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1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.

ANNEXURE-II

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

1 NAME OF THE Mrs. PAVITHRA H.R

CANDIDATE AND Ist YEAR M.Sc. NURSING STUDENT, ADDRESS N.D.R.K. COLLEGE OF NURSING

B.M. ROAD HASSAN, KARNATAKA.

2 NAME OF THE N.D.R.K. COLLEGE OF NURSING, B.M. ROAD, HASSAN, INSTITUTION KARNATAKA.

3 COURSE OF STUDY MASTER OF SCIENCE IN NURSING(CHILD HEALTH AND SUBJECT NURSING)

4 DATE OF ADMISSION 17th June 2009. TO THE COURSE

5 TITLE OF THE TOPIC “EFFECTIVENESS OF TEACHING LEARNING MODULE ON KNOWLEDGE OF MENSTRUAL HEALTH PROBLEMS AND MANAGEMENT STRATEGIES AMONG EARLY ADOLESCENT GIRLS (12-14YEARS) IN SELECTED RURAL AND URBAN SCHOOLS AT HASSAN”.

5.1 STATEMENT OF THE “A COMPARATIVE STUDY TO DETERMINE THE PROBLEM EFFECTIVENESS OF TEACHING LEARNING MODULE ON KNOWLEDGE OF MENSTRUAL HEALTH PROBLEMS AND MANAGEMENT STRATEGIES AMONG EARLY ADOLESCENT GIRLS (12-14YEARS) IN SELECTED RURAL AND URBAN HIGH SCHOOLS AT HASSAN”.

6. BRIEF RESUME OF THE INTENDED WORK:

6.1 “INTRODUCTION” 2 “WHEN YOU KNOW, YOU HAVE FAITH, WHEN YOU DON’T KNOW THEN YOU START BELIEVING”.

Sri Sri Sri ,Ravishankar Gurujee.(2005)

Adolescents constitute over 21.4 % of the population in India. This age group needs special attention because of the turmoil of adolescence which they face due to the different stages of development that they undergo, different circumstances that they come across, their different needs and diverse problems. In this context, UNICEF (United Nations Children’s Fund) and UNFPA (United Nations Fund for Population Activity) in collaboration with WHO, issued a joint statement on the reproductive health of adolescents in 1989, to address their problems. ‘Adolescent’ refers more broadly to the phase of human development encompassing the transition from childhood to adulthood. In terms of age, it is the period of life that is extended from 10-19 years, which includes pubertal development also. This period is very crucial since these are the formative years in the life of an individual when major physical, psychological and behavioral changes take place. Anemia is the major nutritional deficiency found in this group in India and other developing countries. Majority more than three fourth of the adolescent girls were suffering from menstrual related problems which leads to reproductive morbidities. Adolescents are expected to enjoy a good health but this does not seem to be in rural areas of developing country like India, where poverty, malnutrition and repeated infection are rampant to achieve the optimum health and development of the adolescent segment of the population. There is a need to introduce a comprehensive Adolescent Health Initiative (AHI) at block level.1

Menstruation is the part of the female reproductive cycle that starts when girls become sexually mature at the time of puberty. It is a phenomenon unique to the females. During a menstrual period, a woman bleeds from her uterus via the vagina. The menstrual rhythm depends on the hypothalamus pituitary-ovarian function, where as the amount of blood loss depends upon the uterine contraction. The menstrual period lasts from three to seven days. Each period commences approximately every 28 days if the woman does not become pregnant during a given cycle. A deviation of two or three days from the twenty eight day rhythm is quite common. 3 The menarche or time of onset of menstruation varies with race and family, but the average for most girls is from 10 to 14 years until 45 to 55years. Geographical conditions, racial factors, nutritional standards, environmental influences and indulgence in sternous physical activity can all affects the age of menarche. A woman will have approximately 500 periods in her life time. The estimated blood loss is between 50 to 200 ml in each cycle. Menstruation is a very complex process involving many different, the sexual organs and the nervous system. Regular exercise and keeping fit and healthy can help to regulate the menstrual cycle. Menstruation is an awkward subject to talk about especially with preteen girls, who seem to get embarrassed more easily than any other creatures on the planet2

During the post-menarcheal years several kinds of menstrual disorders can be observed, such as abnormal uterine bleeding, dysmenorrheal, and premenstrual syndromes are common reasons for visits to health care providers by adolescent girls.3

6.2. NEED FOR THE STUDY

Menstrual hygiene and management is an issue that is insufficiently acknowledged and has not received adequate attention in the reproductive health and water, sanitation and hygiene (WASH) sectors in developing countries and its relationship with impact on achieving many Millennium Development Goals (MDGS) is rarely acknowledged. The large majority of survey respondents (92%) had known about menstruation before their menarche, particularly from their mothers (51%) or sisters (41%). However, the information provided was mainly about the use of cloth and the practice of rituals and restrictions constructed around the polluting effect of menstruation. Abdominal pain is the most common medical problem experienced by the survey respondents (85%). Menstrual stress is also common, particularly due to constant worry that others may know about their menstruation, about 89% of the survey respondents practice some form of restriction or exclusion, the commonest one being abstaining from religious activities (68%). The socio- cultural reasons are based on concepts of “pollution” surrounding menstruation. Survey showed that about half of the respondents ((53%) had been absent in school at 4 least once due to menstruation. Many girls though physically present in the school, were unable to perform well due to poor concentration and attention resulting from the constant worry. Lack of privacy for cleaning and washing (41%) was the major reason identified by survey respondents for being adolescent during menstruation. This is usually because of lack of water or due to minor issues, such as missing door locks, even when infrastructure of toilet is present.

Most of the survey respondents (66%) used reusable cloths to absorb menstrual flow during menstruation, the use being significantly higher among rural than urban school girls. Only around half of the respondents have toilet with adequate privacy at home (55%) and about two-fifth have at school (42%). On average the girls change the absorbent material between 2 to 3 times in a day and use one re-usable cloth for 3 cycles. Disposal of used cloths and napkins was a challenge in both urban and rural schools. Restrictions during menstruation that limit daily activities and routine are widely practiced. These manifest from beliefs that a woman during her menstruation is ritually dangerous, which can result in them spoiling food and plants, biological and social processes. Abnormal physical conditions, particularly dysmenorrhea and excessive bleeding as well as the mental stress during menstruation affects the daily lives and routines of adolescent school girls to a varying degree, particularly the quality of presence at schools in terms of attention and concentration in curricular activities.4

The girls emphasized the need for emotional support and assurance that menstruation is normal and healthy –not bad, frightening or embarrassing. Before bringing any change in menstrual practices they should be educated about the facts of menstruation and its physiological implications. The girls should be educated about the significance of menstruation and development of secondary sexual characteristics, selection of a sanitary menstrual absorbents and its proper disposal. There is a need for compulsory sex education and health education on menstrual hygiene so that they can discuss freely about it without hesitation.2

PMS and Dysmenorrhea are prevalent medical disorder among urban adolescents. Morbidities, including school absenteeism, are higher among those with negative period expectations. Since only 2% of teens received information regarding menstruation from their heath care provider, it is imperative that health care provider 5 increase their anticipatory guidance regarding normal menstruation. This may aid in the prompt diagnosis and treatment of menstrual disorders, and to decrease their associated morbidities.5

There is a lack of current information concerning the knowledge of menstrual health and problems management strategies among adolescent girls in urban and rural areas. The purpose of this study is to determine the prevalence of dysmenorrheal, premenstrual symptoms and other menstrual disorders among adolescent girls of high school and to teach those regarding simple nursing interventions to treat the problems associated with the menstruation.

6.3 STATEMENT OF PROBLEM

“ A comparative study to determine the effectiveness of teaching learning module on knowledge of menstrual health problems and management strategies among early adolescent girls (12-14years) in selected rural and urban school at Hassan”.

6.4 OBJECTIVES OF THE STUDY:-

1. To assess the knowledge of early adolescent girls regarding the menstrual health problems and management strategies in selected rural and urban schools at Hassan.

2. To develop and implement teaching learning module on menstrual health problems and management strategies among early adolescent girls.

3. To compare and determine the effectiveness of teaching learning module on menstrual health problems and management strategies among early adolescent girls.

4. To find out the association between knowledge of menstrual health problems and management strategies with socio-demographic variables among early adolescent girls.

6.5 RESEARCH HYPOTHESIS- 6 H1: There will be significant difference in knowledge of adolescent girls who have received the teaching learning module on menstrual health problems and management strategies.

H2: There will be significant association between selected socio-demographic variables of early adolescent girls with their knowledge.

6.6 ASSUMPTIONS:

1. The early adolescent girls in the rural schools may have inadequate knowledge regarding menstrual health problems and management strategies.

2. This study will helps to provide adequate knowledge regarding effective management of menstrual health problems among adolescent girls.

3. Helps to determine the association between demographic variables about the menstrual problems and management strategies among early adolescent girls in rural and urban schools.

6.7 OPERATIONAL DEFINITION

1. DETERMINE:

It refers to ascertain the difference between pretest and posttest score on knowledge of menstrual problems and management strategies with appropriate statistical methods.

2. EFFECTIVENESS:

Refers to statistically significant difference found between pretest and post test (knowledge) scores.

4. TEACHING LEARNING MODULE:

It is a planned educational explanatory document prepared by the investigator for the specific duration regarding the menstrual health problems and their management. In terms of pictures and handouts. 7 4. MENSTRUAL HEALTH PROBLEMS:

The health problems related to / associated with menstruation. Such as Dysmenorrhea, Menorrhagia, Cyclic irregularity, menstrual pain, and pre-menstrual syndrome (PMS).

5. EARLY ADOLESCENT GIRLS:

The girls who are at age of 12 to 14 years and attended menarche, studying at the high school.

6. RURAL SCHOOL:

Refers to a formal educational institute, located at rural area. That is Govt high school .Shanthigrama.

7. URBAN SCHOOL:

Refers to a formal educational institute, located at urban area. That is Vanivilas high school. Hassan.

6.8 CRITERIA FOR SAMPLE SELECTION

Inclusion criteria

1. All the early adolescent girls studying at the selected schools in which those who have attended the menarche.

2. Those who are willing to participate in the study.

3. The girls those who are present at the time of data collection

Exclusion criteria

1. The girls those who have not attended menarche.

2. The girls who are not present at the time of data collection.

3. The girls those who are not willing to participate in this study.

4. The girls those who will be taken for pilot study. 8 6.9 LIMITATIONS OF THE STUDY-

Study is limited to-

1. This study will be limited to the early adolescent girls studying at the selected rural and urban schools. 2. This study is limited to sample size of 60 students. 3. This study is limited to the period of one month.

6.10 SIGNIFICANCE OF THE STUDY This study promotes the knowledge of early adolescent girls regarding menstrual health problems and their simple management methods. And it improves the reproductive health of these girls. 6.11 CONCEPTUAL FRAMEWORK Conceptual frame work based on General System model (1968), Ludving Von Bertanlenffy. Is planned to adopt in this study.

6.12 REVIEW OF LITERATURE: Primary amenorrhea is an absence of secondary sex characteristics and no uterine bleeding by 14 to 15 years of age, or absence of uterine bleeding with secondary sex characteristics by 16 years of age. No uterine bleeding after attaining a sexual maturity rating of 5 on the Tanner scale for 1year, or after breast development for 4 years, is also considered as primary amenorrhea. The cause of primary amenorrhea may be anatomic, hormonal, genetic, or idiopathic. Secondary amenorrhea is defined as the absence of menses for 6 months or at least three cycles after menstruation was previously established. Irregular menstrual cycles are common within the first year or two after menarche. These early cycles may be anovulatory, resulting in regular, or absent bleeding; however, cycle lengths outside the range of 21 to 45 days should be investigated. Girls with later onset of menarche will take longer to establish regular ovulatory cycles. Dysmenorrhea is a certain amount of discomfort during the first day or two of the menstrual flow is externally common, most girls experience cramping, abdominal pain, back ache, and leg ache, but in a few cases the pain is intolerable and incapacitating. Primary dysmenorrheal is painful menses not related to any pelvic disease. Secondary dysmenorrheal is defined as painful menses with a pathologic 9 condition such as endometriosis, salpingitis, or congenital anomalies of the mullerian system. Primary dysmenorrheal usually begins at the time of menarche or within 6 to 12 months. The pain begins with menstrual flow or hours before the onset bleeding each month, usually containing for 48 to 72 hours. The exact etiology is unknown, but the pain is clearly related to ovulatory cycles. The overproduction of uterine prostaglandins has been implicated; woman with dysmenorrheal have higher levels of prostaglandins. Overproduction of vasopressin [ a hormone that stimulates the contraction of muscular tissue ] may also contribute to dysmenorrhea.6 The objective of the study was to study the types and frequency of problems related to menstruation in adolescent girls and the effect of these problems on daily routine. Girls selected in the age group 13–19 years who had menarche for at least one year at the time of study. 198 adolescent girls have been studied. Data was collected by personal interviews on a pre-tested, semi-structured questionnaire. The questions covered menstrual problems, regularity of menses in last three cycles of menstruation and the effect of these problems on the daily routine. Analysis was done using SPSS version 12. Percentages were calculated for drawing inferences. Results includes more than a third (35.9%) of the study subjects were in the age group 13– 15 years followed by 17–19 years, 15–17 years respectively. Mean age of study participants was calculated to be 16.2 years. Dysmenorrhea (67.2%) was the commonest problem and (63.1%) had one or the other symptoms of Pre-menstrual syndrome (PMS). Other related problems were present in 55.1% of study subjects. Daily routine of 60% girls was affected due to prolonged bed rest, missed social activities/commitments, disturbed sleep and decreased appetite. 17.24% had to miss a class and 25% had to abstain from work. Mothers and friends were the most common source of information on the issue.7 A study was conducted to assess the reproductive health problems and help seeking behavior among urban school going adolescents. A sample of 300 urban school going adolescents between 11-14 years were chosen at random and assessed using four tools namely, self administered questionnaire provision of adolescent friendly services; medical screening and focus group discussions. Results includes Seventy two percent girls and 56% boys reported health problems during survey with an average of 1.93 complaints per girl and 0.5 complaints per boy. However, only 10 43% girls and 35% boys reported to the clinic voluntarily to seek help and only one fifth the amount of problems were reported at the clinic in comparison to the quantum of problems reported in survey, which probably reflects a poor health seeking behavior. A medical checkup with emphasis on assessment of reproductive health and nutritional status helped in detecting almost the same number of reproductive health problems as reported by them in survey. This intervention helped to increase the client attendance in subsequent period of next one year from 43% to 60% among girls and from 35% to 42% among boys.8

A study was conducted to evaluate the menstrual problem specially dysmenorrhea and its severity in female medical students and its effect on their regular activities. The across-sectional descriptive study design was adopted and conducted on 107 female medical students, all participants were given a questionnaire to complete; questions were related to menstruation elucidating variations in menstrual patterns, history of Dysmenorrhea and its severity, pre-menstrual symptom and absenteeism from college and /or class; to detect the severity of Dysmenorrhea we used the verbal multi-dimensional scoring system, participants were given 20 minutes to complete the questionnaire. The mean age of subjects at menarche was 12.5 (±1.52) years, with a range of 10-15 years. The prevalence of dysmenorrhea was 73.83%; approximately 4.67%of dysmenorrhic subjects had severe dysmenorrhea. The average duration between two periods and the duration of menstrual flow were 28.34 (±7.54) days and 4.5 (±2.45) days respectively. Prevalence of other menstrual disorders like irregularity, prolonged menstrual bleeding, heavy menstrual bleeding and PCOD were 7.47%, 10.28%, 23.36% and 3.73% respectively. Among female medical students who reported dysmenorrhea; 31.67% and 8.68% were frequently missing college & classes respectively. Premenstrual symptom was the second most (60.50%) prevalent disorder and 67.08% reported social withdrawal. Dysmenorrhea and PMS is highly prevalent among female medical students, it is related to college/class absenteeism, limitations on social, academic, sports and daily activities. Maximum participants do not seek medical advice and self treat themselves with prostaglandin inhibitors; like Ibuprofen.9 The present study was undertaken to assess the knowledge and practices related to menstruation among tribal (Gujjar) adolescent girls. The sample for the study comprised of 200 girls in the age group 13-15 years. Both nomadic and semi- 11 nomadic Gujjars were included. A combination of snowball and random sampling technique was used for selection of the sample group from various areas of Jammu district of Jammu and Kashmir State. Interview guide was developed and used to study the knowledge and practices related to menstruation among adolescent girls. Along with the Interview guide, the menstrual history of the sample group was recorded by the medical experts in the proforma devised for the purpose. The results revealed that sample girls lacked conceptual clarity about the process of menstruation before they started menstruating due to which they faced several gynaecological problems. The most common source of information about menstruation for the majority (83%) of the sample girls were friends. There were several socio-cultural taboos related to menstruation. The level of personal hygiene and management of menstruation was found to be quite unsatisfactory. 98% of the girls believed that there should be no regular bath during menstrual cycle. All the girls reported following these cultural practices without much questioning. The results hold implications for professionals involved in improvement of adolescent reproductive health in particular.10 A study conducted among various dimensions of reproductive health, gynecological problems and reproductive tract infections occupy a pivotal place. Among the gynecological problems, menstrual problems are said to be the major ones especially among adolescent girls in rural settings. Understand the magnitude of these problems and their grave consequences among rural adolescent girls are the major challenges to be addressed under the recent comprehensive reproductive health care approach adopted in India. This is because the adolescents are adults in future years. If adolescents carry any disability or if their needs are not addressed, the infirmities will show up in the adult population in future. Moreover, in India, it is even more critical to address the needs of adolescent girls because a large proportion of them particularly in rural areas get married at very young age and thereby, become mothers. In India, though a sizeable number of studies focused in the reproductive health issues of the unmarried adolescent girls mostly they dealt with menstruation and related issues that too focusing mostly on school-going and /or living in urban slums, that too taking the different cut-off points of age so as to categorize as adolescents. Further, though there is little evidence about the magnitude of menstrual problems a few studies looked into the differentials in menstrual problems, whereas 12 almost negligible attempts are being made to find out the major determinants with the help of s multivariate technique. But such an attempt is more useful to identify the principle factors that determine the menstrual problems, so as to recommend and implement appropriate strategies to prevent the occurrence of such problems among adolescent girls. This paper aimed in this direction with the help of data collected from the unmarried adolescent girls, aged 10-19 years as suggested by the WHO.1 A cross sectional descriptive study was conducted among secondary school adolescent females. The purpose of this study was to determine the menstrual characteristics of adolescent females and factors associated with it. Data were collected using a self-administered structured questionnaire on menstruation. Results includes abnormal cycle length (menstrual cycle longer than 35 days or cycle length between 14 to 20 days or irregular pattern) was common and affected 37.2 percent of subjects. The majority (74.6 percent) experienced premenstrual syndrome and 69.4 percent had dysmenorrhea. About 18 percent reported excessive menstrual loss (use two pads at a time to prevent blood from soaking through or confirmed by doctor to be anemic due to heavy menstrual flow). Only 11.1 percent of schoolgirls seeked medical consultation for their menstrual disorders. Mothers remained the most important source of information (80 percent). Menstrual disorders were significantly more common in female adolescents who smoke and have suicidal behaviours (p- value is less than 0.05). At last this study reveals that menstrual problems among adolescent female are common. 12 A study was conducted to assess menstrual patterns among school girls Method was cross-sectional descriptive study in which 1,213 apparently healthy school girls were selected by multistage sampling technique in fifteen secondary schools from the five local governments within the metropolis. Information about details of menstrual experience was obtained with a self-administered questionnaire. Results includes, the girls were aged between 9 and 23 years. Majority of respondents 768 (633%) experienced normal cycle length, 391 (32.2%) had short cycles; and 55 (4.5%) had cycle length greater than 35 days. Prevalence of normal cycles increased with increasing age; abnormalities of cycle length tended to decrease with increasing age (p < 0.01). The majority, 1,152 (95%), had normal menstrual loss. The majority 882 (72.7%) experienced dysmenorrhea; severe dysmenorrhea was reported by 154 (12.7%). Cycle length was not associated with presence of dysmenorrhea (p > 0.05); 13 695 (57.3%) had symptoms of pre-menstrual syndrome. This study concludes that prevalence of menstrual abnormalities among adolescent schoolgirls is high. More attention should be paid to identify and treat this menstrual morbidities.13 Prevalence of menstrual pain, use of medication and school absenteeism due to the pain were studied by means of a mailed questionnaire in a sample representing 12-18-year-old girls in Finland (n = 3370, response rate 87%). Prevalence of menstrual pain was 48% among 12-year-old post-menarcheal girls and 79% among 18-year-olds. Thirty percent of the 16-year-old girls had used medication and 21% had stayed at home due to menstrual pain in the last 6 months; 3% had both been absent and used medication several times. Three types of factors were associated with menstrual pain: (1) physiological (gynecological age, duration of menstrual flow); (2) indicators of poor self-rated health (not feeling active in the morning, bad physical condition, and number of common colds); (3) unhealthy practices (consumption of alcohol, low physical activity, and smoking). The prevalence of menstrual pain did not correlate with the variables describing the place of residence or the socio- economic status of the family. The determinants of menstrual pain are supposed to lie more in the biological construct and micro-environment of the girls than in macro- level structures of the society. The experience of pain seems to be related to self-rated health as a whole and to lifestyle rather than to specific disorders and health practices.14 A study was conducted to determine how adolescents use medication to manage menstrual discomfort. Survey method was adopted as study design to obtain data among adolescent girls in Public high school. Convenience sample of 386 adolescent girls (80% return rate: 10 refusals and 8 exclusions) were selected for study. Two hundred and ninety-one cases were used for analyses (16.26+/-1.00 years [mean+/-SD]; range, 14-21 years), distributed equivalently across grades 10 through 12. Parent's socioeconomic status was predominately class III or lower on Hollingshead's Two-Factor Index of Social Status. The main outcome measures were menstrual Distress Management Questionnaire (designed for study to measure disability and medication use) and the Symptom Severity Scale. A result includes ninety-three percent reported menstrual discomforts during the last 3 menstruations and 70% of these had used over-the-counter (OTC) medications to manage the discomfort. Users of OTC medications reported greater symptom severity and 14 disability than non-OTC users. Seventy-five percent of the OTC medication users took within the recommended dose of 1 to 2 pills, but 57% took medication less often than the maximum daily frequency. The size of a single dose of OTC medication was correlated with how often OTC medication was taken (r[s] =0.40, P<.001). Seventeen percent used prescription medication and reported significantly greater symptom severity and disability than nonprescription medication users. Seventy-one percent of the prescription drug users took the prescribed amount, 13% took less, and 16% took more. At the end the study reveals that adolescent girls frequently suffer from menstrual discomfort and use OTC medications to manage the discomfort, but they may not be using OTC medications effectively. There are possible explanations for medicating behavior and future research directions should be considered.15 Menstrual disorders such as amenorrhea, excessive uterine bleeding, dysmenorrhea, and premenstrual syndrome are common reasons for visits to healthcare providers by adolescent girls. Although menstrual irregularity can be normal during the first few years after menarche, other menstrual signs and symptoms may indicate a pathological condition that requires prompt attention and referral. This article discusses four common menstrual disorders seen in adolescent girls and focuses on specific nursing interventions aimed at eliciting an accurate menstrual history, providing confidentiality and communicating therapeutically, administering culturally sensitive care, and promoting independence and self-care.16 The extent and severity of the problems that adolescents encounter during this phase of their life include many reproductive health issues. Hence the present study was undertaken to know awareness of reproductive Health among school going and school dropout adolescent girls of Jammu City. The results of the study revealed that majority of both school going girls and school drop out girls scored well in the identification of reproductive system. The areas where both school going girls and school dropout girls scored low were-female reproductive organs, conceivable age and reproductive age of men, Unsafe abortion, legal and illegal abortion and its harmful effects, Clinical symptoms and biological symptoms of AIDS and the relationship between AIDS/HIV/STD’s. Knowledge of teenage pregnancy and mode of pregnancy was lower in school going girls than dropout girls. The difference in the knowledge level of reproductive system, teenage pregnancy STD’s, HIV in the two groups were insignificant but the knowledge level related to mode of pregnancy 15 AIDS/HIV in the two settings was significant. The Results of the study revealed that the School dropout girls had more scientific information, than the School going girls. It was due to the fact that teachers hesitated to discuss such topics in the school. 17

7. MATERIAL AND METHODS OF STUDY

7.1 SOURCES OF DATA

Data will be collected from the early adolescent girls studying at the selected rural and urban Schools of Hassan.

7.2 METHOD OF DATA COLLECTION

1. Research design

A comparative study is planned for the research study. In which single group pretest and post test pre-experimental design is planned in both the schools.

Schematic plan of the study

Group of 60 students studying at selected rural and urban Schools of Hassan. Pre-test Intervention Post-test

N = 60 O1 X O2

Key words.

N = pre-experimental study group

O1= Pre-test knowledge of early adolescent girls regarding the menstrual health problems and their management strategies.

X= structured teaching program on menstrual health problems and management strategies.

O2= Post-test knowledge of early adolescent girls regarding the menstrual health problems and management strategies.

2. Research setting

Setting is the urban school that is Vanivilas high school and rural school is Govt high school, Shanthigrama. Both are located in Hassan. 16 3. Population

All the early adolescent girls studying at selected rural and urban schools of Hassan.

4. Sample

High school early adolescent girls those who will fill the inclusion criteria.

5. Sample size.

60 early adolescent girls studying at selected rural and urban schools of Hassan.

6. Sampling technique.

Probability sampling with simple randomization technique will be used for the selection of subjects.

7. Tool for data collection.

Self administered questionnaire method is planned for collection of data by using a structured questionnaire.

8. VARIABLES

Independent variable

Teaching learning module for early adolescent girls regarding menstrual health problems and management strategies.

Dependent variable

Knowledge regarding menstrual health problems and management strategies.

Influencing variable-Socio demographic variables like age, education, family monthly income, religion and previous exposure.

9. PLAN FOR DATA ANALYSIS

Descriptive and inferential statistics is planned as follows.

. Descriptive statistics-

To describe knowledge and socio demographic variables in number (n), frequency (f), percentage (%), mean and standard deviation.

. Inferential statistics- 17 To associate the socio demographic variables with knowledge the chi-square (x2), and paired‘t’ tests will be used.

10. PILOT STUDY

10% of population is planned for the pilot study.

11. ETHICAL CONSIDERATION-

1. Does the study require any intervention to be conducted on early adolescent girls? Yes, informed consent will be taken from the respondents.

2. Has ethical clearance been obtained from your institution? Yes, it will be taken.

3. Has the consent been taken from School authorities? Yes, it will be taken.

12. LIST OF REFERENCES

1. Patil S.N, Wasnik V. et al “Health problems among adolescent girls in rural areas of Rathnagiri Dist of Maharastra .India” 2009 .October. 18 2. Dr.Prakash Adhikari. Et al “Knowledge and practice regarding menstrual hygiene in rural adolescent girls of Nepal” Kathmandu University of medical Journal (2007), vol 5, No.3, Issue 19, 382-386.

3. Deligeorglou E, Creatsas G. et al “menstrual disorders during adolescence” Division of paediatric adolescent Gynecology and Reconstructive surgery. “Aretaieion” Hospital. Medical school, University of Athense Grecce-2006-Jan.

4. Water Aid’s Programme-Nepal. “Is menstrual hygiene and management an issue for adolescent school girl” 2009.February.

5. Houston AM, D’Angelo L.J.et al “Knowledge, attitude and consequences of menstrual health in urban adolescents females “. Journal of paediatric adolescent gynecology. 2006-August; 19(4)271-5.

6. Wong’s Text book of ‘Essentials of Paediatric Nursing’ 8th Edition. Marilyn j Hockenberry. David Wilson. Page no 541-542.

7. Pragya sharma, Renuka saha. et al “Problems related to menstruation amongst adolescent girls “ Dept of community medicine.M.A.M.C.New Delhi. 2008. February.

8. B.N Joshi, V.Bhadoria “Reproductive health problems and help seeking behavior among adolescents in urban India” Indian Journal of pediatrics.2006; 73(6):509-513).

9. Amita Singh, Pavan Tiwari “Prevalence and severity of Dysmenorrhea: A problem related to menstruation, among first and second year medical students” S.S.Medical college, Rewa (MP), Indian Journal of physiology, 2008; 52(4); 389-397.

10. Rajini Dhingra, Anil Kumar and Manpreet Kour.”Knowledge and practices related to Menstruation among Tribal (Gujjar) adolescent girls” P.G.Department of Home science, University of Jammu. India. 2009. Ethno-Med, 3(1):43-48(2009).

11. Audinarayana.N, Jothimani.N “Prevalence of menstrual problems and its determinants among adolescent girls in a rural setting of Tamil Nadu” February 4-5, 2005.14 p.

12. Lee.L.K, Kour.J “Menstruation among adolescent girls in Malaysia, a cross-sectional school survey” Singapore Med Journal 2006 Oct; 47(10):869-74.

13. Fawole.AO, Ojenqbede OA “menstrual characteristics of secondary school girls in Ibdan, Nigeria” West Afr J Med, 2009 March; 28 (2):92-6. 19 14. Teperi J, Rimpela M, “Menstrual pain, health and behaviors in girls” Dept of Public Health, Finland. 2005.

15. Campbell M.A, McGrath P.J. “Use of medications by adolescents for the management of menstrual discomfort”. Canada.1997.

16. McEvoy M, Coupey S.M. “Common menstrual disorders in adolescence; nursing interventions” –MCN American Journal of child nurs; 2004 Jan- Feb; 29(1):41-9.

17. Nidhi Kotwal, Rashi upta.”Awareness of reproductive health among rural adolescent girls”. (Comparative study of school going girls and dropout girls of Jammu).Stud home comm sci, 2(2); 149; 154 (2008).

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13 Signature of the candidate

14 Remarks of the guide

15 Name and designation

15.1 Guide

15.2 Signature

15.3 Co-guide

15.4 Signature

15.5 Head of the department

15.6 Signature

16 Remarks of principal

16.1 Signature

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