6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“If women are supposed to be less rational and more emotional at the beginning

of our menstrual cycle when the female hormone is at its lowest level, then why isn’t it

logical to say that, in those few days, women behave the most like the way men behave

all the month long?”

By, Gloria Steinem

The word adolescence is derived from a Latin word adolescence, which means to

grow into maturity. Adolescence is regarded as a unique phase of human development.

Among adolescent girls menarche is an important landmark in the process of growth and

menstruation. Though menstruation is a natural and normal physiological process for all

healthy adult women, as ever it has been surrounded by secrecy and myths in many

societies1.

When girls begin to go through puberty their bodies and minds change in many

ways. The hormone in their bodies stimulates new physical development, such as growth

and breast development. About 2 to 2 ½ years after a girl’s breast begin to develop; she

usually gets her first menstrual period2.

Twelve million girls are born every year in India, and it is reported that 19% of

world’s population are in the age of 10-18 years. In India 25% of population lies in the

age group of 15-25 years accounting for 38 million persons. It is noted that the adolescent

girls between the ages of 10-18 years compare about 22% of female population in India 3.

Adolescents undergo important physical and sexual changes and face several

psychological pressures associated with growth and maturity. Menarche, the critical life

event for girls takes place during this period. It initiates the process of menstruation and

takes the girl to womanhood. For boys, embarrassing secondary sexual changes like the

growth of beard and change in voice begin to appear, and primary sexual features like

ejaculation take place on their way to manhood4.

Menstruation is a major stage of puberty in girls, its one of the many physical

signs that a girl is turning into a women. Menstruation is the periodic uterine bleeding

which is the shedding of the secretory endometrium of the uterus when fertilization of the

mature ovum does not take place. The first menstrual period, which occurs at puberty, is

called the menarche. Menstruation continues until the menopause, approximately 40

years. Menstruation takes place approximately 14 days after ovulation. The first day of

bleeding is considered the first day of the menstrual cycle. The average cycle lasts for 28

days, although normal range is from 24 to 32 days. Average duration of the menstrual

period is 5 days and the average blood loss is 10ml5.

The researcher observed the subject of menstruation does not permit itself to be

widely studied in traditional Indian society where the mere mention of the word can

cause embarrassment, he further said that even among students from urban background

there was an apparent lack of knowledge about menstruation and that many young girls

would not admit that they attained menarche on initial contact for interviewers attempting

to study this process. The subject of menstruation is surrounded by superstitions, taboos

and feeling of shame, embarrassment and resentment. The menstruating women is

considered unclean, and is prevented taking part in normal daily activities in some

communities4.

The present study was undertaken with the aim of filling this gap in health

education and information to adolescents. The study assumes that with adequate

knowledge of the process of menstruation and the methods of maintaining menstrual

hygiene adolescent school girls would improve their self-care ability and adopt positive

health practices.

6.1 NEED FOR THE STUDY

Menstruation can be confusing. Some adolescent girls cant wait to start their

periods, where as others may feel afraid or anxious. Many girls don’t have a complete

understanding of a woman’s reproductive system or what actually happens during the

menstrual cycle2.

Though menstruation is a natural and normal physiological process for all healthy

girls and women, it has been shrouded in myth and mystery in many societies. Most of

these continue even to this day. The silence and secrecy of menstruation does not allow

an open discussion on the subject. Very few mothers, even today, talk to their daughters

openly about the process of menstruation because of the taboos and cultural practices

associated with it. The biological, sexual and sociocultural nature of menstruation puts

young girls into embarrassing difficult and helpless situation. As a result, adolescent girls

becoming negatively oriented towards this process and begin to view it as a deplorable

part of life4.

A study was conducted on understanding of menstruation in early adolescent

girls. There education for menstruation reflected at best incomplete knowledge and more

typically a variety of misconception or ignorance. The girls’ knowledge of location and

function for reproductive structure was faulty and most did not understand how they were

interrelated. In view of reports of high levels of sexual activity, often at every young age

and without protection and high risk for acquiring STD, the failure to adequately educate

girls about their own anatomy and physiology had serious implication6.

A study was conducted on the characteristics of menstrual cycle among high

school girls and it was felt that there is need for a multidisciplinary schools health

counseling programme that would provide relevant information on menstrual pattern and

its common variation, identify abnormal pattern for early referral, psychological support,

drug relief of distressing menstrual symptoms and information on other contemporary

adolescent problems. Adolescent girls need to acquire knowledge of menstruation and

menstrual hygiene in order to engage in healthy practices. The level of knowledge

regarding menstruation varies among group of adolescent girls of the same background.

Relevant factors influencing knowledge of menstruation are age of the girl, age of onset

of menarche, mothers education, socioeconomic status, culture and customs of the family

and community, attitudes and practices of the family7.

Nurses are appropriate for teaching adolescent girls about menarche, menstruation

sexual health, conception, contraception and other health concepts and practices related

to female reproductive health. Their training and knowledge promote a more positive

outlook on physiological process associate with sex 4.

Thus the investigator felt the need to design a study to assess the effectiveness of

structured teaching programme on menstruation and menstrual hygiene among the girls

of age 13-15 years. Considering the age, ethnic group, socioeconomic status, knowledge

and practice on menstrual hygiene

6.2 REVIEW OF LITERATURE

This chapter presents review of literature related to the present study. The role of

the literature review is to formulate and clarify the research problem, to ascertain what is

already known in relation to problem of interest, for developing a broad conceptual

context, facilitate cumulating of scientific knowledge for interpreting the results of the

study.

“Review of literature is the reading and organizing of previously written materials

relevant to the specific problems to be investigated; framework and methods appropriate

to perform the study ”8.

The reviews of literature are presented under the following headings.

Knowledge and practices

Attitudes

Awareness

Abnormalities

General

Structured teaching programme

Knowledge and practices

A study was conducted on menstrual knowledge and practices among secondary

school girls in Nigeria. The menstrual knowledge and practice of 353 randomly selected

healthy Nigerian schoolgirls were studied. 187(53.1%) had attained menarche, 40% of

the subjects were different in knowledge about menstruation. Although menstrual

knowledge was higher in post menarcheal girls 10% of these were totally ignorant about

menses and 84%were not psychologically prepared for the first menses. The girls’

menstrual knowledge was positively associated with the parental education. The major

source of menstrual information was the family. Although more than half of the girls

menstruated regularly 66.3% used in sanitary material as menstrual absorbent. There is an

acute need for education and psychological preparation of the girls for menstruation well

ahead of menarche9.

Attitudes

A study was conducted on the development of menstrual related beliefs and

behavior during early adolescence. Co-relational analysis indicate that girls who learned

more from male sources rated menstruation as more debilitating negative than those girls

who learned less from male sources. The importance of socialization in the emergence of

menstrual distress and negative menstrual attitude is discussed10.

Awareness

A study was conducted on awareness and health seeking behaviour of rural

adolescent schoolgirls on menstrual and reproductive health problems. 130 girl students

were selected aged 13-17 years in Harayana, Mean age at menarche of the girls was 13.6

years and awareness about the process of menstruation was poor. Knowledge about

normal duration of pregnancy and need for extra food during pregnancy was poor. Most

of the girls knew about importance, duration of child spacing and need for three medical

examinations during pregnancy. Major sources of information were television (73.1%),

radio (37.1%) and parents (36.1%). Girls preferred to consult parents (99.2%) and doctors

(44.6%) for help at times of having reproductive health problems. This study highlights

need for educating schoolgirls about adolescent health, pregnancy and reproductive

health problems through schools and parents by the health professionals11.

Abnormalities

A study was conducted on menstrual pattern and abnormalities in the high school

girls of Dharan across sectional study in two boarding schools. This study has been

carried out to find out the menstrual pattern and awareness of the abnormalities in

menstrual pattern among school going pubertal age group girls in Dharan. Cross sectional

study was done in 96 girls of two different school of Dharan of the age group ranging

from 11 years to 17 years. The median age of menarche was 12 years. There were 6.9%

cases of oligomenorrhea and 10.0% of hypomenorrhoea. Menorrahagia was seen in 6.2%

of the girls. Spasmodic dysmenorrhoea was seen in 67.0 % of the girls, but the daily

activity was hampered only in 20.0%. Out of the 96 students 73.0% were prepared

psychologically before hand. Very less students (8.0%) knew only very little about the

abnormalities in menstruation, rest were ignorant about it. Thus it was seen that these

school going girls needed education about the abnormalities of menstruation so that they

can differentiate the normal phenomenon from abnormality and report in time incase of

abnormality in the menstrual cycle12.

General

A study was conducted on menstrual hygiene among rural adolescent girls. It is

clear from the study findings that majority of the girls were having correct knowledge

about menstruation. Regarding the practice only 10 girls were used boiled and dried cloth

as menstrual absorbent. Though almost all 64 girls received advice regarding menstrual

hygiene from different source some of their practices were unhygienic. This shows that

the mothers of these girls were lacking right knowledge and the same thing was

transferred to there offspring’s. Before bringing any change in menstrual practices they

should be educated about the facts of menstruation and its physiological implications.

The girls should be educated about the significance of menstruation and development of

secondary characteristics, selection of sanitary menstrual absorbent and proper disposal.

This can be achieved through educational television programmes, schools, nurses and

health personnel’s, Compulsory sex education in school curriculum and knowledge to

parents, so that she does not develop psychological upset and the received education

would indirectly wipe away the age-old wrong ideas and make her to feel free to discuss

menstrual matters without any inhibitions13.

Structured teaching programme

A study was designed on teaching adolescent girls about menstrual hygiene. The

objective of the study was to assess knowledge and awareness of girl students regarding

menstruation before administering planned teaching programme. To design and

administer a planned teaching programme a multistage sampling technique was adopted

to select senior secondary school, 9th standard girls who had attained menarche. These

girls were systematically divided into two groups, one experimental group and the second

control group. Structured questionnaire was used for data collection. Findings of the

study in pre test scores of the two groups did not differ much in their level of knowledge

and both groups had a high level of knowledge deficit4.

6.3 STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of structured teaching programme on

menstruation and menstrual hygiene among high school girls of age 13-15 years studying

in selected high schools of Tumkur.”

6.4 OBJECTIVES OF THE STUDY

To assess the knowledge of high school girls regarding menstruation and

menstrual hygiene

To identify the practice of menstrual hygiene among high school girls.

To evaluate the effectiveness of structured teaching programme regarding

menstruation and menstrual hygiene.

To determine the association between knowledge and practice of

menstrual hygiene of the high school girls with demographic variables.

6.5. OPERATIONAL DEFINITIONS:

Assess

Refers to the statistical measurement of knowledge of the high school girls

on questionnaire regarding menstruation and menstrual hygiene. (Or) It

refers to the analysis of STP on menstrual hygiene given to the high

school girls.

Knowledge

The correct written expression in response to the knowledge items listed in

the tool related to menstruation and menstrual hygiene.

Practice

It refers to the activities performed by the high school girls in relation to

the menstrual hygiene as per the step in the checklist tool.

Structured Teaching Programme

It refers to systematically developed instructions designed for a group of

high school girls to provide information regarding menstruation and

menstrual hygiene.

Effectiveness

It is the significant improvement in knowledge and practice of the high

school girls regarding menstruation and menstrual hygiene after the

implementation of structured teaching programme as evidenced by the

differences in the pre test and post test scores.

Menstruation

It refers to a phase of menstrual cycle, when uterine bleeding occurs and

has duration of three to five days.

Menstrual hygiene

It is an activity performed to maintain perineal hygiene by the girls during

her menstrual period.

High school girls

They are the girls of the age group 13-15 years studying in 9th and 10th

standard of selected high school of Tumkur.

6.6. HYPOTHESIS

H1: There will be significant relationship between knowledge and practice

regarding menstruation and menstrual hygiene among girls in high school.

H2: There will be significant relationship between structured teaching

programme and the changes in knowledge and practice of menstruation

and menstrual hygiene among the girls in high school.

H3: There will be significant association between the knowledge and practice

with selected demographic variables of the students such as age, sex,

religion, family, income etc.

7. MATERIALS AND METHODS

The purpose of this study is to determine the effectiveness of structured teaching

programme on the knowledge and practice regarding menstruation and menstrual hygiene

among high school girls in selected schools of Tumkur.

7.1. SOURCES OF DATA

7.1.1. Research approach :The experimental approach is used for the

study

7.1.2. Research Design : One group pre test and Post test

experimental design is used

to assess the effectiveness of STP

7.1.3. Setting of the study : Selected high schools of Tumkur

7.1.4. Population : 100 subjects

7.1.5 Sampling technique :Simple random sampling

7.1.6. Selected variables

Demographic variable- age, sex, religion, education etc

Dependent variable-knowledge and practice

Independent variable- Structured teaching programme.`

7.1.7. Sampling Criteria

Inclusion criteria

Girls who attained menarche and studying in high school.

Girls those who were willing to participate

Girls who can understand kannada and English

Exclusion criteria

Girls who have not attained menarche

Girls those who are not willing to participate

Girls who are not available at the time of data collection

7.2. METHODS OF DATA COLLECTION

7.2.1. Tools for data collection : Structured questionnaire

Tool 1. Part A : Proforma for collecting demographic data

Part B : Structured questionnaire to assess the

knowledge and practice on menstrual

hygiene.

Tool 2 : Structured teaching programme.

7.2.2. Methods of Data analysis and interpretation

Data will be analyzed according to the objectives of the study using

descriptive and inferential statistics and will be presented in the form of tables,

graphs and diagrams.

7.2.3. Duration of the study : 6 weeks.

7.3. Does the study requires any investigation or intervention to be conducted on the

patients or other human being or animals? If so please describe briefly.

No

7.4. Has Ethical Clearance been obtained from your institution in case of the above?

Yes ethical clearance has been obtained from the institutions ethical committee.

8. REFERENCES:

1.Nursing Journal Of India, March 2003

2. www.Pubmed.com

3. www.uterus1.com

4. Kalpana Mandal, “Teaching adolescent school girls about menstrual hygiene”, The

Indian Journal Of Nursing and Midwifery, September 1998.

5. Dugas, “ Introduction to patient care”, 4th edition, Saunders publication, Page no.

640

6. Koff E, Rierdan J, “ Early adolescent girls understanding of Menstruation”,

Women Health 1995.

7. Fakeye O, Adegoke A, “ The characteristics of the menstrual cycle in Nigerian

school girls and the implications for school health programmes”, African Journal

Of Medicine and medical science

8. Polit D.F and B.P Hungler, “ Textbook of nursing research principles and

methods”, Lippincott publications, Page no. 57

9. Abioye- Kuteyi E.A, “ Menstrual knowledge and practices amongst secondary

school girls in Nigeria”, J.R soc Health March 2000.

10. Brooks Gunn J., Ruble D.N, “ The development of Menstrual- related beliefs and

behavior during early adolescence”, Child development, December 1982

11. Singh M.M, Devi R, Gupta S.S, “ Awareness and health seeking behavior of rural

adolescent school girls on menstrual and reproductive health problems”, Indian

Journal Medical science, October 1999.

12. Sharma M, Gupta S., “ Menstrual pattern and abnormalities in the high school

girls of Dharan: A cross sectional study in two boarding schools”, Nepal Medical

College journal, June 2003

13. Drakshayani Devi K, Venkata Ramaiah P, “ A study on menstrual hygiene among

rural adolescent girls”, Indian Journal Medical Science, June 1994.