RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

Ms. LAISOM ROSY

M.Sc. NURSING 1ST YEAR

Noor College of Nursing,

Bhoopasandra, Bangalore

2. NAME OF THE INSTITUTION

NOOR COLLEGE OF NURSING

Noor College of Nursing,

Bhoopasandra, Bangalore 3. COURSE OF THE STUDY

AND SUBJECTM.Sc, NURSING Ist YEAR

OBSTETRICS AND GYNECOLOGY

NURSING

4. DATE OF ADMISSION TO COURSE 01/06/2009

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

EFFECTIVENESS OF

STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE AND

ATTITUDE REGARDING PREVENTION

OF POLYCYSTIC OVARIAN DISEASE

AMONG COLLEGE GIRLS IN SELECTED

COLLEGES AT BANGALORE”.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

Gynecological problems of adolescents occupy a special space in the spectrum of

gynecological disorders of all ages. This is because of the physical nature of the

problems which are so unique, special, and specific for the age group, and also because

of the associated and psychological factors which are very important in the growth and

psychological remodeling of someone in the transition between childhood and

womanhood. 1.

Gynecological diseases are fairly common but most of us women ignore

the symptoms or we are unaware, till the time the problem really worsens. One of

them, now days faced by girls, is POLYCYSTIC OVARIAN DISEASE. (Stein

leventhal Syndrome). This is the commonest course of Amenorrhea in young girls.

The Amenorrhea with polycystic ovaries was first described in 1935 by Stein and

Leventhal. 2

PCOS, also known as Polycystic Ovarian Syndrome, is reported to be a

growing problem with adolescent girls. It can be very difficult to diagnose PCOS in

teenage girls as they often experience irregular or absent menses and acne. 3

A population study revealed that overt and occult PCOD accounted for 90% of

patients with oligomenorrhea and 37% with amenorrhea, or 73% with oligo- or

amenorrhea. Oligo- or amenorrhea accounted for 21% of couples with infertility and

the annual incidence was 247 patients per million of the general population. The

annual incidence of infertility due to PCOD per million was 41 with overt PCOD and

139 with occult PCOD (total 180). Of those, 140 appeared to respond well to

clomiphene (78%) but 40 (22%) failed, requiring alternative therapy.4

Polycystic ovarian disease is also known as Stein Leventhal Syndrome (PCOD),

about 6 to 10% of girls gets affected by this disease and are even not aware of their

presence. In a prospective study of 400 women of reproductive age, 4% to 4.7% of white

1

women and 3.4% of African American women had PCOS. 2 A similar rate of 4% to 6%

has been found in other populations.5

Polycystic ovarian disease prevalence is fast increasing among college girls in

urban Mumbai about 30% of young college girls were detected with the POCD.

A study on teen girls and college girls in several colleges around India was found

to show a higher percentage of college girls with PCOD and there was around 36 % of

increase in cases of PCOD compared from a period of 2007-08, showing a severe fast

increase of cases of PCOD among college girls in an alarming rate

Polycystic Ovarian Disease is not curable but treatment is available to alleviate

the symptoms. This disease is so dread able that such girls are unable to conceive and its

pathology of spreading to other organ is far greater than that of infertility. 6

Polycystic Ovarian Disease is very common among girls the main symptoms are

irregular or no menstruation, multiple small cysts in the ovaries which is a common

finding, high blood pressure, excessive pimples and rise in level of insulin are the

common findings.7

Present day lifestyle, food habits, environmental exposure to toxins along with

hereditary predisposition for metabolic syndrome (obesity, hyperlipidemia, diabetes and

hypertension) and stress has contributed to the common problem faced by today’s female

population which is PCOD. 8

Children as young as 16 years are diagnosed with polycystic ovarian disease

which occurs due to the imbalances or abnormalities in the hormones. Hormonal

abnormalities can make the ovaries produce more eggs. These eggs turn into cysts and

the ovaries become large and studded with numerous cysts. It begins as early as in

teenagers and mostly effects adult girls of childbearing age. 9

6.2 NEED FOR THE STUDY:

“Education is given for the sake of individual with a view to save from

destruction”

2

Thompson

Polycystic Ovarian Disease is a common problem among teen girls and young

girls. In fact, almost 1 out of 10 girls have Polycystic Ovarian Disease. A study

findings shows that Adolescent Girls with Polycystic Ovary Syndrome Have an

Increased Risk of the Metabolic Syndrome Associated with Increasing Androgen

Levels Independent of Obesity and Insulin Resistance.14

A study done by U.S. Scientists reported that the prevalence of Polycystic

Ovarian Syndrome may be as high as 11.2% in girls of reproductive years. Among this

group, adolescent girls make up a large part, perhaps as high as 50% of young girls

suffer with polycystic ovarian disease (PCOD).10

A study done on college girls regarding prevalence and risk factors of PCOD

shows that high increase of 30% to 40% within a period of month was noted who

followed sedentary dietary practices. 11

Polycystic ovarian disease or syndrome (PCOS) is a common problem which

may start in the adolescence and affect the girls till her old age. In this condition the

ovary develops many small cysts. This results in an abnormality of the hormones, with

the male hormone dominating. As a result, the girls with this syndrome show features

such as acne, excessive facial hair growth (hirsutism), weight gain and irregular or

scanty menses. 12

A study findings shows that obese girls with polycystic ovary morphology

(PCOM) had a greater risk of developing of Polycystic Ovarian Disease (95%) than

non obese girls with Polycystic ovary morphology. Obese girls with Polycystic ovary

morphology had a higher incidence oligomenorrhea and biochemical

hyperandrogenemia than non obese adolescent girls with PCOM. Obese subjects with

PCOD had a higher risk of developing oligomenorrhea and biochemical

hyperandrogenemia than non obese girls with PCOD. Moreover, obese girls with

PCOD had significantly higher serum total T levels and more prolonged menstrual

intervals than non obese women with Polycystic ovarian disease.13

3

In a study, at the University of Pennsylvania and colleagues identified high rates

of depression (35 percent) among girls with Polycystic ovarian disease, 15

A study conducted in school girls shows that Thirty-seven percent of adolescent

girls with polycystic ovarian disease had metabolic syndrome (MBS) compared with

5% of NHANES III girls (Third National Health and Nutrition Examination Survey).

None of the girls of normal body mass index (BMI) had MBS, whereas 11% of

overweight and 63% of obese girls with PCOS had MBS compared with 0 and 32% of

NHANES III girls, respectively. Girls with polycystic ovarian disease were 4.5 times

more likely to have MBS than age-matched NHANES III girls after adjusting for BMI.

The odds of having the MBS were 3.8 times higher for every quartile increase in

bioavailability testosterone in girls with polycystic ovarian disease after adjusting for

BMI and insulin resistance.16

Polycystic ovary syndrome (PCOS) is the most commonly encountered

endocrinopathy in girls of reproductive age. It has significant reproductive and non

reproductive consequences. Girls of any ethnic background can present with PCOS. In

a prospective study of 400 adult girls of reproductive age, 4% to 4.7% of white girls

and 3.4% of African American girls had Polycystic ovary syndrome. A similar rate of

4% to 6% has been found in other populations.17

Hyperinsulinemia is noted in 50% to 70% of PCOS patients. It is defined as

impaired action of insulin on glucose transport and antilipolysis in adipocytes in the

presence of normal insulin binding.18

Patients with polycystic ovarian disease can present with a bundle of complaints

such as menstrual disturbances, infertility, hirsutism, and acne, their point of entry into

the medical system may be by way of a primary care physician, gynecologist, nurse,

endocrinologist, or dermatologist. Thus, all these disciplines need to be familiar with

this syndrome and its long-term consequences.19

4

Overall, 60-85% of patients with polycystic ovarian disease demonstrate overt

menstrual dysfunction primarily oligomenorrhoea although 5% may demonstrate

polymenorrhoea. Chronic anovulation leads to endometrial hyperplasia due to chronic

estrogenic stimulation. Rao found 2.8 % of the causes of puberty menorrhagia were

due to polycystic ovarian disease. The present study shows that 3.07% of puberty

menorrhagia was due to polycystic ovarian disease. 20

The best treatment of the polycystic ovarian disease is life style modification and

weight loss. Even a 5% reduction in weight can help. Hence proper diet and some

exercise regimen to control body weight are of utmost importance. 21

The only quantitative study performed in adolescent girls regarding polycystic

ovarian disease which uses a well-validated instrument shows that health related

quality of life was worse in those with polycystic ovarian disease specially in the areas

of general health perceptions, behavior, physical functioning and family activity.

However, qualitative psychological studies have demonstrated higher levels of

depression, psychological and psychosexual morbidity and an increased response to

stress in girls with polycystic ovarian disease compared with control group. Low self-

esteem, decreased social activity and less romantic contentment were reported in girls

with polycystic ovarian disease. 22

Life style modification in polycystic ovarian disease is very important because

sedentary lifestyles and lack of exercises and fast food consumption by the ladies are

leading to the rise in cases of polycystic ovarian disease especially among urban

college girls.23

Lack of knowledge and the negative lifestyle attitude towards polycystic ovarian

disease among college girls and not taking any measures to improve their lifestyles is

felt by the investigator that these college girls can be helped by assessing their

knowledge and with a view to change their lifestyles by providing necessary

information, so as to help them to get aware about the polycystic ovarian disease. 24

5

6.3 REVIEW OF LITERATURE:

“Review of literature is an essential activity of scientific research project;

“Literature review involves system identification, location securing and

summary of written material that information on research problem”

[Polit – 1978]

Polycystic ovarian disease is well recognized inherited disorder. Its genetic basis

has been postulated on the basis of evidences from familiar clustering and reports of

concordance in monozygotic twins. However, factors involved in its genetic

predisposition and the mode of inheritance are still not clear.25

Polycystic ovarian syndrome is the most common endocrine disorder in girls of

reproductive age group, affecting 5 to 10% of girls exhibiting, the full blown syndrome

of hyperandrogenism, chronic anovulation and polycystic ovaries. We now know that

approximately 75% of anovulatary ladies of any cause have polycystic ovaries and 20

to 25% of women with normal ovulation demonstrate ultrasound findings typical of

polycystic ovaries. Chronic anovulation accompanied by hyperandrogenism and

clinical manifestations including, hirsutism, acne, elevated testosterone and

androstenedione, and frequently but not always obesity is seen in PCOD.26

A study on knowledge and attitude of college girls regarding dietary factors and

life style modifications causing PCOD shows that college girls had very poor

knowledge 10% on dietary factors effecting PCOD. Colleges girls also had lack of

knowledge regarding various factors effecting PCOD . 27

A teaching progamme on management of PCOD was conducted among college

girls on prevention of PCOD and was found to be very effective in increasing a

knowledge of 40%. 28

Negative Attitude of college girls regarding PCOD was very much the hindrance

in improving the knowledge among college girls with PCOD and there was a need to

improve there attitude. 29

PCOD is not a new condition, but despite the fact that it was first identified in

6

1935 (and was originally known as Stein-Leventhal syndrome after the doctors who

discovered it), there has been no real agreement as to its cause. As recently as five

years ago, according to Dr. Ronald Feinberg, Polycystic Ovaries, and Insulin

Imbalance many specialists still believed it to be primarily a result of dysfunctional or

diseased ovaries, which was Stein's and Leventhal's original supposition.30

Cysts in the ovary are not a disease but a symptom of some metabolic

derangement in the cellular level present in each one of the cells in the body and not

just among the ovarian cells. The core pathology lies in the insulin receptor and

signaling pathways in cellular metabolism which leads to glucose intolerance. The

excess insulin will derange the LH: FSH ratio (hormones secreted in the brain). LH

along with insulin will make the ovarian wall (theca cell) hypertrophied and prevents

the follicle from ovulating. This finally leads to cyst formation.31

As many as 1 out of every 15 assessed was found to be suffering with PCOD in

Wellington college and there knowledge was very poor regarding the subject. College

girls were afraid to talk about there disease to the parents .32

A study reveals that the urban college girls shows that there was a considerable

increase on obesity causing polycystic ovarian disease and their attitude was found to

be very low related to dietary pattern and sedentary lifestyle leading to polycystic

ovarian disease and parent’s attitude was found to be negative and very low among

their daughter suffering polycystic ovarian disease.

Video teaching conducted among college girl in Ukraine was found to increase

the knowledge 55% related to polycystic ovarian disease and its side effect on health

was found to be very effective when compare to the previous knowledge without

implementing video teaching.

6.4 STATEMENT OF THE PROBLEM:

“A study to assess the effectiveness of Structured Teaching Programme on knowledge and attitude regarding prevention of Polycystic Ovarian Disease among college girls in selected colleges at Bangalore”.

7

6.5 OBJECTIVE OF THE STUDY:

To assess the level of knowledge regarding prevention of Polycystic

Ovarian Disease among college girls.

To assess the level of attitude regarding prevention of Polycystic Ovarian

Disease among college girls.

To determine the effectiveness of Structured Teaching Program regarding

prevention of Polycystic Ovarian Disease in terms of knowledge and attitude

score of college girls.

To find relationship between knowledge and attitude of college girls

regarding prevention of Polycystic Ovarian Disease.

To find the association of post test level of knowledge and attitude of

college girls with the selected demographic variables.

6.6 OPERATIONAL DEFINITION:

Assess: It is operationalised as the statistical measurements of the knowledge and

attitude scores of the college girls regarding prevention of polycystic ovarian

disease.

Knowledge: The term knowledge refers to the response of college girls regarding

prevention of polycystic ovarian disease by questionnaire in terms

of knowledge scores.

Attitude: The term attitude refers to the written expressive feelings regarding

prevention of Polycystic Ovarian Disease.

Structured teaching programmed: It refers to a well planned instructional

module through lecture cum discussion methods on selected aspects regarding

8

prevention of Polycystic Ovarian Disease.

Effectiveness: The term effectiveness refers to the knowledge and attitude

scores after administration of structured teaching program regarding prevention of

Polycystic Ovarian Disease among college girls.

Prevention: The term prevention refers to systematically developed instruction

designed to provide knowledge and attitude of college girls regarding prevention

of Polycystic Ovarian Disease.

Polycystic Ovarian disease : It refers to the hormonal imbalance

which causes irregular menstrual periods, obesity, unwanted or excess hair

growth and acne.

College Girls : Girls with age group of 17 to 21 years and studying in selected

colleges.

6.7 HYPOTHESIS :

H1: There will be significant difference in the level of knowledge regarding

prevention of polycystic ovarian disease between pre-test and post-test scores.

H2: There will be significant difference in the level of attitude regarding

prevention of polycystic ovarian disease between pre-test and post-test scores.

H3: There will be significant relation between knowledge and attitude scores of

polycystic ovarian disease

H4 : The level of knowledge and attitude of college girl regarding prevention of

polycystic ovarian disease will be significantly associated with the selected with

the demography variable.

6.8 ASSUMPTION:

1. College girls possess some knowledge and attitude regarding prevention of

9

Polycystic Ovarian Disease

2. College girls will be free to answer the question.

3. Having proper knowledge and attitude regarding prevention regarding of

polycystic ovarian disease reduces the risk of getting Polycystic Ovarian disease

among college girls

6.9 DELIMITATION:

Assessment of attitude related to prevention of polycystic ovarian disease among

college girl is limited to eliciting through attitude checklist only.

7 MATERIALS AND METHODS:

7.1

7.1.1

7.1.2

7.1.3

SOURCES OF DATA

PRIMARY SOURCE College girls studying in different colleges at Bangalore.

RESEARCH APPROACH: An evaluative research approach.

RESEARCH DESIGN: Pre-experimental 1 group pre and post test research design.

7.2 METHODS OF COLLECTION OF DATA:

7.2.1 SAMPLE CRITERIA:

Inclusion criteria

Exclusion Criteria

1. College girls studying in selected

colleges.

2. College girls of age group 17-21years.

3. College girls who can communicate in

Kannada or English.

4. College girl available during period of

10

study.

1. College girls of age groups more than 21

years.

2. College girls who are not willing to

participate in the study.

3. College girls who are not available at the

time of study.

7.2.2 POPULATION College girls who are in age group 17 -21 years studying in selected college in Bangalore.

7.2.3VARIABLES UNDER

STUDY:

Independent variable

Dependent Variable

Attribute Variable

Structured teaching program regarding prevention of

Polycystic Ovarian Disease

Knowledge and attitude of college girls.

Age, socioeconomic status, year of education, place of

residence etc.

7.2.4 SETTING OF STUDY: This study will be conducted in selected Colleges at

Bangalore

7.2.5 SAMPLE College girl those who are all fulfilling inclusion

criteria.

7.2.5 SAMPLE TECHNIQUE: Non probability convenient sampling.

7.2.6 SAMPLE SIZE: 60 college girls who are in17 – 21years studying in

selected colleges at Bangalore.

7.2.7 TOOLS OF RESEARCH As per objective of the study a tool is prepared as

1. Structured questionnaires related to socio

11

demographic variables of college girls.

2. Structured questionnaires related to knowledge

aspect on prevention of Polycystic Ovarian

Disease among college girls.

3. Checklist to assess the attitude of college girl

regarding prevention of Polycystic Ovarian

Disease.

4. STP regarding prevention of Polycystic Ovarian

Disease.

7.2.8 METHOD OF DATA COLLECTION :

A prior formal permission will be obtained from the

concerned authority. The purpose of the study will be

explained and consent will be obtained from the

subjects. The investigator will select samples as per

inclusion criteria. Structured questionnaires and

checklist will be use to assess the level of knowledge

and attitude as pre test. STP will be administered after

one week of pre test. Reassess the knowledge and

attitude of college girl regarding polycystic ovarian

disease during 6 weeks.

7.2.9 METHOD OF DATA ANALYSIS AND INTERPRETATION:

DESCRIPTIVE STATISTICS:

The researcher will use appropriate descriptive and

inferential statistics for data analysis and present in the

form of tables, graphs and diagrams. with the help of

structured questionnaires to collect the data and

knowledge and attitude.

12

INFERENTIAL STATISTICS :

1. Frequency and percentage distribution will be used

to analyze the demographic data of college girls.

2. Mean, median range and standard deviation will be

used to assess the level of knowledge and attitude

scores regarding prevention of Polycystic Ovarian

Disease among college girls.

1. To assess effectiveness of Structured

teaching program on knowledge and attitude of

prevention of Polycystic Ovarian Disease among

college girls.

2. Knowledge and attitude score of college

girl regarding prevention of Polycystic Ovarian

Disease.

3. Co-relation co-effectiveness to find the

relationship between knowledge and attitude of

prevention of Polycystic Ovarian Disease.

4. 2 test to determine the association between

knowledge and attitude scores regarding college

girl prevention on Polycystic Ovarian Disease with

the selected demographic variables.

7.4 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVIEWS TO BE CONDUCTED ON THE PATIENTS OR OTHER HUMAN BEINGS OR ANIMALS?

YES, STP will be conducted and knowledge level will be assess.

No other investigation or interviewer will be conducted on subject.

7.5 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOU

INSTITUTION?

Yes, informed consent will be obtained from the institution authorities and

subjects. Privacy, confidentiality and anonymity will be guarded. Scientific objectivity

13

of the study will be maintained with honesty and impartiality.

8 BIBLIOGRAPHIC OF REFERENCES:

1. Ashman. R; “Polycystic ovarian disease” 1 edition Jaypee brothers. 1999; p.

190 - 192

2. Roberts Feldman. “Understanding PCOD”. VI edition. New Delhi. Grew

Hill Publishers. 2004. p. 274-285.

3. Bat show Mol. “Diagnostic and statistical manual of PCOD”. 11 editions.

American Obstetrics association 2000. Washington.

P. 20-25.

4. Ntswane AM, et all mar: 30(1) 40-42 (2007) http:/ pubmed.com

5. The Nursing Journal of India. Nursing service. Vol XLVIII, No. 9. Sept.

2006.p.199-200.

6. Ntswane AM et. Al. Midwifery Mar 2007, 30(1). 85-96.

7. Community living of Minnesota. Minneapolis USA Jan. 2005. d17 (1) : 41-

50.

8. http://google.com

9. Chakrabarti k et.al. “Study on ethological factors on PCOD”. International

journal of General Medicine (2003) 5(1):7-25.

10. Roeleveld Net. Al medical Jan 1992. 21 (1) :110-9 htt://pumbmed.com.

11. Csabi get a; Young Girls with PCOD. “The prevalence of informative

morphogenetic variants”. International Journal of Midwifery Pharmacology

14

(2007) 9 (4): d197-200.

12. Feldman M.A, Obstetrics jul: (1994): 15 (4): 299-332

Http: // google.com.

13. Sparks B, et.al “International journal of women health” sep-oct 1993;

14(15):387-408.

14. Backken J, et.al “Teaching parents with mental retardation. Knowledge

versus skills”. American Journal of mental Retardation (1993) 97 (4): 17-405.

15. Narayan J et.al “Factors influencing the expectation of parents for their

mentally retarded children.” Indian Journal of Intellect Disable (1993) (pt 2) 8-

161.

16. Rycle-Bran dt.B “Anxiety and depression in young girls with PCOD.”

International Journal of obstetrics (1990) 156:21-118.

17. Mavrin- cavorl, “A comparison of the attitude of young girls of non PCOD

and of PCOD girls towards their lifestyles and treatment regimen.” International

Journal of obstetrics (1986) (4):24-315.

18. Margalit M, “Ethnic differences in expressions of shame feeling by women

with PCOD.” International journal of soc – obstetrics (1979) 25(2):79-81.

19. Roskan I et. Al “A qualitative analysis of mother’s childrearing behavior

towards their ovarian cysts.” Indian Journal of Mental Health (2007) 28 (2): 44-

130.

20. Najman JM, et.al “Bias influencing maternal reports of child behavior and

emotional status.” In soc-Psychiatric Epidemiology (2001) 36 (4): 94-186.

15

21. Wild RA. “Long-term health consequences of PCOS.” Hum Reprod

Update. 8: 2002; 231-241.

22. Clark AM, Thornley B,Tomlinson L. “Weight loss in obese infertile women

results in improvement in reproductive outcome for all forms of fertility

treatment”. Hum Reproductive. 13: 1998; 1502-1505.

23. Carmina E, Lobo RA. “Polycystic ovary syndrome (PCOS): Arguably the

most common endocrinopathy is associated with significant morbidity in

women” Journal Clinical Endocrinology Metabolism. 84: 1999; 1897-1899.

24. Polson DW, Wadsworth J, Adams J. “Polycystic ovaries: A common

finding in normal women”. Lancet. 1: 1988; 870-872.

25. Waldstreicher J, Santoro NF, Hall HE. “Hyperfunction of the hypothalamic

pituitary axis in women with polycystic ovarian disease: Indirect evidence for

partial gonadotroph desensitization.” Journal Clinical Endocrinology

Metabolism. 66: 1988; 165-172.

26. Sagle M, Bishop K, Ridley N. “Recurrent early miscarriage and polycystic

ovaries”. BMJ. 297: 1988; 1027-1028.

27. Hoeger K., “Obesity and weight loss in polycystic ovary syndrome”.

Obstetrics Gynecology Clinical North Am. 28: 2001; 85-97.

28. Harborne L, Fleming R, Lyall H. “Descriptive review of the evidence for

the use of metformin in polycystic ovary syndrome.” Lancet. 361: 2003; 1894-

1901.

29. Akhi. R; “Polycystic ovarian disease” 1 edition Jaypee brothers. 1999; p.

190 - 192

30. Daniel DW, Wadsworth J, Adams J. “Polycystic ovaries: A common

finding in normal women”. Lancet. 1: 1988; 870-872.

31. Janet RA. “Long-term health consequences of PCOS.” Hum Reprod

Update. 8: 2002; 231-241.

32. http://google.com

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9 Signature of the Candidate

10 Remarks of the Guide

11 NAME AND DESIGNATION

11.1 Guide

11.2 Signature

11.3 Co – Guide

11.4 Signature

11.5 Head of the Department

11.6 Signature

12 12.1Remarks of the Chairman and

Principal

12.2 Signature

17