INTRODUCTION:

A woman is the essence of the whole universe and the universe without women would be like galaxy without sun. In the journey of the life, there are events that can change a girl’s life forever. One of the highest step in the amazing journey of a women’s life is the transition from girlhood to womanhood is the first time the girl gets menses.

In the arrival of the first menses holds the same meaning for every girl, it is the proof that she is becoming a woman.

Only a woman can give birth to new generations¹. Menarche is a hallmark event in the life of most adolescent girls. The little girl enters into a new life. The menopause is the end of menstruation. Menstruation is the physiological discharge through the vagina of blood and mucosal tissue from the non pregnant uterus. Regular menstruation is a natural and normal physiological process. A normal cycle is taken to be 28 days long and recurs regularly. It last for 2-7 days with a normal blood loss of 35-80 ml. Many factors such as hormones and other substances help in regular menstrual flow².

Menstrual hygiene refers to the maintenance of cleanliness during the menstrual period, which included the use of clean pads or cloths, changing of soaked pads and cloths, perennial and personal cleanliness, disposal of soiled pads and cloths, with daily activities, exercise, diet and ways of preventing discomfort and problems related to menstruation. A menstrual cup is a new and effective alternative method to minimize the difficulties faced by woman during menstruation³.

A menstrual cup is a type of feminine hygiene product which is usually made up of medical grade silicone, shaped like a bell and it is flexible. Menstruating women can wear it in her vagina to catch the menstrual flow. At the end of the monthly period, the cup can be sterilized, usually by boiling in water. Unlike tampons and pads, the cup collects, menstrual fluid rather than absorbing it. Manufactures have different recommendations regarding replacement of the cups, but in general they can be reused for10 years or more⁴. Menstrual cup can be recommended to the women as its more economical, environment friendly, reusable, inodorous, aids in minimal bacterial growth and is safe and more convenient to us.

NEED AND SIGNIFICANCE:

Menstruation is a normal and natural process. Menstruation is a unique phenomenon of females of reproductive age group. Menstrual cycle is a key drive of reproductive event in women, which is a physiological process and associated with the ability to reproduce. Menstruation is the process of vaginal discharge of blood and mucosa from a non pregnant uterus. Menstrual cup is a better alternative to pads and tampons by marketing them as practical, cheaper and eco-friendly device⁵.

A menstrual cup is a type of female product that has many advantages. It is worn inside the vagina by folding it in c shape as it is flexible and gets adjusted to the shape of vaginal cavity during menstruation to catch menstrual fluid⁶. About every 4 to 12 hours (depending on the individual flow, the menstruating women removes the menstrual cup from her vagina, empties the collected blood in the toilet or sink, washes the cup under running water and insert it again. At the end of monthly period, the cup can be sterilized, usually by boiling in water. Unlike the commonly used material, the menstrual cup collects the menstrual fluid rather it absorbs. The benefits of menstrual cup are that they are economically affordable due to reusability. They only need to use 5 or 6 vaginal cups since they are reusable for up to 10 years. Next, they are environment friendly and lessons the waste disposal. Using sanitary pads and tampons is a big threat to the environment, from raw materials to processing and production⁷. The cups can be easily emptied when it is full and minimal or almost no bacteria are present since it can be sterilized after use⁸.

It is easily accessible and convenient to use as the cup is made up of silicone and rubber it is flexible for quick and easy insertion, although the pads easy to place but are associated with more risks. It is an inodorous hygienic product. Using of scented hygienic products is discouraged by medical experts because the added chemicals cause irritation and further vaginal infections due to reaction between expel the blood and preservative gel present in pads and environment of vaginal flora. So, with cups there is no need to be too conscious about unpleasant menstruation odor since there is very less exposure of fluid to the air⁹. Menstrual cups are a new and alternative method introduced for the management of menstrual bleeding which is gradually going to replace the conventional method of use of sanitary pads and tampons. As a nursing student researcher decided to conduct a study on knowledge and attitude regarding the menstrual cup among women to create awareness among population and also to assess the existing knowledge and attitude towards it.

STATEMENT OF PROBLEM:

A descriptive study to assess the knowledge and attitude regarding menstrual cup among women at LLM Hospital, Kidangoor.

OBJECTIVE:

· To estimate the knowledge regarding menstrual cup among women.

· To estimate the attitude regarding menstrual cup among women.

· To determine the correlation between knowledge and attitude regarding menstrual cup among women.

Operational definition:

· Knowledge: In this study, it refers to the existing information regarding menstrual cup among women, assessed using a structured questionnaire.

· Attitude: In this study, it refers to the way of thinking or feeling about menstrual cup among women assessed using a rating scale.

· Women: In this study, it refers to the female between the age group of 20-35 years who are admitted as patients, bystanders of admitted patients, visiting OPD as patient or bystander at LLM Hospital.

· Menstrual cup: In this study, it refers to a feminine hygiene product made up of medical grade silicone, shaped like a bell, inserted into vagina to collect blood during monthly reproductive cycle.

ASSUMPTION:

· Use of menstrual cup may be less common among women.

· Women may cooperate and respond to questionnaire and rating scale appropriately.

· Women may have some knowledge regarding menstrual cup.

HYPOTHESIS:

H₀There is no significant correlation between knowledge and attitude regarding menstrual cup among women.

Delimitation:

The study is limited to women who are:

· In the age group between 20-35years.

· Come to LLM Hospital.

· The study limited to the assessment of the knowledge and attitude among women

REVIEW OF LITERATURE:

The related literature and presented in the following subheading:

· Section A: Studies related to menstrual hygiene.

· Section B: Studies related to menstrual cup.

A comparative study was conducted in Nepal on menstrual hygiene among teenage girls using cloths versus pad. The sample where girls aged between 10 to 19 years who had attained menarche. A structured questionnaire was used to collect data from 300 teenage girls selected using quota sampling. The result of the study showed that majority of teenage girls using cloth 54.5%, and teenage girls using pads are (130) 50.7%.

A descriptive study was conducted in Wayanad to assess the effect of community-based health education intervention on management of menstrual hygiene among rural adolescent girls. The study object were unmarried rural adolescent girls from 9 to 12 years. The tool was handmade slip book containing needs based key messages about the management of menstrual hygiene. The result was the practice of using readymade pads increased significantly from 5% - 25% and reuse of cloth declined from 85% to 57%.

A descriptive study was conducted to evaluate the cognizance of health care professionals on alternative solutions for menstrual hygiene management specifying on the use of menstrual cup in western Kenya. The study sample were 492 health care professionals. The data analyzing tool was self-structured questionnaire. The result of the study revealed that out of 492 participants 43% of healthcare professionals had heard about menstrual cup device where as 57% had not heard about any other alternatives.

A descriptive longitudinal study was conducted on adaptability and efficacy of menstrual cups in managing menstrual hygiene and health among its users in Kerala. Study samples were women of 18- 50 years of age. The result showed that 68.9% of participants started that they would continue the menstrual cup usage. The majority 67% had no side effects, 10% had irritation and leakage and 13% had an unpleasant odor.

METHODOLOGY:

Research design:

In this study quantitative, non-experimental descriptive study design was used.

Setting of study:

The study was conducted in J2, J3, J4, M2 and M3 and wards and OPDs of Little Lourdes Mission Hospital (LLM), Kidangoor in Kottayam.

Population of study:

In this study the population was all the women in the age group between 2035 years at Kidangoor.

Sample:

In this study, the sample consisted of 50 women in the age group of 20-35 years who was admitted as patients, bystander of patients, visits OPD as patient or bystander at LLM Hospital, Kidangoor.

Sample size:

The sample size for the study was 50.

Criteria for selection of sample:

Inclusion criteria:

Women who are:

· Able to read and understand Malayalam

· Available for at least half an hour

· Already using menstrual cup

Exclusion criteria: Women who are:

· Severely ill

· With emergency condition

· Immediate post-operative patients

Sampling technique:

Sampling technique is the process of studying the population by gathering information and analyzing that data. Non-probability purposive sampling technique was used for the study.

Pilot study:

Pilot study has been carried out among 10 women who came to LLM Hospital, Kidangoor and possessing similar characteristics of sample of the main study. The study was done by providing the questionnaire to the selected women. It was found that the question was clear and understandable. Therefore, no changes were made in the questionnaire.

Reliability:

In the study the reliability value of knowledge is measured as 0.98 and reliability value of attitude is 0.84.

ANALYSIS AND INTERPRETATION OF DATA:

Analysis is the process of organizing and synthesizing the data so as to answer research question and test hypothesis. It includes compilation, editing, coding, classification and presentation of data. Here the study includes mainly 4 sections.

Section A: Analysis and Interpretation of Demographic Variables:

Section A deals with analysis and interpretation of demographical variables. The demographic variables of present study are age, education, occupation, marital status, area of residence, age of menarche, duration of menstruation, menstrual pattern, previous information, source of information, types of sanitary protection used, duration of change in sanitary materials and ever used menstrual cup.

Table 1: Frequency and percentage distribution of demographic variables N=50

Demographic variables	Frequency	Percentage
1. Age
20-25	15	30
26-30	20	40
31-35	15	30
2. Education
Primary School	5	10
High School	6	12
Higher Secondary	13	26
Under graduate	16	32
Post graduate	10	20
3. Occupation
Housewife	14	28
Self employed	4	8
Government employee	6	12
Private employee	14	28
Other	12	24

Majority of the women who participated in the research study that is 40% was from the age group of 26 to 30yrs. The women between the age group of 20- 25yrs and 31-35yrs who participated in our study was about 30%. The educational qualification of 32% of women who participated in our study were graduates. Some of the women, about 26% had higher secondary level of education, 20% of the women were postgraduates, 12% of the women had High school education level and 10% of the women had only primary school level of education. According to occupation, majority of the women were private employees and housewives which was about 28%, respectively. About 24% of the women came under the category of others, 12% of women were government employees and 8% of the women were self employed. Regarding marital status, 76% of the women were married and about 24% of the women were unmarried. Among the 50 samples, 72% of the women resided in rural area and 28% of the women resided in urban area. Most of the women, that is about 58% of the women attained menarche at the age of 13 -15 yrs and 28% women at the age of 10–12 yrs, 8% of the women at the age of above 15yrs and 6% of women at an age less than 10yrs. In majority of the women, 56% reported that their duration of menstruation was about 3-4 days. Also 30% of women had the duration of menstruation about 2-3 days and about 14% of the women had the duration of menstruation for more than 5days. Majority of the women, that is, about 80% of women had a regular menstrual cycle pattern and about 20% of women had irregular menstrual pattern. The study result showed that about 84% of the women were previously heard or was familiar with menstrual cup and about 60% of women didn’t have any previous information about menstrual cup. About 16% of the women had previous information regarding Menstrual Cup from social medias and about 10% of women got information about Menstrual Cup from healthcare workers. Only 6% women got information about Menstrual Cup from books or journals and only about 2% of women got information regarding Menstrual Cup from family members. The study result showed that about 62% of women changed their sanitary materials every 3 hourly and about 18% of the women changed their sanitary materials every second hourly and 16% of women changed their sanitary materials whenever it got soaked and only 4% of women changed their sanitary materials every hourly. Among the women who is using Menstrual Cup as their regular sanitary protection method about 55% of the women uses it alternatively with other sanitary products and about 45% of women uses it as a regular sanitary protection method.

Section B: Analysis and Interpretation of Knowledge Regarding Menstrual Cup

Table 2: frequency and percentage distribution of knowledge regarding menstrual cup.

Rating Scale	Frequency (n=50)	Percentage
Good	12	24
Average	31	62
Poor	7	14

Table 2 shows that among 50 samples, 12 women have good knowledge regarding menstrual cup, 31 have average knowledge and 7 have poor knowledge regarding menstrual cup.

Figure 1: Frequency distribution of sample according to knowledge regarding Menstrual Cup.

Figure 1 shows that about 62% of women have average knowledge about Menstrual Cup, 24% of women have good knowledge about Menstrual Cup and about 14% of women have poor knowledge regarding Menstrual Cup.

Section C: Analysis and interpretation of attitude regarding menstrual cup.

Section C deals with the analysis of attitude regarding menstrual cup.

Table 3: Frequency and percentage distribution of attitude regarding menstrual cup.

Rating Scale	Frequency (n=50)	Percentage
Positive	28	56
Uncertain	22	44
Negative	0	0

Table 3 shows that among 50 samples, 28 women have positive attitude regarding menstrual cup, 22 have uncertain attitude and none of them have negative attitude regarding menstrual cup.

Figure 2: Frequency distribution of sample according to attitude regarding Menstrual Cup.

Figure 2 shows that about 56% of women have a positive attitude towards the Menstrual Cup and 0% of women have negative attitude towards Menstrual Cup. 44% of women didn’t have either positive attitude or negative attitude towards Menstrual Cup, that is, their attitude regarding Menstrual Cup is uncertain.

Section D: Correlation between knowledge and attitude regarding menstrual cup:

In this study, the correlation between knowledge and attitude was analyzed by using Karl Pearson’s Correlation Coefficient formula. The value of r obtained by calculation is 0.551, which shows that there is a moderately positive correlation between knowledge and attitude regarding menstrual cup among women.

CONCLUSION:

A quantitative, non-experimental research study was conducted among 50 women in the age group of 20 – 35 years who was admitted as patients, visited OPD as patients or bystander at Little Lourdes Mission Hospital, Kidangoor. After the study, it was found that, majority of the women who participated in the research study, that is 40% was from the age group of 26 to 30yrs. The educational qualification of 32% of women who participated in the study were graduates. According to occupation, majority of the women were private employees and housewives which was about 28% respectively. Regarding marital status, 76% of the women were married. Among the 50 sample, 72% of the women resided in rural area. Most of the women, that is about 58% of the women attained menarche at the age of 13 -15yrs. In majority of the women, 56% reported that their duration of menstruation was about 3-4 days. Majority of the women, that is, about 80% of women had a regular menstrual cycle pattern. The study result showed that about 84% of the women have previously heard or was familiar with menstrual cup. About 16% of the women had previous information regarding Menstrual Cup from social medias. Majority of the women, that is, about 84% of the women used sanitary pads as their sanitary protection method during menstrual cycle. The study result showed that about 62% of women changed their sanitary materials every 3 hourly. Among the total of 50 sample, about 78% of women have not used Menstrual Cup. Among the women who is using Menstrual Cup as their regular sanitary protection method about 55% of the women used it alternatively with other sanitary products.

Among the 50 subjects, 62% of women had average knowledge, 24% had good knowledge and about 14% had poor knowledge regarding Menstrual Cup. The study result also showed that about 56% of women had a positive attitude and no one had negative attitude towards Menstrual Cup. Some of the women, about 44% of women had neutral attitude towards menstrual cup.

NURSING IMPLICATIONS:

The present study was conducted to assess the knowledge and attitude regarding menstrual cup among women at Little Lourdes Mission Hospital, Kidangoor. The nursing implication of the study can be made in the following field of nursing education, nursing administration, nursing practice and nursing research.

Nursing education:

This project helps to assess knowledge and attitude regarding menstrual cup among women. This research study adds better knowledge to the body of knowledge of nursing profession, it helps to expand the knowledge of nursing students and can be included in the curriculum. Nurses are good agents for transferring their knowledge to general population. Nurses have a major role in developing a healthy society.

Nursing Administration:

Further studies can be conducted to improve the knowledge in administrative level. The study creates awareness to authority on knowledge and attitude of women regarding menstrual cup and also creates awareness among nursing administrators to conduct awareness programmes for staff to provide information regarding menstrual cup.

Nursing practice:

Research helps to expand the body of knowledge of nursing profession. Nurses who have good knowledge and who apply the evidence based practice can provide a better care for patients based on scientific knowledge. Active participation of student nurses can be encouraged by proceeding opportunity for clinical teaching and health programmes to college students. Knowledge and attitude regarding menstrual cup among women can help nurses to identify the potential menstrual problems and hygienic measures among female patients and can give appropriate management measures.

Nursing Research:

The findings of the study can be used as a reference material for future students. The result of the study helps to expand the body of professional knowledge upon which further research can be conducted.

LIMITATIONS OF THE STUDY:

The following are the limitations of our study:-

1. Generalization of the study is limited due to small sample size.

2. Sample selection limited to only one hospital.

3. Time was limited for a shorter period.

RECOMMENDATIONS

On the basis of the study findings, the recommendations are:

A similar study can be conducted in a larger sample so that the findings can be generalized.

This study can be conducted among females between age group of 15 – 45 years.

A study can be conducted as qualitative research like case study method.

REFERENCE:

1. Kaiser. S. Menstrual hygiene Management Policy Brief Seecon International Gnbh, 13; 2018(Dec) :1-8https://do.org/10.1111/j.1460-2966.1999

2. Waghachavare BV. Chavan V. M, Dhumale BG. Study of menstrual problem among the female student in rural area of Ghandhi district. 2013; 4: 236-234

3. Kakani CR, Bhatt. JK. Study of adaptability and efficacy of menstrual cup in managing menstrual health and hygiene, IJRCOG. 2014; 6(7): 3045-53

4. El-Gilany AH, Badawi K. Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt. Reprod Health Matters. 2005; 13: 147–52.

5. Drakshayani Devi K, Venkata Ramaiah P. A study on menstrual hygiene among rural adolescent girls. Indian J Med Sci. 1994; 48: 139–43.

6. Poureslami M, Osati-Ashtiani F. Attitudes of female adolescents about dysmenorrhoea and menstrual hygiene in Tehran suburbs. Arch Iranian Med. 2002; 5: 219-24

7. Waghachavare BV. Chauan VM, Dhumale BG, A study of menstrual problems among the female junior students from the rural area of Bangli district National Journal of Community Medicine. 2013; 4: 236-239 .

8. Konar, H. D C Dutta’s Text book of Obstetrics. Jay Pee Brothers’ Medical Publications. 9th ed. 2020. p. 55-63

9. Marshall, J. Raynor, M. Myles Textbook for Midwives. Churchill Livingstone Elsevier Publication. China. 16^th ed. 2014. p. 80-93

Received on 18.01.2024 Modified on 15.03.2024

Int. J. Nur. Edu. and Research. 2024; 12(2):124-129.

DOI: 10.52711/2454-2660.2024.00028