RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,

KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE : SHILBY

AND ADDRESS I YEAR M.Sc NURSING

SMT VASANTHA COLLEGE OF NURSING,

NAUBAD, BIDAR

2. NAME OF THE INSTITUTION : SMT VASANTHA COLLEGE OF NURSING,

BIDAR

3. COURSE OF STUDY AND : MASTER DEGREE OF NURSING,

SUBJECT PADEATRIC NURSING.

4. DATE OF ADMISSION TO : 10.10.2011

COURSE

5. TITLE OF THE TOPIC : “A STUDY TO ASSESS THE EFFECTIVENESS

OF STRUCTURED TEACHING PROGRAMME ON

KNOWLEDGE AND PRACTICE OF MENSTURAL

HYGIENE AMONG ADOLESCENT GIRLS IN

SELECTED SCHOOL AT BIDAR”.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Yesterday I dared to struggle. Today I dare to win. Bernadette Devlin

In INDIA about 34%of total population belongs to adolescent period. The

blossoming of adolescence in each generation is as fascinating a sight as the unfolding

offspring each year predictable and repetitive. Adolescents belong to vital age group,

not only because they are the entrant population to parenthood but also because they

are threshold between childhood and adulthood. As they attempt to cross this

threshold they face various physiological, psychological and developmental changes.

The word ‘’Adolescent’’ is derived from the Latin word ‘adolescere’ which means to

grow to maturity that indicate the defining features of adolescence. During puberty the

physical changes occur which transform the body of child into that of an adult,

changes in body size, and changes in body proportions.

Menstruation is a physiological phenomenon which is unique to females

that begins in adolescence. Menstruation is also properly called menses (or) catamenia

and more commonly a period of monthly flow. Menstruation is not an illness. It is a

healthy, normal, mature process. The ages of onset is from 9-16 years and termination

occurs approximately every 28days and last for about five days. Menstrual flow

consists of blood, mucus, and tissue particles. Average blood loss is about three

ounces. Factors that may alter the menstrual cycle are stress, fatigue, exercises, acute

(or) chronic illness, and changes in climate. Personal hygiene to be followed during

menstruation are to use sterile pads during early period of heavy flow, bathe daily for

comfort and to feel fresh, keep perineal area clean from anterior to posterior, cotton

under garments preferred. The most striking change in adolescent girls is the onset of

menstruation, 3-5 days bleeding from the uterus once a month that will occur

throughout the lifetime till menopause. The first menses is called “Menarche”.

Menarche is the signal that sexual maturation of the young female has occurred and

that the body is capable of supporting pregnancy. With onset of menstruation a girl

becomes aware of her emerging identity as a female capable to reproduce. Her

understanding and acceptance of her new identity will be greatly influenced by the

feed back she receives from peers, educators and most importantly her parents.

Menstruation occurs periodically throughout the child bearing years, except during

pregnancy and lactation. The ages of onset of menstruation differ from person to

person but seem to be affected by heredity, racial background and nutritional status.

Most of the girls receive their gynecological information from their

mothers, religious books, older sister or a peer. However such information was

generally given after menarche rather than before A study conducted in (2006) using

qualitative research data and quantative survey revealed, that prior to menarche the

knowledge about menstruation was deficient among the respondents and ten percent

of women respondedants and reported various taboos related to menstruation. Hence

there is a need to provide healthy family life education to the woman particularly the

adolescent girls. Very few similar studies have been conducted in India which has

explored the knowledge and practice areas. But the attitudinal aspects of menstruation

have not been studied specifically.

Menstruation is still regarded as something unclean or dirty in Indian society.

The reaction to menstruation depends upon awareness and knowledge about the

subject. The manner in which a girl learns about menstruation and its associated

changes may have an impact on her response to the event of menarche. Although

menstruation is a natural process, it is linked with several misconceptions and

practices, which sometimes result into adverse health outcomes.

Menstruation is still regarded as something unclean or dirty in Indian

society. The reaction to menstruation depends upon awareness and knowledge about

the subject. The manner in which a girl learns about menstruation and its associated

changes may have an impact on her response to the event of menarche. Although

menstruation is a natural process, it is linked with several misconceptions and

practices, which sometimes result into adverse health outcomes.

Hygiene-related practices of women during menstruation are of

considerable importance, as it has a health impact in terms of increased vulnerability

to Reproductive Tract Infections (RTI). The interplay of socio-economic status,

menstrual hygiene practices and reproductive tract infections are noticeable. Today

millions of women are sufferers of Reproductive tract infections and its complications

and often the infection is transmitted to the offspring during pregnancy.

Women having better knowledge regarding menstrual hygiene and safe

practices are less vulnerable to Reproductive Tract Infections and its consequences.

Therefore, increased knowledge about menstruation right from childhood may

escalate safe practices and may help in mitigating the suffering of millions of women.

The social stigma attached to menstruation causes many girls and women to

carryout dangerous hygiene practices. Lacking a platform to share menstrual hygiene

problems, girls and women often suffer from discomfort and infection, avoiding

urination during menstruation and using any kind of cloth available old (or) unwashed

as an absorbent. These kinds of practices can lead to problems like infection, boils and

itching but still girls are not visiting medical practitioners.

6.1 NEED FOR THE STUDY:

Today’s adolescents (34%) are tomorrow’s adults who are the strength of the

nation. Today’s adolescent girls are our future homemakers. Most of the adolescents

tend to be extremely unaware of their own body their physical well being and

psychological change. Half of the adolescence do not know about menstruation until

its onset.

Menstrual cycle has come to occupy an increasingly important place in

discussions of woman’s health attention is again focusing on the impact of the onset

of menarche. Studies of girl’s response to menarche have determined that it is a

highly salient, intensely experience event and a turning point in female development.

They also have demonstrated that more adequate preparation is associated with a

more positive initial response .Despite a sense of being prepared and even excited

about impending event, however, most girls still find menarche mildly stressful.

A study was conducted in (2007), due to lack of information on this

natural phenomenon and culturally divergent beliefs and practices, rural adolescent

girls in India often manage menstruation in an unsafe manner that leads to

reproductive tract infections and other reproductive health problems.

The girls should be educated about significance of menstruation and

development of secondary sexual characteristics, selection of sanitary menstrual

absorbent and its proper disposal. So that she does not develop psychological upset

and received education would indirectly wipe away the age-old wrong ideas and make

her feel free to discuss menstrual matters without any inhibitions.

Menstruation and puberty hygiene is rarely discussed at home as well as

schools; especially in the regions the current study was conducted. Due to some

cultural and religious restrictions many young girls in this country lack appropriate

and sufficient information regarding menstrual hygiene causing incorrect and

unhealthy behavior during their menstrual period.

A study was conducted by James (2003) on, “knowledge and practice of

menstrual hygiene” in Punjab. The main finding of the study was that adolescent

school girls as a whole had an inadequate knowledge on menstrual hygiene.

A study was conducted by Kolf (2001), on “Understanding of menstruation

in early adolescent girls”. Their explanation for menstruation reflected at best

incomplete knowledge and more typically a variety of misconception or ignorance.

A study was conducted by Sreenivasa (1999), on “Knowledge and Attitude

of adolescent girls regarding menstruation” showed that the emotional response of the

majority of girls (60%) at the onset of menstruation.

The above studies and personal views of the investigator and her exposure to

the surroundings in the form of relatives, neighborhood who faced certain problems in

the aspect of menstruation and its crisis situation created an insight to conduct a study

to assess the effectiveness of STP on menstrual hygiene and practice among

adolescent girls in selected school at Bidar.

6.2 REVIEW OF LITERATURE

Review of literature is a broad systematic and critical collection and evaluation

of important scholarly published literature as well as unpublished materials. The

review serves as an essential background for any research.

A study was conducted by Turkan Turan (2003). “Determination of

knowledge and practices about menstruation”. The data was collected using a 21-item

questionnaire developed by the researcher based on information in the literature. The

mean age of the girls included in the study was 12.88+0.94. More than half of the

girls (52%) had begun menstruating and the mean age for menarche was 12.29+0.81.

The majority (90%) had received information about menstruation but 10% had not. A

significant difference was found between frequency of changing sanitary pads and the

students' income status (p=0.001). As their income level decreased their frequency of

changing pads decreased. In conclusion the children had a knowledge deficit about

menstruation and education needs to be given at their schools and in their families.

A study was conducted by Parwej.S, Kumar, Agarwal AK. (2005)

“Experiences in relation to menstruation”. The study finding showed that most of the

girls talked about how their menstrual bleeding makes they feel dirty and unclean and

reported feelings of embarrassment and shame. During menstruation one was

completely shocked; another reported that she was not allowed to enter in the temple

and kitchen. Such prohibitions do induce feelings of isolation and shame in young

girls.

A study was conducted by Rembeck G I, Moller .M. (2006). “Attitude and

feelings towards menstruation and womanhood in girls at menarche”. To elucidate

early adolescent girls' attitudes, thoughts and feelings towards menstruation and their

bodies. METHODS: 309 12-y-old girls answered questionnaires. One part of the

questionnaire dealt with thoughts and feelings towards menstruation. The other part

dealt with thoughts and feelings towards menstruation and sex and ability to

communicate on aspects of womanhood. The study reveals that Postmenarcheal girls

were less positive towards menstruation than premenarcheal girls (p = 1 x 10(-6)).

Many girls (43%) did not reaffirm the statement "I like my body" and almost one

quarter stated being teased for their appearance. Many of the girls claimed that they

had been called "cunt" (38%) or "whore" (46%). If called "cunt" or "whore", 17%

stated that they felt alone, 76% felt anger and 50% were offended. Mothers were those

with whom girls could most easily "chat" about their period. Sixty-seven per cent

received information about menstruation from school nurses.

A study was conducted by Trinoye OO, OPgunghomi A, Ajo AO. (2003)

“Menstruation : knowledge, attitude and practices of students in Taiwan”. The

purpose of the study was to explore gender differences in knowledge and attitudes

towards menstruation among Taiwanese adolescents. This study was a secondary data

analysis of a cross-sectional comparison study conducted in Taiwan. A total of 287

female and 269 male students at a junior high school participated in the study. The

results showed that almost all the students had heard about menstruation and most of

them had received menstrual information at school. However, their knowledge about

menstruation was not accurate. Moreover, the male students expressed more negative

attitudes towards menstruation than the female students

A study was conducted by Dasgupta A, Sarkar. (2008) “Menstrual hygiene;

how hygienic is the adolescent girls”. Menstruation and menstrual practices are still

clouded by taboos and socio-cultural restrictions resulting in adolescent girls

remaining ignorant of the scientific facts and hygienic health practices, which

sometimes result into adverse health outcomes. A descriptive, cross-sectional study

was conducted among 160 adolescent girls of a secondary school situated in the field

practice area of Rural Health Unit and Training Center, Singur, West Bengal, with the

help of a pre-designed and pre-tested questionnaire. Data was analyzed statistically by

simple proportions. Results shows Out of 160 respondents, 108 (67.5%) girls were

aware about menstruation prior to attainment of menarche. Mother was the first

informant regarding menstruation in case of 60 (37.5%) girls. One hundred and thirty-

eight (86.25%) girls believed it as a physiological process. Seventy-eight (48.75%)

girls knew the use of sanitary pad during menstruation. Regarding practices, only 18

(11.25%) girls used sanitary pads during menstruation. For cleaning purpose, 156

(97.5%) girls used both soap and water. Regarding restrictions practiced, 136 (85%)

girls practiced different restrictions during menstruation. Conclusions: Menstrual

hygiene, a very important risk factor for reproductive tract infections, is a vital aspect

of health education for adolescent girls. Educational television programmes, trained

school nurses/health personnel, motivated school teachers and knowledgeable parents

can play a very important role in transmitting the vital message of correct menstrual

hygiene to the adolescent girl of today.

A study was conducted by Shukla .S (2005). “working on menstruation with

girls in Mumbai, India”. Menstruation is considered a polluting factor among Hindus.

In many places menstruating girls and women are considered untouchable. Such

attitudes and practices are unlikely to create a positive self image with in girls. Shukla

found that girls and women teachers were very knowledgeable about the intricate

system of taboos and sanctions that pertained to menstruation but had very little actual

knowledge about the biological process of maturation and normal physiology. This is

lack of factual information, compounded by the prevalence of myths, means that girls

practical needs related to managing menstruation are often not appreciated (or)

appropriately addressed, e.g. of the provision of adequate sanitary protection .Most

girls are left to cope as they can with rags (or) other insufficient protection.

A study was conducted by Ei-Gilany AH, Badawai K, (2005). “Menstrual

hygiene among adolescent schoolgirls in Mansoura, Egypt”. This study among 664

schoolgirls aged 14-18 in Egypt, asked about type of sanitary protection used,

frequency of changing pads or cloths, means of disposal and bathing during

menstruation. Girls were selected by cluster sampling technique in public secondary

schools in urban and rural areas. Data were collected through an anonymous, self-

administered, open-ended questionnaire during class time. Use of sanitary pads may

be increasing, but not among girls from rural and poor families and other aspects of

personal hygiene were generally found to be poor, such as not changing pads

regularly or at night, not bathing during menstruation. Lack of privacy was an

important problem. But a large majority of girls said they needed more information.

A study was conducted by Kirk .J, Sommer, M. (2005). “Menstruation and

awareness; critical issues for girls education”. Lack of sanitary protection during

menstruation is often mentioned as a barrier to girl’s regular attendance in school. In

many poor families providing adequate clothing for the whole family can be a

challenge. Insufficient (or) inadequate sanitary protection can be very embarrassing

for a girl attending school during her monthly period.

A study was conducted by Bista,M.B(2004). “A review of research literature

on girls education in Nepal”. Bista reports, local cultural expectations that

menstruating women should remove themselves from public spaces has led to classes

taught by female teachers being discontinued for several days at a time (or) to women

teachers who continue to teach during menstruation being viewed negatively by the

community not only does this disrupt the learning process, but it may simultaneously

very negative messages about what is expected of women and girls.

A study was conducted by Rajashree R. Kamble (2001). “A study to access

the knowledge and practice of menstruation and menstrual hygiene among school

girls”. The findings of the study showed that 61.66%of the girls had an average

knowledge regarding menstruation on menstrual hygiene and 87.66% of the girls

followed correct practices.

STATEMENT OF THE PROBLEM:

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE OF

MENSTURAL HYGIENE AMONG ADOLESCENT GIRLS IN SELECTED

SCHOOL AT BIDAR”.

6.3 OBJECTIVES OF THE STUDY:

1. To assess the knowledge and practice of menstrual hygiene among adolescent

girls.

2. To evaluate the effectiveness of structured teaching programme in term of

knowledge and practice of menstrual hygiene.

3. To determine the corelation between the knowledge and practice of menstrual

hygiene among adolescent girls.

4. To determine the association between the knowledge and practice of menstrual

hygiene among adolescent girls with their selected socio-demographic

variables

6.4 HYPOTHESES OF THE STUDY:

H1: There will be significant increase in the knowledge and practice on menstrual

hygiene among adolescent girls studying in 8th to 12th standard after structured

teaching programme.

6.5. OPERATIONAL DEFINITIONS:

1. Knowledge: Refers to understanding of adolescent girl’s on

menstrual hygiene as elicited by the structured questionnaire devised by the

questionnaire.

2. Effectiveness ; it refers to determine the extent of significant

knowledge among adolescent girls.

3. Menstrual hygiene: Includes all those measures taken by the

individual to keep the genital area clean and dry during the menstrual period / cycle.

4. Adolescent girls: Refers to the girls who had attained menarche

between 13-17 years and who are studying in 8th and 12th standards of selected

schools.

5. Structured Teaching Programme ; It is a well prepared teaching

programme with systematically developed instruction for a group of

adolescent girls on Menstrual hygiene knowledge and practice for one hour.

6.6. ASSUMPTION:

1. Adolescent girls may have some knowledge and practice of

menstrual hygiene.

6.7. DELIMITATION:

This study is de-limited to 13-17 years Adolescent girls who are

studying 8th and 12th standards.

This study is de-limited to young adult females.

This study is de-limited to 80% Adolescent girls who are studying 8th

and 10th standards.

7.0. MATERIALS & METHOD:

7.1. SOURCE OF DATA:

Data will be collected from adolescent girls who are studying 8th and

10th standards selected at Bidar.

7.2 METHOD OF COLLECTION OF DATA:

7.2.1 RESEARCH DESIGN:

The research design that will be used to achieve the objectives of the

study is one group pretest posttest experimental design.

7.2.2RESEARCH APPROCH:

The approach of this study will be experimental in nature.

7.2.3 SETTING OF THE STUDY:

This study will be conducted in selected schools in Bidar.

7.2.4 POPULATION:

The population of the study comprises of adolescent girls who

are studying 8th and 10th standards in selected school Bidar.

7.2.5 SAMPLE SIZE:

The total sample of the study consists of 80 adolescent girls who are

studying 8th and 10th standards.

7.2.6 SAMPLING TECHNIQUE:

Convenient and Purposive sampling technique.

7.2.7 SAMPLING CRITERIA:

INCLUSION CRITERIA

1. Adolescent girls who are studying 8th and 12th standards who are willing

to participate.

2. Adolescent girls who are studying 8th and 12th standards who are

available during the period of data collection.

3. Adolescent girls who are studying 8th and 12th standards who are able to

speak and read Kannada.

4. Adolescent girls who are studying 8th and 12th standards between the age

between of 13 to 17 years.

EXCLUSION CRITERIA

1. Adolescent girls who are studying 8th and 12th standards are not

willing to participate and not available during the data collection.

2. Adolescent girls who are studying 8th and 12th standards are not able

to speak and read Kannada.

3. Adolescent girls who are studying 8th and 12th standards are above 17

years.

7.2.8 TOOL FOR DATA COLLECTION:

A structured Questionnaire is drafted for this purpose and the relevant

data will be collected from the sample.

Part – I:

Selected demographic variables such as age, educational status, religion,

type of family, family income monthly, source of information, age at

menarche, educational status of the mother, number of elder sisters.

Part- II:

Structured knowledge questionnaire regarding menstrual hygiene

PROCEDURE FOR DATA COLLECTION:

The data will be collected with in the prescribed time period in selected

Adolescent girls who are studying 8th and 12th standards.

The objective of the study will explained to adolescent girls who are

studying 8th and 12th standards before starting the data collection.

7.2.9 DATA ANALYSIS METHOD:

The data analysis will be carried out through experimental and

inferential statistics with the help of computer software package (SPSS).

INFERENTIAL STATISTICS:

Chi square test will be used to find out the association between the

knowledge and practice with selected demographic variables.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTION TO BE CONDUCTED

ON PATIENTS OR OTHER HUMANS OR ANIMALS?

No, health education pamphlet will be given to adolescent girls regarding

substance abuse based on identified needs.

7.4 ETHICAL CLEARANCE:

Permission will be obtained from

- The research committee of Smt. Vasantha College Of Nursing.

- Authorities of selected areas.

8. LIST OF REFERENCES:

BOOK REFERENCE

1. Parthasarathy. A Text book of pediatrics. 2nd edition. jaypee Brothers (p)

New Delhi; 2002; 38-40.

2. Kolf.e, Rierdan. Early adolescent girls understanding of menstruation. Journal of

women health. 1995; v 22(4); 1-21.

3. Basavanthappa B.T. The text book of community health nursing. 1stedition.

Jaypee Brothers (p). New Delhi: 1998; 205-206.

4. Dawn C.S. The text book of gynecology.The dawn books (p): Calcutta. 1982; 234.

JOURNAL REFERENCE

5. Mohammad poureslam. Project (online): 2001 Nov ;(cited 2001 Nov) availalable

From: URL: http;//www.ams.ac.ir/Aim/0254/0254219.htm.32k.

6. Dasgupta.A, Sarkar. Menstrual hygiene; how hygienic is the adolescent Girl.

Indian Journal of community medicine. 2008: v 33(2); 77-80.

7. Rembeck G.I, Moller. M. Attitudes and feelings towards menstruation and

womanhood in girls at menarche. Journal of pediatrics. 2006: v (95);

8 . Ei-Gilany .AH, Badawi,Karima. Reproductive health matters. 2005: V 13(26);

147-152.

9 . Shukla. Working on menstruation with girls in Mumbai, India. Vacha Women’s

resource centre equals.2005: v (15);4-5.

10. Krick. J, Sommner.M. Menstruation and body awareness, critical issues for girls

on education. 2005: v (15); 4-5.

707-714.

11. Bista. M.B. A review of research literature on girl’s education in

Nepal. Journal of medical sciences. 2004.

12. Trinoye. Ogunghomi. A. Menstruation: knowledge attitude and practices of

students in Nigeria. Journal of Medical Sciences. 2003: v 12(1); 43-51.

13. Parwej.S, kumar, agarwal A.k. Reproductive health education international trial.

Journal of pediatrics India. 2005: v (72); 287-291.

14. Turkan, Turan. Determination of knowledge and practices about

Menstruation. (Online) 2003.

15. Rajashree R. Kamble. A study to assess the knowledge and practice of

menstruation and menstrual hygiene among school girl. Journal of sch.

2001: v 75 (3); 89-99.

9 SIGNATURE OF THE

CANDIDATE

10 REMARKS OF THE

GUIDE

11 NAME & DESIGNATION

OF

GUIDE

SIGNATURE

HEAD OF THE

DEPARTMENT

SIGNATURE

12 REMARKS OF THE

PRINCIPAL

SIGNATURE