RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE KARNATAKA, BANGALORE.

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

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

MISS.KUKKU SARA BOBAN

1ST YEAR M.SC NURSING

S.C.S COLLEGE OF NURSING SCIENCES

KECT TOWER

ASHOK NAGAR

MANGALORE2. Name of the institution SCS COLLEGE OF NURSING SCIENCES,

ASHOK NAGAR,MANGALORE

3. Course of study and subject M.SC NURSINGOBSTETRICS AND GYNAECOLOGY

4. Date of admission to the course 20.05.2010

5. TITLE OF THE STUDY:

EFFECTIVENESS OF A SELF INSTRUCTIONAL MODULE ON

SYMPTOMS ASSOCIATED WITH MENOPAUSE AMONG

PREMENOPAUSAL WOMEN IN A SELECTED COMMUNITY AREA AT

MANGALORE

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6.BRIEF RESUME OF THE INTENDED WORK

Introduction:

Everything has changed but our way of

thinking ,and if these do not change ,we drift towards unparalled

catastrophe

- Albert Einstein

Human beings, both male and female experience many body changes

through their life time. Mid life is a period of transition for both men and

women. Many of these changes are mainly due to varying levels of hormones

in the body which occur at different stages of life. Accordingly menopause is

a normal but one of the major transitional periods in the life of every woman.

The experience of menopause is different for every woman.

Menopause is derived from the Greek word ‘menos’ means month and

‘pause’ means to stop, which refers to the ‘last menstrual period’ and is

generally considered to have occurred after one year of amenorrhea. Once the

body of women has completed the changes and she has not had periods for 12

months in a row, she is said to have passed through menopause.

(Margolese,2003).1

Menopause is a event in life, not a disease. “It is a single event in a

woman’s life-her menstrual period. Menarche heralds the onset of

reproductive function and menopause signals its end. Menopause is an event

with variety of symptoms. As cited in “A guide to problems associated with

menopause”, various menopausal symptoms experienced by the women are

irritability, hot flushes, mood swing and so on.

However, the influence of this fluctuation varies from one woman

to another.

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6.1 Need for the study

All our knowledge brings us nearer To our ignorance. T.S. Elliot With the increasing life expectancy a women spends

almost a third of her life in menopause. Menopause is a very complex time in

women’s life during which unpredictable and wide fluctuations in ovarian

function and their physiologic consequences occur. A greater understanding of

their physiologic events in woman’s life is important but what is of greater

importance for medical personnel is how women perceive these events.

Numerous physical and psychological symptoms have been attributed

to the hormonal changes of menopause. The prevalence of menopausal

symptoms varies widely not only among individuals of the same population

but also between different ethnic populations. Even there is a great diversity in

nature of symptoms and frequencies across countries, even in the same

cultures. Mean age at menopause ranges in Indian women from 40.32 to 48.54

years and in developed countries from 48.0 to51 years. Most of the women

reach menopause between ages of 45 and 55, but menopause may occur as

earlier as the 30’s or 40’s or may not occur.1

Although menopause is a naturally occurring process in the reproductive

life cycle for most women, the menopausal experience has been largely

medicalised as a biomedical event. In addition to coping with the physical

challenges of menopause (hot flushes, vaginal dryness and mood swings and

insomnia), women are often dealing with concurrent stresses such as changes

in relationships, perceptions of aging ,death of family or friends,

illness ,changes in employment and finances ,as well as caring for aging and

ailing parents.2

A study was conducted to determine the difficulties that Indian women

have during the climacteric changes. 405 women between 40-50 years of age

from general population were contacted and interviewed. Result showed that

hot flushes, night sweats and insomnia were clearly associated with

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menopause. The study recommended that a multidisciplinary approach is

needed to the problem of menopause.3

It is given that menopause is both socially constructed and is influenced,

it is important to gain an understanding of it not only from a biophysical

stance but also in the social context of women’s lives. Research has shown

that women’s perceptions of the menopausal phase can greatly influence their

coping with the associated physical and psychological changes.

A descriptive study was conducted to assess the impact of socio

psychological factors on women’s experience on menopause. The study

revealed that women either reported or were found to have variety of health

problems including urinary incontinence (37%), UTI (11) and RTI (39%) and

uterine prolapsed (41%).Therefore there is a need to educate the women

regarding the symptoms associated with menopause.

As menopausal health demands priority in Indian scenario, due to

increase in life expectancy and growing population of menopausal women,

large efforts are required to educate and make these women aware of

menopausal symptoms.1 Nurse as a health personal can identify and help the

women to understand and make them to adapt to the various changes taking

place in her body, so that the women will be better equipped to face the

changes. The nurse is important health personnel who can help the

menopausal women to cope with the problems of using specific interventions.

Women very seldom discuss about menopausal symptoms with others and that

they want more information and more communication. Thus, the investigator

feels that a self instructional module on menopausal symptoms could be

helpful in early reorganization of symptoms, reduction of discomfort and fears

and enable to seek appropriate medical care if necessary.

6.2 Review of literature

Literature can serve a number of important functions in the

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research as well as important function for nurses seeking to develop an

evidence-based practice. A literature review helps to lay the foundations for

the study when researches are trying to make sense of their findings. Review

of literature helps the investigator to develop a deeper insight into the problem

stated before. It provides the basis for the future investigation, justifies the

need for replication and throws light on the feasibility of the study.4

An evaluatory study was conducted at wardha city, Gujarat, India, to

evaluate the effectiveness of self instructional module on knowledge

regarding menopausal changes and coping among pre-menopausal women. A

sample of 50 pre-menopausal women aged between 40-45 years was included

and a structured questionnaire was used to assess the knowledge regarding

menopausal changes and its coping. Result shows that there was a significant

difference between the pre-test and post test knowledge score regarding

menopausal changes and its coping as z value was 6.17 and p value 0.000

where p<0.05. Thus, the result showed that the self instructional module was

effective in enhancing the knowledge of pre menopausal women regarding

menopausal changes and coping.5

A cross-sectional study was carried among urban women in Jammu

Kashmir to evaluate the menopausal symptoms in women above the age of 40,

117 menopausal women between 40-50 years of age from general population

were contacted and interviewed. Result showed that mean number of

menopausal symptoms in three age groups were as (mean+/-SD) 10.53+/-

7.33,7.70+/-6.46 and 14.50+/-10.77 in 40-44 years,45-50 years and >50years

age groups respectively suggesting that at transition of menopause and its

post menopausal period, the number of symptoms were more and in between

number of complaints were less.

Statistical significant variation was observed in between 45-50 years and

>50 years age group. Fatigue and lack of energy (72.93%), headache (55.9%),

hot flushes, cold sweats, cold hands and feet (53.86%) each and weight gain

(43.13%) were most frequently complained menopausal symptoms. The study

also stated that this type of regional studies not only create awareness but also

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help in education of women regarding an early identification of women with

menopausal symptoms.6

An exploratory study was conducted in rural areas of Nova Scotia,

Canada. The objective of the study was to explore the menopause experience

of women living in rural areas. A sample of 25 menopausal women were

interviewed. The result showed that women living in rural communities

described a need to understand fully the intensity of menopause related

symptoms including changes in their physical and mental well-being. The

study concluded that, nurse should provide comprehensive women’s health

care and must employ innovative strategies to provide support to women

living in rural areas or communities to enhance both health and well-being as

they transition through menopause and as they age.7

A study was conducted in Karnataka, India, to determine age at

menopause and menopause transition.111 postmenopausal women were

included in the study. Out of 111 postmenopausal women, 55(49.5%) reported

that they had experienced some changes in their menstruation before reaching

menopause and others reported that their menstruation stopped all of a sudden

without any changes. The study concluded that by educating and planning

ahead for this time of challenges and opportunities, every woman can make

this period as one of the most rewarding and enriching time of her life.1

A study was conducted in Dr. TMA Pai hospital in South India to

analyse the age at onset of menopause and the prevalence of menopause and

menopausal symptoms in South India. 352 postmenopausal women were

included in the study and the result showed that the mean age was 48.7 years.

Most of the frequent menopausal symptoms were aching in muscles and

joints, feeling tired, poor memory, lower backache and difficulty in sleeping.

So there is a need to create awareness among the women regarding

menopausal symptoms.

A cross-sectional study was conducted in Amistar, Punjab ,India to

determine median age at menopause and frequency of various related clinical

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symptoms among educated women. A sample of 539 women aged between

40-50 years were interviewed. The study shows that median age at menopause

was 47.54+/-2.31 years and the most common clinical symptoms associated

with menopause were hot flushes and night sweats(55.08%) , insomnia

(53.12%), headache and body aches(38.28%), fatigue(42.18%) ,irritability

(35.15%), perspiration(34.76%), palpitation (22.26%), short breath(20.31%),

nervous tension(10.56%) and depression(8.20%). The study reveals that

woman’s ability to cope with the menopausal symptoms can be enhanced by

education and social support.9

A cross-sectional study was conducted at out patient department of Isra ,

Pakistan, to determine the knowledge and attitude of women towards

menopause and to investigate the symptoms experienced by post menopausal

women, and the result shows that about 78.79% women were aware about

menopause but only 15.87% had knowledge about symptoms and health

implication of menopause. So it is important to encourage schools and other

educational institutions, medical care providers and the health department to

co-operate in educating women about menopause, its symptoms long term

consequences and treatment options. The combined effort by educational

programs and health care providers will help in increasing public awareness.10

6.3 Statement of the problem Effectiveness of a self instructional module on symptoms

associated with menopause among pre menopausal women in a selected

community area at Mangalore.

6.4Objectives

1. To assess the pre-test knowledge of pre menopausal women on

symptoms associated with menopause as measured by structured

knowledge questionnaire

2. To evaluate the effectiveness of self instructional module on

symptoms associated with menopause among pre menopausal women

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in terms of gain in post test knowledge scores

3. To find the association between the pre test knowledge scores on

symptoms associated with menopause among pre menopausal women

with selected demographic variables

6.5 Operational Definitions

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

the self instructional module has achieved the desired effect and is measured

in terms of gains in post test knowledge scores.

Self Instructional Module : In this study, self instructional module refers to self contained written

material which can be used by the women for self learning on symptoms

associated with menopause.

Symptoms associated: In this study, symptoms associated refers to the symptoms which are

associated with menopause such as vasomotor, psychological, psychosomatic,

urinary and vaginal problems.11

Menopause: In this study, menopause refers to the permanent cessation of

menstruation.

Pre menopausal women: In this study, pre menopausal woman refers to the women who are

in the age group of 40-45 years.

6. 6 Assumptions:

The assumption of the study is:

1. Women will have some knowledge on symptoms associated with menopause.

2. Self instructional module will enhance the knowledge of pre- menopausal

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women on symptoms associated with menopause.

6.7 Delimitations The study is delimited to women who are:

1. aged between 40-45 years

2. ready to participate in the study

3.available at the time of the study

6.8 Projected outcome/hypothesis

All hypothesis will be tested at 0.05 level of significance.

H1 : The mean post-test knowledge scores of the pre menopausal women on

symptoms associated with menopause will be significantly higher than their

mean pre-test knowledge scores.

H2 s: There will be a significant association between pre-test knowledge scores

on symptoms associated with menopause with selected demographic

variables.

7.MATERIALS AND METHODS

7.1 Source of data collection

Data will be collected from pre menopausal women aged between 40-

45 years in a selected community area at Mangalore.

7.1.1 Research design

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

Pre-test Administration of self instructional module

Post-test

01 x 02

01 = Administration of structured knowledge questionnaire on

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symptoms associated with menopause among pre menopausal women

X = Administration of self instructional module among pre menopausal

women on symptoms associated with menopause on 1st day

02 = Reassess the knowledge on symptoms associated with menopause

among pre menopausal women using the same structured knowledge

questionnaire on the 7th day.

7.1.2 Settings

The study will be conducted in a selected community area at Mangalore.

7.1.3 Population In the study population consists of pre menopausal women aged between

40-45 years in a selected community area at Mangalore.

7.2 Method of data collection

7.2.1 Sampling procedure Sample will be selected by purposive sampling technique.

7.2.2 Sampling sizeSample size will be 50 pre menopausal women aged between 40-45 years

in a selected community area at Mangalore.

7.2.3 Inclusion criteria:

1. Pre menopausal women aged between 40-45 years

2. Pre menopausal women who are able to read and understand

kannada

7.2.4 Exclusion criteria 1. Women who have attained menopause

2. Women who underwent hysterectomy

3. Women who are absent during the time of data collection

7.2.5 Instrument intended to be used

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A Structured knowledge questionnaire is developed to determine

the knowledge of pre menopausal women on symptoms associated with

menopause. It consists of two parts. part 1:-demographic data and part 2:- a

structured knowledge on symptoms associated with menopause

7.2.6 Data collection method

Prior to data collection permission will be obtained from the concerned

medical officer of the community area for conducting this study. Consent will

be taken from the subjects selected for the study. Pre test knowledge will be

assessed by using structured knowledge questionnaire .Then a self nstructional

module will be administered. After seven days post test knowledge will be

assessed by the same structured knowledge questionnaire.

7.2.7 Data analysis plan The data will be analyzed by using descriptive and inferential

statistics

7.3 Does the study require any investigation or interventions to be

conducted on patients or animals or humans? It so please describe

briefly

Yes. The study will be conducted on women aged between 40-45 years

to assess the knowledge on symptoms associated with menopause.

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

Yes, ethical clearance has beens obtained from the ethical committee of

the institution.

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8. LIST OF REFERENCE

1. Hussain Khan C.G , Hallad J.S. Age at menopause transition: perspectives

of Indian rural women .(online) available from:http://epc2006.

princeton.edu

2. Lowdermilk, Perry, Boback .Maternal and women health care. 6th edn.

Philadelphia.Mosby;1997

3. Sharma V.K, Saxena M.S.L Climacteric symptoms: A study in the Indian

context .April 2005;(online) available from:http://www.ncbi.nlm.nih.gov

4. Polit DF,Hungler BP.Nursing Research:Principles and Methods,6th edn.

Philadelphia:Lippincott;1999.

5. Kharat M, Kaur S.P.To assess the effectiveness of self instruction module

on knowledge regarding menopausal changes and coping among pre-

menopausal women in selected areas of Wardha city India.International

Journal of Nursing Education 2010;2:53-54

6. Sharma S, Tandon V.R, Mahajan A. Menopausal symptoms in urban

women .Jammu Kashmir science 2007;9:13-17

7. Price S L, Storey S, Lake M. Menopause experience of women in rural

areas. Journal of American Nursing 2007;5:503-511

8. Bairy L, Adiga S, Bhat P, Bhat R. Prevalence of menopausal symptoms and

quality of life after menopause in women from south India .Australian and

New Zealand journal of obstetrics and gynaecology 2009;49(1):106-109

9. Sidhu S , kaur A , Sidhu M. Age at menopause in educated women of

Amristar (Punjab);2005 (on line) available from:http://www.

krepublishers.com.

10. Nusrat N, Zehra N, Gulfareen H,Aftab M, Asia M.Knowledge, attitude and

experience of menopause;2008 (online) available from :http://

www.ayubmed.edu.pk/ JAMC/PAST/20-1

11. Dasgupta D,Ray S.Menopausal problems among rural and urban women

from eastern India;(on line) available from:http://www.jsbhs.org/files

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