

¾ MRS.JONSY M.Sc(N)., H.O.D (Maternity Health Nursing) P.S.G College of Nursing, Coimbatore.

I am thankful to Mr. JOSEPH MATHEW, MA ( English) Rtd. English Professor, for editing the thesis clearly and effectively.

I am immensely thankful to our Librarians Ms.REVATHY, B.A., Mrs.

SULOCHANA, B.A., B.L.I.Sc., for allowing me a free hand into many racks of the library.

I thank them (Mr. JAMES, LITTLE FLOWER INTERNET CAFÉ, Mr.

VENKADESH, GREEN PARK INTERNET CAFÉ and Mr. RAMA MURTHY, KOVAI STAR XEROX) for computing the manuscript clearly, legibly and effectively in a short span of time.

I sincerely thank all the teaching faculty and non-teaching faculty members of Annai Meenakshi College of Nursing for the help rendered in various ways to fulfill my research work.

ABSTRACT

ABSTRACT

The female climacteric is attributed to physiological ovarian failure which in turn causes the women in the perimenopausal period to suffer numeric physiological, psychological, and vasomotor changes which are need to be tackled to have a peaceful life.

Hence the research study was conducted among perimenopausal women with climacteric symptoms in Vazhukaparai Village with the aim to reduce the climacteric symptoms by practicing pranayama.

The objectives of the study include;

o

To assess climacteric symptoms among perimenopausal women,

o

To evaluate the effectiveness of pranayama in reducing climacteric symptoms among perimenopausal women,

o

To determine the association between climacteric symptoms and selected demographic variables.

The research design adapted for this study was one group pre test post test design. The conceptual frame work for this study was based on Emogen King’s Goal Attainmenytheory (1960). A Simple Random sampling technique was adopted. The sample size was 30. Severity of climacteric symptoms was assessed by using Modified Green Climacteric Symptoms Scale before and after the intervention. The intervention of Pranayama for 10 minutes daily for 5 weeks performed by the samples. Paired‘t’ test was used to evaluate the effectiveness of pranayama in

reducing climacteric symptoms among perimenopausal women. The obtained “t”

value 6.63 was significant at p< 0.05, and in the selected demographic variables Age and BMI had a significant association with climacteric symptoms. The study revealed that pranayama can reduce the severity of climacteric symptoms.

Keywords: Effectiveness, Perimenopause, Climacteric symptoms, Pranayama

CONTENTS

TABLE OF CONTENTS

CHAPTER CONTENTS PAGE NO

I

II

III

INTRODUCTION

™ Need for the Study

™ Statement of the Problem

™ Objectives

™ Hypotheses

™ Operational Definitions

™ Assumptions

™ Delimitations

™ Projected Outcomes REVIEW OF LITERATURE

™ Studies Related to Climacteric symptoms.

™ Studies Related to Pranayama.

™ Studies Related to Effectiveness of Pranayama on Climacteric Symptoms CONCEPTUAL FRAMEWORK.

METHODOLOGY

™ Research Approach

™ Research Design

™ Setting of the Study

™ Population

™ Sample

4 7 7 7 7 8 8 9

10 14 20

27

28 28 31 31 31

CHAPTER CONTENTS PAGE NO

IV V VI

™ Sampling Technique

™ Criteria for Sample Selection o Inclusion Criteria

o Exclusion Criteria o Development of the Tool

™ Description of the Tool

™ Scoring Procedure

™ Validity and Reliability

™ Pilot Study

™ Data Collection Procedure

™ Plan for Data Analysis

™ Protection of Human Rights

DATA ANALYSIS AND INTERPRETATION DISCUSSION

SUMMARY, COMMUNICATION AND RECOMMENDATIONS

™ Summary

™ Major Study Findings

™ Conclusion

™ Implications of the Study

™ Limitations

™ Recommendations REFERENCES

APPENDICES

31 32 32 32 32 33 33 34 35 36 36 37 38 57 60

61 63 63 64 66 66

LIST OF TABLES

TABLE NO.

TITLE PAGE

NO.

1.

2.

3.1

3.2

4.1

4.2

Frequency and Percentage Distribution of Perimenopausal Women with Climacteric Symptoms in Relation to their selected Demographic Variables.

Frequency and Percentage Distribution of Pretest Intensity of Climacteric Symptoms among Perimenopausal Women.

Frequency and percentage Distribution of Pre test and Post test Intensity of Climacteric Symptoms among Perimenopausal women.

Mean, Standard Deviation, Mean Difference and t value of Pretest, Post test Intensity of Climacteric Symptoms Among Perimenopausal women

Frequency, Percentage Distribution and χ² value of Pre test Intensity of Climacteric Symptoms Among Perimenopausal Women with their Selected Demographic Variables.

Frequency, Percentage Distribution and χ² value of Post test Intensity of Climacteric Symptoms Among Perimenopausal Women with their Selected Demographic Variables.

40

43

45

47

49

53

LIST OF FIGURES

FIGURE

NO. CONTENTS

PAGE NO.

1

2 3

4

5

Conceptual Framework Based on Emogen King’s Goal Attainment Theory (1968)

The Schematic Representation of Research Methodology

Percentage Distribution of Pretest Intensity of Climacteric Symptoms Among Perimenopausal Women.

Percentage Distribution of Pre test and Post test Intensity of Climacteric symptoms among perimenopausal women.

Mean value of Pretest and Post test Intensity of Climacteric Symptoms among Perinmenopausal women.

27

30 44

46

48

LIST OF APPENDICES

APPENDIX TITLE

A

B

C

D

E

F

G

H

I

J

K

L

M

Letter Seeking and Granting Permission to Conduct Study in Arisipalayam PHC, Coimbatore

Letter Requesting the Opinion of Experts on Content Validity of the Tool

List of Experts Consulted for Content Validity

Structured Interview Questionnaire (English)

Structured Interview Questionnaire (Tamil)

Evaluation Criteria Rating Scale Checklist for Validation of Tool

Intervention on Pranayama (English)

Intervention on Pranayama (Tamil)

Evaluation Criteria Checklist for Validation of Intervention on Pranayama

Certification of Validation

Training certificate

Criteria for sample selection among Perimenopausal Women

Letter Seeking Consent of Subjects for Participation in the Study ( English, Tamil)

INTRODUCTION

1

CHAPTER I

INTRODUCTION

There is no more creative force in the world than the perimenopausal women with zest.

Margaret Mead

The women’s body is truly a miracle. Throughout her life, a women’s amazing

reproductive system goes through at least three stages, these stages are known as

“The Stages of Menopause”, which include perimenopause, menopause and postmenopause. Perimenopause, which is sometimes called the menopausal transition is the time leading to a woman’s last period, the stage where the woman’s body preparing to enter yet another age marker. Perimenopause may become the worst thing if the woman have no idea about what is it and what to expect. During this time, the hormonal changes occur causing the woman to experience many symptoms called climacteric symptoms, and the woman’s body doesn’t feel normal.

The average age for Menopause in Indian women is 47 years.Menopause may sound pretty straight forward, but before reaching that momentous day, many women experience a variety of physical and emotional changes. This pre menopause period is known as perimenopause, and it ranges between 3 to 5 years and lasts up until menopause, or is the time leading up to a woman's last period. Perimenopause can occur anytime between 40 – 50 years of age. For some of the women perimenopausal symptoms are quite acceptable whereas, for the majority, the changes are distressing.

Perimenopausal symptoms are a combination of emotional, physical, psychological,

2

and mood disturbances. There is relatively a small number of women who hardly notice any changes before menopause.

The natural cessation of menstruation occurs due to termination of ovarian function. A woman’s age and menstrual cycle may be most clinically useful in determining the likelihood of the approaching menopause. This changes is usually not an acute physiological event and generally occurs between the ages of 43 and 47years, rather the physiologic antecedent associated with the transition from premenopausal to menopausal follicular function which occurs in the perimenopause. Perimenopause has been described as an opportune time for teaching women about health promotion and disease prevention strategies.

During perimenopause, hormones especially estrogen plays a huge role in the cause of perimenopausal symptoms, the loss in oestrogen affects women and feel a change in mood, anxiety and depression. Because perimenopause is the early phase on the road to menopause, many of the symptoms experienced are similar to those of menopause. 85% to 90% of perimenopausal women experience hot flashes and night sweats. These symptoms can occur while sleeping, which can disrupt the sleep cycle and result in fatigue, poor concentration, and disphoria. Hot flashes are due to the hypothalamic response to declining ovarian estrogen production. Even with normal sleep cycle fatigue still be reported. Irritability, forgetfulness, headache, stiff joints, joint pain, vertigo, palpitations, stomach bloating, fluid retention, and breast tenderness can also occur. Menstrual symptoms include irregular menstrual flow, excessive or deficient amounts of menstrual flow, and infrequent flow. Sexual symptoms include a decrease in sexual interest or desire, vaginal dryness, dissatisfaction with sexual relationship, and painful intercourse

3

The effect of climacteric symptoms have emphasized the need to develop and explore the efficacy of alternative therapeutic avenues that have demonstrated promise in alleviating perimenopausal symptoms. The climacteric symptoms can be reduced by using various lifestyle changes and other yoga therapies. Mind-body therapies have been shown to be effective in clinical treatment of perimenopausal disorders. Pranayama, or breathing exercises improve control over the autonomic nervous sysyem and increases self-awareness and insight into thought patterns and habits. Slow deep breathing practice has important implications as it may underlie the basic mechanism that synchronizes the brain with the autonomic response and gives strength, vitality, inspiration, and magic powers to cope with the climacteric changes.

Pranayama is a type of yoga therapy which can be practiced by the perimenopausal women without any fear of adverse effect to reduce the climacteric symptoms .

“Breath Depict Life.”Alternate Nostril Breathing is the method that is recommended for most women when they are actually entering menopause. Practice of Alternate Nostril Breathing helps in the deep penetration of prana (oxygen), where the blood receives a larger supply of oxygen than in other types of pranayama that thoroughly cleans and purifies the blood, calms the mind, soothes anxiety and stress, balances left and right hemispheres, and promotes clear thinking. It also purifies the arteries and veins, through which the blood flows in the body and improves the wellbeing.

A recent study from the University of Virginia cited

“paced respiration” as a potentially viable means of helping to control hot flashes and other perimenopausal symptoms. And also help to reduce anxiety, and improve the

4

circulation of the blood. Pranayama regulates and balances the metabolism and send energy to the areas of brain where it is most needed.Pranayama is a skill which could incorporate into daily life to reduce stress and manage perimenopausal symptoms.

Pranayama is cost free and have no known side effects and can safely be combined with another type of treatments.

Need for the Study

Perimenopausal period begins 3 to 5 years before menopause. The consequences of physical, psychological, and vasomotor changes cause women to suffer from a variety of symptoms. Modern medicine has significantly increased the life expectancy of women throughout the world. And nearly 85% of women are spending more than one third of their life in hormone deficient state with impaired quality of life.

Climacteric symptoms refer to the troublesome side effects of menopause.

Perimenopausal symptoms affects about 70% of women who are approaching menopause and elicits various somatic, vasomotor, sexual and psychological symptoms that impair the overall quality of life of women.

According to the Health information from the NIH (National Institutes of Health), the world statistics shows 22 million women between the ages of 40 and 49.

The world population of women aged over 60 years was below 250 millions in 1960 and it is estimated that in 2030, 1.2 billion women will be peri or post-menopausal and this will increase by 4. 7 million a year.

5

S.Palacios et.al; (2010) included data from MEDLINE (1966- 2009)and EMBASE (1975 -2009) revealed that the prevalence of climacteric symptoms ranges between 22-63% in Asian women. A relatively higher prevalence of vasomotor symptoms was reported among Indian women. Among 50 perimenopausal Indian women 32% reported climacteric symptoms.

According to IMS (Indian Menopause Society) research, there are currently 65 million Indian women over the age of 45 experiencing climacteric symptoms.

According to (Rebar; 1994) the report from one menopausal center shows that of the women who sought help, 79% reported physical symptoms and 63% reported emotional symptoms.

According to Gomnon Hanse & Goodwin, (1987) Midlife women need more alternatives for treating perimenopausal symptoms that are both safe and effective.

Mind body techniques promote increased relaxation and better stress management and psychological stress, common triggers of hot flashes.

Freed man in 1992 suggest that there is no adverse reactions were noted in practicing pranayama for climacteric symptoms among perimenopausal women. The prevalence of perimenopause symptoms are high including skin dryness (44.2%), fatigue (41.0%), and excessive sweating (34.7%) in a cross sectional studies.

The utility of such mind- body practices may have an application beyond that of just personal health. Pranayama may be effective in reducing climacteric symptoms,

6

primarily through improvement in psychological well being and increased ability to manage the symptoms.

Even today the vast majority of women are largely unaware of what to expect during this period. As a result many women experience confusion and uncertainty during their perimenopausal years. So the nurses can assist women with their questions and concerns about perimenopausal period and the climacteric symptoms.

Nurses can provide the women the knowledge and tools they need to sail smoothly through perimenopause, at the same time empowering them with the understanding that menopause is not a disease or a deficiency but the entrance into a wondrous new phase of life and can foster a positive image of perimenopause as a time of vitality and attractiveness. They should be taught that the symptoms are normal and only temporary, and through nonpharmacological approaches including a regular programme of exercise and physical activity the symptoms can be managed. In nutshell, perimenopausal women need more alternatives for treating climacteric symptoms that are safe and effective.

Finally the studies and statistics revealed the crucial need for more research in women’s health concerning the perimenopause specifically. So the investigator got interested in conducting a research among perimenopausal women with climacteric symptoms to determine whether pranayama which is a non pharmacologic, cost effective and an easy approach is beneficial in reducing climacteric symptoms which can be taught by the nurse investigator to the perimenopausal women. And whether pranayama can be incorporated as a regular nursing care in the gynecological practice.

7

Statement of the Problem

A Study to Evaluate the Effectiveness of Pranayama in Reducing Climacteric Symptoms Among Perimenopausal Women in a Selected Rural Area at Coimbatore.

Objectives

•

To assess the intensity of climacteric symptoms among perimenopausal women.

• To evaluate the effectiveness of pranayama in reducing climacteric symptoms among perimenopausal women.

• To determine the association between the intensity of climacteric symptoms among perimenopausal women with their selected demographic variables.

Hypotheses

• H1 – There will be a significant difference between the mean pre and post test intensity of climacteric symptoms among perimenopausal women.

• H2 – There will be a significant association between the intensity of climacteric symptoms among perimenopausal women with their selected demographic variables.

Operational Definitions

Effectiveness

It refers to the outcome of pranayama in terms of reducing climacteric symptoms among the perimenopausal women.

8 Pranayama

Pranayama is a breathing technique in which alternate nostril breathing practiced by the perimenopausal women.

Climacteric symptoms

These are symptoms occurring during perimenopausal period that affects psychological, physical and vasomotor functioning.

Perimenopause

Perimenopause is the period of transition from normal ovulatory cycles to cessation of ovarian function which ranges between 43- 47 years of age.

Assumptions

• Pranayama may have an effect in reducing the climacteric symptoms among perimenopausal women in selected areas at Coimbatore.

• Pranayama will cause no adverse effect in perimenopausal women with climacteric symptoms.

• Pranayama will help to improve the well being of perimenopausal women.

Delimitations

• This study is limited to perimenopausal women in the age group of 43 - 47 years in Vazhukkuparai Village, Coimbatore.

• This study is limited to women with climacteric symptoms.

• The study period is limited to 6 weeks.

9

Projected Outcomes

• The study will help the investigator to assess the climacteric symptoms among perimenopausal women.

• The study will help the investigator to identify the effectiveness of pranayama in reducing the climacteric symptoms among perimenopausal women.

• The study will help the investigator to teach pranayama as an intervention in reducing climacteric symptoms among perimenopausal women.

10

CHAPTER II

REVIEW OF LITERATURE

Review of literature is an important step in the development of research project. It helps the researcher to analyze what is known about the topic and to describe methods of inquiry used in earlier work including the success and short comings. It gives a broad understanding of the problem. According to B.T.

Basavanthappa (2006), the review of literature is defined as a broad, comprehensive in depth, systematic and critical review of scholarly publications, unpublished scholarly print materials and personal communications. According to Polit Hungler (2004), literature review is a critical summary of research on a topic of interest, often prepared to put a research problem in context.

Research literature were reviewed and organized under the following headings.

• Studies Related to Climacteric symptoms

• Studies Related to Pranayama

• Studies Related to Effectiveness of Pranayama on Climacteric Symptoms.

Studies Related to Climacteric Symptoms

Sharma V K et al., (1981) conducted a study for the purpose of unravelling the difficulties that the Indian women have to face during the perimenopausal period. They did survey and included 405 married women aged between 40 to 55 years from general population and interviewed. The result obtained with the

11

Menopausal Symptom Checklist indicates that hot flushes, night sweats and insomnia

seems to be clearly associated with the menopause. This study underlines the necessity of a multidisciplinary approach to the problems of menopause and

ageing.

Hammar et.al., (1984) conducted a study in a selected Swedish women to assess the prevalence of climacteric symptoms. A questionnaire on climacteric symptoms was distributed among 120,000 inhabitants. Climacteric symptoms were reported by 75% of the women. The predominating complaints were sweating attacks and hot flushes. Vaginal dryness and tenderness were experienced by 30% of the perimenopausal women.

Barentsen R et.al.,(2001) studied the Climacteric symptoms in 269 representative Dutch female population sample aged between 45 to 65 years, using Green Climacteric Symptoms Scale and sub scaled the symptoms as [psychological, somatic, vasomotor, and sexual].The study used an interview method. A significant difference between pre, peri and post-menopausal women was observed in the psychological, somatic, and vasomotor subscales. The score in perimenopausal women (15.78+/-9.09) and postmenopausal women (15.33+/-9.01) were significantly higher than in the premenopause. The study concluded that the prevalence and the intensity of climacteric symptoms increases during menopausal transition.

Travers C et.al., (2005) conducted a longitudinal study in Betty Byrne Henderson women’s Health Research Centre , where a cohort of 500 premenopausal, perimenopausal and postmenopausal women aged 40 to 60 years were participated to

12

assess the climacteric symptoms and to investigate the prevalence of climacteric symptoms in the samples. All participants completed the Green Climacteric Symptom Scale and the information regarding their perimenopausal status. The result was that the 50 to 59 year age group achieved the highest scores on the vasomotor, and on the depression scales in comparison to other age groups. In conclusion, vasomotor symptoms as assessed by the Green Climacteric Symptoms Scale are common during the perimenopause.

Sierra B et al., (2005) measured the Climacteric Symptoms in a low socio economic population using Green Climacteric Symptoms Scale and determined factors involved with high scorings. In the study 385 women aged 47.6+/- 5.5 years were selected. Self administered questionnaire was used to assess the prevalence of climacteric symptoms. The total Greene Climacteric score for postmenopausal was found to be higher than premenopausal total score (18.78+/- 8.11 versus 16.31 +/- 7.62, p < 0.05). In conclusion in this specific population climacteric symptoms presenting in all menopausal groups as measured with the green climacteric scale resulted to be higher.

Sao Paulo et al., (2006) conducted a cross sectional population based study to assess the climacteric complaints among very low income women from a tropical region of Brasil with the objective to identify climacteric symptomatology among Brazilian women living in a hot and humid region. The study involved 354 perimenopausal women. The number of symptoms per woman was 8.0 +/- 5.7. The study concluded with the result that Brazilian climacteric women of low income and low schooling present multiple symptoms. Vasomotor and psychosexual symptoms

13

were the most prevalent disorders, and hot flushes were associated with nervousness, forgetfulness, and fearfulness.

Kakar V et al., (2007) conducted a study to assess the variation in perimenopausal symptoms with age, education, and working/ nonworking status using Menopause Rating Scale by organizing a menopause clinic in collaboration with primary health centre in Panjab. A random sample of 208 women aged 35 to 65 were participated. The result was that a significantly higher percentage of perimenopausal women (36 %) showed a psychological symptoms, while a higher percent of postmenopausal showed somatic and urogenital symptoms. The study concluded that age, level of education, and working/ nonworking status may also contribute to significant variations in perimenopausal symptoms.

Kapur P et al., (2009) measured climacteric symptoms and age at natural menopause in Indian population using Green Climacteric Symptoms Scale. A sample of 129 women in the age group of 30 to 65 years were included in the study. The categories were premenopause, early postmenopause and late post menopause.

Interview method was used with four point scale. The result was that the SD age at menopause was 45.2 +/ - 4.35 years, and an increase in the percentage of occurrence and severity of symptoms with transition to menopause was observed. The most prevalent symptoms were muscle and joint pain (55.81%),followed by feeling tired or lack of energy (51.19%), eye problems (49.61%),headache (43.41%), and feeling unhappy or depressed (36.43%).

14

Studies Related to Pranayama

N.K. Subbalakshmi et.al.,(2002) Physiological Society of Thailand, conducted a randomised control study among 10 normal healthy subjects and assessed the effect of pranayama for a duration of 20 minutes for 4 weeks in cardiopulmonary and higher brain functions. The instruments used were sphygmomanometer, stethoscope, Wright peak flow meter. Paired t’ test was used to compare the parameters within groups.

P<0.05 indicated a significant difference. The study findings revealed that practicing pranayama improves the cardiac and pulmonary functions, and a significant decline in basal heart rate and systolic blood pressure was observed.

Sandeep et al., (2005) studied the calming effect of pranayama on mind in Manipal Institute of Medical Sciences, which exert profound physiological effect on pulmonary, cardiovascular and mental functions of the brain. The study carried out in human physiology laboratory department of physiology to assess the immediate effect of pranayama on resting heart rate, blood pressure, peak expiratory flow rate and simple problem solving ability in young healthy subjects. The study included 50 samples of 17 to 20 years doing bachelor degree in physiotherapy. The study concluded with the result that practicing pranayama for 20 minutes for a period of 6 weeks improved pulmonary, cardiovascular and mental functioning.

Smith C et al., (2007) conducted a randomised trial to assess the effectiveness of pranayama in reducing subject stress, anxiety, blood pressure, and improves quality of life.131 subjects with mild to moderate levels of stress were recruited from the community in South Australia. The scale used was State Trait Personality Inventory Sub Scale Anxiety, General Health Questionnaire. The study concluded with the

15

result that following 10 weeks intervention, stress, anxiety and quality of life scores improved over time.

Lane j. D et al., (2007) Department of Psychiatry, Medical Centre in Durham, conducted a study using a single group pre test post test design to assess the effect of pranayama for perceived stress and negative emotion, and to determine the effect of practice frequency and test the moderating effects of neuroticism on treatment outcome, for 200 healthy adults with instructions to practice pranayama for 15 to 20 minutes twice daily. The effect of pranayama measured using Perceived Stress Scale, States-Trait Anxiety Inventory and Brief Symptoms Inventory and suggested that the practice of pranayama can improve negative mood and perceived stress. All 4 outcome measures improved significantly after instruction, with reductions from baseline that ranged from 14% (STAI) to 36% (BSI). It is recommended that more frequent practice is associated with better outcome. `

K. Jellgren et al., (2007) conducted a controlled pilot trial in Sweden to assess the wellness through a comprehensive yogic breathing programme where 6 day intensive programme of yogic breathing practiced by 55 adults for 6 weeks. Hospital Anxiety Depression Scale measured the degree of anxiety and depression, Life Orientation Test measured positional optimism, Stress and Energy Test measured individual's energy and stress experiences. Experienced Deviation from Normal State measured the experience of altered state of consciousness. The data obtained suggested that participants in the experimental group lowered their degree of anxiety, depression and stress and also increased their degree of optimism (ANOVA;p<0.001).

16

Lundgren et al., (2008) conducted a study to evaluate the effectiveness of pranayama in 18 samples with drug refractory epilepsy. The design consisted of a randomized controlled trial. All participants had an EEG-verified epilepsy diagnosis with drug-refractory seizures. Therapeutic effects were measured using seizure index.

The treatment protocols consisted of 12 hours of therapy distributed in two individual sessions, two group sessions during a 5-week period, and booster sessions at 6 and 12 months post treatment. Quality of life was measured after treatment and at the 6month and 1-year follow-ups. The results indicated that practice of pranayama significantly reduced the seizure index and increased the quality of life over time.

Vyas R et al., (2008) conducted a study in B. J. Medical College and Civil Hospital, Ahmadabad to assess the effectiveness of pranayama on the lipid profile of 49 post-menopausal women. They were divided into pre-menopausal (n=23) and post- menopausal (n=26) groups. They were further divided into non-meditators, short-term meditators, and long-term meditators. Serum cholesterol, triglyceride and low-density lipoprotein-cholesterol in nonmeditators were significantly more in post-menopausal women as compared to pre-menopausal women. Serum cholesterol and low density lipoprotein-cholesterol were significantly lowered in both short and long term meditators as compared to non-meditators in post-menopausal women. No significant difference was observed in lipid profile in pre-menopausal women. The result revealed that practice of pranayama can lower serum cholesterol and low-density lipoprotein-cholesterol in post-menopausal women.

Tekur P et.al, (2008) Swami Vivekananda Yoga Research Foundation, Bangalore conducted a randomised controlled study to assess the effect of pranayama

17

for one week, on pain, functional disability and spinal flexibility in chronic low back pain. The study included 80 samples. The outcome was measured using Oswestry Disability Index and by Spinal Flexibility. There was a significant reduction in ODI scores in the study group compared to the control group (p =0.01; effect size 1.264).

Spinal flexibility measures improved significantly in both groups but the study group had greater improvement as compared to controls on spinal flexion (p=0.008; effect

size 0.146), spinal extension (p=0.002;effect size 0.251), right lateral flexion (p=0.059; effect size 0.006); and left lateral flexion (p = 0.006; effect size 0.171).

The result suggested a significant reduction in ODI scores, and in spinal flexibility.

The study concluded that the seven days of practice of pranayama reduced pain related disability and improved spinal flexibility in patients with chronic low back pain.

Maize Ritomy et al., (2008) conducted a study to assess the effect of Pranayama in patients with fibromyalgia. The study included 40 women aged between 20 and 60 years, and randomly assigned into two groups of 20 patients: the experimental group performed pranayama for 1 hour, four times a week, for 4 weeks.

Questionnaires such as SF-36, Fibromyalgia Impact Questionnaire, Hamilton Anxiety Scale, and Pittsburg Sleep Quality Index were applied before and after intervention to assess quality of life and functional capacity. The study group compared with the control group showed improvement in SF-36 scores (physical functioning, bodily pain, vitality, social functioning, emotional role), in FIQ (total score, work missed, fatigue, morning tiredness plus in anxiety and quality of sleep.

18

Vadiraja H., (2009) conducted a study to compare the effects of pranayama with brief supportive therapy in breast cancer outpatients undergoing adjuvant radiotherapy at a cancer center at Bangalore. 88 stage II and III breast cancer outpatients were randomly assigned and received the therapy prior to radiotherapy treatment. Assessments included diurnal salivary cortisol levels 3 days before and after radiotherapy and self-ratings of anxiety, depression, and stress collected before and after 6 weeks of radiotherapy. Analysis of covariance revealed a significant decreases in anxiety, depression, and in perceived stress. There is a significant positive correlation between morning salivary cortisol level and anxiety and depression. The result revealed that practice of pranayama can manage psychological distress and modulating stress hormones in early breast cancer patients undergoing adjuvant radiotherapy.

Javnbakht M et al., (2009) conducted a randomised controlled study to evaluate the influence of pranayama in relieving symptoms of depression and anxiety in 34 Iran women. Beck and Spielberger depression scale was used to assess the symptoms. The experimental group (n=34) participated in twice weekly for 90 minutes duration for two months. The average prevalence of depression in the experimental group in pre and post intervention was 12.82+/-7.9 and 10.79+/-6.04 respectively, a statistically insignificant decrease (p=0.13) was found. However, when the experimental group was compared to the control group, women who practiced pranayama showed a significant decrease in the state of anxiety (p=0.03) and trait anxiety (p<0.001). The result revealed that practicing pranayama for two-months can lead to a significant reduction in perceived level of anxiety in women who suffer from anxiety disorders.

19

Dr. Sheena Singh et al., (2009) conducted a randomised controlled study in Medical College Ludhiana to assess the effect of pranayama on pulmonary functions in patients with bronchial asthma. The study included 120 patients of asthma, randomized into two groups. Pulmonary function test was performed on all the patients at baseline, after 4 weeks and then after 8 weeks. The study concluded with the result that the subjects practiced pranayama showed a statistically significant improvement in pulmonary function at 4 weeks and 8 weeks as compared to samples not practiced pranayama. Thus practice of pranayama adjunctively with standard pharmacological treatment significantly improves pulmonary functions in patients with bronchial asthma.

Tenzin Kyizom et al.,(2010) conducted a study to assess the effect of pranayama among clients admitted in Bahadur Hospital Delhi on cognitive brain function in type 2 diabetes mellitus – p3 event. The study included Sixty patients of type 2 diabetes from diabetic clinic and divided into two groups - control group on only conventional medical therapy and experimental-group on pranayama. P300 (or P3) is a component of endogenous cerebral evoked response that assesses higher functions of the brain. The study aimed to see the role of pranayama on P300 latency and amplitude in type 2 diabetic patients. The study concluded with the data that pranayama has a beneficial effect on P300 and thus can be incorporated along with the conventional medical therapy for improving cognitive brain functions in diabetes.

Diana M. Taibi et al., (2010) conducted a pilot study on pranayama for sleep disturbances in women with osteoarthritis. The study included 14 older women and the participants were women with symptoms consistent with insomnia. The study

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21

baseline. The results indicated that a larger, randomized controlled trial to explore the efficacy of pranayama for treatment of perimenopausal symptoms would be safe and feasible.

Booth La Force etal.,(2007) University of Washington, conducted a study to observe the effect of pranayama in the treatment for perimenopausal symptoms. A prospective within-group pilot study was conducted among 12 peri and post menopausal women. Assessments were administered before and after completion of pranayama for 10-week. Participants were asked to practice pranayama at home for 15 minutes each day in addition to weekly classes. Significant pre- to post-treatment improvements were found for severity of questionnaire-rated total perimenopausal symptoms. The study concluded with the suggestion that improvement in symptom perceptions and well being warrant further study of pranayama for perimenopausal symptoms, with a larger number of women and including a control group.

Elavsky.S et al.,(2007) Department of Kinesiology, conducted a randomised controlled trial investigating the effect of Pranayama to improve the climacteric symptoms including the quality of sleep. The study included 164 low active middle aged women. The result suggested that pranayama improved the sleep quality domains assessed using Pittsburg Sleep Quality Index.

Chattha. R et.al.,(2008) Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore , conducted a randomised controlled study with experimental and control group to assess the efficacy of pranayama on cognitive abilities in climacteric symptoms. 108 perimenopausal

22

women between 40 and 55 years were included in the study, where the experimental group practiced pranayama while the control group practised a set of simple exercises for 1 hour per day for 5 days for 8 weeks. The main outcome was measured using Vasomotor symptoms check list, Six letter cancellation test and Punit Govil Intelligence memory scale. The experimental group performed significantly better (P<0.001) with higher effect sizes compared with the control group. The study concluded with the result that pranayama can improve hot flushes and night sweats and also can improve cognitive functions.

Innes.K.E et.al.,(2010) Department of community Medicine, USA, conducted a study to assess the effect of Pranayama on perimenopausal symptoms. The study included 12 randomized controlled trials (N=719), 1 non-randomized controlled trial (N=58), and 5 uncontrolled trials (N=105). Eight of the nine studies reported improvement in overall perimenopausal and vasomotor symptoms; six of seven trials indicated improvement in mood and sleep and four studies reported reduced musculoskeletal pain. Collectively, findings of these studies suggested that pranayama is beneficial for alleviating specific perimenopausal symptoms.

Joshi S et al.,(2011) conducted a prospective randomised, and interventional study to observe the effect of pranayama on perimenopausal symptoms. The symptoms Measured using Total Menopause Rating Scale (MRS) Score and three subscale scores (somatovegetative, psychological and urogenital) on day 1 and day 90. It was observed that on day 1 the scores in both the groups were comparable. On day 90, the scores in the study group showed a reduction in score on all the subscales, which was statistically significant. No significant difference was noted in the control

23

group. The study concluded with the result that Pranayama is effective in reducing perimenopausal symptoms and should be considered as alternative therapy for the management of menopausal symptoms.

24

CONCEPTUAL FRAMEWORK

IMOGENE KING’S GOAL ATTAINMENT THEORY

According to Nancy Burns, (2001) conceptual framework is a set of interrelated concepts that symbolically represent and convey a mental image of a phenomenon.

A conceptual framework for the present study was based on King’s Goal Attainment Model (1981).Theory of Goal Attainment was first introduced by Imogene King in the early 1960’s. King’s theory offers insight into nurse’s interactions with individuals and groups within the environment. It highlight the importance of client’s participation in decision making that influences care and focuses on both the process of nurse- client interaction and the outcome of the care.

King’s Goal Attainment Model is based on the concept of interaction including perception, judgement, action, reaction, and transaction.

Perception

According to Imogene King, perception means: a person imparts energy from the environment and transforms, processes, and stores it. Each person’s representation of reality. In this present study, the nurse investigator identifies the climacteric symptoms among perimenopausal women using the demographic variables and Modified Green Climacteric Symptoms Scale and comes to a conclusion that climacteric symptoms are common in women during their perimenopausal period.

The samples Perceives that the symptoms are associated with perimenopause .

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Judgement

Analysing the area of activity which is carried out. Both the investigator and the samples have their own perceptions and come up with their own judgemet. In this study judgement refers to nurse investigator judges that perimenopausal wome in Vazhukkaparai village exhibit moderate and severe climacteric symptoms. On the other hand the perimenopausal women need some measure to reduce the climacteric symptoms and the goal is set to reduce climacteric symptoms.

Action

According to Imogene King’s goal attainment theory, the individual exports the perceived energy as demonstrated by observable behaviour by taking mental or physical action. In this present study, action refers to nurse investigator plans to reduce the climacteric symptoms by the intervention of Pranayama. Following goal setting, the participants take action by making themselves ready to perform pranayama.

Reaction

Reaction means developing action and acting on perceived choice for goal attainment. In the present study the investigator observes the samples in practicing pranayama for 10 minutes daily for a duration of 5 weeks. While the samples performs pranayama for 10 minutes daily for 5 weeks.

Transaction

Imogene King said that transaction is the process where the two individual naturally identify goals and means to achieve them. They reach an agreement about

26

how to attain these goals and then set about to realize them. It is a purposeful interaction leading to goal attainment. In this present study post test assessment done using Modified Green Climacteric Symptoms Scale and assessed the outcome.

27

28

CHAPTER III

METHODOLOGY

Research methodology is one of the vital sections of a research, since the success of any research is mostly ends upon the methodological issues that are followed in the execution of the research work. This chapter deals with the methodological approach adopted for the study. It includes description of research approach, research design, setting of the study, population, sample and criteria for sample selection, sampling technique, development of tool, scoring procedure, pilot study, data collection procedure, data analysis and protection of human rights.

Research Approach

Polit and Hungler, 2004 defined the approach as “A general set of orderly discipline procedure used to acquire information”.

A quantitative approach was used for analyzing the effectiveness of pranayama in reducing climacteric symptoms among perimenopausal women.

Research Design

According to Polit and Hungler (2005). A researcher’s overall plan for obtaining answers to the research questions or for testing the research hypothesis is referred to as the research design.

29

One group pre and posttest design was chosen for this study to analyze the effectiveness of pranayama in reducing climacteric symptoms among perimenopausal women. The diagrammatic representation of research design is as follows:

Group Pretest Intervention Posttest

Study group O1 X O2

Keys

O1 : Pretest assessment of intensity of climacteric symptoms

X : Intervention on pranayama for 10 minutes daily for 5 weeks (35 days).

O2 : Posttest assessment of intensity of Climacteric Symptoms Scale.

O2 – O1 : Effectiveness of Pranayama in reducing climacteric symptoms.

Variables

A variable is “An attribute of a person or object that varies that is taken on different values”. A variable is any phenomenon or characteristic or attribute that changes. Variables are measurable characteristics of a concept and consist of logical group of attributes.

Dependent Variable

In this present study the dependent variable is intensity of climacteric symptoms among perimenopausal women.

Independent Variable

In this present study the independent variable is pranayama for 10 minutes for 5 weeks (35 days).

30

Figure 2: The Schematic Representation of Research Methodology Target Population

Perimenopausal women

Accessible population

One group pretest posttest design

Perimenopausal women with

climacteric symptoms in Vazhukkaparai Village

Sampling Technique

Non-probability purposive sampling technique.

Structured interview questionnaire. (Modified Green Climacteric Symptoms Scale)

Intervention on Pranayama for (10 minutes for 5 weeks)

Post-Test assessment by using Modified Green Climacteric Symptoms

Scale

Descriptive and Inferential Statistics

Severity of climacteric symptoms Pre-Test assessment by

using Modified Green Climacteric Symptoms

Scale

Data Analysis

Criterion Measures Research design

Data collection

31

Setting of Study

The study was conducted in selected rural area of Coimbatore district. The rural area selected was Vazhukkaparai village, under Arisipalayam Primary Health Centre. This area was situated at a distance of 8 kms away from Annai Meenakshi College of Nursing, Coimbatore. The total population of vazhukkuparai Village is around 2234.

Population

According to Polit and Hunger (2005) “A population is the entire aggregation of cases in which a researcher is interested”.

The target population is the aggregation of cases about which the investigator would like to make generalization. An accessible population is the section of the target population. For this study the target population was perimenopausal women.

The accessible population of this study was 65 perimenopausal women with climacteric symptoms residing in Vazhukkaparai village.

Sample

The samples selected for the present study was 30 perimenopausal women with moderate and severe climacteric symptoms in Vazhukkaparai Village at Coimbatore. The total subjects selected for this study is 30.

Sampling technique

In this present study the sampling technique adopted was non probability purposive sampling method. The investigator has done survey for 2 days and

32

identified 65 perimenopausal women. 30 subjects were selected for the study based on the inclusion and exclusion criteria.

Criteria For Sample Selection Inclusion Criteria

• Perimenopausal women between 43 to 47 years of age.

• Perimenopausal women with moderate to severe climacteric symptoms.

• Perimenopausal women who are willing to do pranayama.

• Perimenopausal women who can understand Tamil and English.

Exclusion criteria

• Peri menopausal women who are on complementary therapies.

• Perimenopausal women with mild climacteric symptoms.

• Peri menopausal women who are not willing to participate.

• Perimenopausal women with respiratory problems.

Development of the tool

Treece [1990] emphasized that the instrument selected in research should as far as possible be the vehicle that would best obtain data for drawing conclusion.

The research instrument was developed in English after extensive review of literature and expert opinion and translated in Tamil. Climacteric Symptoms Checklist was used to identify the samples with climacteric symptoms. The Modified

33

Green Climacteric Symptoms Scale was used as an instrument to measure the severity of climacteric symptoms among perimenopausal women.

Description of the Tool

The tool consists of 2 parts

PART I: It consists of demographic variables like age ,education, occupation , marital status, family, and body mass index.

PART II: It consists of Modified Green Climacteric Symptom Scale to assess the intensity of climacteric symptoms among perimenopausal women.

Scoring procedure

Part II: The Modified Green Climacteric Symptom Scale consists of 21 questions with likert (4 point) scale to assess the intensity of climacteric symptoms among perimenopausal women.

The total score is 63.

The score is categorized as follows:

Not at all - 1 – 16 (1 - 25%) Mild - 17 – 32 (26 – 50%) Moderate - 33 – 48 (51 – 76%) Severe - 49 – 63 (77 – 100 %)

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Intervention

Pranayama is an alternate breathing technique in which inhale through one nostril, retain the breath, and exhale through the other nostril. The investigator demonstrated pranayama to the perimenopausal women. Pranayama includes 2 phases, preparatory phase and practicing phase. Pranayama has to be performed by the perimenopausal women for 10 minutes for a period of 5 weeks (35 days).

Validity and Reliability

Validity

According to Burns and Grove, (2005) “the totality of an instrument is the determination of the extent to which the instrument reflect the abstract constant that is being examined”. Validity is the degree of precision with which the test employed measures, what is intended to measure. To ensure the content validity of the tool, along with the statement of the problem, objectives, hypothesis, methodology, and intervention protocol, criteria check list were given to 10 experts, 7 OBG specialist, 2 gynecologist and to 1 statistician. The experts were requested to judge the items for relevance, clarity, and appropriateness of the topic. Some modifications were made in the tool based on experts suggestion and consultation with the guide, where in Modified Green Climacteric Symptoms Scale the 5^th and 10^th questions which were expressed in medical term changed in simple term for easy understanding.

Reliability

Brink (1985) stated that reliability refers to the consistency, stability and reliability of a data collection instrument.

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Reliability was established through Cohen”s Kappa”s method.The tool was administered to 5 samples, representing the characteristics of the population. In that 19 questions were found to be perfect agreement and 2 were found to be substantial agreement.

Pilot Study

Polite and Beck,(2004) denotes that “Pilot Study is a small –scale version or trial run done in preparation of a major study.

The pilot study was conducted in Meenakshipuram, at Coimbatore. The permission for conducting the study was obtained from Deputy Director of Health Services, and medical officer of Arisipalayam Primary Health Centre. The data collection procedure was done for 35 days in Meenakshipuram, at Coimbatore.10 samples were selected by using non-probability purposive sampling technique. On the 1^st day the samples were informed about the nature and purpose of the study and using symptoms checklist the samples were collected. On the second day pretest done among the samples using Modified Green Climacteric Symptoms Scale. On third day pranayama was practiced by the samples for about 10 minutes and continued for 35 days. After that on day 38, post test was done by using Green Climacteric Symptoms Scale. The effectiveness of pranayama in reducing severity of climacteric symptoms found by using statistical ‘t’ value of 7.72* found to be significant at 0.05 level. The result showed that the setting, samples and the tool was feasible enough to conduct the main study.

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Modifications in demographic variables, and criteria for sample selection were made after the pilot study. In demographic variables, the age limit changed from (39- 51years) to (43- 47 years). Other variables like marital status and type of family are included in the main study, and the age at marriage is removed.

Data Collection Procedure

The data collection procedure was done for 35 days in Vazhukkaparai village, at Coimbatore. The permission for conducting the study was obtained from Deputy Director of Health Services and Medical Officer of Arisipalayam Primary Health Centre. The samples were informed regarding the nature and purpose of the study.

The written consent was obtained from each sample. Pre-test done to assess the intensity of climacteric symptoms among perimenopausal women with climacteric symptoms using Modified Green Climacteric Symptoms Scale. Pranayama was demonstrated to the participants by dividing them into 6 groups. Participants were observed daily for practice, lasted for 10 minutes for 5 weeks (35 days). After 5 weeks, post test was done to assess the intensity of climacteric symptoms using Modified Green Climacteric Symptoms Scale.

Plan for Data Analysis

The demographic variables were analyzed using descriptive statistics (frequency and percentage).The intensity of climacteric symptoms was analyzed using descriptive statistics (mean, standard deviation).The effectiveness of pranayama in reducing Climacteric Symptoms was analyzed by using inferential statistics (Paired

“t” test). Association between climacteric symptoms among perimenopausal women with their selected demographic variables was analyzed by using chi –square test.

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Protection of Human Rights

The study is conducted after the approval of research committee of the college. The nature and purpose of this study was explained to the health care personnel involved. The written consent was obtained from the study participants.

Assurance has been given to the study samples that the anonymity of each individual will be maintain strictly.

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CHAPTER-IV

DATA ANALYSIS AND INTERPRETATION

The chapter deals with analysis and interpretation of data collected from 30 Perimenopausal women with Climacteric symptoms to evaluate the effectiveness of Pranayama in reducing Climacteric symptoms. The purpose of the analysis was to reduce the data to an intelligible and interpretable form, so that the relation of the research problem can be studied and tested.

Polit and Beck, (2003) has noted that data analysis as the systematic organization, synthesis of research data and testing of research hypothesis using those data.

The analysis and interpretation of this study was based on the data collected through symptom check list and structured interview method using Green Climacteric

Symptoms Scale, among perimenopausal women with climacteric symptoms.

The results were computed using descriptive and inferential statistics.

The study findings are presented in sections as follows:

Section I : Data on Demographic Variables of Perimenopausal Women with Climacteric symptoms.

Section II : Data on the Intensity of Climacteric Symptoms Among Perimenopausal Women .

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Section III: Data on Effectiveness of Pranayama in reducing Climacteric Symptoms among Perimenopausal women with Climacteric symptoms.

Section IV : Data on Association between the intensity of Climacteric Symptoms

among Perimenopausal women with their Selected Demographic Variables.

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SECTION I: DATA ON DEMOGRAPHIC VARIABLES OF PERIMENOPAUSAL WOMEN WITH CLIMACTERIC SYMPTOMS

Table: 1

Frequency and Percentage Distribution of Perimenopausal Women with Climacteric Symptoms in Relation to their Demographic Variables.

N=30 S. No. Demographic Variables

Frequency n

Percentage

%

1.

2.

3.

Age a) 43 b) 44 c) 45 d) 46 e) 47 Education

a) Primary b) Secondary c) Degree d) Illiterate Occupation

a) Employed b) Unemployed c) Self employed

- 7 5 14

4

19 - - 11

20 10 -

- 23 17 47 13

63 - - 37

67 33 - Cont…

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S. No. Demographic Variables Frequency n

Percentage

%

4.

5.

6.

Marital status a) Married b) Unmarried c) Widow Family

a) Joint family b) Nuclear family Body Mass Index

a) 18.5 – 22.9 b) 23.0 - 24.9 c) 25 and above

28 - 2

3 27

9 21

-

93 - 7

10 90

30 70 -

Regarding age, there were 7 (23%) perimenopausal women with climacteric symptoms in the age of 44 years, 5 (17%) in 45 years, 14 (47%) in 46 years and 4 (13%) in 47 years.

As far as the educational status, majority of the perimenopausal women 19 (64%) with climacteric symptoms had primary education and 11(37%) were illiterate.

It was found that majority of the perimenopausal women 20 (67%) with climacteric symptoms were employed, and 10(33%) were unemployed.

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With regard to marital status, majority of the perimenopausal women 28 (93%) with climacteric symptoms were married and 2 (7%) were widow.

Regarding family, 27 (90%) perimenopausal women with climacteric symptoms were from nuclear family, and 3(10%) from joint family.

Regarding body mass index, majority of the perimenopausal women 21 (70%) with climacteric symptoms had the BMI between 23.0 – 24.9 and 9 (30%) had the BMI between 18.5 – 22.9.

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SECTION II: DATA ON INTENSITY OF CLIMACTERIC SYMPTOMS AMONG PERIMENOPAUSAL WOMEN

Table: 2

Frequency and Percentage Distribution of Pretest Intensity of Climacteric Symptoms among Perimenopausal Women

N = 30

S. No. Intensity of Climacteric Symptoms

Classification of Respondent Frequency

n

Percentage

%

1.

2.

3.

4.

Not at all Mild

Moderate Severe

- - 9 21

- - 30 70

The above table 2 shows that among 30 subjects, in pretest, none of them were in the category of without any symptoms and mild symptoms. 9(30%) had moderate climacteric symptoms, and 21(70%) had severe climacteric symptoms. The findings inferred that majority of the women in their perimenopausal period suffer from climacteric symptoms.