INTRODUCTION:
“Learn from yesterday, live for today, hope for tomorrow. The important thing is to not stop questioning.” -Albert Einstein
Menopause may be smooth experience for some women with only symptom of cessation of menstrual flow while others face one or more of post-menopausal symptoms. But there is lack of awareness of its cause, effect and management pertaining to it. A wide gap in the knowledge has been documented in the women from developed and developing countries. And this gap is even wider in women from slums and urban area in developing countries.1
Another significant phenomenon in this age group is the post-menopausal bleeding (PMB) which is likely to be misinterpreted to be a normal phenomenon. But this can spell disaster as it may be the warning signal for cancer cervix. This demands raising awareness about the gynecological examination along with Pap smear. Post-menopausal bleeding is a problem in both general and hospital setting. Postmenopausal bleeding must be considered as indicative of malignant disease until proven otherwise still holds true in our circumstances.2
Postmenopausal bleeding is the most common presentation of malignant disorders of the endometrium. Its prevalence in the general population is estimated to be 40.9% immediately after the first 12 months of amenorrhea following menopause, falling to 4.2% more than 3 years after menopause. The reported prevalence of malignancy in women presenting with bleeding after menopause varies between 5% and 15%. It is therefore mandatory that all women presenting with postmenopausal bleeding undergo further investigation. Investigation is directed towards differentiating benign from malignant causes of bleeding, in particular maximizing the sensitivity for detection of malignancy.3
Bleeding is the presenting sign in more than 90% of patients with endometrial cancer, any bleeding after 12 months of amenorrhea in a postmenopausal woman warrants immediately evaluation, no matter how scant or episodic the bleeding. The true incidence of postmenopausal bleeding decreases with age but probability of cancer being the cause increases from 9% for patients in their 50s to 60% in their 80s.
The majority of postmenopausal bleeding in all women is due to atrophy of the endometrium or vagina, endometrial cancer and polyps.5
Ever since the inception of community development movement, health education has been identified as one of the important function to create awareness among people especially in rural areas. So, there is a greater need for health education among women of high-risk groups to improve their knowledge and change their attitude.4
Based on the above facts the investigator felt that there is a need for giving a planned teaching programme among women about postmenopausal bleeding, its causes and its management, since these women have lack of adequate knowledge regarding postmenopausal bleeding. Giving education will impart appropriate knowledge regarding the risk factors, causes, signs and symptoms and management, which will make the women more aware of their health, and they can impart the gained knowledge to their family and community.
STATEMENT OF THE PROBLEM:
“Effectiveness of planned teaching programme on knowledge regarding postmenopausal bleeding among the females of age group between 40-60 years in selected area of Anekal, Bangalore”.
OBJECTIVES OF THE STUDY:
1. To assess the pretest level of knowledge regarding postmenopausal bleeding among females of age group between 40-60 years.
2. To find the effectiveness of planned teaching programme regarding postmenopausal bleeding among females of age group between 40-60 years.
3. To find the association of pre-test level of knowledge regarding postmenopausal bleeding of females of age group between 40-60 years with their selected demographic variables.
HYPOTHESES:
H1: There will be a significant difference in pre-test and post-test knowledge regarding postmenopausal bleeding among females of age group between 40-60 years.
H2: There will be a significant association between pre-test knowledge scores of females regarding postmenopausal bleeding with their selected demographic variables.
MATERIALS AND METHODS:
Research approach: An evaluative approach was adopted to test the effectiveness of planned teaching programme on knowledge regarding postmenopausal bleeding.
Research design:
Pre-experimental (one group pre-test post-test) design was adopted for the study.
Setting of the study:
The present study was conducted in Marasur village, Anekal Taluk, Bangalore.
Sample:
The present study was conducted among 60 females of age group between 40-60 years.
Sampling technique:
The investigator used non probability purposive sampling technique to select 60 women from the selected area for the study.
Sampling criteria:
Inclusion criteria:
· Women who were available at the time of data collection.
· Women who were willing to participate in the study.
Exclusion criteria:
· Women who had already attended similar teaching programme.
· Women who were not willing to participate.
Development of tool for Data collection:
In this study, the data collection instrument was structured interview questionnaire on postmenopausal bleeding. The final draft of the tool was prepared considering suggestions of validators, which comprised of two parts.
Part 1: Baseline characteristics
Part 2: Structured interview questionnaire on postmenopausal bleeding.
Validity of the Instrument:
The content validity of the tool was obtained from various experts from different field like medicine, nursing and research.
Reliability of the Instrument:
The reliability of the tool was tested by split half technique (Spearman’s Brown Prophecy) where r = 0.85 was found.
Pilot Study:
The pilot study was conducted with ten women to refine the methodology. The findings of the study revealed that the Mean±SD of post-test knowledge score (21.6±1.11) was higher than the Mean±SD of pre-test knowledge score (11±1.67). Chi-square analysis showed no association between the pre-test knowledge scores and selected baseline characteristics. The investigator found that the study was feasible and practicable to conduct main study.
Development of the Planned Teaching Programme:
The following steps were adopted for the development of planned teaching programme,
· Review of literature
· Framing outline of the content
· Preparation and organization of the content
· Deciding the method of instruction and audio visual aids
· Development of criteria checklist
· Content validation of the planned teaching programme
· Pre-testing of the planned teaching programme
· Preparation of the final draft
Data Collection Procedure:
The data collection was conducted among 60 women after obtaining written permission from the concerned authorities for undertaking the study and informed consent was also taken from the study participants. The socio demographic data and knowledge regarding postmenopausal bleeding of the participants were collected using structured interview questionnaire. Immediately after pre-test, planned teaching programme on postmenopausal bleeding was administered to the participants with suitable audio-visual aids. Post test was conducted on 7th day for the same group to find out the effectiveness of planned teaching programme in increasing participant’s knowledge.
RESULTS:
The data collected from the participants were analysed using descriptive and inferential statistics.
Section 1: Description of the baseline characteristics of women:
Most of 35% women were between 40-45 years, 26.66% of women were between the age group of 46-50 years. Most of women (76.66%) of women were married whereas 10% were widowed. Less than half (38.33%) of women had primary education while 23.33% had no formal education. Majority (65%) of the women were belongs Hindu religion whereas 21.66 % were belongs Christian religion. Majority (48.33%) of the women were home makers and 23.33% were coolie workers. Most of women (3.33%) were vegetarians and 16.66% were non-vegetarians. The findings related to source of information on postmenopausal bleeding was mass media was the main source of information (46.66%), while 43.33 of the women got information from health personnel. Most of women (55%) got menarche at the age of 11-13 years whereas 45% of women got menarche at the age of 14-16.
More than half (68.33%) women attained menopause at the age of 40-45 years whereas 26.66% women attained menopause at the age of 46-50 years.