Assessment of the effectiveness of Planned Teaching on Knowledge Regarding Menopausal Syndrome and its Management among Premenopausal women in selected community area

 

Ms. Nikita Kishor Dhanorkar

Kasturba Nursing College, Sevagram, Dehankar Lay-Out, Sindhi Meghe, Wardha, Pin Code 442001

 

ABSTRACT:

Menopause may be smooth experience for some women with only symptoms of cessation of menstrual flow while others face one or more of postmenopausal symptoms.¹² Investigator during community posting experience, found that the postmenopausal women in the community, were having a lot of problems regarding associates changes after menopause and management, and the post-menopausal women not able to cope up the situation. Therefore, the investigator felt with own experience the need to create awareness on menopause among premenopausal women and very strongly to conduct the study to educate the premenopausal women to help them face problems positively. Objectives of the study were:

·         To assess the knowledge of premenopausal women regarding menopausal syndrome and its management before planned teaching

·         To assess the knowledge of premenopausal women regarding menopausal syndrome and its management after planned teaching

·         To associate the knowledge of the premenopausal women regarding menopausal syndrome and its management with selected demographic variables such as age and education.

The analysis of the study revealed that there was a significant improvement in the knowledge of menopausal syndrome and its management among premenopausal women. The planned teaching proved to be effective in improving the knowledge of premenopausal women regarding menopausal syndrome and its management. Hence, in this study Hypothesis H₀ is rejected and so, Hypothesis H₁ is accepted

 

 

 

INTRODUCTION:

When we are no longer able to change a situation, we are challenged to change ourselves.¹

                                                                   (Victor frank)

Every living thing in nature is susceptible to changes. The flower that blooms today will fall off tomorrow, the leaf that looks green today will get dried off, so is with the humans.

 

Human beings experience various turning points in their life cycle which may be developmental or transitional. Women have been intimately connected with the natural ebb and flow of human life and that of the natural world around them since primordial times.

 

Each stage of a woman’s life is organized around what Goddess Cultures called the blood mysteries: menarche, (the first monthly flow of blood); childbirth, which is accompanied by blood from birthing; and menopause, when a woman’s “wise blood” remains inside her to give her wisdom. These are still powerful landmarks, which profoundly influence women’s lives. The ancient tripartite divisions of Maiden, Mother, and Crone can be even more meaningful in women’s lives as the Crone stage becomes one third of our lifespan ². A Woman has been the torchbearer of the society for centuries. She is responsible for the miracle of birth. She is the image of the society and considered the guardian of the respect and corner stone of a family. As life goes on, there are lot of changes occur in women’s life cycle. Major concern in woman’s life is reproductive health, and need much attention than the counter parts.³

 

According to the Indian menopausal society research, there are currently 65 million Indian women over the age of 45. Not only that, menopause often strikes Indian women as young as 30-35 years.⁴ Economic Survey highlight that on an average nearly 4 percent of Indian women are already menopausal between the ages of 29-34 years. It goes up to 8 percent in the case of women between 35 and 39 years. This is shocking because normal menopause starts between the ages of 45 and 55, with a mean age of around 51 years worldwide. The results showed that a higher number of illiterate women experience premature menopause than educated, the percentage of women hit by premature menopause is marginally lower in urban areas (16.1 percent) as against rural (18.3 percent). Interestingly, women who marry and have children late have less reason to worry, as they experience a delayed onset of menopause.⁵

 

As of 1 January 2015, the population of the world was estimated to be 7 266 171 118. In the India total current population is 1,286,614,547 (1.28 billion) As of September 18, 2015 out of which total female population is 622,206,794 (622 million in 2015).

 

The life expectancy of the population around the world is estimated to be 75-80 years. Today, there are over 200 million postmenopausal women worldwide and 40 million in India. The women population above 50 years age group is expected to increase 1200 million, by the year 2020 AD. A Total of 130 million Indian women are expected to live beyond the menopause into old age by 2015.⁶

 

Many women arrive at their menopause years without knowing anything about what they might expect, or when or how the process might happen and how long it might take. Very often a woman has not been informed in any way about this stage of life; it may often be the case that she has received no information from her physician or from her older female family members, or from her social group. As a result a women who happens to undergo a strong perimenopause with a large number of different effect, may become confused and anxious, fearing that something abnormal in happening to her. This is a strong need for more information and more education among the women regarding menopause.⁷

 

As menopausal health demands priority in Indian scenario due to increase in life expectancy and growing population of menopausal women, large efforts are required to educate and make these women aware of menopausal symptoms.⁸ There was a time when menopause was not discussed aloud, but now the things have been changed. Most women wish they had known more about their menopause before it happened. This will help in early reorganization of symptoms, reduction of discomfort and fears and enable to seek appropriate medical care if necessary.⁹ Changes in menstrual function are not symbols of ominous change, understanding the physiologic reasons for these changes will do much to reinforce a healthy, normal attitude towards menopause.¹⁰

 

From the above facts it is clear that there are many physical and psychological problem faced by menopausal women. The review of literature also revealed that most of the studies are done in abroad regarding psychological changes during menopause and very few studies have been done among pre-menopausal women. In India, though some non-research literature is available but no researched literature could trace out regarding pre-menopausal women’s knowledge and attitude on psychological changes during menopause. There is a dearth of literature on psychological changes during menopause in Indian population and published data. Keeping these facts this researcher realized the importance of problem in current situation and created an intention to administer a planned teaching to assess the knowledge of the women in menopausal stage regarding the menopausal symptoms, thereby enhancing their awareness on menopausal symptoms and ability to manage and cope up with those symptoms.

 

A cross sectional study was conducted on menopausal symptom among postmenopausal women of North India in March 2012-2015. The aim was to determine the mean age of attaining menopause and the prevalence of various menopausal symptom. Study samples were 218 postmenopuasal women. The mean age of attaining menopause was 48.26years.The prevalence of symptoms among ladies were muscle and joint pain (70%), mood swings (65%), low backache (46.7%), hot flush and excessive sweating (45%), change in sexual desire (44%), dryness of vagina (41%), urinary symptoms(35%) and anxiety and irritability in (11%) females. Thus, the study stated that all the women were suffering from one or more number menopausal symptoms. Women should be made aware of these symptoms, their causes and treatment respectively.¹¹

 

MATERIAL AND METHODS:

Research Approach:

Descriptive Evaluatory approach was used in this study. This approach was selected because the aim of this research study was to evaluate the efficacy of planned teaching on the knowledge regarding menopausal symptoms and its management among premenopausal women in selected community area. With this approach it would be possible to describe the knowledge of the women. The descriptive evaluatory approach would help the investigator to evaluate the effect of “planned teaching” on the variable that is knowledge of the women.

 

RESEARCH DESIGN:

A research design is an overall plan how to obtain answer to the question being studied and how to handle some of the difficulties encountered during research process and also enhances for the specification of the study to be used in the research process. The research design helps the researcher in the selection of the subject, manipulation of the experimental variables, procedure of the data collection and the type of statistical analysis to be used to interpret the data.

 

In the present study Quasi experimental one group pre test post test research design was used for the study. A pre-test was administered by means of structural questionnaire depicted as 0₁ and then planned teaching given depicted as X. A post test was conducted using the same structured questionnaire depicted as 0_2. The study design is depicted as under

 

Table 1: Quasi Experimental one group pre test post test design

 

KEYS:

0_1: Pre test

X: Planned teaching

0_2: Post test

 

VARIABLE:

Independent variable:

In this study independent variable is planned teaching on knowledge regarding menopausal symptoms and its management.

 

Dependent variable:

In this study dependent variable is knowledge regarding menopausal syndrome and its management.

 

SETTING OF THE STUDY:

This study was conducted in selected community area.

The researcher found the setting appropriate to conduct the study because adequate number of women was available who could be taken for the study and also the area authorities were cooperative and gave permission to conduct the study. Data collection was done during the day time.

 

POPULATION:

In this study the population was all the women (age between 30-40 years) from selected community area.

 

Target population:

In this study the target population consisted of all women (age between 30-40 yrs) from selected community area.

 

Accessible population:

In this study accessible population consists of women who met the designated criteria and who were available for the research study.

 

SAMPLE:

In this study sample were women who were fulfilling the inclusion and exclusion criteria.

 

SAMPLE SIZE:

In this study sample size was 50 women (age group between 30-40 yrs) from selected community area.

 

SAMPLING TECHNIQUE:

The sampling technique used in the study was non probability convenient sampling.

 

CRITERIA FOR SAMPLE SELECTION:

Inclusion Criteria:

·         Women at the age between 30 yrs to 40 yrs residing at the selected community area

·         Women who are willing to participate in the study

·         Women who are present at the time of data collection

·         Women who could understand and speak Marathi or Hindi

 

Exclusion Criteria:

·         Women who are health professionals.

·         Women with illness like mental disorders

 

TOOL PREPARATION:

Closed ended questions are to assess the knowledge of premenopausal women regarding menopausal syndrome and its management. Tool was prepared in English.

 

Development of the tool:

Structured questionnaire consists of two sections.

Section A– Consists of demographic variable of the women to be participated in the study e.g. age, education etc.

 

Section B- Consists of 28 questions on knowledge regarding menopausal syndrome and its management.

 

SCORING:

·         Score 1 was given for correct answer.

·         Score 0 was given for wrong answer.

·         Knowledge was graded from poor knowledge to excellent knowledge based on scores

 

Table 2: Scoring process on level of knowledge among premenopausal women regarding menopausal syndrome and its management.

 

DEVELOPMENT OF PLANNED TEACHING ON KNOWLEDGE REGARDING MENOPAUSAL SYNDROME AND ITS MANAGEMENT:

The planned teaching was developed for women. The steps adopted in the development of planned teaching were:

·         Through review of relevant published literature and websites on various aspects of menopausal syndrome and its management.

·         Preparation of the first draft of the planned teaching

·         The area covered in the planned teaching

The areas covered under planned teaching were:

a.        Introduction

b.       Definition

c.        Climacteric

d.       Types of menopause

e.        Age of menopause

f.         Surgical menopause

g.       Hormonal changes during menopause

h.       Signs and symptoms of menopause

i.         Management of menopause

j.         Summary

·      Content validation of the planned teaching

·      The preparation of the final draft of the planned teaching

·      A cover page with appropriate title and illustration was prepared.

 

VALIDITY:

In order to obtain content validity, the tool was given to 12 experts who were from the field of Obstetric and Gynaecological Department and Obstetrical and Gynaecological Nursing .After receiving opinion from the experts and consultation from the guide some modifications were done in framing the items and same were incorporated in the tool.

 

RELIABILITY:

The reliability of questionnaire was done by Guttmann’s Split Half Coefficient Method.

The correlation coefficient ‘r’ of the questionnaire was 0.88. Hence the questionnaire was found to be reliable.

 

 

TESTING OF THE TOOLS:

FEASIBILITY OF THE STUDY:

It is small scale test to determine the feasibility of the larger study i.e. pilot study

·         The researcher did not find difficulty in getting the subject.

·         Adequate number of women were available.

·         Availing permission for conducting study was easy.

·         It became easy to know the problem during the main study.

·         To know how the problems could be overcome.

·         To know if any modification was needed in the tool and planned teaching.

·         Problems were identified and measures were taken to overcome.

·         No modifications were needed in the tool and planned teaching.

 

METHOD OF DATA COLLECTION:

The data gathering process began from 4^th Jan to 16^th Jan 2016 .The researcher visited the selected community area in advance and obtained the necessary permission from the concerned authorities. The researcher introduced herself and informed them about the nature of the study so as to ensure better cooperation during data collection. The researcher collected a group of samples, made them comfortable and oriented them to the study and administered questionnaire to them, instructed them not to interact with each other and their doubts were clarified. Once the questionnaire was completed, researcher collected them back. The samples required approximately 30 min duration to complete the structured questionnaire. After the pre test planned teaching was initiated by the researcher.

 

Post test was administered with the same questionnaire on the 7^th day. The collection of data was performed within the stipulated time. After the data gathering process the researcher thanked all the study samples as well as the authorities for their cooperation.

 

 

 

Table 3: Data analysis plan

Sr. no	Data analysis	Method	Remark
1.	Descriptive statistics	Mean, standard deviation, percentage	Knowledge regarding menopausal syndrome and its management
2.	Inferential statistics	“t” test	Efficacy of planned teaching
		“t” test and ANOVA test	Associate demographic variable with the level of knowledge.

 

RESULTS:

The analysis and interpretation of the data are given in the following section.

·         Section A: Distribution of Women with regards to demographic variables

·         Section B: Assessment of knowledge of premenopausal women regarding menopausal syndrome and its management before planned teaching.

·         Section C: Assessment of knowledge of premenopausal women regarding menopausal syndrome and its management after planned teaching.

·         Section D: Evaluate efficacy of planned teaching regarding menopausal syndrome and its management among premenopausal women

·         Section E: Association of knowledge score in relation to demographic variables.

 

Table 4: Distribution of women according to their demographic characteristics.(n=50)

 

Table 5: Assessment of overall knowledge score with pre test (n=50 )

 

Table 6: Assessment of overall knowledge score with post test (n=50)

 

 

Table 7: Comparison of knowledge score in pre test and post test (n=50)

 

Table 8: Significance of difference between overall knowledge score in pre and post test of premenopausal women of selected community area in relation to menopausal syndrome and its management

Knowledge Regarding	Overall	Mean	Mean percentages	SD	t value	P value	Result
Comparison of knowledge before and after planned teaching	Pre	16.92	61.64	5.14	16.16	0.000 S, p<0.05	SS
	Post	23.84	84.42	9.83

 

Table 9: Comparison of difference between knowledge score in pre and post test of sample in relation to area wise knowledge regarding menopausal syndrome and its management.

 

Table 10: Significance of difference of knowledge on menopausal syndrome and its management in relation to age of premenopausal women (n=50)

(NS = Not Significant)

 

Table 11: Significance of difference of knowledge on menopausal syndrome and its management in relation to educational status of premenopausal women (n=50)

 

Table 12: Significance of difference of knowledge on menopausal syndrome and its management in relation to occupational status of premenopausal women (n=50)

 

Table 13: Significance of difference of knowledge on menopausal syndrome and its management in relation to marital status of premenopausal women (n=50)

 

 

Table 14: Significance of difference of knowledge on menopausal syndrome and its management in relation to menstrual pattern of premenopausal women (n=50)

 

Table 15: Significance of difference of knowledge on menopausal syndrome and its management in relation to previous exposure to information of premenopausal women n=50

 

Table 16: Significance of difference of knowledge on menopausal syndrome and its management in relation to source of information of premenopausal women n=50  

 

DISCUSSION:

The findings show overall knowledge score in pre test score, 3(6%) of women have inadequate knowledge, and 47(94%) of women had moderate level of knowledge regarding menopausal syndrome and its management. The findings show overall knowledge score in post test scores, 1(2%) woman had inadequate knowledge, 4(8%) women had moderate level of knowledge and 45(90%) had adequate level of knowledge after planned teaching regarding menopausal syndrome and its management.

 

The findings show in comparison of overall knowledge score in pre test and post test that 47(94%) had moderate and 45(90%) had adequate level of knowledge score. The minimum score in pre-test was 14 and the maximum score was 19, the mean score for the pre-test was 16.92±1.41 whereas in post test the minimum score was 10 and maximum score was 27.45(90%) were having adequate level of knowledge , 4(8%) having moderate knowledge score , the mean score for post test was 23.84±2.45. A one group pre-test post-test pre-experimental approach was adopted to assess the Effectiveness of Structured Teaching Programme on Knowledge Regarding Menopausal Symptoms and Its Management among Women of Vadodara, Gujarat, India. The study aimed at assessing the existing knowledge regarding Menopausal symptoms and its management among women, determining the effectiveness of structure teaching programme on Menopausal symptoms and its management among women and finding the association between post-test knowledge scores and selected demographic variables like age, education, occupation .and family type. The study was conducted among 60 menopausal women conveniently selected from two villages of Vadodara. The content validity of the tool and teaching plan was established. Reliability of the tool was tested by split half technique. It was found that the effectiveness of structured teaching programme in terms of increase in knowledge score among menopausal. Women were 46.13 %.There was significant increase in the knowledge of women regarding menopausal symptoms and its management. The structured teaching programme was found to be an effective strategy to increase the knowledge of women regarding menopausal symptoms and its management.¹²

 

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2.        Linta savage, the three stages of a womens life. 8 Nov2010 http://www.sandiego therapist.com/three stages.html

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4.        Jyothi unni. Third consensus meeting of Indian menopause society (2008). Asummary. j mid-life health. http://www.jmidlife.org/text.asp?2010 /1/1/43/66987. 2010;1:page no.43-47

5.        G A Bachmann, E W Freeman sheriff, R Hardy, et.al; Menopausal symptoms www.acupuncture.org.uk/…/1137-acupancture-and-menopausal-symptoms.

6.        Sengupta A. The emergence of the menopause in India. Climateric, Volume 6,1 June 2003,Page no. 92-95(4)

7.        Wikipedia. Making life easier. $ 2, 249,735.Our goal: $ 6 million. Lttp://en-Wikipedia-org/wiki/menopause.

8.        Shoba Cicil Lobo. Physical and psychological problems of menopausal women in a selected rural community Surathkal. ( unpublished Master of science in nursing dissertation, Rajiv Gandhi University of Health Sciences, Banglore, 2002)

9.        G.K Bedi. Health matters. Infertility specialist. 2004(4): 3-5

10.     Mary Ellen Rousseau. Health care of midlife and aging women. In: Helen Varney, Jan. M. kriebs, Carolyn L Gegor. Varneys text book of midwifery. Fourth edition. New Delhi, All India publishers and distributors, 2005; 335-66.

11.     Ruchika Garg, Rajani Rawat , et.al Menopausal symptoms among postmenopausal women of North India A cross sectional study, Journal of South Asian federation of menopause societies January-June 2015;3(1): 3-5

12.     Vruti patel IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-ISSN: 2320–1959.p- ISSN: 2320–1940 (May-Jun. 2014), Volume 3, Issue 3 Ver. III, Page no. 22-26 www.iosrjournals.org

 

 

 

 

Received on 27.01.2017     Modified on 29.03.2017

Accepted on 01.05.2017     © A&V Publications all right reserved