Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore s5

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF THE CANDIDATE Ms.RAISA VARGHESE AND ADDRESS 1 YEAR M.Sc. NURSING N.D.R.K. COLLEGE OF NURSING B.M.ROAD, HASSAN, KARNATAKA

2 NAME OF THE INSTITUTION N.D.R.K. COLLEGE OF NURSING,

3 COURSE OF THE STUDY AND MASTER OF SCIENCE IN NURSING, SUBJECT MEDICAL-SURGICAL NURSING

4 DATE OF ADMISSION OF THE 2ND MAY 2008 COURSE

5 TITLE OF THE TOPIC “EFFECTIVENESS OF PLANNED TEACHING PROGRAMME REGARDING THE KNOWLEDGE ON EARLY DETECTION AND PREVENTION OF CERVICAL CANCER AMONG THE HIGH SCHOOLS TEACHERS” INTRODUCTION:

I will keep the lamp of knowledge burning to achieve the vision- Developed India. - A.P.J.ABDUL KALAM

Cancer is being diagnosed more and more frequently in the developing world. The recent WHO report, stated that 7.5 million people would die of cancer in 2005, and that over 70% of these deaths would be in low and middle income countries. The importance of the challenge posed by cancer was reiterated by the World Health Assembly in 2005, in resolution 58.22 on cancer prevention and control, which emphasized the need for comprehensive and integrated action to stop this global epidemic. (WHO report 2005).1

Cervical cancer is the second most common type of cancer among women, and was responsible for over 250000 deaths in 2005, approximately 80% of which occurred in developing countries. Deaths due to cervical cancer are projected to rise by almost 25% over the next 10 years. The achievements of the Millennium Development Goals are prevention of these deaths by adequate screening and treatment (WHO report 2005). 1

Cervical cancer is one of the leading causes of cancer death in women in the developing world. The primary underlying cause of cervical cancer is infection with human papilloma virus (HPV), a very common virus that is sexually transmitted. Most HPV infections resolve spontaneously; those that persist may lead to the development of pre cancer and cancer. It usually takes 10 to 20 years for precursor lesions caused by HPV to develop into invasive cancer. Effective interventions against cervical cancer exist, including screening for, and treatment of, pre cancer and invasive cancer.. (WHO report 2005). 1 A survey conducted by the WHO in the year 2000 on global and regional patterns of annual death by cause emphasized that in more developed countries cancer had accounted for 21.6% of annual death and in less developed countries around 9.8% had died due to cancer now in developing countries the incidence of the disease was increasing and had accounted for 1 in every ten deaths. It was also predicted that by the year 2020 there would be around million new cases registered per year in more developed countries and 9.3 million new cases in less developed countries. Over all in all the countries around 5.3 million deaths were predicted (WHO Report 2005) 1

The main reasons for the higher incidence and mortality in developing countries are:  Lack of awareness of cervical cancer among the population, health care providers and policy makers.  Absence or poor quality of screening programmes for precursor lesions and early- stage cancer. In women who have never been screened, cancer tends to be diagnosed in its later stages, when it is less easily treatable;  Limited access to health care services; Lack of functional referral systems.(WHO 2005) 1 6. BRIEF RESUME OF THE INTENDED WORK:

6.1 NEED FOR THE STUDY

You know that you know nothing. Find out that knowledge. That is liberation or mukti. SRI. RAMANA MAHARISHI

The American cancer society estimates that in 2007, about 11,150 cases of invasive cervical cancer will be diagnosed in the United States. Some researchers estimate that non-invasive cervical cancer is about 4 times more common than invasive cervical cancer. 2

About 3,670 women will die from cervical cancer in the United States during 2007. Cervical cancer was one of the most common causes of cancer death for American women. The cervical cancer death rate decline by 74% between 1955 and 1992. The main reason for this change is the increased use of the Pap test. This screening procedure can find changes in the cervix before cancer develops. It can also find early cancer in its most curable stage. The death rate from cervical cancer continues to decline by nearly 4% a year. 2

Cervical Cancer occurs most often in Hispanic women; the rate is over twice that in non- Hispanic white women. African – American women develop this cancer about 50% more often than non-Hispanic white women (ACS 2007) 2

Saeed Khana, etal (2007) conducted study on “Human papilloma virus (HPV) subtype 16 is common in Pakistani women with cervical carcinoma” HPV is recognized as a major causative agent for cervical carcinomas based on their oncogenic potential. They selected women visiting two tertiary care hospitals in Karachi, diagnosed with carcinoma of the cervix within the past 15 years, were 60 samples analyzed, HPV subtypes in their cancer specimens, only one sample was HPV negative; the rest of the samples were positive for the presence of HPV.59 HPV positive samples, 56 showed the presence of HPV 16 and one sample was positive for HPV 18; HPV subtype could not be determine in two samples. 3

Luiz Carlos Zeferino MD (2006) article on “Cervical cancer in the developing world” reveals that in developed countries, systematic screening programmes have reduced the morbidity and mortality resulting from cervical cancer. Cytological methods of screening have been the mainstay in these countries. Nevertheless, there is scant evidence that cytology-based screening has had any effect in reducing cervical cancer mortality in less-developed countries. Currently, there are two main issues on this subject; the assessment of simpler screening methods, and the evaluation of different strategies regarding which women to target and screening interval. Achieving high rates of coverage and compliance of the target population through thigh-quality procedures has remained the most difficult goal to achieve. Nevertheless, it is believed that creativity cancer, flexibility and well-focused use of resources can reduce the inequitable burden of cervical cancer borne by women in poor countries. 4

According to (WHO 2005) report the majority of women in developing countries still do not have access to cervical cancer prevention programmes. Cervical cancer is not detected until it is too late to be cured. An effort is required if this situation is to be corrected. Health promotion, including education and counseling of women and men, should be an integral understand that cervical cancer control programmes. Health education should aim to ensure that women, their families and the community at last should understand that cervical cancer is preventable. The researcher found that there are a very few studies of High School Teachers based. Hence this study aims to provide necessary information to the High School Teachers, Keeping in view the changing profile of life style and prevention of cervical cancer in urban population. 6.2 REVIEW OF LITERATURE:

Review of literature is divided into three parts a. Literature related to incidence and prevalence of cervical cancer b. Literature related to knowledge on prevention of cervical cancer c. Literature related to Planned teaching Programme

a) Literature related to incidence and prevalence of cervical cancer based on Global, National and Regional.

Global: Cancer of the cervix is the second most common cancer in women worldwide and is a leading cause of cancer-related death in women in underdeveloped countries. Worldwide, approximately 500,000 cases of cervical cancer are diagnosed each year. Routine screening has decreased the incidence of invasive cervical cancer in the United States, where approximately 13,000 cases of invasive cervical cancer and 50,000 cases of cervical carcinoma in situ are diagnosed yearly. Invasive cervical cancer is more common in women middle aged and older and in women of poor socioeconomic status, who are less likely to receive regular screening and early treatment. There is also a higher rate of incidence among African American, Hispanic, and Native America women. (ACS 2007).

Boer MA, etal 2008 Conducted a population based study on prevalence of human papillomavirus in Indonesia: in the three regions. A sample of 2686 women, aged 15-70 years, in Jakarta, Tasikmalaya, and Bali, Indonesia. The overall HPV prevalence was 11.4%, age-standardized to the world standard population 11.6%. The most prevalent types found were HPV 52, HPV 16, HPV 18, and HPV 39, respectively, 23.2, 18.0, 16.1, and 11.8% of the high-risk HPV types. In 20.7% of infections, multiple types were involved. Different age-specific prevalence patterns were seen. HPV 52 was the most prevalent type in the general population. 5 National: Dr. Rangaswamy Sankaranarayanan etal (2007) conducted study on “Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomized trial” They assessed the effect of screening using visual inspection with 4% acetic acid (VIA) on cervical cancer incidence and mortality in a cluster randomized controlled trail. 114 study clusters in Dindigul district, 57 were randomized to one round of VIA by trained nurses, and 57 to a control group. Healthy women aged 30 to 59 years were eligible for the study. The primary outcome measures were cervical cancer incidence and mortality. 49311 eligible women in the intervention group, 31 343(63.6%) were screened. 30 958 control women received the standard care. 3088 (9.9%) screened positive, 3052 had colposcopy, and 2539 directed biopsy. Of the 1874 women with precancerous lesions in the intervention group, 72% received treatment. In the intervention group, 274 430 person years, 167 cervical cancer cases, and 83 cervical cancer deaths were accrued compared with 178 781 person-years, 158 cases, and 92 deaths and in the control group during 2000-06 ( includes hazard ration 0.75 [ 95% CI 0.55-0.95] and mortality hazard ration [0.47 – 0.89]) 6

REGIONAL: Rao Rs etal (2007) conducted a cross-sectional study on “Downstaging for cervical cancer in rural areas of Udupi district, Karnataka, India”. Population included all married women in the age group of 35-59 years in two villages of the field practice area. Two ANMs were trained in history taking, visual inspection of the cervix, using of speculum and collecting Papanicolaou smears. After training, they made home visits and identified women with gynaecological symptoms suggestive of cervical cancer. These women were asked to report to Rural Maternity and child Welfare homes where the ANMs did a visual inspection of cervix and made a cervical smear. A total of 1402 women were registered of the ANMs could identify 368 women (26%) with sumptoms. Only 192 (52.2%) of these women reported for examinations. Chronic cervicitis accounted for the largest proportion of the cases (48.8%) three cases were diagnosed as suspected cases of cancer cervix. And three cases (1.5%) turned out to be malignant. When clinical findings of the ANM compared with results of cytological examination, ahigh degree of sensitivity (78.4%) and positive predictive value (97.1%) were observed in diagnosing abnormal cytological findings. 7 b) Literature related to knowledge towards prevention of cervical cancer Baykal C etal (2008) conducted a study “on knowledge and interest of Turkish women about cervical cancer and HPV vaccine”. Using a 25 –item questionnaire was distributed to women in three different cities located in separate socio cultural locations. At the closure of the study 143 women responded and returned the survey. Of the participants 62.2% (89) had a university degree, 36.4% (52) a high school education, and 1.4%(2) had lower school degrees; 98.5% of the women would consent to have their daughter vaccinated for HPV and 94.7 would consent to have their son vaccinated if vaccine provided prevention against cancer and related diseases. However in both cases women gave importance to the “cost”-unless vaccine could be free. 8

Ayinde OA, et al, (2007) conducted a study on “knowledge, attitude and practices related to prevention of cancer of the cervix among female health workers in Ibadan”. A 20-item questionnaire containing items on characteristics and knowledge of respondents on aetiology and prevention of cervical cancer was administered to a total of 205 female doctors, nurses and hospital maids in three hospitals. Knowledge about the condition was high among doctors, surprisingly inadequate among nurses and predictably poor among hospital maids. 93.2% of respondents have never had pap smears performed. The study found that need to intensify compaign towards prevention of cervical cancer even among health workers. 9 c) Literature related to Planned teaching Programme Mann B (2007) conducted a study “to evaluate the effective use of planned teaching programme (P.T.P) regarding rehabilitation of cancer of breast patients after Mastectomy in terms of knowledge and expressed practice of Nursing personal in selected Hospital of Delhi”. A quasi experimental method was used and sampling technique involved multi stage random sampling method and total samples are 150 Nursing personal. The knowledge questionnaire was used to collect data, the pretest scores was 42.86% and posttest score was 80.22% which revealed the effectiveness of PTP. Paired ‘t’ test was used to analyze the difference on knowledge scores of patients. 10

MS Sheeliya white.N (2006) conducted a “experimental study to determine the effectiveness of planned teaching programme (PTP) regarding the knowledge on Vitamin A supplementation among mothers of under-five children in selected area of Hassan”. A quasi experimental method was used and sampling technique involved non probability sample, purposive sampling method was used. The pretest knowledge score was 30% and post test scores showed that 100% of mothers were having adequate knowledge in all aspects of vitamin A supplementation. The findings of the study revealed the planned teaching programme as increased the knowledge of mothers of under-five children. 11 STATEMENT OF THE PROBLEM “ A study to evaluate the effectiveness of Planned Teaching Programme regarding the knowledge on early detection and prevention of cervical cancer among the High School Teachers in selected High Schools of Hassan, Karnataka”

6.3 OBJECTIVES OF THE STUDY

6.3.1 To assess the pretest knowledge scores of High School Teachers on early detection and prevention of cervical cancer. 6.3.2 To develop and administer Planned Teaching Programme on early detection and prevention of cervical cancer. 6.3.3 To evaluate the effectiveness of Planned Teaching Programme on early detection and prevention of cervical cancer in terms of post test knowledge scores. 6.3.4 To find out the association between the knowledge of the High School Teacher with their selected socio-demographic data.

HYPOTHESIS:

HO = There will not be any significant association between the knowledge of the High School Teacher with their selected demographic variables.

H1 = The mean post test knowledge scores of High School Teachers after administration of Planned Teaching Programme will be significantly higher than their pretest knowledge scores.

ASSUMPTIONS: 1. The High School Teachers will have a less than adequate knowledge regarding early detection and prevention of cervical cancer. 2. The High School Teachers will be expressing their willingness to learn and understand the disease. OPERATIONAL DEFINITIONS:  Effectiveness: Refers to gain in knowledge scores achieved by High School Teachers regarding early detection and prevention of cervical cancer after administration of PTP.  Knowledge: In the present study knowledge means the scores obtained through Planned Teaching Programme on early detection and prevention of cervical cancer.  Planned Teaching Programme (PTP): It is a formal and specific teaching develops for High School Teachers on early detection and prevention of cervical cancer.  Cancer: cancer is a term used for the malignant, autonomous and uncontrolled growth of cells and tissues.  Cervical cancer: Cancer that begins on the cervix, which is the opening of the womb. Cells on the cervix begin to grow abnormally, if they are not treated, they become cancer.  High School Teachers : High School Teachers are those who had graduation, graduation with B.Ed/M.Ed degree by the recognized university and teaching in High Schools.

7. MATERIAL AND METHODS: 7.1 SOURCE OF DATA: Data will be collected from the High School teachers in selected high schools of Hassan.

7.2 METHODS OF COLLECTION OF DATA 7.2.1 RESEARCH APPROACH Evaluative approach

7.2.2 METHODOLOGY:  Research Design: Quasi-experimental study with single group pretest posttest design

Group Pre-test Intervention Post –test

High School O1 X O2 Teachers

O1 = Assessment of pre-test knowledge X = Structured Teaching Programme on early detection and prevention of Cervical Cancer.

O2 = Assessment of post-test knowledge.

7.2.3 POPULATION

The High School teachers working in the High Schools of Hassan.

7.2.4 SAMPLE

High school Teachers working in selected High Schools of Hassan.

7.2.5 SAMPLE SIZE

The sample consists of 60 High School Teachers.

7.2.6 SAMPLING TECHNIQUE

Non probability sample a purposive sampling technique will be used.

7.2.7 SELECTION OF TOOL Structured questionnaire consists of two sections.

Section A: Demographic Variables

Section B: Knowledge questionnaire on early detection and prevention of cervical cancer

2.9.8 CRITERIA FOR SELECTION

Inclusion Criteria

1. Who are willing to participate in study. 2. Who can read and write English 3. Teachers who are present during data collection

Exclusion criteria

1. Those who are on leave or vacation 2. Those who have family history of cervical cancer

7.2.9 SETTING OF THE STUDY

The study will be conducted in selected High School of Hassan

7.2.10 PILOT STUDY

The pilot study will be planned with 10% of the population which will be conducted in the selected High schools of Hassan and that High Schools will be excluded in the main study. 7.2.11 VARIABLES 1. Independent Variable: Planned Teaching Programme on early detection and

prevention of cervical cancer.

2. Dependent variable: Knowledge of High School Teachers regarding early

detection and prevention of cervical cancer.

3. Extraneous variables: Socio-demographic variables such as age, educational

status , experience in teaching , residential back ground, religion, type of family ,

marital status , family history of cervical cancer of High School Teachers

7.2.12 DATA ANALYSIS METHOD

It includes descriptive and inferential statistics.

Descriptive Statistics: The descriptive statistics analysis includes percentage,

frequency, mean and standard deviation.

Inferential Statistics: It includes paired t-test with Chi-Square test.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE CONDUCTED ON, PATIENTS OR OTHER HUMANS OR ANIMALS?

Yes, the planned teaching programme is used as an intervention on high school teachers.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? Permission will be obtained from the research committee of theN.D.R.K. College of Nursing and authorities of selected High schools in Hassan. Informed consent will be obtained from the subjects who are willing to participate.

DURATION OF THE STUDY:DEC 2008 to FEB 2010

8. REFERENCES: Journals 1. World Health Organization Report 2005 – 2006 2. American cancer society Cancer Facts and Figures 2007. 3. Saeed Khana, etal “ Human Papillomavirus subtype 16 is common in Pakisthani women with cervical carcinoma” International Journal of infectious Diseases 11, (4), July 2007, 313-317. 4. Luiz carlos Zeferino MD “Cervical cancer in the developing world” Best practice and research and clinical obstetrical & gynecology volume 20, Issues 3, Jun 2006, pages 339-354. 5. Boer MA, etal “Prevalence of Human papillomavirus in Indonesia: a Population- based study in three regions” Br J Cancer . 2008 Jul 8;99(1): 214-8. 6. Dr. Rangaswamy Sankaranarayanan etal “Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India”. A cluster- randomized trial volume 370, Issue 9585, 4 August 2007, 398-40. 7. Rao RS, et al, “Downstaging for cervical cancer: a community based study in the rural areas of Udupi district, Karnataka, India. Trop Doct. 2007 Apr;37(2):73-5. 8. Bavkal C, etal “knowledge and interest of Turkish women about cervical cancer and HPV Vaccine”. Eur J Gynaecol Oncol. 2008;29(1):76-9. 9. Avinde OA et al, “Knowledge, attitude and practices related to prevention of cancer of thecervix among female health workers in Ibadan.” Lancet. 2007 Aug 4;370(9585):365-6. 10. Mann B “Planned Teaching Programme on rehabilitation cancer of breast after Mastectomy in terms of knowledge and expressed practice of nursing personal” Obstet Gyneco Clin North Am. 2007Dec;24,(4) 783-802. 11. Ms.Sheeliya White N “A experimental study to determine the effectiveness of planned teaching programme regarding knowledge on Vitamin A supplementation among mothers of under-five children in selected areas at Hassan.