Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address (in block letters)

NEETHU K. ALEXI YEAR M. Sc. NURSING ATHENA COLLEGE OF NURSINGFALNIR ROADMANGALORE – 575 001.

2. Name of the Institution ATHENA COLLEGE OF NURSINGFALNIR ROADMANGALORE – 575 001.

3. Course of Study,Subject

M. Sc. NURSINGOBSTETRICS AND GYNAECOLOGICAL NURSING

4. Date of Admission to the course

20.05.2013

5. Title of the Topic

A STUDY TO ASSESS THE EFFECTIVENESS OF AN

INFORMATION BOOKLET ON KNOWLEDGE

REGARDING REPRODUCTIVE HEALTH (RH) AND

SELECTED REPRODUCTIVE TRACT INFECTIONS (RTIs)

OF WOMEN AMONG ACCREDITED SOCIAL HEALTH

ACTIVIST (ASHA) WORKERS IN SELECTED

COMMUNITIES OF MANGALORE

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6. Brief Resume of the Intended Work

Introduction

According to the formal definition by the World Health Organization

(WHO), Health is more than absence of illness. It is a state of complete

physical, mental and social well being. Similarly, Reproductive Health also

represents a state of complete physical, mental and social well being, and not

merely the absence of reproductive diseases or alterations.1 Healthy

reproductive system, processes and function are imperative components of

adequate overall health. It may be a reflection of a healthy childhood, is crucial

during adolescence, and sets the stage for health in adulthood and beyond the

reproductive years for both men and women. At each stage of life, individual’s

health needs may differ. Reproductive life span does not begin with sexual

development at puberty and ends at menopause for women or when a man is

no longer likely to have children rather it follows through out an individual life

cycle and remains important in many different phases of development and

maturation. An inability to deal with reproductive health problems at any stage

in life may set the scene for later health problem.2 So, good reproductive health

is essential for preventing the reproductive health problems.

6.1 Need for the Study

Reproductive health is a fundamental component of an individual’s

overall health status and a central determinant of quality of life. Reproductive

health involves all of the reproductive processes, function, and systems at all

stages of life. Reproductive health is a universal concern, but is of special

importance for women particularly during the reproductive years.3

Reproductive Health should also be understood in the context of healthy

relationships in which there is an understanding of balance between fulfilment

and risk. Reproductive health contributes enormously to physical and

psychosocial comfort and closeness between the individuals. Poor

Reproductive Health is frequently associated with disease, abuse, exploitation,

unwanted pregnancy, and death.4

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Maternal health is one of the United Nations Millennium Development

Goals (MDG5). To improve maternal health are increasingly the focus of the

international research community. The National Population Policy-2000 has

recognized adolescents as an underserved vulnerable group that need to be

served especially by providing reproductive health information and services.5

Reproductive Tract Infections (RTIs) being increasingly recognized as

a global health problem with serious impact on individual women and men,

their families and communities. World Health Organization estimates that each

year there are over 340 million new cases of sexually transmitted infections in

which 75- 85% occur in developing countries. In India alone, 40 million new

cases emerge each year. RTIs generally seen as a silent epidemic can have

severe consequences including infertility, ectopic pregnancy, chronic pelvic

pain, miscarriage, neonatal blindness, increased risk of HIV infection and even

death. But the consequences of RTIs extend beyond the realms of health. The

morbidity associated with RTIs affect economic productivity and the quantity

of life of many individual men, women and ultimately of whole community.6

A quasi experimental one group pre-test post test research design was

conducted to evaluate the adolescents’ knowledge, attitude, and behaviour

about RH before and after the RH teaching program in Tanzania. A 23 item

questionnaire was provided to 305 students aged 11-16 years. The program

was conducted with different AV aids and group discussion. The result

revealed that there was significant increase of knowledge score in post-test

(t=7.9, p=0.000) and post- test behaviour score (t=3.0, p=0.003). The pre-test

and post test score attitude scores showed no statistical difference for both

boys and girls.7

A cross sectional time bound community based study was conducted in

KBN institute of Medical Sciences, Gulbarga, India with an aim to find out the

prevalence of RTIs among the reproductive age group women and socio-

demographic factors influence the occurrence of the disease. A total of 656

women between the age group of 15-45 years were the samples. The structured

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interview schedule was used to collect information. The result obtained with

the statistical test of Z-test and chi-square test revealed that the prevalence of

RTI increased with relation to married life from 1 year (30.4%) to 5 years

(51.75%). RTI was common among illiterate women (46.5%) and showed

decreased trend with an increase in level of education (p=0.001) and lower

socio-demographic group (p 0.001).6

ASHA workers are very close to the localized people and they only

have the basic knowledge of health. The investigator’s experience and

discussion with the colleagues and experts helped her realize that they need to

have a better knowledge regarding RH and RTIs. Through acquiring

knowledge they cannot only improve their own reproductive health and

prevent RTIs bright transfer that knowledge to others. Therefore, the

investigator decided to undertake the study to assess the effectiveness of

information booklet on RH and RTIs for ASHA workers in selected

communities of Mangalore.

6.2 Review of literature

A quasi experimental one group pre-test post test design was conducted

in Taluk and District of Belgaum, India with an aim to find out the

effectiveness of planned teaching programme (PTP) on RH. A sample of 86

rural adolescent girls was selected using purposive sampling technique. A

structured knowledge questionnaire was used to collect data. The result reveals

that the mean post-test knowledge score (34.35) was significantly higher than

the mean pre-test knowledge score (21.81). The ‘t’ test showed statistically

significant difference( 0.000000). The study concluded that there is a need for

PTP on RH.8

A Task-Force study was planned to test the awareness level of

adolescents regarding various reproductive health issues and to identify

lacunae in knowledge, particularly in legal minimum age of marriage, number

of children, male preference, contraceptive practices, about STIs/AIDS etc.

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A sample of 8453 school going adolescents (aged 10-19 years) was surveyed

by means of an open ended, self-administered questionnaires maintaining

confidentiality. The study showed tremendous lacunae in awareness of all RH

matters. Awareness of all RH matters was more in boys than girls and more in

late teens (15-19) than earlier teens (10-14). There is a need for evolving

information, education and communication strategies to focus on raising

awareness on RH and gender related issues.9

A cross sectional exploratory research design was conducted in urban

slum areas of Bhubaneswar, Odisha, with an aim to assess the knowledge of

adolescent girls regarding RH. A sample of 84 adolescent girls was selected by

using convenient sampling technique. The structured interview schedule was

used to collect the information. The result showed that 64.29 percent having

average knowledge regarding RH and there is no significant association

(p≤0.05) between knowledge scores and demographic variables and there was

significant association between knowledge scores and education of the

adolescent girls.5

A community based study was conducted out to estimate the load of

RTIs among married rural women aged 15-44 years in Mahindergarh district

in Haryana, India. A total of 2325 women were interviewed by auxiliary nurse

midwives and were invited for medical examination in a health camp set-up in

their village. Sixty-one percent (1415/2325) women reported symptoms of

RTIs. Out of those examined, 32% (263/812) had vaginitis, 21% (175/812)

had cervicits, and 19% (156/812) had pelvic inflammatory disease. Vaginal

smear of those having discharge revealed that 48% (231/476) had bacterial

vaginosis, 0.8% (4/476) had fungal infection 9% (44/496) had trichomonal

infection and none was found to be having gonococcal infection. Study

revealed high load of RTIs and low utilization of treatment facility.10

A descriptive study was done to find out the prevalence and causes of

RTIs among in-patient and out-patient attending a tertiary hospital in Benin

city, Nigeria. High vaginal swabs or endocervical swabs and blood were

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collected from 957 patients consisting of 755 out-patients and 202 in-patients.

The swabs were processed and microbial isolates identified using standard

technique. Disc susceptibility tests were also performed on microbial isolates.

The blood samples were used for serological diagnosis of syphilis. There was

no significant difference in the prevalence of female RTIs between in-patient

(52.48%) and out-patient (47.02%), although in-patient showed a significantly

higher risk of developing mixed infections (in-patient v/s out-patient; 34.91%

v/s 22.25%, QR=1.873 95% CI= 1.169, 3.001; P=0.01). Candida albicans was

the most prevalent etiologic agent among out-patients studied while

Staphylococcus aureus was the most prevalent etiologic agent among in-

patients. Trichomonas vaginalis was observed only among out-patients.11

A cross-sectional study was done to find the prevalence of RTIs among

reproductive age group women and the socio-demographic factors influencing

the occurrence of the disease. A sample of 656 women of 15-45 years was

selected by a simple random sampling technique. The study revealed that the

prevalence of RTIs among the reproductive age group women was 40.4%

based on their symptoms, with majority having abnormal vaginal discharge.

The prevalence of RTIs based on clinical finding was 37.4% with majority

having vaginitis. The laboratory test revealed a prevalence of 34.3% with

majority having candidiasis. The influence of socio-demographic factors like

increased parity, poor socio-economic conditions, poor menstrual hygiene,

illiteracy has its direct effect on occurrence of RTI in the community.6

6.3 Problem Statement

A study to assess the effectiveness of an information booklet on

knowledge regarding Reproductive Health (RH) and selected Reproductive

Tract Infections (RTIs) of women among Accredited Social Health Activist

(ASHA) workers in selected communities of Mangalore.

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6.4 Objectives of the Study

1. To determine the knowledge level of ASHA workers regarding RH and

selected RTIs as measured by a structured knowledge questionnaire.

2. To evaluate the effectiveness of an Information Booklet on

Reproductive Health and selected Reproductive Tract Infections among

women in terms of gain in mean post test knowledge score.

3. To find the association between mean pre-test knowledge score and

selected demographic variables (age, education and years of

experience).

6.5 Operational Definitions

Knowledge: In this study, knowledge refers to the correct responses of

the ASHA workers on the items regarding RH and selected RTIs as

measured by a Structured Knowledge Questionnaire.

Effectiveness: In this study, effectiveness refers to the extent to which

an information booklet on knowledge regarding RH and RTIs has

achieved the desired effects on ASHA workers in terms of gain in

mean post test knowledge score.

Information booklet: In this study, information booklet refers to

systematically organized and validated written material which provides

information regarding RH and selected RTIs.

Reproductive Health and Reproductive Tract Infections: In this

study, Reproductive Health refers to the knowledge of normal

functioning of reproductive organs and reproductive process and

selected Reproductive Tract Infections include Vulvitis, Vaginitis,

Candidiasis, Trichomoniasis and PID.

ASHA Workers: In this study, ASHA workers refers to the Accredited

Social Health Activist who are working in a selected community

areas.12

6.6 Assumptions

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The study assumes that:

The ASHA workers will have some knowledge regarding RH and

RTIs.

The ASHA workers will be interested and willing to participate in the

study.

Information booklet is an accepted strategy to improve knowledge of

ASHA workers.

6.7 Delimitations

This study will be delimited to ASHA workers who are working in

selected communities of Mangalore.

6.8 Projected outcome (hypothesis)

All hypotheses will be tested at 0.05 level of significance.

H1: There will be significant difference between mean pre-test and post test

knowledge scores of ASHA workers regarding RH and selected RTIs.

H2: There will be significant association between the mean pre-test

knowledge score and selected demographic variables.

Variables under study

Independent variable: In this study, the independent variable is the

information Booklet on RH and Selected RTIs.

Dependent variable: In this study the dependent variable is the

knowledge on RH and RTIs.

Extraneous variables: In this study the extraneous variables are the

age, education, and years of experience.

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7. MATERIAL AND METHODS

7.1 SOURCE OF DATA

Data will be collected from 30 ASHA workers who are working in the

selected communities of Mangalore.

7.1.1 Research Design

Pre-experimental one group pre-test post-test design will be used as the

research design.

Pre-test Intervention Post-test

O1 X O2

Key

O1 Pre-test

X Information booklet

O2 Post-test

7.1.2 Setting

The study will be conducted on 30 ASHA workers of a PHC of

selected communities of Mangalore.

7.1.3 Population

In this study the population refers to the ASHA workers of selected

communities.

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7.2 METHOD OF DATA COLLECTION

7.2.1 Sampling Procedure

Purposive sampling technique will be used to select the sample.

7.2.2 Sample Size

The sample for the present study will consist of 30 ASHA workers who

are working in selected communities of Mangalore.

7.2.3 Inclusion criteria for sampling

1. ASHA workers who are working in the PHC of selected communities.

2. ASHA workers who are willing to participate in the study.

7.2.4 Exclusion Criteria for sampling

ASHA workers who are absent at the time of data collection.

7.2.5 Instrument intended to be used

The tool would consist of two sections:

1. Section I: Demographic Proforma.

2. Section II: Structured Knowledge Questionnaire on RH and selected

RTIs.

7.2.6 Data collection method

Permission will be obtained from the concerned authority. The purpose

of the study will be explained to the subjects and informed consent will be

taken. Pre-test will be conducted with a structured knowledge questionnaire.

This will be followed by administration of an information booklet. After seven

days post-test will be conducted using the same structured knowledge

questionnaire.

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7.2.7 Data Analysis Plan

Descriptive and inferential statistics will be used to analyse the data.

Findings will be presented in the form of tables and figures.

1. Demographic data will be presented in form of frequency, percentage,

mean, and standard deviation.

2. Effectiveness of information booklet will be analysed by using paired

‘t’ test.

3. The association between selected demographic variables and mean pre-

test knowledge score regarding RH and RTIs will be determined by

Chi square test.

7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so, please describe briefly.

No. The study does not involve any investigation or intervention.

However, an information booklet will be given to the sample on RH and RTIs.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Ethical clearance will be obtained from the ethical committee of

college of nursing prior to the conduction of the study. Administrative

permission will be obtained from the concerned authorities. Written consent

will be obtained from the sample and confidentiality will be maintained.

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List of References

1. WHO. Department of Reproductive Health and Research, Partner

Brief. Geneva, Switzerland, World Health Organization, 2009 [online).

Available from:

URL:whqlibdoc.who.int/hq/2009/WHO_RHR_09.02_eng.pdf

[Accessed on 22.8.2013].

2. UNDP/UNFPA/WHO/World Bank. Social science method for research

on reproductive health topics. Geneva, Switzerland, 2006 [online].

Available from:

URL:whqlibdoc.who.int/hq/1999/WHO_RHR_HRP_SOC_99.1.pdf

[Accessed on 22.8.2013].

3. United Nations Population Information Network (POPIN).Guidelines

on reproductive health. Geneva, Switzerland, 2002 [online]. Available

from:

URL:www.un.org/popin/unfpa/taskforce/guide/iatfreph.gdl.htmal

[Accessed on 22.8.2013].

4. WHO. The Reproductive Health Library (RHL). Geneva: World

Health Organization; 2008.

5. Dash B. Knowledge of adolescent girls regarding reproductive health

care. The Nursing Journal of India 2012 Aug.;CIII(4):157-9.

6. Balamurugan SS, Bendigeri ND. Community-based study of

reproductive tract infections among women of the reproductive age

group in the urban health training centre area in Hubli, Karnataka.

Indian Journals of Community Medicine 2012 Jan;37(1):34-8.

7. Frida M, Shigeko H, Mariko L. Evaluation of a reproductive health

awareness program for adolescence in urban Tanzania. Reproductive

Health 2011;8:21.

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8. Itti JG. A study to evaluate effectiveness of planned teaching

programme on selected aspects of reproductive health among the rural

adolescent girls. Nightingale Nursing Times 2007 Mar;48-9.

9. Gupta N, Mathur AK, Singh MP, Saxena NC. Reproductive Health

awareness of school-going, unmarried, rural adolescents. Indian

Journal of Paediatrics 2004 Sep;71(9):797-801.

10. Aggarwal AK, Kumar R, Gupta V, Sharma M. Community based study

of reproductive tract infections among ever married women of

reproductive age in a rural area of Haryana, India. J Commmun Dis

1999 Dec;31(4):223-8.

11. Omoregie R, Egbe AC. Prevalence and etiologic agents of female

reproductive tract infection among in-patient and out-patient of a

tertiary hospital in Benin city, Nigeria. N Am J Med Sci 2010

Oct;2(10):473-77.

12. Kumari N, Sharma S. Midwifery and gynaecological nursing. 2nd ed.

New Delhi; Orient Longman Pvt. Ltd.

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8. Signature of the Candidate

9. Remarks of the Guide

10. Name and Designation of (in block letters)

10.1 Guide SR. SELINAMMA DEVASIA (SR. DHANYA)

ASSOCIATE PROFESSOROBSTETRICS AND GYNAECOLOGICAL

NURSINGATHENA COLLEGE OF NURSINGFALNIR ROADMANGALORE.

10.2 Signature

10.3 Co-guide (if any)

10.4 Signature

11.1 Head of the Department SR. SELINAMMA DEVASIA (SR. DHANYA)

ASSOCIATE PROFESSOR & HODOBSTETRICS AND GYNAECOLOGICAL

NURSINGATHENA COLLEGE OF NURSINGFALNIR ROADMANGALORE.

11.2 Signature

12.2 Remarks of the Chairman and Principal

12.3 Signature

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